There is great disparity in the price of medicines of the same composition produced by different companies. Chief Drug Administrator at the Ministry of Health and Population (MOHP) Bhupendra Bahadur Thapa stated that doctors invariably prescribe the costlier versions because of kickbacks from the companies. [break]
"The government buys the antibiotic amoxicillin at Rs 2 per capsule while the same medicine costs over Rs 5 at medical stores. There are also other antibiotics which cost up to Rs 60 and doctors prescribe these expensive substitutes for inexpensive amoxicillin," Thapa said.
A drug producer conceded that such kickbacks to doctors significantly raise the prices. "We can sell our products at a much lower price if we do not have to help doctors participate in seminars abroad, decorate their clinics and fill their homes with imported goods," the drug producer claimed, prefering anonymity.
He also confessed that patients have to bear the cost of fat salaries for MRs, up to 250 percent commissions provided to dispensaries and special gifts sent to doctors during festivals like Dashain and Tihar.
"Have you seen the children of doctors not becoming doctors? However mediocre they may be, they have to become doctors and we have to contribute for their medical studies," he added. Director of Bir Hospital Dr Buland Thapa also conceded that gifts from drug producers have a massive impact on the prescribing of medicines because of doctors´ greed.
Price apart, MRs eat up the valuable time of doctors that should be dedicated to the diagnosis and treatment of patients. Patients hardly get three minutes of a doctor´s time at government hospitals after waiting hours in long queues, but medical representatives have easy access to them and can enter the doctor´s cabin any time. Doctors are also not averse to meeting them individually and spending hours with different MRs daily.
Patan Hospital is a glorious exception to this malaise that plagues even private hospitals and clinics. It does not allow its doctors to meet MRs. The hospital has its own standard drugs list and its doctors can only prescribe from that list.
"MRs are not the only source of information about new drugs. There are a lot of scientific magazines which give authentic information about new products," Vice-chancellor of Patan Academy of Health Sciences (PAHS) Dr Arjun Karki explained.
He contends that the MRs only talk about brands, the generic forms and the benefits, and never mention the side-effects. "Most of the time MRs convey inadequate information as they themselves are poorly informed," Dr Karki added.
Bir Director Dr Thapa conceded that MRs get much more time than patients at his hospital despite his directive to the doctors not to meet them when they are supposed to be seeing patients. He disclosed that Bir does not have its own essential drugs list and doctors there are prescribing drugs randomly.
Chief Drug Administrator at MOHP Thapa said that doctors do not hesitate to try new and more expensive drugs even on out-patients.
"New medicines should be given to in-patients under the supervision of the doctors," Thapa argued. "But they are trying the new medicines out on out-patients as well, which makes evaluating the effectiveness of new medicines difficult. The patients who are cured do not return and those not cured invariably go to other doctors," he explained.
Chief administrator Thapa opined that every hospital should have its own policy for dealing with MRs and the latter should be met collectively if doctors indeed need information about new products.
Executive Director of Deurali Janta Pharmaceuticals Pvt Ltd Haribhakta Sharma said, "There are malpractices in all sectors including pharmaceutical companies due to poor regulatory mechanisms and lack of accountability on the part of the companies".
The Department of Drug Administration (DDA), the national regulatory body for drugs, said that checking such unethical practices by drug manufacturers does not fall within its jurisdiction.
"We have no power to check the activities of MRs and every hospital should make its own rules like Patan Hospital," Chief of DDA Radharaman Prasad suggested.
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