Dolo-650, a medicine with 650 mg of paracetamol — an antipyretic (fever-reducing) and analgesic (pain-reducing) drug — is now a household name in India. During the Covid pandemic, every family in the country kept Dolo tablets in their houses to deal with cases of high fever.
The Federation of Medical and Sales Representatives Association of India (FMRAI) on 18 August informed the Supreme Court that the Central Board for Direct Taxes (CBDT) has accused the maker of the Dolo tablet of spending ₹1,000 crore to distribute freebies to doctors for prescribing the medicine.
Upon hearing this, Justice DY Chandrachud remarked, “What you are saying is not music to my ears. This [Dolo] is exactly what I had when I had Covid.”
Speaking to South First, doctors, pharmacists, and sales representatives federation members said that the practice of giving freebies to doctors is not restricted to the maker of Dolo.
They revealed that such a practice was common in the pharma industry as the companies invariably use freebies to sell their medicines.
Not all freebies to doctors in the form of cash
When any company releases a new drug, the product name is not known to the doctors or pharmacists.
“The companies have invested hundreds of crores in the production of drugs. They have to sell them. Only then will any profit come out of the product. The best way is to market it through the doctors. Doctors get some cut, even sometimes up to 30 percent, if he or she prescribes thousands of tablets of that company,” UV Krishnaiah, member of FMRAI from Andhra Pradesh, told South First.
Krishnaiah also added that sometimes doctors are sent to foreign countries for tours sponsored by these companies.
A doctor told South First on condition of anonymity: “It’s not always that doctors get freebies in the form of cash. For instance, last year, there was a doctors’ conference in Bengaluru. If the doctors have to travel to Bengaluru and stay in a hotel, the expenditure is quite high. So these pharma companies will sponsor their stay. Doctors will get knowledge while pharmaceutical companies will get to market their products.”
Pharmacists in Hyderabad also said that once a doctor prescribes a medicine and it is successful, that one prescription can work at least five to seven times.
“When Covid cases were high, one prescription from a doctor was being shared among family and friends. From one prescription, those drugs were sold to five to seven other patients. In this way, a doctor helped the company in selling a product more than once,” Shankar from the Hyderabad Wholesale Pharmaceutical Association told South First.
‘How else will pharma firms recover their investments?’
Krishnaiah said that it’s easy for pharma stores to sell the medicine if it is already marketed to the doctors.
“Sometimes, the doctor even tells a patient that a medicine will be available only in a particular store. The companies will give a pharmaceutical store three boxes of that particular medicine at the cost of two. These stores will try to sell the particular medicine more as they are also getting profit out of it,” he explained.
“We sell medicines that are prescribed by doctors. We are told by the pharma company’s representative that a given product will be in demand. And if we see the demand, we ask for more of the product. Also, sometimes over-the-counter when a person comes without a prescription, we try to sell that medicine only,” said a pharmacist in Hyderabad to South First on condition of anonymity.
The pharmacist also said that companies have to make a profit out of the drug as they have invested a lot on it.
“Patents, research, setting up production facilities, all these require a lot of investment. How will they recover these investments? Companies have to market their products through doctors and pharmacists only, right!” said the pharmacist.
Dolo freebies and the Supreme Court PIL
A PIL has recently been filed by FMRAI in the Supreme Court seeking statutory backing to the Uniform Code of Pharmaceutical Marketing Practices (UCPMP). The first hearing, in which Justice Chandrachud commented on the alleged freebies offered by Dolo, took place on 18 August.
It stated that the right to health is a part of the right to life, and pharma companies should adhere to ethical marketing practices.
“Pharmaceutical marketing has been corrupted by many unethical practices. That’s why we are raising this issue in the Supreme Court. All companies should be brought under the UCPMP so that the marketing can be regulated properly,” said Krishnaiah.