A spotlight on cosy ties between Thai doctors, drugmakers

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BURNING ISSUE
A spotlight on cosy ties between doctors, drugmakers
PONGPHON SARNSAMAK

BANGKOK: -- Over the past few months, the Public Health Ministry, led by its permanent secretary Dr Narong Sahametapat, has been at the forefront of the country's reform movement, demanding improvement in the public health system.

One issue the ministry should raise as a top reform priority was the commercial ties between pharmaceutical companies and hospitals - in particular, companies' move to influence medical staff to prescribe certain drugs to patients.

On occasion, hospital patients glimpse commercial representatives from dozens of drug companies sitting outside doctors' rooms, especially at medical schools, waiting to present medicos with their pharmaceutical products and equipment.

Often they push hard to convince doctors about their products - offering special services such as picking them up at the airport, buying gifts for them and taking them to dinner. Their hope is that doctors will prescribe their particular product to patients at every opportunity.

Some drug companies team up with medical workers to test their products on patients before launching them on the market.

Other drug makers have sponsored doctors to attend international conferences abroad, sometimes to attend only one session.

It is difficult in Thailand to limit relations between drug companies and hospitals - especially in public hospitals, as there are no regulations requiring doctors to publicly report their assets, as in the case of politicians.

In the US, drug companies recently revealed details of payments made to doctors and other health professionals for promotional talks, research and consulting. Owing to legal action, at least 15 drug companies published such information, according to the prominent investigative news website Propublica.

As a result, the US public can now check their doctor’s decision to prescribe a drug for them and assess whether it is based on their medical condition - not just the influence of drug companies.

Four years ago in Thailand, the Pharmaceutical Research & Manufacturers Association (PReMA) urged 3,200 pharmaceutical company sales representatives to stop pressuring state hospital doctors into ordering their products by offering benefits and gifts.

The move was part of PreMA's campaign to promote sales ethics among the 32 drug companies on PreMA's membership list - and to control the behaviour of their representatives.

According to PReMA, competition was high among companies in the Bt100-billion pharmaceutical market, and many pushed their representatives for ever-higher sales targets.

Some approached state hospital doctors to persuade them to buy their products by offering special benefits and gifts; others called on doctors while they were checking their patients.

The more ethical allowed doctors to make their own decisions about ordering products based on the scientific information available.

In a bid to control over-zealous drug company sales representatives, PReMA has for the past 40 years issued a code of conduct.

Under this code, PreMA's members are prohibited from offering special benefits to doctors or cajoling them into asking hospitals to buy their products. However, they can still offer gifts and gimmicks, but only under Bt500 value, and Bt3,000 to support a doctor's education.

The rules also call for good etiquette when approaching doctors.

Sales representatives must provide scientific information and research about drug products so doctors can make the right decisions, based on the patient's welfare, before asking a hospital to place orders with drug companies.

The code says they should wear company uniforms when they visit doctors and provide them with scientific details about their products, instead of giving them presents.

Also, all representatives should hold a science degree.

At present, the 32 company members of PReMA have 3,200 sales representatives, 80 per cent of whom have passed PreMA's ethics certification examination. Companies that permit sales reps to offer bribes to doctors face a fine of Bt100,000 for the first offence and a Bt200,000 fine for a second.

The association has sent letters to hospitals across the country to keep a close watch on drug company sales reps and if they find any malpractice, they should inform the association immediately.

Given that patients need unbiased, efficient and treatment that does not break the bank, it is perhaps best for drug companies, medical schools, hospitals and doctors to stay clear of expensive incentives or marketing gimmicks.

It is indeed time for all these parties to work together in laying down clear-cut rules that will stop doctors from taking any incentives from drug firms and stop representatives from engaging in excessive marketing techniques.


-- The Nation 2014-04-22

[focus27]

Not only in Thailand - everywhere in the world, the drug pushers want all of us drugged. A recent Mayo Clinic survey found 70% of Americans on drugs - prescription drugs from their distributor doctor.

Making headline news, GSK is facing criminal charges for bribing doctors in Poland. Notice that a 'code of conduct' is a worthless piece of paper and that bribery is a criminal offence. As in far too many cases, here in Thailand, the potential penalties for criminal activities are... laughable.

