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Vellore, Tamil Nadu, India
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Saturday, July 16, 2011

My serendipitous brush with big pharma

Date: 07/16/2011

Disclaimer: This essay documents some extremely disparaging comments made about Indian doctors by a member of the Indian pharmaceutical industry. I do not believe these are entirely objective observations and I definitely don’t believe that they apply to every or even most Indian doctors. I have only positive superlatives to use for the doctors, young and old, that I’ve met at CMC and AIIMS like Drs. Rama, Pandav, Kartik, and Gemlyn. I respect them immensely and hope to be like them one day. Remember, my parents are also doctors who practiced in India. I don’t mean to offend them or cast aspersions on their ethical impeccability. My sole intention is to bring the corruption that afflicts a certain proportion of Indian physicians and surgeons to attention and reveal the modus operandi of the pharmaceutical industry. 
With a running jump, I hurled myself into the bus headed to Chennai. Phew! Just made it. After chucking my bag under a seat, I flung myself into a seat, my chest heaving and the S1 and S2 sounds of my heart (LUB-DUP) audible at a range of five feet. I was taking one day off work and nothing could stop me. Being totally antisocial, I wrote a blog post for four-fifths of the journey, but ultimately turned off my mac and gazed at the sights outside. Having no idea where we were, I turned to my fellow passenger, an immaculately dressed bloke with a self assured smile with sharp features. He looked like he was perpetually amused by an inside joke. Let’s call him Lex for the purposes of this post. Lex thought we were on the outskirts (hmm...never quite understood the etymology of that word) of Chennai. We fell into a spontaneous conversation about our lives and he revealed that he was the brand manager for a pharmaceutical company.
My formerly audible heartbeat almost stopped. We med students speak of “big pharma” in hushed whispers and the discussions usually centre on how appallingly greedy they are or how little they care about human life and suffering. Consequently, I felt like I had engaged a minor minion of the devil in a congenial chinwag. I consider myself a pretty ethical individual and hesitated to converse further. My conscience desperately wondered whether there was some way of changing my seat without being too rude. Alas, there was nothing to do, but talk to him while keeping a sharp eye on my soul.

Lex: What’re you doing in Vellore?
Pranay: (very uptight) errr...research
Lex: On what?
Pranay: umm...medicine. So, what do YOU do exactly?

Lex’s smile broadened as he began explaining: “ Look, I travel all over the country with my scientific presentations, but if that’s all I have for a doctor, he’ll instantly toss me out of his office. The gifts and dinners make sure they listen. We help them out with stuff ranging from their daughter’s dowries to recharging the talktime on their prepaid cellphones. Check any doctor’s passport. You won’t find a single page empty. Who do you think funds that travel? The idea is simple. If we put in 100,000 worth of gifts, we expect them to prescribe that amount of our medicines every month. If they don’t, we stop sponsoring them and showering them with gifts. This is why they tack on multivitamins and other supplements to your prescriptions. It’s the poor man on the street, who doesn’t know what the drug is for, who suffers financially.”
“Ha! So, we agree on a few pharmacies in town. We ship our drugs to these pharmacies and the doctors ensure that their patients buy their prescriptions at these specific pharmacies. This is how we monitor whether the doctor is doing our bidding. Frequently, the doctor asks patients to check back with them ostensibly to check whether they got the correct medication. In fact, they do so to ensure that they purchased the correct brand, our brand.”

I was horrified at Lex’s smooth explanation of his modus operandi, but I couldn’t stop now: “Surely, it’s the older doctors who do this. The younger blokes must be idealistic, right?” Lex threw his well groomed head back, clapped his hands very hard, and laughed. 

“Who do you think we do phone recharges for? We get the young doctors doing their post-graduate medical studies early. They need money to buy bikes, afford cable TV, take out their girlfriends for valentine’s day...just name it! Pranay, I used to think of doctors as gods when I was a bachelor’s student in pharmacology, but when I see them asking us for these petty things and queueing up for extra pens and bags at our conventions, I can’t help but think of them as puppets and-- I hate to use the word-- beggars. We have them in our pockets.”

Hearing his awful tales, I felt a need to justify myself: “Listen, I am the University of Virginia which has banned medical reps from the premises and we’re not even allowed to have pens from pharma industries.”

At this point, Lex revealed something interesting: “You know, Dr. Ketan Desai, head of the Medical Council of India (MCI) was instituting strict rules preventing doctors from accepting our gifts. We were actually happy! The pharma industry had numerous conferences discussing the return to scientific marketing instead of gift based marketing. We even drew up standard operating procedures on how to sell drugs to doctors using scientific pitches. However, just three months after the MCI edict, the Dr. Desai was arrested in a bribery scandal and the anti-gift rule fell by the wayside. Consequently, it was business as usual. I was annoyed, but it wasn’t like we hadn’t corrupted the doctors in the first place.”

Lex was trying to portray science based marketing as ethically impeccable so I decided to call him out on it: “Lex, it’s not like you guys don’t muck around with your scientific studies. I have heard so much about your manipulation of the controls and enrollments in your clinical trials to make your drugs look better than they are.”

Lex was clearly taken aback for a second: “Oh, very good. Not many of you take the time to really look at the papers, but we actually go beyond that even. I have frequently visited big research hospitals and given the doctors there a set of results I want for a particular drug. I follow up with a cheque for a large sum that we’re willing to donate to their department in return for a favorable publication.”

“Aren’t they offended when you do this?”
“Hah! They’re usually ecstatic at the opportunity to supplement their income.”

My horror had long turned to indignation. I had had enough: “Lex, you admitted that you guys corrupted the doctors in the first place and that it’s the poor man who suffers. Don’t you ever feel bad about this?”
His ever-present smile faltered and he lowered his eyes and gazed silently at the black folder with his company’s name emblazoned on the cover. He slowly fingered his expensive looking purple tie with his right hand as he contemplated my uncharacteristically direct question. When he spoke again, the self-assurance was missing and it seemed like he was, for once, not entirely convinced of his utterance: “In have can’ can’t be emotional in business. It won’”

I left a significant chunk of my alacrity on that bus. The elephant in the room (in the bus,  rather) had been whether I, Pranay Sinha, would ever succumb to the temptations of the pharma industry as a full fledged doctor. I pray that I remain strong and never falter in this regard. And my plea to my colleagues in the medical industry is to stay strong and resist this temptation as well. We CANNOT make a laughingstock out of our noble profession. Saving lives and assuaging wounds is a calling and a privilege, not a business. We CANNOT discard our emotions and ethics like Lex!

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