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Times of India
5, March 2010
By Kiran Kabtta Somvanshi

Medical Govt
ANY attempt to bring down healthcare costs anywhere faces resistance, or ineffective. The Medical Council of India’s (MCI) latest code of conduct for doctors to bring down drug bills for patients runs the risk of failing, if the government does not follow up with strict laws governing companies.

The autonomous body’s code asking doctors to refrain from taking gifts from drug manufacturers would make sense only to those who practice with ethics and those who do so may not need such a code at all. In the absence of strict punishment, the code may just be worth the paper it is written on.

The MCI’s intentions may be good, but it lacks the expertise and manpower required to monitor whether its code of ethics is strictly followed, experts say.

“Having guidelines on paper is one thing, but implementing them is a different thing altogether,” said Ajit Dangi, president and CEO of Dansen Consulting, and former director general of Organisation of Pharmaceutical Producers of India.

The MCI has amended the ‘Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations 2002’ stipulating guidelines to be followed by medical practitioners in the country. The amended code of conduct prohibits medical practitioners from receiving gifts, cash or monetary grants, accepting any travel facility, paid vacations or any hospitality from any representatives of pharma or healthcare companies under any pretext. No punishment has been laid down for violators and many are seeking clarifications on what it means. “First, no medical professional should be influenced by any pharma company,” said Ketan Desai, president, MCI. “Secondly, since pharma companies will save on their marketing spend on doctors, we expect that they will pass on the benefit to the patients by reducing the prices of drugs,” he added.

The Indian drug industry, estimated to be Rs 40,000 crore, spends as much as 25% of its revenues on marketing its products. That includes maintaining of an army of tie–clad salesmen ubiquitous with a heavy leather bag carrying free samples spotted outside the doors of almost all the 7–lakh doctors practising in the nation.

The MCI in its eagerness may have come up with a code that may not be enforceable for months, or even years. The issue is, it is finding it difficult to define what a “gift” is?

“We have received many clarifications from the medical fraternity and the pharma industry, so we are working on defining the nature of gifts and quantum of punishment in case of default,” said Mr Desai. The council is likely to notify additional details in response to the clarifications by the end of March.

Even if it arrives at a definition, it won’t be able to monitor with just a few hundreds of staff and that too not so experienced in probing and taking an offence to a logical conclusion.

“The concern is whether the medical fraternity will take it seriously,” said an executive at a pharma company, who did not want to be identified. A better way to attack the menace of corruption is to bring in laws to regulate the companies with strict penalties, as they are a few thousands, who can be monitored and punished for violations, unlike lakhs of doctors, who can violate the code without much consequence. “Initially, Good Manufacturing Practices were introduced as voluntary guidelines for pharma companies. Not much happened. Once it was made part of Schedule M of the Drugs and Cosmetics Act, almost 200 small companies shut down due to non–compliance,” said Mr Dangi.

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