Keep taking the Xanax - or you might think too much.

[noitom]

The Thai press should be thorough and take a look at the "coziness" of Thai insurance companies as well.

[Tatsujin]

It's no different here to anywhere else in the world aside from it's probably just a little more "obvious" it's happening . . .

[chainarong]

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Not only in Thailand - everywhere in the world, the drug pushers want all of us drugged. A recent Mayo Clinic survey found 70% of Americans on drugs - prescription drugs from their distributor doctor.

Making headline news, GSK is facing criminal charges for bribing doctors in Poland. Notice that a 'code of conduct' is a worthless piece of paper and that bribery is a criminal offence. As in far too many cases, here in Thailand, the potential penalties for criminal activities are... laughable.

Keep taking the Xanax - or you might think too much.

Sometimes the being behind in penalties has the same effect as some of these pills , a state of utopia , were corruption is king, unfortunately every one in the Thailand community are on the pill. .

[geriatrickid]

It's no different here to anywhere else in the world aside from it's probably just a little more "obvious" it's happening . . .

It is very different than elsewhere. Engaging in deficient selling practices can cost a pharmaceutical company billions of $. One need only look at the fiasco that was oxycodone and Purdue Labs. People went to jail and massive fines were assessed. Companies in North America and the EU are self reporting improprieties. As I have repeatedly stated, the procurement contracts under the control of long time bureaucrats and hospital directors make the rice pledging issue seem like chump change in comparison. When the government moved to more public health care, costs were to be controlled by encouraging the use of much less costly generic drugs. The profiteers in the hospital sector did not like that.

[focus27]

It's no different here to anywhere else in the world aside from it's probably just a little more "obvious" it's happening . . .

It is very different than elsewhere. Engaging in deficient selling practices can cost a pharmaceutical company billions of $. One need only look at the fiasco that was oxycodone and Purdue Labs. People went to jail and massive fines were assessed. Companies in North America and the EU are self reporting improprieties. As I have repeatedly stated, the procurement contracts under the control of long time bureaucrats and hospital directors make the rice pledging issue seem like chump change in comparison. When the government moved to more public health care, costs were to be controlled by encouraging the use of much less costly generic drugs. The profiteers in the hospital sector did not like that.

The scam in the West goes deeper, with pharmacorps sponsoring research resulting in false claims and the endemic corruption within the FDA and its national equivalents. Just read Ben Goldacre's Bad Pharma as a starting point.

There are very very few medicines that actually cure anything - the aim is to attenuate symptoms and create side-effects that then require further medications until chronic dependency is achieved - the perfect consumer-patient.

As to cheaper generics, the big problem there is quality control from sources in places such as India and China. They are cheaper not only because the patent has expired.

As a real-life example, my own dermatologist told me he is fully aware of the pharmashit his colleagues prescribe but has been unable to persuade them to stop.

[Tatsujin]

It's no different here to anywhere else in the world aside from it's probably just a little more "obvious" it's happening . . .

It is very different than elsewhere. Engaging in deficient selling practices can cost a pharmaceutical company billions of $. One need only look at the fiasco that was oxycodone and Purdue Labs. People went to jail and massive fines were assessed. Companies in North America and the EU are self reporting improprieties. As I have repeatedly stated, the procurement contracts under the control of long time bureaucrats and hospital directors make the rice pledging issue seem like chump change in comparison. When the government moved to more public health care, costs were to be controlled by encouraging the use of much less costly generic drugs. The profiteers in the hospital sector did not like that.

I'd have to say you were being more than a touch naive if you think it is any different elsewhere in the world. Big pharma pay a lot of money to ensure their products are being used across the board, including "incentives", "inducements" and out and out "bribes" directly to Hospitals, Doctors and most often to Congress/Senators to support their "cause".

The few cases where they've been prosecuted for it are few and far between and the tip of the iceberg.

[Diddl]

What’s more is that a lot of doctors don’t even know what they are prescribing and just believe hearsay. They don’t even read the side-effects’ note of the drugs they prescribe. Both my parents were killed by these quacks. My mother was prescribed a drug that should not be given to patients with high blood pressure, and she had high blood pressure. This induced a cerebral haemorrhage (one of the side-effects mentioned on the label of the drug!) and she died. A few years before, she was prescribed an anti-nausea drug when she had peritonitis and, if I had not taken her to the hospital, she would have died! These so-called medical experts are no longer experts at all – they come out of the pharmaceutical-paid universities and can only write prescriptions! Some will say that they don’t have the time, then, as far as I am concerned, they should not be practising.

