Dr. Sanwar Agrawal's long-worded, disjointed, rambling tirade (using expressions more suited to a small town newspaper than an international scientific publication) against the Pharmaceutical Industry as well as the Medical Profession(1) must not go unchallenged.

1. There is no doubt that the Pharmaceutical industry represents a commercial enterprise and profit making is essential for its very survival. Advertising and promotion is a part and parcel of this venture. By and large the informative literature provided by various concerns is factual and useful. Most of them gladly supply more detailed information on request.

2. The doctor prescribing one or more medications bears complete responsibility for his decision, which must be based on his judgement and guided by clinical acumen, knowledge and information. Continued education of the doctors is obviously important to allow judicious and rational use of drugs and indeed various diagnostic procedures. Education will, however, not help the dishonest few in the profession whose motivations are different. Provided the information is correct and evidence based it should not matter how it is obtained.

3. Dr. Agrawal talks of ethics and bribes. In the context of medical representatives handing out trivial "gifts" and drug samples (which are mainly used for poor patients), I am sure no serious objections can be raised. In any case one is quite free to decline them. The big prizes such as Air tickets and hotel expenses are rare and meant for a chosen few such as Presidents of Associations and 'opinion makers'! There certainly is a case for Professional Bodies to establish" codes of conduct" and guidelines. Their office bearers should not be permitted to accept financial support from the Industry without approval by the Executive committee of the concerned Association.

4. The subject of holding scientific meetings a comfortable and pleasant venues versus those with inadequate facilities, and whether we can do away with financial help from the Industry for such conferences has been discussed ad 11l1useum. Suffice it to say that it is not possible to organize these meetings- big or small-without considerable sup- port. In general poor ambience and discomfort are not conducive to learning and education. We must not feel guilty if our meetings are held at clean and aggreable places.

5. The misuse of modem drugs by practitioners of other systems of medicine and quacks is of serious concern for which there is no easy solution. Quackery must be combated by strict enforcement of legislative measures and public education.

6. A small minority among us indulge in professional misconduct, which is a very difficult problem to tackle. There are legal measures and now the consumer protection act (the latter has its own shortcomings). Professional Associations can inform and instruct but have no punitive powers.

7. Dr. Agrawal has attempted to paint the Pharmaceutical industry with tar. Is he totally unaware of any good done by manufacturers of drugs and medical equipment? Does he not know that almost all modern drugs have been developed by Pharmaceutical Houses? And that the production of a drug, from the laboratory to various trials, approval and its commercial manufacture is an extremely costly under- taking? Where does the funding for research and development come from?

8. I am afraid the majority of suggestions that Dr. Agrawal has listed are in- appropriate and impractical. Sanctimonious sermons also do not deserve serious notice.

9. We must take a mature view of our relationship with the Industry. There should be constant dialogue, mutual understanding and cooperation in various fields between us. A spirit of partnership should always be maintained in which one is willing to listen to the views of the other. The medical profession can playa guiding role and pro- vide expertise, whereas the Industry can help us in our academic efforts. The manufacturers of drugs and a variety of other products and medical equipment should be regarded as our associates in the delivery of health care and not as adversaries or mercenaries.

R.N. Srivastava,
Consultant Pediatric Nephrologist,
Apollo Hospital,
New Delhi 110 044,
India.
 

1. Agarwal S. Medical Profession and the Pharmaceuticals: Indian scenario. Indian Pediatr 1998; 35: 641-645.