Doctoring the Truth: Uncovering the Link Between Pharma Misconduct and Declining Health Indicators in Pakistan.

The pharmaceutical industry of any country plays a crucial role in healthcare, but unfortunately, malpractice within this sector can have severe consequences for public health. Understanding the connection between these malpractices and the state of national health in Pakistan is essential for addressing existing issues and improving healthcare outcomes.

Recently I had the opportunity to go through one of the top national pharmaceutical company investment plans to grow their business. For this investment in HCPs (Including Doctors and Chemists/Druggists), they conducted an internal (their Sales force/field force-MR, FLLs, SFLs) and External Survey (Doctors/Chemists).  It is intended to gauge their perception of the effectiveness of various promotional activities undertaken by the company for its promising business growth in the new year.

In Picture, the top left chart titled "What kind of Activities / Engagement would you suggest for BRAND NAME?" ranks various activities by the percentage of HCPs who selected them. The most popular activity is "Obligation", followed by "Local CME", "Samples", and "Family Program".

The top right chart titled "What Activities Were Effective for BRAND NAME?" asks HCPs to rate the effectiveness of various activities on a scale of 1 to 5. The highest-rated activities are "Samples", "Family Program", and "Discount".

The bottom left chart titled "Company Internal Survey (Field force towards HCP perspective)" asks HCPs to rate the effectiveness of various activities that helped them in the generation of Brand Name prescriptions. The highest-rated activities are "KFC Vouchers", "Samples" and "ER Engagement" etc.

The bottom right chart titled "Company Internal Survey (From HCP)" asks HCPs which activities would help them outperform their competition. The most popular activities are "Samples", "Family Programs", and "Discounts".

Overall, the survey results suggest that HCPs in Pakistan consider vouchers, sampling, family programs, and discounts to be the most effective promotional activities for pharmaceutical brands. They also value local CMEs and obligation programs.

Common Malpractices in the Pharma Industry in Pakistan (as a whole):

1. Excessive Drug Prices: One of the most significant concerns is the inflated price of essential drugs. This often makes them unaffordable for a large portion of the population, leading to untreated illnesses and worsening health outcomes. Factors like price gouging, monopoly practices, and weak regulatory controls contribute to this issue.
2. Inadequate Quality Control: Substandard or counterfeit drugs pose a serious threat to public health. These drugs may be ineffective, harmful, or even fatal. Weak regulatory oversight, corruption, and unethical manufacturing practices can contribute to the circulation of such drugs.
3. Unethical Marketing Practices: Misleading advertising, exaggerated claims of efficacy, and targeting vulnerable populations with unnecessary medications are common tactics used by some pharmaceutical companies. This can lead to misuse of drugs, antibiotic resistance, and unnecessary financial burdens on individuals and the healthcare system.
4. Influence on Healthcare Professionals: Offering doctors and healthcare workers incentives like gifts, trips, and kickbacks to prescribe specific drugs, regardless of their suitability for the patient, is a concerning practice. This can compromise medical ethics and prioritize profits over patient well-being.

Impact of Malpractices on National Health Status:

1. Increased Morbidity and Mortality: Unaffordable essential drugs, substandard medication, and inappropriate prescriptions can lead to untreated or poorly managed illnesses, ultimately contributing to higher morbidity and mortality rates.
2. Antibiotic Resistance: Inappropriate use of antibiotics due to aggressive marketing and lack of awareness can accelerate the development of antibiotic-resistant bacteria, rendering many common infections untreatable.
3. Erosion of Public Trust: Unethical practices by the pharmaceutical industry can erode public trust in healthcare professionals and the medical system as a whole. This can discourage people from seeking healthcare and worsen overall health outcomes.

Addressing the Challenges:

1. Strengthening Regulatory Frameworks: Robust regulatory measures are crucial to ensure drug quality, prevent price gouging, and address unethical marketing practices. Independent regulatory bodies with adequate resources and enforcement power are key.
2. 2. Promoting Price Transparency and Affordability: Measures like price control mechanisms, generic drug promotion, and public awareness campaigns can help make essential drugs more affordable for the general population.
3. 3. Ethical Professional Practices: Encouraging ethical conduct among healthcare professionals through education, awareness campaigns, and stricter regulations on conflicts of interest can help ensure patient-centered care.
4. 4. Empowering Consumers: Public education on responsible medication use, identifying counterfeit drugs, and understanding drug pricing can empower individuals to make informed decisions about their health.

The malpractices of the pharma industry in Pakistan pose a significant threat to national health. By acknowledging these issues, implementing stricter regulations, promoting ethical practices, and empowering consumers, Pakistan can take crucial steps towards improving public health outcomes and ensuring access to quality, affordable healthcare for all.