Successive Governments have failed to implement NBC Guidelines on Physician’s Interaction with Pharma Trade and Industry


 Supreme Court might have to intervene to stop this Robbery

Successive Governments have failed to
implement NBC Guidelines on Physician’s
Interaction with Pharma Trade and Industry

Medical profession must come back to the lecture halls
and Auditoriums of medical institutions from
Banquet Halls of Five Star Hotels

Billions of rupees are spent on Lunches and Dinners
at these Five Star hotels which deprives millions
of poor patients of their medications

Pharma industry is also fed up with the ever increasing
demands for funds from the conference organizers

By Shaukat Ali Jawaid

ISLAMABAD: Pharmaceutical trade and industry all over the world sponsors medical conferences, seminars, symposia as well as all other Continuing Medical Education Programmes for the medical profession but they have some principles, clearly laid down guidelines which are implemented in letter and spirit. However, in Pakistan in the absence of any monitoring and accountability, over the years the situation has gone from bad to worse. Pharma industry is now also fed up with the ever increasing demands for more and more funding from the medical profession for organizing these conferences at Five Star Hotels. National Bioethics Committee (NBC) constituted by the Government of Pakistan finalized its Guidelines on “Physicians’ Interaction with the pharma trade and industry” many years ago and this comprehensive document takes care of all the issues. It offers a practical, feasible, implementable solution to all the issues besides laying emphasis on transparency in all these transactions. These Guidelines were approved by the Pakistan Medial & Dental Council as well as the Federal Government about four years ago but they have not been implemented. Hence, though I am personally not at all in favour of intervention by the higher judiciary in every area but when the successive governments have failed to realize their responsibilities, Supreme Court of Pakistan might have to intervene to stop this Robbery as well.

Every year, billions of rupees are spent on organizing these conferences at Five Star Hotels on lunches and dinners. Most often these conferences which have very little scientific value turn out to be social get-togethers of healthcare professionals with their family members all paid for by the pharma trade and industry which then passes it on to the poor patients in the form of high cost of services, drugs and medicines. Little does these elite of the society realize that every lunch and dinner they take at these Five Star Hotels, deprives a few patients of their medications. Studies have time and again showed that one of the important reasons for failure of treatment is the non-compliance of patients with drug therapy as many a times they cannot afford expensive medicines. If a particular pharmaceutical company can afford to pay ten to fifteen million rupees to a particular conference organizers, it shows that they can afford to reduce the cost of their drugs by atleast 10-15% if they do not have to pay the conference organizers. Time has come that the medical profession must come back to the lecture halls and auditoriums of medical institutions from the Banquet Halls of Five Star Hotels and has some pity on poor patients. What is more surprising is the fact that chronic diseases like diabetes, cancer, cardiovascular diseases, hepatology etc., which needs long term treatment or in some cases lifelong treatment have too many professional specialty organizations, groups within groups and all of them are keen to have their conferences at Five Star Hotels. The pharma industry being in a vulnerable positon, cannot afford to say “No” to any of these groups. Not only that, sometimes these conference organizers come up with such demands for funding which many in the pharma industry find it extremely difficult to fulfill. These conference organizers then resort to blackmail, coercion and threats and use all means to extract huge money from the pharma industry. In many cases, no record is maintained and no audit is carried out.

This Bookelet must be gathering dust in the Federal Health Ministery and PM&DC.
Nobody has bothered to gets these NBC Guidelines implemented.

There is always a fight to become an office bearer of these professional specialty organizations during the elections because whosoever occupies these coveted offices, enhances their value and importance and they are in a better positon to blackmail the pharma industry to sponsor their visits overseas, cough up huge funding for the conferences, not only sponsor them but at times their family members as well which are all unethical. However, there are some exceptions and there is no death of God fearing, kind hearted healthcare professionals who not only believe but practice ethical medicine; but it is the intellectually corrupt, unethical healthcare professionals whose conduct brings a bad name to the entire medical profession. People like Prof. Kh.Saadiq Hussain who can be termed as conscience of the medical profession whenever they get a chance to address the medical profession do point towards these things, call upon the medical profession to be honest, refrain from such unethical practices but so far it all has fallen on deaf ears. In fact some healthcare professionals are notorious, can be termed as “social dacoits” for whom this has become a business and they use these conferences to make money.

Innovative ideas to extract more funding

Members of the medical profession in Pakistan might not have come up with some innovative ideas in teaching, training, patient care, research, improvement of functioning of the medical institutons, healthcare facilities but it has been successful in conceiving and practicing innovative approaches on how to extract more and more money from the pharmaceutical trade and industry. Some of the tactics they use offering corporate membership to the pharmaceutical companies by the professional specialty organizations committing to donate millions of rupees annually, Platinum, Gold, Silver sponsors at the conferences, hospitality suites, sponsoring a session, symposium which all cost millions of rupees. This is not all, the organizers also ask for conference bags, shields, paying Registration Fee for the delegates which also ranges from five to ten thousand rupees for each delegate. Many a times one can see the badges of these delegates lying at the registration counter or the pharmaceutical company stalls as most of them are neither interested nor they come to attend the conference. However, it does serve one purpose of the organizers i.e. to generate funds which these companies have to pay. This is over and above the sponsorship of speakers, delegates to the conference looking after their travel and accommodation during the conference which is all paid for by the different pharmaceutical companies. Put together this again comes to millions of rupees.

