TOPICS : Malpractices in drug market and public health

According to a report of Pharmaceutical Horizon of Nepal (PHON), total expenditure on medicine consumption in Nepal during 2006-07 is expected to rise by 16.1%, amounting to Rs 13,725 million. Looking at the figures, one might be surprised at the expenses incurred on medicines, particularly in a poor country like Nepal.

If we analyse the market profile, 59 % of medicines available in the market are imported, 32% of the demand is met by domestic industries and 9% of the demand is met by government, NGOs and INGOs. However, one should take note of the fact that unlike other transactions we claim to ‘dispense’ medicine instead of ‘selling’ it, assuming health care comes under the service sector. Market is a place where consumer goods are sold. As long as there is production, there has to be a market. Market is the only regulator that tells us about the mismatch between demand and supply. However, though the consumers usually have the right to select the commodity and service as per their needs, medicine is a consumer-based commodity in that they do not choose a particular medicine. Physicians prescribe medicines for the patient and it is ‘dispensed’ by the pharmacy. The majority of the patients have little knowledge about the proper use of medicines. Since medicine is used for prevention, mitigation or cure of diseases, pharmaceutical business comes under the ambit of social marketing. However, marketing of a pharmaceutical product has always been a complex issue.

Market promotion of medicines refers to all informational and promotional activities that increase sales of medicines, in which the marketer has to strictly uphold the ethics of health service sector. Sadly, the increasing number of drugs per prescription indicates the unholy practice of prescribing medicines on a haphazard basis. General assumption among the patients is that they must be prescribed medicines once they visit a doctor and this culture is on the rise, thereby intensifying the risk of people consuming medicines unnecessarily.

The unethical approach to promoting drugs, like making false claims about the effectiveness of the drugs, deliberately suppressing the risk of dangerous side effects and providing underhand incentives to doctors, has further put drug users at a grave risk. Though it is the responsibility of the Department of Drug Administration (DDA) to bring an end to such practices, political instability has made it almost dysfunctional, needing political intervention. The inability of the government to institute strict measures to bring this culture to an end can indeed have serious impact on public health and safety. Recently, DDA announced that it would soon bring guidelines on ethical promotion of medicine, but it might take years before such a provision finally comes into force. Until then, the public should exercise self-awareness while consuming medicines and be wary of cheap marketing gimmicks that are only aimed at boosting sales without any concern for promoting public health.