I work in research. Early research, pulling-stuff-out-of-thin-air type early drug research. I’m about as far from the commercial end of the companies I’ve worked at as I can be, but it’s the commercial end that pays my salary and keeps the labs running.
But that does not mean that everything that drug companies do to sell drugs is therefore justified. Far, far from it. Unfortunately, I have another entry today that will go into my category tag marked “The Dark Side”. It’s on drug sales tactics in India, which are explored by Frederik Joelving in this article at Reuters. It is not pretty:
The Abbott guide — reps say the company produces them regularly — is evidence of a larger problem in India. In interviews with Reuters, dozens of doctors, drug reps and other healthcare insiders said domestic and multinational drug makers routinely shower Indian doctors with gifts, posh junkets abroad, and cash payments disguised as consultancy or other types of fees.
“Indian CRM,” or customer-relationship management, is what industry insiders call this system of inducements. None of the doctors or reps who described their participation in this trade would speak on the record. Under Indian law, doctors are prohibited from accepting cash, gifts or travel from drug companies. Still, enforcement is rare, and drug makers may lavish gifts on doctors with impunity, though their home countries may punish the practice.
In a country where doctors often make less than $10,000 a year, it can be an effective strategy.
The drug reps apparently have entire catalogs, with the incentive gifts laid out – a coffeemaker for this drug at this prescription level, a new vacuum cleaner over here, cookware, an invitation to a “conference” in Thailand, what have you. And the indications are that even these gifts are being replaced by more direct inducements, such as sheer cash. That’s paid out for being part of a “postmarketing study” that no one controls, whose numbers no one pays attention to, and whose only purpose is to provide cover to pay people off:
Doctors and reps say that often, companies use these studies as cover for paying doctors to prescribe the drugs under study. According to one Abbott rep, the company doesn’t pay doctors if sales at nearby pharmacies don’t increase.
A doctor who has done post-marketing studies in India says the companies rarely monitor the studies or check the data. “We all understand that post-marketing studies are not really true studies,” says the doctor, a diabetes specialist at a Calcutta hospital. They’re “just a way to offer an honorarium. So we also don’t take them seriously.”
Several companies are named in the article – Abbott, Ranbaxy, local Indian drug makers – but the strong impression one gets is that this is how everyone is doing business there, and has for a long time. And that’s a major problem. The sales and marketing people in such situations take this as normal, and no one’s shocked or upset. They should be, though. Treating this sort of thing as no big deal is bad for the culture of a company, and it’s obviously not saying anything good about Indian business culture, either.
I think that there are three levels of corruption. These are distinctions I worked out a while back; see if they make sense. Level 1 is paying people to do something that they wouldn’t normally do. Get me good tickets, bump me to the front of the line, that sort of thing. Level 2 is paying people just to do what was supposed to be their job in the first place (but which they won’t actually perform unless the honorarium is coming). And Level 3 is the worst – that’s when you’re paying them not to harm you. A protection racket, in other words, whether it’s run by the mob or some Russian regulatory agency that might just enforce some little-known tax laws on you if you don’t play ball.
This Indian drug-rep stuff is Level 1 for sure, and probably some Level 2 as well. It wouldn’t surprise me at all if there weren’t some doctors who wouldn’t bother to prescribe a given medicine at all – medical judgement be damned – if the sales reps hadn’t provided the goods. That’s what I mean when I say that no one comes out the better for this – not the companies, not the doctors, not the patients, not the country. India is full of people who realize that the country is being held back by this sort of corruption, that it’s a deadweight loss compared to not having to bribe everyone all the time.
But drug companies are supposed to be full of people who realize that this sort of thing is wrong. That’s a culture of corruption for you, though: paying people off with toasters and trips to Thailand is how you make your numbers, and if you don’t make your numbers, well, they’ll find someone who will. Don’t feel like lugging around a sack of kitchen gadgets and consumer electronics? Don’t be a drug rep in India – simple.
No, this whole thing is disturbing and disgusting. As I said, I spend my time back in early research, thinking up ideas that might turn into a drug one day. It would not make me happy, to put it mildly, to think of a drug that I’d had a part in discovered being flogged via sleazy vacation offers and sets of cookware dumped on a doctor’s office floor. It’s my hope that articles like the Reuters one will bring enough attention (and be the source of enough controversy and shame) to start making a difference.