Medicine today is not about curing, it is about money! Why haven’t they supposedly found a cure for cancer after so many years and after so many donations? – Simple! Cancer treatment is profitable, curing is not! ‘Real’ doctors in the past have found cures for cancer but they have all been assassinated or silenced by threats.

The pharmaceutical industry does not care if you sue them because their profits are much higher than their total payouts! In many cases and countries today they are even exempt from liable.

What about Codex Alimentarius? It forbids the European member states from producing or consuming vitamins and minerals, and other natural drugs and, in certain cases, it allows certain products to be consumed at a very low dose that would have no benefit of course. I wonder whether the pharmaceutical industry had something to do with this! Hmmm, they can’t patent natural products can they!

[focus27]

What’s more is that a lot of doctors don’t even know what they are prescribing and just believe hearsay. They don’t even read the side-effects’ note of the drugs they prescribe. Both my parents were killed by these quacks. My mother was prescribed a drug that should not be given to patients with high blood pressure, and she had high blood pressure. This induced a cerebral haemorrhage (one of the side-effects mentioned on the label of the drug!) and she died. A few years before, she was prescribed an anti-nausea drug when she had peritonitis and, if I had not taken her to the hospital, she would have died! These so-called medical experts are no longer experts at all – they come out of the pharmaceutical-paid universities and can only write prescriptions! Some will say that they don’t have the time, then, as far as I am concerned, they should not be practising.

Medicine today is not about curing, it is about money! Why haven’t they supposedly found a cure for cancer after so many years and after so many donations? – Simple! Cancer treatment is profitable, curing is not! ‘Real’ doctors in the past have found cures for cancer but they have all been assassinated or silenced by threats.

The pharmaceutical industry does not care if you sue them because their profits are much higher than their total payouts! In many cases and countries today they are even exempt from liable.

What about Codex Alimentarius? It forbids the European member states from producing or consuming vitamins and minerals, and other natural drugs and, in certain cases, it allows certain products to be consumed at a very low dose that would have no benefit of course. I wonder whether the pharmaceutical industry had something to do with this! Hmmm, they can’t patent natural products can they!

Sorry to hear about your parents, and I totally believe the scenario - I nearly died and am left with an "idiopathic autoimmune disease", which is medspeak for "we haven't a f@cking clue." I've had to do my own research and have a pretty good idea of the mechanism, but it doesn't help much as there is no known way to reverse the process.

In relation to Thailand, the arm of the pharmacons is long and merciless. In 2009 Thailand tried to put various herbs and spices on a hazardous list - at the same time removing some seriously dangerous chemicals - this included ginger, turmeric, neem and chillies!! But don't panic, their target was organic producers. (http://www.naturalnews.com/026013_companies_chemical_turmeric.html) I believe this list was later partially revised, but haven't tracked down a recent article on the current state. The point is that they will try again and is part of the Codex Alimentarius food control protocols.

BTW for anybody who doubts the difference between naturally and chemically grown products, compare organic garlic with the standard stuff; the difference is very noticeable. [how far we have fallen that I refer to junk as 'standard'. Ed]

One other recent event in the attempt to eradicate any alternative to the pharma-poisons is the case of Parhatsathid Nabadalung aka Ted from Bangkok, Thailand (http://www.earthclinic.com/ted-from-bangkok-thailand.html). [The blog layout makes it a bit hard to follow but by the end the story becomes clear.] Astonishingly, Ted even had a functioning "Rife machine" (Google it), I thought they were rarer than hen's teeth!

OK, I'll go take my soma now.

Edited April 22, 2014 by focus27

[Jonmarleesco]

'Often they push hard ... offering special services? ... drug makers have sponsored doctors ...' Say it as it is: in true Thai tradition, they use corrupt practices.

'... others [sales reps] called on doctors while they were checking their patients.' I'm sure many of us would relish one doing that while we were with a doctor.