Home ›› 06 Jul 2022 ›› Opinion
Profit and ethics are both important for the sustainability of a business. But if we take the case of pharmaceutical companies as our point of debate, which we consider a noble business, it has been observed in some cases that a few of these companies take undue advantage of doctors prescribing and promoting drugs which have no brand and time tested reputation. Here, we see profits being prioritized over ethics.
The basic role of a medical representative is to apprise the doctor about his or her company's new drugs. There is nothing wrong in that as long as the ultimate beneficiary of this information is the patient. Unfortunately, there is often a conflict of interest between the patient and the doctor as far as the drug promotion of a less reputed company is concerned.
The interaction of drug companies with doctors in order to promote their medical products through seminars is an acceptable practice in many countries. But interacting with each doctor individually in public hospitals during their duty time cannot be acceptable. Patients come first, and thus duty time should be reserved for patients.
Some drug companies give gifts and other incentives to doctors in public hospital which is a serious breach of code of conduct. Sometime, patients feel very uneasy to overcome crowds of bikes of representatives. It seems hospitals are there for company’s representatives not for patients. But it is also true that there are ethical doctors who continue to prescribe medicines that are most beneficial and economical to their patients despite being under pressure from medical representatives of drug companies.
There have been news reports that medical representatives give gifts such as pens and writing pads with drug names inscribed. Some physicians don't consider it unethical to accept gifts like pen stands, calendars, drug samples, company funded lunches or dinners, etc., where a company's products are visibly mentioned, to influence prescribing behaviour that is morally wrong.
This 'culture of gifts' is forbidden almost everywhere around the world. In Bangladesh, Secretaries to the Government or officers of equivalent status may accept gifts offered abroad or within Bangladesh by institutions or official dignitaries of foreign government of comparable or higher levels, provided that the value of the gift in each case does not exceed Tk 500 and the said gift has to be deposited to State Toshakhana (USD 6.5) (Rule 5 of Government Servants (Conduct) Rules, 1979). Philosophy behind the rule is that just to honor the guest, so that she or he cannot be embarrassed due to non-acceptance.
In Australia, any gift or gratuity may be considered a bribe under the law. The prohibition against bribing public officials can therefore extend to the provision of gifts, travel expenses, meals and entertainment. In Cambodia, there is no specific limitation on the value of gifts that can be given to government officials under the law. However, the law clearly prohibits the giving of gifts of any value for the purposes of corruption. The purpose of the gift given to a government official or professional is more important than the value of the gift. In China, no specific types of gifts or gratuities are considered permissible under the PRC Criminal Law and, theoretically, gifts which may create conflict of interest constitute a crime.
In India, as a general rule, public servants are prohibited from accepting lavish hospitality or frequent hospitality from any individual, industrial or commercial firms, organizations, etc. having or likely to have official dealings with such a public servant. In Indonesia, any gift to a public official must first be approved by the government. Any undisclosed gift is deemed as an offence. In Japan, the Ethics Act has established gifts register and requires senior level public officials to disclose gifts in excess of 5,000 yen (under USD 50). Japanese statutes do not provide a minimum threshold for a gift. The Ethics Act and the Ethics Code serve as a reference for the gifts and the public service officials cannot receive any kind of entertainment. In Malaysia, any limit in relation to gratification, given or received, is an offence of corruption. In Hong Kong, the Anti-Corruption Law makes no clear articulation of a minimum level which makes gifts acceptable. Any gift or economic benefit could potentially constitute a bribe depending upon the context in which it is given. In New Zealand, the Code of Conduct sets minimum expectations of behaviour for public servants, one of which is that they perform their official duties honestly and do not ask for or accept gifts, rewards or benefits which might compromise their integrity and that of their department and the public service or which might place the public servant under an obligation to another person.
In the Philippines, Presidential Decree No. 46 makes it punishable for any public officer to receive, directly or indirectly, and for private persons to give, or offer to give, gifts, presents or other valuables to a public officer during any occasion. In Singapore, all gifts need to be approved by a permanent secretary and only gifts under SGD 50 (USD 40) can be accepted. Any gifts valued at more than SGD 50 (USD 40) can only be taken by the public official and it is to be deposited to department. In South Korea, there is no minimum threshold for a gift that makes it a bribe i.e. any amount of gift received is the violation of the public official bribery provision of the Criminal Code. Gifts cannot be accepted unless they are given in an appropriate occasion or circumstance. In Vietnam, generally the giving or receiving of gifts and hospitality is deemed a bribe under Vietnamese law if it satisfies all elements of a bribe.
In Bangladesh, it is now the need of the hour that the interaction between doctors and drug companies be contained within acceptable boundaries. The real challenge for the medical profession, drug companies and the drug administration is to formulate mutually acceptable guidelines to avoid unethical practices of giving and receiving gifts. It is to be remembered that in our anti-corruption law, there is no difference between gift and bribe. If the intention of transaction in the public hospital is to divert doctor’s prescribing behavior with ill motive, the representative of the company can be prosecuted. Mushrooming of drug companies is also responsible for this unethical gift practices. Many ethically sound doctors, I have seen in the hospitals, they do not like to allow this ill motivated gift giving practice of drug companies. If they have any authority, they could take action against this ill practices. So, a solution can be brought out in dialogues by three main stakeholders such as doctor’s associations, association of pharmaceutical companies and drug administration. If the three main stakeholders can sit together for a dialogue to stop this bad culture with a view to save invaluable treatment time of doctors in hospitals, that could be a one step further development of satisfactory health services in our public hospitals. Competition between drug companies often compromises the quality of the drug. If the retail price, quality, genetic and generic names of drugs are regulated and standardized at a regular basis by the drug administration, this unethical gift practice of some drug companies can be put in check.
The writer is a former Senior Secretary and currently teaching as an Adjunct Faculty at the Bangladesh Institute of Governance and Management (BIGM). He can be contacted at [email protected]
