You sense it when you spend time with doctors in the developing world. They have the same aspirations as you do: to have a comfortable life, bring up children who are successful, and to save a little bit for their retirement. Yet their lives are really quite a lot more complicated, and a lot more conflicted.
In my travels this past couple of weeks, I spent time in the Middle East and South Asia. I observed lots of interactions between nephrologists and drug representatives and pharmaceutical company managers that would be frowned on in North America and most of Europe. Chauffeured cars, meals, gifts, favors, you name it and it’s on offer and accepted. In return, I am told “the relationship” that these doctors develop leads to certain prescribing habits. For example, in India rather than prescribing an epo biosimilar the doctors will prescribe Eprex or epoetin alfa that is nearly twice the price. There are over 40 biosimilar molecules available on the market and not all of them are sub-standard in quality. The same is true for other drugs.
This practice wouldn’t be fine even if patients could afford it. And, obviously only perhaps a fraction of doctors are conflicted in some way. However, most dialysis patients in India dialyze twice weekly because they cannot afford both the cost of dialysis and the cost of the associated medications. They cut corners and probably cut their longevity.
I know about the interactions of nephrologists with industry representatives but I am told that this happens across all specialties, some more than others, depending on the drugs and the size of the market.
In the midst of this are the industry representatives or “reps”. These people are usually young men who are a few years out of college who are also trying to make a living. Their income depends on sales. Many reps cultivate relationships that develop over years. They get to know the doctors’ families, they attend family events, and they have privileged access.
What should happen? Clearly the practice is ethically and morally questionable – whichever way you look at it. The government's of these countries need to increase scrutiny rather than turn a blind eye to it. One way to address the problem is to target the companies themselves – the boards and the management of these companies need to be held responsible for what is essentially corruption. Medical societies and hospitals need to ensure these practices are stamped out by greater oversight. Above all, though, doctors need to stop accepting favors in return for prescriptions.
