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Diagnosis by drug reps - India's health camps

Investigation shows testing and screening is being carried out in exchange for prescriptions in developing countries

Indian mother and child
Gene is a partner in the consumer law and product safety team at Leigh Day.  He has a particular interest in clinical trials having represented clients injured in the Northwick Park 'elephant man' drug trial case.
A report by the British Medical Journal has found that pharmaceutical representatives are completing screening and diagnostic testing in return for prescriptions at India’s ‘health camps’.

Free health camps for people who lack access to affordable medical care are reported to be widespread in India. ‘Mega camps’ frequently set up between pharmaceutical companies and civil society organisations are held at temples or schools near slum areas. Smaller patient camps are held in hospitals and doctor’s offices. Thousands attend yearly.

It seems a good thing - charitable provision of healthcare. Patients are screened for health conditions such as heart problems, lung disease and diabetes. The testing materials, such as electrocardiographs, spirometers, bone density scanners and glucose meters are provided for free by drug companies.

Yet the BMJ states it has evidence that pharmaceutical involvement and influence extends far beyond charitable donation. Physicians participating in health camps are reported to prescribe the specific drugs of the attending sales representatives as a ‘quid pro quo’ for donations. In some cases the bargain is express; in others, an implicit thank you for services provided.  

Chillingly, the BMJ further reports it has evidence that unlicensed employees of Indian drug firms, as well as the Indian arms of Abbot, Bayer, GlaxosmithKline, Roch and Sanofi, are completing medical testing. An Abbot representative described the “grossly unscientific” manner of the testing: “We do a random glucose test. Based on that the doctor gives medicine”. Again, in return for testing, physicians are reported to ensure that a prescription is made for the drug the representative is promoting.

The interests of the drug companies are plain - they obtain new customers, capture a market share, and are able to influence the prescribing practices of physicians. The statistics stand for themselves. In 2011 Abbot India screened over 240,000 people for thyroid disorders. Its leading product Thyronorm (thyroxine) outperformed cheaper competitor brands the same year.

The Medical Council of India (MCI) has been clear that these practices are in breach of national regulations. They state that only registered medical practitioners may complete screening and diagnostic testing. Further, under Indian law doctors are prohibited from accepting gifts from drug companies. Yet, under the guise of charity and corporate social responsibility, drug company involvement in Health Camps continues.

The risk of malpractice and misdiagnosis is significant. There is a danger that drugs are being dangerously overprescribed, and that expensive brands are being prescribed instead of cheaper ones. Further, as patients are frequently the poorest of society, follow up is difficult and the consequences of misdiagnosis or unsuitable prescription are unknown.

If Big Pharma’s actions really are in the name of charity and not commerce the tie between donations and prescription must be ended immediately.

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