Lack of Research and Publications

Proceedings of these medical conferences are never published which could benefit those who could not attend these due to some reasons. The overall contributon of Pakistani doctors to world medical literature is highly disappointing. We are far behind from our neighbouring counties in the region like Iran, India, Turkey and China. We have just three medical journals which enjoy Impact Factor and none of the medical journals published by the medical universities, medical colleges and specialty organizations enjoy international recognition. Many of them even do not publish any journal. This reflects their apathy towards research. Some of them often complain about lack of funding but they forget the fact that medical profession in Pakistan spends Billions of rupees every year on organizing the conferences and social get togethers. If all these academic activities were held within the medical institutons, the financial support from the pharma trade and industry can be judiciously used to provide the facilities which are lacking, improve libraries, establish research departments, upgrade and furnish lecture halls and auditoriums besides offering grants to young postgraduates who are interested in research. All this go a long way in promoting research culture in the country.

Need for a detailed enquiry

If an enquiry is ordered by the Supreme Court and all state institutons are asked to collect the information, figure of funds doled out by the various pharmaceutical companies over the last few years to these conference organizes and who got how much funds, how they were spent, is there any record and call for audit reports, it will make startling disclosures. We have time and again drawn the attention of the conference organizers to these issues but without any success. We have also reminded them many times that it was time they start self monitoring and accountability of their members. Every specialty organization, institutions must ensure ethical behavour of their members, employees. We have also told them that if they failed in self monitoring and accountability, somebody else will start doing it and then it will be very painful for them. This has been proved when the Supreme Court of Pakistan took up the issue of Stents, interventional cardiology procedures. Now it is the court which is telling them how much to charge for all these procedures. When the young doctors created law and order situation, forced their senior professors and institution management to accept their nominated people for Residency pogroms rather than selection on merit, the bureaucracy took the whole selection procedure in its own hands. The result was centralized selection of postgraduates for training. When the owners of the private medical and dental colleges failed to control some black sheep among them who were asking for huge donations for admission over and above the admission fee and annual tution fee, the Supreme Court of Pakistan intervened and it ordered centralized admission which also has some advantages but some advantages as well and it might not work in the long run. For example, how can you force the private medical universities, medical and dental colleges to admit students who may not be suitable to be selected for this profession. Academic grades should not be the only criteria for selection. Empathy, attitudes, behavour, communication skills, tolerance, sincerity to serve the ailing humanity etc., are some other qualities which are also important. Who is going to ensure all this? Then some of the student might drop out finding themselves unfit to continue and take up medicine as a professional career. How these seats will then be filled and if not, the institution will suffer huge financial loss. If they have no say in final selection of their students, it will have too many problems. For the success of any scheme it is extremely important to take all stake holders into confidence and have their input before finalizing any policy.

Working of the PM&DC & intellectual corruption

Yet in another case when the elected members of the Pakistan Medial & Dental Council failed to perform their duties honestly, helped each other to increase the seats, increase tution fee, start numerous postgraduate diplomas, degree programmes without adequate teaching, training facilities and other infrastructure, the Supreme Court of Pakistan had to intervene. The leading political parties Pakistan Muslim League (PML N) and PPP failed to find a solution to the problems PM&DC was facing, they failed to pass the new PM&DC Ordinance streamlining its affairs and composition. Intellectual corruption was at its best, hence the Supreme Court of Pakistan once again had to intervene and set up an adhoc PM&DC Council headed by a retired Judge of the Supreme Court Ms.Justice Shakirullah Jan. The new Council has taken some positive and far reaching steps. For example for the first time in the history of PM&DC the Journals Committee has offered membership to professional medical editors and it has finalized the Terms of Reference (TORs) for recognition and evaluation of medical journals. Medical Editors and Pakistan Association of Medical Editors (PAME) has been asking or this all these years but again this fell on deaf ears of PM&DC tin-gods and distinguished medical personalities of the medical profession who were chairing the Journals Committee all these years. Is it not a matter of shame for the medical profession that such a positive step has at last been taken by the PM&DC when it is headed by a non-doctor? Credit for all this of course goes to Prof. Arshad Javed Vice Chancellor of Khyber Medical University who himself being an Editor knew the importance of input from the professional medical editors and got it implemented.

It is still time. Let the medical profession in general and the conference organizers in particular listen to the saner voices from within the profession and stop harassing, coercing, and blackmailing the pharmaceutical trade and industry asking for millions of rupees for their academic activities. They should start organizing all these academic activities in the medical institutons. It will reduce the cost to a great extent, the pharma industry will also find it easy to sponsor all this. However, it is the corrupt elements within the pharmaceutical trade and industry and intellectual corrupt within the medical profession who have joined hands to help each other. Those in the industry who practice ethical marketing have to suffer whereas the unethical and corrupt elements in the industry also increase their sales manifold every year which they manage by bribing the medical profession who reciprocates the favours which they receive from them by prescribing their drugs. One hopes that those who believe and practice ethical medicine in the medical profession will co-operate with those in the pharma industry who also believe in ethical marketing. It is the networking and helping each other that they can defeat the corrupt, unethical people among their ranks. Eventually if they also failed, then everyone must get ready to be monitored and held accountable for their misdeeds by someone else. It appears this step will have to be taken sooner or later.

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