Government urged to implement National Bioethics Committee Guidelines on Physician-Pharma Industry Interaction in letter and spirit

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Generic Prescribing will create more problems than it can solve
Government urged to implement National
Bioethics Committee Guidelines on
Physician-Pharma Industry Interaction
in letter and spirit
It will check unethical marketing practices by
the pharma industry and unethical medical
practice by physicians to a great extent
It will also ensure patient safety, rational
prescribing & monitoring of academic activities

By Shaukat Ali Jawaid

KARACHI: The recent notification by the Drug Regulatory Authority of Pakistan (DRAP) advising physicians to prescribe drugs with their chemical/generic names rather than brand name will create more problems than it will solve. In fact the solution lies in implementing the National Bioethics Committee (NBC) Guidelines on Physician-Pharma Trade and Industry Interaction finalized many years ago which were also approved by the deceased Pakistan Medical & Dental Council (PM&DC) besides by the Federal Health Ministry (which must be gathering dust somewhere) in letter and spirit. It will check the unethical marketing practices by the pharmaceutical industry and unethical practices by the medical profession as well to a great extent.

At the same time it is also important to strengthen community, hospital pharmacy, make sure that all the chemists’ shops are manned by qualified pharmacists. Not only that the pharmacists should also be made part of the healthcare team in the healthcare facilities, they should accompany the physicians in ward rounds and offer advice to the physicians on prescriptions to ensure proper drug dosage, to avoid drug interactions and drug-drug interactions as well. The pharmacists should respect the physicians as team leader in healthcare and the medical profession in return must give the pharmacists due respect and consult them while writing prescriptions. The ultimate objective should be patient safety which can only be ensured if the doctors and pharmacists work in close collaboration. However, it is also important that the teaching and training of pharmacists is improved, they must improve their Attitudes, Communication and Behaviour which at present is greatly lacking in most of the pharmacists, and of course there are some exceptions. Those pharmacists who are intelligent, competent and have professional approach and are already working in various tertiary healthcare facilities already enjoy great respect and they are often consulted by the physicians.

Various professional bodies and agencies in different fields often come up with very useful reports, suggestions but these are never implemented by the authorities. The PPP Government in 1989 had prepared National Formulary containing Essential Drugs and even presented it in WHO for appreciation but then it was never implemented.

DRAP appears to have issued the notification without giving it a serious thought about its serious repercussions. At present a vast majority of the chemist shops are manned by ill trained staff many of them even cannot read the drug names. Expecting them, to dispense prescriptions with chemical/generic names is calling for a miracle. It is neither feasible, practical at present nor will it be in the interest of patients.

It is also a fact that at present unethical marketing practices in the pharma industry and unethical medical practice in the medical profession is rampant. At the same time it is also true that none of the governments in Pakistan in particular during the last three decades have been interested in meaningful reforms to ensure ethical practices in the health sector. It includes governments formed by the major political parties like Pakistan Muslim League (N), Pakistan People’s Party and now the Pakistan Tahreek-e-Insaf. The NBC Committee headed by Prof. Farhat Moazzam of which I was also a member, had prepared this document (NBC Guidelines) after great efforts and it remained under discussion in the NBC and PM&DC for over two years before it was finally approved which was later approved by the Federal Health Ministry as well. I had personally presented a copy of this document to Mrs. Saira Afzal Tarrar the Minister for Health in the PML (N) Government with a request to go through it and ensure its implementation but I am sure she never read it as we never heard a word about it later on.

More recently when the PTI formed the Government, I asked Dr. Zafar Mirza about the NBC Guidelines, if he was aware of it and whether the government was interested to implement it? He said, he has heard about it and have planned a meeting with the NBC members soon. Few weeks later he was shown the door and one does not know if Dr. Faisal Sultan the new Health Advisor to the Prime Minister is interested to get these guidelines implemented. He himself has been very keen and at Shaukat Khanum Hospital symposium, it is said, professional ethics were always upheld.

NBC Guidelines, it may be mentioned here is a comprehensive document which takes care of all the issues including the medical conferences which are sponsored by the pharma trade and industry, Workshops, Seminars and Symposia, Samples, Continuing Medical Education activities which are also most often sponsored by the pharma trade and industry. It has proposed that any payment made to the professional specialty organizations, medical institutions should be made public, shared with the government authorities like NBC, it should also be displayed on the company website. Accounts of all the professional specialty organizations should be regularly audited to ensure that they are judiciously used for the purpose they have been received. Sponsored should be encouraged to provide services instead of payments in cash or through cheque for all such academic activities like sponsoring the speakers, participants at the academic activities, audiovisual arrangements, and lunch or dinner etc. they should make payment direct to the caterers or service providers rather than the conference organizers.

Medical conferences and all other academic activities all over the world are sponsored by the pharma trade and industry, Pakistan is no exception but while overseas there are some checks and balances, close monitoring, in Pakistan no such restrictions are in place. Thus it encourages unethical marketing practices by the pharma industry particularly those who have recently entered the business. In order to increase their sales, they indulge in corrupting the medical profession by all sort of incentives. Most of the medical conferences have also turned out to be social get-togethers of doctors with their families with very little scientific contents. In CME Credit Hours scheme which was introduced some time ago is re-started, the various universities issuing CME Credit Hours for all such academic events based on the scientific contents, it will go a long way in checking these malpractices. The conference organizers should share the details of scientific programme with the universities in advance who should then approve Credit Hours based on the quality of contents and duration of the conference, meetings and there should also be strict monitoring and post conference report to be submitted to the respective universities. It will help realize the desired objectives of ethical practices both by the pharma industry and the medical profession.

Medical profession itself needs to put its house in order. At present some of the conference organizers have in fact made it a business to earn quick money. They coerce, force and even at times do not hesitate to black mail the pharma trade and industry to get funding’s which runs into millions of rupees and most often there is no audit of these accounts. Some of the conference organizers also earn money from Hotels where these conferences are organized by bulk advance bookings of rooms and then these are offered to the participants on exorbitant rates through event organizers which are of course then paid for by the pharma industry which have sponsored those delegates. The industry then passes this expenditure on to the patients in the shape of high cost of drugs and other services. There are some exceptions and some conscious, kind hearted, God fearing among the physicians have been raising voice against all such malpractices but they have miserably failed to convince their colleagues. Eminent medical personalities like Prof. Kh. Saadiq Hussain former Principal of king Edward Medical College who also served as the President of College of Physicians & Surgeons of Pakistan in his speeches has often termed it as CC Virus (Corruption and Commercialization virus) which has infected the medical profession. It is high time that we do something about it and make sure that patients get not only drugs and medicines, but investigations, hospitalization at cost which is affordable. It will be ideal if the medical profession initiates self-monitoring and accountability rather than some other agency doing it.

Visit the following website to see the NBC Guidelines in detail.

http://www.pulsepakistan.com/images/Pulse/NBC_Guidelines.pdf