Pharma, Physicians and Patients: Perception and Reality

The Pharma industry spends around 3-12 % of its revenues on promotion. While new brand launches take away more promotional budgets, old established brands spend about 3 to 5 %. This figure drastically comes down for price-controlled medicines.

Pharma, Physicians and Patients: Perception and Reality
PNH is a rare, acquired, life-threatening disease of the blood and is characterized by the destruction of red blood cells, blood clots, and impaired bone marrow function. (File)

By Gauri Chaudhari

During the COVID era, every Indian had a solid reason to be proud of the Indian pharmaceutical industry. The world frequently looked to India for supplies to combat the pandemic, whether it was hydroxychloroquine in the early days or vaccinations in the latter days.

Closer home, during the strict lockdown period, the Indian pharmaceutical industry worked diligently to ensure the production and supply of medicines. No diabetic or cardiac patient went without medicine during the lockdown as the pharma professionals worked relentlessly to ensure supply. Though remedesivir was in short supply, for a few days, during the delta wave due to unexpected demand, the industry quickly matched the requirement.

No wonder, as per the report published by Statista, the world’s No 1 Business Data Platform, India topped the chart of the trust barometer. A trust barometer survey was conducted in 28 countries with 33,000 respondents. The educated and informed citizens were asked how much they trust the pharma sector of their own country. 83% of Indians unequivocally said they trust the Indian pharma sector, whereas only 47% of Americans and British trusted the pharma industry in their own country.

Sadly, today, the same Indian pharma sector is undergoing a media trial. The headlines in the newspapers are filled with stories that question the very basis of the trust industry enjoys. It all started with Dolo 650.

According to the media, Dolo 650 gave doctors freebies worth Rs 1000 crs to promote higher doses of paracetamol. They claimed that the recommended dose of paracetamol for fever is 500 mg. To increase its earnings, pharma companies promoted 650mg.

In addition, some media sources reported that, unlike 500 mg, paracetamol 650 mg is not subject to price regulation, and pharma companies unethically promoted the 650 mg dose to circumvent the government-imposed price cap.

Those who had taken Dolo 650 during COVID became concerned after reading these news reports. Even Justice D Y Chandrachud, who was prescribed Dolo 650 during his COVID illness, expressed concern for his health.

So is there a problem with Paracetamol 650 mg dose? Were we given an extra 150 mg dose because the pharmaceutical industry wants to increase its profits?

The answer to this question is one emphatic NO! Paracetamol 650 is the internationally recommended dose for fever. There are several studies to support its use. And YES, contrary to media reports, Paracetamol 650 mg is under price control.

Another set of media speculations revolved around Dolo 650 giving doctors RS 1000 worth of freebies. Let me clarify that I am not associated with Dolo and don’t have an exact idea of their marketing practices. Yet having spent 27 years in pharma and healthcare marketing.

I can say this allegation does not sound true. How can a brand worth Rs 350crs give freebies worth Rs 1000 crs? It makes no business sense.

The Pharma industry spends around 3-12 % of its revenues on promotion. While new brand launches take away more promotional budgets, old established brands spend about 3 to 5 %. This figure drastically comes down for price-controlled medicines. So paracetamol brands spending Rs 1000crs on promotion is difficult to fathom.

There is no doubt that negative news sells, and sensationalizing help get more eyeballs, but the media must avoid misinformation. This kind of misinformation can have devastating short-term and long-term impacts on society. Short-term consequences like anxiety, worry and the nocebo effect cannot be undermined. But the long-term effect, like people moving away from well-researched modern medicine for their acute and chronic illnesses, can be devastating for a country like India.

Does this mean there is no nexus between physicians and pharma? Aren’t freebies given to influence prescription?

Let me admit that there are instances of unethical promotion, and this practice must stop on SOS. There has to be a mechanism to spot corrupt practices and deal with those involved with an iron fist. But painting all the branded generics with the same brush is not correct.

So what is the way forward?

To ensure strict ethical practices in healthcare, Pharma companies, Policy makers, Physicians’ associations, and Press must act decisively. If these 4 Ps come together, the 5th P, the Patients, will immensely benefit.

Pharma companies have an essential role to play. India is a diverse market, and each patient segment has different requirements. The needs of a patient from rural India differ from those of an urban patient. The needs of a working professional are different from those of a homemaker. Pharma businesses can build brands for various patient segments thanks to the Indian market’s branded generic nature. Unfortunately, pharma companies create similar brands, rely on requesting doctors for prescriptions or spend higher money to increase their share of voice in the market. A few pharma companies indulge in unethical practices for the very same reason. Pharma companies must differentiate brands based on patient segment needs.

Policymakers must act decisively on Uniform Code for Pharmaceutical Marketing Practices (UCPMP) code. Though UCPMP guidelines are available, policymakers must consultatively work with various associations to improve the effectiveness of UPCMP. Open dialogue, transparency and assigning responsibility keeping the real-world scenario at the center would be the key to the success of UCPMP.

There has been a demand for strengthening the UCPMP code and its strict implementation. Any further delay will adversely impact all stakeholders.

Physicians and their associations also have an important role to play. India is unique in terms of disease burden, etiologies and required treatments. The associations / medical councils must advise treatment algorithms for Indian patients to avoid overuse, misuse or abuse of medicines (if it exists), which is often blamed on the pharma-physician nexus.

The press needs to handle healthcare news with care. Healthcare in India is unique and complex. The issues need deeper understanding before the conclusion. Different sides of the narrative should be heard and represented. The media must understand them in detail and avoid the spread of misinformation. Sensationalizing issues will not help anyone, definitely not the patients.

While malpractices must be stopped, tarring the entire industry with the same brush will do no good for the Indian pharma sector or the patients.

(The author is Founder Brand Innerworld and Author of The Perfect Pill. Views expressed are personal and do not reflect the official position or policy of the

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