Pakistan Pharma industry has made tremendous progress but unethical marketing practices needs to be checked

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Pakistan Pharma industry has made tremendous
progress but unethical marketing practices
needs to be checked

Medical Representatives should be given proper training
before they are asked to call on doctors to detail various products

Prof. Altaf Hussain Rathore, FRCS *
Mr. Israr Nawaz, BSc, B. Pharmacy **

Before World War II there were not many drugs in the world. The physicians used to treat their patients by the herbal extracts, biological products, mineral salts, mineral oils, opium products and diet. Besides oral ingestion most of the medications were in form of local application and enemas, Sulpha, Aspirin were the magic drugs like opium and digitalis for the heart. So there was hardly any need of the pharmaceutical companies and what to talk of representatives or the agents for marketing. In second half of the twentieth century tremendous research was undertaken in the field of the pharmaceuticals. As a result a good number of new drug molecules were synthesized for almost every disease and marketed. This gave birth to many pharmaceutical companies who started doing a lucrative business throughout the world specially in the West with neck breaking competition to capture maximum share of the drugs market. Until four decades ago almost 80-90% of pharmaceutical market in Pakistan was in hands of the multinational companies (MNC). They used to have their own patented brands of products and at time they were unable to meet the market demand. These MNCs were about thirty in number. They used to employ highly qualified educated people as medical representatives and provide them intensive training before they were asked to go in the market and call on the doctors to detail them about their products. After 1972, with the introduction of Generics in Pakistan by the then PPP Government, there was a mushroom growth of local pharmaceutical companies who managed to get drug manicuring licenses. Some of these companies made huge investments in setting up state of the art drug manufacturing facilities with exceptionally high standard of quality control systems in place but there were others who did not bother much as regards Good Manufacturing Practices. According to M. Zaka, Chairman of PPMA Drug Pricing committee there are about 575 local drug manufacturing companies and over a dozen MNCs were operating in Pakistan. Over the years the number of MNCs has decreased due to international economical changes, there had been so many mergers and take over’s that their number has decreased tremendously. Some of these MNCs closed down their business in Pakistan; others sold their right of marketing to local companies. The MNCs used to have their medical representatives highly educated B. Pharm or medical graduates who had enough knowledge of pharmacy and the products they were dealing in. For the physicians, it used to be a pleasure to meet these Reps, talk to them and discuss their products as they used to be knowledgeable and worked as dignified professionals.


Prof. Altaf Hussain Rathore

The trade volume of Pharma industry of Pakistan was about 302 billion dollars in 2014. Pakistan exported drugs worth two hundred million US$ to over 50 countries. Some of the companies are involved in toll manufacturing. The branded generics produced and marketed in Pakistan are a lot cheaper than the branded products.

Pharmaceutical companies have a long list of marketing personnel working at different levels and the lowest of all is the medical representatives which the healthcare professionals most often see. These Medical Representatives of Sales Promotion Officers are supposed to call on ten to twelve doctors daily and convince them to prescribe their products. Most of them are usually pharmacy graduates of have B.Sc degrees. They are detailed about the product and are asked to work hard with patience, be polite, well mannered and well dressed. Their salary is usually Rs. 20,000 to 30,000 per month and some companies also give special incentives. These representatives while calling on the doctors to detail about their products often present gift items like office desk calendars, table diary, coffee mug, or wall clock etc. However, now some of the companies have started bribing the doctors offering expensive gifts, pleasure trips within the country and abroad and this has in fact gone too far.

Doctors who are qualified and practice ethical medicine, (not the greedy one) expect that these medical representatives should be exceptionally well mannered with reasonably good personality, a good command over communication skills and of course well dressed. But what we usually find these days is lowly qualified, inadequately trained medical representatives who lack communication skills, does not have even the basic knowledge about the products they are supposed to detail which shows the poor quality of training they are imparted. They do carry literature of their products but don’t know much about it. The quality of the product literature prepared by some of the local companies also leaves much to be desired. Some companies have hired the female representatives who go on mumbling some words which the doctor cannot hear or understand. They show the literature across the table which is difficult to read. More recently a female representative of a company visited me along with her senior colleague may be area manager. After introduction he asked me to help this poor soul (the female rep) by writing her products otherwise she will lose her job. Doctors and hospital owners do not respect these representatives. There are about three thousand registered drug molecules of which 75,000 products are registered by different trade names which are manufactured. Doctors are also too busy and have hardly any time to look at the quality of the drugs and many a times their prescribing practices are influenced by the companies who offer them expensive gifts and are involved in unethical marketing practices. When we were young medical graduates, a very senior professor who became the principal of a medical college later on, once had a trip of London on some companies expenses and every one of us used to look down upon him. Doctors were not so bad till they were corrupted by the pharmaceutical industry and now the situation has become so bad that infected with materialistic virus, some doctors straight away ask for the money for prescribing their products and are getting regular payment from the companies. To begin with it was the MNCs who started offering expensive gifts and pleasure trips but now some of the national pharmaceutical companies have emerged as leaders in unethical marketing practices and were doing roaring business. It has seriously affected the image of the medical profession and eroded their credibility in the society. Medicine used to be a noble profession but now it has been converted into trade, doctors have become disease merchants and some of them could be better called as social dacoits or blood suckers.

Pharmaceutical industry in Pakistan has no doubt made tremendous progress and a large number of them who believe and practice Good Manufacturing Practices, continue to make further investments, improve, expand their operations and are busy in producing safe, effective quality drugs but a few black sheep among the industry which are involved in unethical marketing practices are bringing a bade name to the entire Pharma industry. Drugs produced in Pakistan are of better quality as compared to India and Pakistan and that is why they are still preferred in many countries where we export our drugs. National Bioethics Committee (NBC) formed by the Government of Pakistan has formulated very useful Guidelines on Doctors interaction with the Pharma Trade and Industry and if they are implemented in letter and spirit, it can eliminate unethical marketing practices to a great extent. This is something which the Drug Regulatory Authority of Pakistan (DRAP), Pakistan Medical & Dental Council as well as the other government agencies in particular need to look into. In order to ensure ethical medical practice and ethical pharmaceutical marketing practices, we would like to offer the following suggestions:

  1. Government should encourage and provide protection to the local manufacture of basic raw materials.
  2. Drug prices should be allowed a reasonable increase.
  3. There should be no compromise on the quality and safety of the drugs and those found guilty should be given exemplary punishment.
  4. Pharma industry should be given incentives to make further investment, modernize their drug manufacturing facilities to earn FDA approval.
  5. DRAP should be manned by qualified experienced professionals who know their job and if need be, it should not hesitate to induct people from the market and offer them remuneration which they deserve.
  6. Doctors should give due respect to the Pharma representatives. There should be a waiting room and fix visiting day and time for them.
  7. Pharma industry must provide their representatives adequate training before they are asked to call on doctors to detail their products.
  8. Pakistan Pharma industry is capable of increasing its drugs export manifold provided the government is sympathetic, looks into their problems, removes impediments and a corporate culture is introduced in the government departments acquiring the services of professionals.

   * Surgeon Foundation Hospital Rajana, Distt. Toba Tek Singh, Punjab.
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   ** Chief Pharmacist, Foundation Hospital Rajana
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