On March 12, 2024, the government of India issued the Uniform Code for Pharmaceutical Marketing Practices (UCPMP) 2024, which is meant to regulate interactions between pharmaceutical companies and healthcare professionals.
On March 14, with the Supreme Court doggedly persisting with its demand for transparency, the State Bank of India finally disclosed a list of donors in the controversial electoral bonds scheme. The list revealed that 35 pharmaceutical companies donated electoral bonds worth almost Rs 800 crore to political parties.
These two events may be termed the perfect oxymoron: of these forces doing what they did with ‘donations’ from pharma companies versus the social responsibility needed to build a public health system that works for even the poorest of the poor in the republic.
The nexus of doctors and pharmaceutical companies in India is beyond holy. The rampant use of money by pharma giants in luring doctors into prescription, poor practices and use of unnecessary procedures and implants is well-known.
In fact, what is worrying is the audacity of both healthcare professionals and pharmaceutical companies in this tie-up. Their love for each other is brazen, with no fear of the law or punitive action on the part of either.
Unfortunately, the UCPMP is not the first step in controlling this nexus. Previous attempts by the erstwhile Medical Council of India and subsequently by the National Medical Council to control the pharma-doctor nexus have hardly yielded any results.
To the best of my knowledge, not a single physician has ever been expelled from the medical register in India on charges of favour or bribery from pharmaceutical or medical implant companies.
On the contrary, I am aware of many orthopaedic surgeons who themselves or through close family members are actual dealers of orthopaedic implants manufactured by global implant giants.
In all honesty, to believe that the UCPMP will rein in any such people, is merely fairy-tale imagination.
The chilling details of pharmaceutical companies donating to the ruling dispensation and other political parties are now available in the public domain.
How can we fathom the fact that one of the largest donors of electoral bonds in this cohort is actually a corporate hospital? Can we expect any action against the misdoings of such hospitals if they are caught for patient negligence in future? Or will we be made to believe the rhetoric that justice is blind to the pervasiveness of money and power?
How can we now explain the validity of approvals for the COVID-19 vaccines, when we know that there were hefty donations by vaccine firms through electoral bonds?
And what about the fact that so many pharma companies which bought electoral bonds were already under the regulatory scanner of the Income Tax department?
All this is a serious breach of trust of the common person, who is made to believe day in and day out in the integrity and honesty of both doctors and their political masters.
In April 2018, Prime Minister Narendra Modi condemned the allopathic doctors of the country during an interaction called Bharat ki Baat, Sab ke Saath with the diaspora in London.
The PM condemned the Indian doctors on charges of corruption and malpractice. He emphasised the doctor-industry nexus and shared concerns on the fallout of such a relationship. He, being the head of state, had a golden opportunity to set this relationship on the right path.
Unfortunately, with the current disclosures on electoral bonds, this hideous relationship is further legitimised and strengthened. My medico friends in the private sector are smiling at the political dispensation’s awkwardness in this unholy nexus with pharmaceutical companies. Living in a world of “whataboutery”, most doctors involved in this nexus now feel insolently relieved.
The involvement of the ruling party in this mess is reason enough to feel that nothing is wrong, that nothing surpasses the power of capital and that we can continue to rule in a universe bugged by the virus of money and power.
The Indian pharmaceutical industry is already reeling under charges of misappropriation and poor quality controls. In their eye opening book, The Truth Pill: The Myth of Drug Regulation in India, authors Dinesh Thakur and Prashant Reddy T. have elaborated on the critical vulnerabilities of India’s drug manufacturing industry and the broken moral compass which besieges it.
In an article in Bloomberg entitled “Just How Dangerous are India’s Generic Drugs? Very”, published on April 4, 2023, author Ruth Pollard writes:
“For a nation that seeks to claim the mantle of “pharmacy to the world,” India is scandalously short on regulatory oversight. In the last six months alone, its generic cough syrups have killed dozens of children, its eye drops have caused blindness and its chemotherapy drugs have been contaminated [sic]”.
As a doctor, these lines made me flinch. They are sad, serious allegations.
The revelation that pharmaceutical companies have also been actively involved in electoral bonds have further eroded the credibility of not only the pharmaceutical industry or the ruling class, but also of healthcare professionals who stand to be benefited directly through this unholy alliance of politics and industry.
For my medico friends, I can only remind them of what Immanuel Kant had once said: “We are not rich by what we possess, but by what we can do without”.
Shah Alam Khan is professor of orthopaedics at AIIMS, New Delhi. Views are personal.