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.