[india-drug] Response to drug promotion

[Rama Murthy <NVRAMAMURTHY@express2.indexp.co.in>]

Discourage unethical promotion
--------------------------------

It is a known fact that pharma companies use the medical professional 
and if need be, their associations, for enhancing certain claims for 
indications of a product that may have more of commercial interest than
in pushing thorough scientific investigations to its logical
conclusion. This is because of a near absence of keeping abreast with
latest medical and 
scientific findings by the doctors in India. The situation easily 
allows a majority of them to be convinced by what the pharma companies
offer in the name of medical literature.

When an off-label use of a known drug has the potential to deliver
extra 
sales, it is but natural for the marketing honchos in a pharmaceutical 
company to convince and override their medical departments to 
ultimately  drive the show.  Ofcourse, the post-marketing surveillance
gives 
important feedback to a pharmaceutical company. It is another matter
how 
selective or judicious the companies are, in using or not using such 
data for their own end.  

Both cyproheptadine and buclizine are being promoted as appetite 
stimulants in India where the crying need of a majority of the children
is food. 
Appetite stimulants can come much later. Again, it could be required 
maybe only by a small percentage of children or people who have some 
metabolic deficiency. Such products cannot apply to the vast majority
of normal children whose lack of appetite these days could be
attributed to so 
many reasons other than medical. The moot point is how many of the GPs
and paediatricians really look into this aspect to protect the
interests of 
their patients overriding the lucrative incentives offered by the
pharma 
companies.

It is almost a decade now since the deletion of appetite stimulation as

an indication for cyproheptadine in the US and elsewhere, but Indian 
pharma companies continue promoting the product here and the doctors
also 
continue prescribing it. It is a pity that a vast majority of the
medical 
community is either not aware or updated on latest happenings but
continue to be dependant on the pharma companies to supply them with
medical 
information which unfortunately will have vested interests.   

It is ironical that cyproheptadine's appetite stimulation and 
consequent weight gain was later attributed to an interference with the
regulation of the secretion of growth hormone itself. Buclizine may not
be banned yet as an appetite stimulant abroad because it is not used
for the purpose elsewhere except perhaps Brazil. If antihistamines
continue to be used for doubtful therapeutic gains, apparently neither
the doctors recommending it, nor the pharma companies promoting it, are
too concerned about the adverse effects it could have on children in
the long term.  

Whether it is irrational combinations or withdrawal of wrongfully 
promoted drugs, laws are in place in the advanced countries. They are
strictly 
enforced and also followed by the industry. This is generally slack in 
developing countries and therefore comes in handy for companies who do 
not believe in erring on the side of caution. 

Even as the regulatory action for mispromotion or providing misleading 
information by pharma companies gets strengthened, it is time for the 
entire medical fraternity, not just a handful activists, to see through
such 
gimmicks and actively discourage unethical drug promotion. 

N V Ramamurthy
Editor
Express Pharma Pulse
Express Healthcare Management
Express Towers, First Floor
Nariman Point,
Mumbai 400 021
Tel : 5630 1020 Extn 223
e-mail : <nvramamurthy@express2.indexp.co.in>



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