The Hindu : Dispute over `preferential prescription'

Online edition of India's National Newspaper
Monday, Nov 04, 2002

Southern States

Southern States - Kerala

Dispute over `preferential prescription'

By K. S. Sudhi

KOCHI Nov. 3. Don't be surprised if your neurologist insists on you taking a drug manufactured by a particular pharmaceutical company. For, sometimes he may be exercising a ``preferential prescription'' option for ``reciprocating the favours'' received by the professional association to which he belongs.

In what is termed as a case of violation of medical ethics, the Neurological Society of India (NSI) Kerala chapter, has asked its members to ``preferentially support'' the products of pharmaceutical companies that have ``come forward in a big way to help raise funds'' for the impending conference of neurologists, Neurocon 2002, to be held in Kochi from December 14 to 17.

A letter, signed by Mathew Abraham, coordinator of the conference, and D. Mohanlal, secretary of NSI, Kerala, has attached a list of 19 pharmaceutical companies that had ``supported the NSI and need preferential prescription''.

The NSI has asked doctors to ``firmly persuade the pharmaceutical companies that have not come on board so far''. It has also attached the list of five companies that have not yet ``come on board''. The letter also estimated the cost of the conference at more than Rs. 1 crore.

``It is only appropriate that we, the members of the NSI Kerala chapter reciprocate their generosity by preferentially supporting their products, within the limits of ethics and propriety. We have listed such companies which need our active support, and we are sure you will cooperate,'' the letter said.

``We need your help very specifically to persuade other companies to come on board, especially those who specialise in neuropsychiatry products,'' the letter said. According to the organisers, ``many pharmaceutical companies have expressed an interest in participating, but need our active encouragement and persuasion''.

``We are sure that you can use your stature and influence to help these companies decide positively in our favour. We are enclosing a list of some of the companies you can personally help to persuade, and we will keep you updated about any developments,'' the organisers informed the members.

Meanwhile, the suggestion for preferential prescription from NSI has drawn flak from eminent neurologists and public health experts. According to B. Ekbal, Vice-Chancellor of Kerala University and chairman of the Health Sub-Committee of Kerala Sastra Sahithya Parishad, the letter asking the doctors to give preference to drugs marketed by certain drug companies for prescription was unethical and can unnecessarily hike the health

expenditure.

Even though the letter talks about ethics and propriety, it is in violation of the ethical standards the profession should follow, he said. In this case doctors are themselves trying to canvass for drug companies to prescribe certain branded products, he said.

Since the drug prices are rising and also because many of the neuro-related drugs will have to be taken for life-long like the anti-convulsants, neurologists should be conscious of the price of drugs. But by advocating for certain brands they will be playing into the hands of drug companies and supporting their business interests, he criticised.

According to C. R. Soman, former professor of neurology of Medical College, Thiruvananthapuram, and a public health expert, the letter was a reflection of the rot that had crept into the profession. ``When an organisation is dependent on the generosity of pharmaceutical companies for organising a scientific meeting, it would have to return the favour by way of prescriptions,'' he said.

``One may even be tempted to prescribe an expensive drug when a cheaper one would serve the purpose. Moreover, doctors will have to prescribe drugs that may not be needed at all. With the five-star medical conference culture growing, doctors may have to extort money from firms which will overburden the patients,'' he said.

Reacting to the issue, Ramankutty, son of the former Chief Minister, C. Achutha Menon, and executive director of the NGO Health Action by People, said such unethical practices had been existing here for quite some time. He said the practice of arm-twisting pharmaceutical companies for funds and supporting and extending solidarity to those companies that were generous was increasing.

Aravindan, vice-president of the Kerala Sastra Sahithya Parishad, deemed it a fit case of unethical practice that warranted the intervention of Medical Council of India (MCI).

Mathew Abraham, coordinator of the conference, said there was nothing unethical in asking the members to go for preferential prescription and seeking the support of pharmaceutical companies in organising continuing medical education conference as it was an internationally accepted practice.

Terming the letter as a private one intended to be circulated among its members, Dr. Mathew said that it was only fair to support the companies that had voluntarily contributed funds for the conduct of the conference. He also dismissed the views that the preferential prescriptions would eventually overburden the patients.

``The selection of a drug, which is the prerogative of a doctor, is done on the basis of its effectiveness, quality and cost. The selection will always be done in favour of the patient,'' he added.

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