One of my family friend happens to be in the pharma industry in Patna. With over 20 years of experience in the sales and marketing in the industry, he has also started a company which supplies certain medicines in their own brand name. During a discussion with him, I came across various facts of the pharmaceutical industry.
The total industry is run by the doctors. In fact the pharmaceutical companies consider the doctors as their customers rather than the distributors, dealers, retailers or the end users. “Behind every successful (read ‘executed’) prescription there is a successful medical representative (and a corrupt doctor)!”
I’d like to share one of my experience with one of the doctors in Patna. Dr. X of Road No.1, Rajendra Nagar, Patna is a quite a good (read ‘Popular’) doctor. His receptionist (no, not female), first of all shouted at me when I asked him whether I need to enroll my name for the queue. My crime was that I didn’t know whether to enroll the name. Anyways, these things are not that important you know, because, we are not customers and they are not service providers. Its like the patients are at the mercy of the doctors. Anyways, we still have time to discuss that. Lets get back to Dr. X. There were about 5 patients who had enrolled before me. Among them was a ailing lady who was continuously requesting the receptionist to let her visit the doctor first. Her ail was apparent and anybody could have said so looking at her condition. It was getting very difficult for her to sit and wait, due to pain. The receptionist, who had taken the fees in advance was not paying a heed. In the meantime a medical representative came down with his boss, had a brief talk with receptionist and went directly inside the chamber while the doctor was checking his first patient! Its still ok you know, because we are at the mercy of doctors; isn’t it? The receptionist did not allow the ailing lady to visit the doctor before her turn. Frustrated, the lady decided to move out. When she asked for her money to be returned, the receptionist refused! “Money once taken, cannot be returned. You can come down tomorrow if you do not have time today. This is the rule here.” Well, I didn’t know till then about any fucking rule that doesn’t allow a person to take back his/her money in case the services are not taken. But then, this is us.
When my turn came, I went inside the chamber. The doctor after doing his needful, wrote down a good number of sentences in the prescription, which was illegible to common man. When I came out of the chamber, immediately the receptionist snatched the prescription from me. He went through the prescription. Me, a moron, could not shout at him for breaking the privacy rules. He took out bunches of preprinted leaflets and handed me three different types of leaflets. The receptionist briefed me,” The red one is the name of the medicine shop from where, you have to take medicine. The green one is the name of the USG centre from where you need to do the USG test. The blue on contains the address of the place from where you have to do the blood test. If you are not taking the medicines from given shop, we won’t any blame in case you do not recover. We won’t accept any reports from place other than provided.” He handed me the prescription. I felt pity for us, we, the people of India.
Intentionally, I did not take the medicines that day. Searched out the Internet for the compositions. Went to a good medicine shop (needless to say, not the one mentioned by the doctor) and asked for the compositions. The retailer looked at me as if I was an alien when he discovered that I was purchasing medicine which had brand names different from the what was written on the prescription. I recovered by taking the medicines and did not go for the tests.
It has become an open secret, how many doctors take commission on the pathological tests and the medicines. A good percentage of what we pay to the pathology test centre goes directly to the doctor’s pocket!
Medicines! You won’t believe how medicines are pushed. Having margins which vary from 50% to 200% and in certain medicines it goes up to 2000% and beyond, a major portion goes to the doctors prescribing the medicines. The benefits in certain cases are cash and in other cases it is kinds and services. The work of the field force in this industry is basically to build rappot with the doctors, gain their trust and provide them certain gifts, services or cash as a percentage of the business the doctors provide. For eg. a doctor prescribing medicines of a certain company worth 5 lac per month, can easily avail services, goods or cash from the company. As far as the company is concerned, if the company sells medicines worth 5 lac, easily earns a profit of 2.5 lacs. The company doesn’t mind spending 50K on the doctor.
Now, there might be questions. The first one is what’s the harm if we as customer buy a brand suggested by the doctor. Esp., when the medicine prices are highly regulated in India and none of the companies can sell at a price more than what is defined by the Govt. Well, let me try to answer the question.
To answer the question, I need to explain how the different companies work in the industry. There are three types of companies in the industry. Type A, the companies which manufacture as well as sell their own brand. Type B, the ones who do not have any manufacturing unit, but sells their brands. Third, the one which only manufactures as per the order of the type B companies.
These type B companies have literally no control on the manufacturing process of the medicines they sell. On one certain question, someone explained me that unlike automobile (where u can visually verify the existence of the components), you can not visually verify the components and composition. You take the medicines because of the trust you have on the doctor. However, these are the companies which can invest the maximum on the doctors because their investment level is low which doesn’t include the establishment cost of a plant.
Moreover they do not have any quality control. One may argue that ISO certification can help. What if B type of companies ensure purchase from ISO certified type C companies. Well, the truth, which may me harsh is that the ISO is not sitting there in the factory to check the composition of every single tablet you consume!
The Medical council of India has recently banned doctors from accepting gifts from pharma companies. But, is it going to help? What about the illegal cash transactions? Do we have any control over them? I still wonder why the Govt. is not doing anything to ban prescription of medicine brands? Why as a consumer, we can not decide on the which brand to select for us? Why can’t we decide on where to have our pathological tests done?
Of course it’ll threaten the existence of small type B companies. But it’ll also promote healthy competition and give the consumers an advantage.
Wake up India, wake up Indians!
P.S.: This has nothing to do against the doctor community. Many of my close relatives, family friends and close friends are doctors.No harms meant. It’s an effort to discourage unethical marketing practices followed in Pharma Industry.