Two of the biggest names in the pharmaceutical world in India – Abbott and Sun Pharma are alleged to be giving inducements to “quack” doctors of gifts and cash to encourage them to prescribe large amounts of antibiotics, propelling the rise of drug-resistant superbugs around the world.
Undercover reporting by the Bureau of Investigative Journalism (BIJ) has revealed that the two companies promote antibiotics to healthcare practitioners who often have no formal medical training. Their products and devices are supplied and used in more than a hundred countries, including the US and by the National Health Service (NHS) in the UK. Although illegal to sell antibiotics to quack doctor in most parts of India, the law is seldom enforced. Moreover, there are no restrictions on promoting the drugs to them.
Due to lack of better healthcare facilities in impoverished communities, the quacks often take advantage of the situation and prescribe drugs incorrectly. By offering such incomplete and unnecessary treatments, they play catalyst in creating the superbugs which go on to kill thousands of babies in India alone annually.
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According to the BIJ report, an Abbott salesman suggested that he knew the drugs might be misused, but the monetary benefit lured him into it. Furthermore, a Sun Pharma salesman revealed to an undercover reporter that quacks and real doctors were given expensive gifts so that they stick to the same drug supplier. Ranging from gift cards, medical equipment, refrigerators, televisions to travel and cash, sales representatives would not stop just here. They went on to offer extra pills or cash as an incentive to buy more antibiotics, advancing potentially dangerous over-prescription.
With revenue of more than £3bn, Sun Pharma is the largest drug manufacturer in India. They supply drugs to NHS. NHS has no rule against buying from companies that give inducements to doctors, provided none are listed in the British supply chain. Moreover, NHS also purchases devices from Abbott Laboratories, a US company that pulled in more than £24bn in revenue last year. Abbott India, its Indian subsidiary, happens to be the second pharmaceutical industry in the country.
As confirmed by an Abbott salesman, the doctors and quacks were cajoled into buying in bulk, with gifts worth up to Rs 2,000 (£23), and encouraged to prescribe more regardless of the need. Several unqualified doctors in India, often from rural areas, earn so little that these incentives can raise their monthly income by as much as a quarter. Not just that, companies like Abbott also offers doctors a taste of luxury by throwing surprise parties for their families in five-star hotels.
However, the spokespeople of both companies denied any truth in these claims. They went on to say that they prohibit offering gifts to healthcare providers to propel prescriptions.
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Antimicrobial resistance (AMR), one of the world’s greatest health threats, is a resultant of excessive use of antibiotics. Over the course of time, bacteria evolves resistance against the drugs and become superbugs. The inappropriate dosage speeds up the process.
Experts condemned the pharmaceutical companies for encouraging incorrect use of antibiotics and selling to quacks, who contribute to AMR when they wrongly prescribe the drugs. Lord Jim O’Neill, who led a global review of AMR, called the Bureau’s findings astonishing. He said, “Many pharmaceutical companies like to position themselves as being responsible and here is some rather frank evidence to the contrary.”
Professor Ramanan Laxminarayan, director of the Centre for Disease Dynamics, Economics and Policy (CDDEP), said, “When you consider that there are five times the number of rural medical practitioners in India as there are trained medical doctors, it should come as no surprise that the majority of antibiotics reach patients through this channel. It is no surprise that pharma companies push antibiotics through [them].” Laxminarayan further said that the biggest challenge is to balance the access to antibiotics and prevent overuse and abuse of the same.
This article first appeared in The Bureau of Investigative Journalism. Read the original here.