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Chapter 4: Drug Marketing    
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The IFPMA Code is inadequate as it tends to legitimise existing practices. It does not suggest improvements nor encourages improved practices. It fails to prevent companies producing inappropriate promotional materials, or utilising unethical marketing practices.

The WHO Ethical Criteria for Medicinal Drug Promotion (1988) fails to adequately cover such promotional practices as offering gifts to health workers, distribution of free samples, advertising and promotion to general public, the prominence of essential information in promotional communications to health workers, the volume of promotion for less-than-essential products, and the role of the industry in continuing medical education. In addition, the WHO Criteria lacks monitoring procedures.

The Health Action International (HAI), a network of consumer, development action and other like-minded organisations, published a more comprehensive draft code on pharmaceuticals in 1981. Published as a discussion document, it is aimed at encouraging constructive discussions between all parties involved in the supply and use of pharmaceuticals. It suggests standards for drug promotion, pricing, sales, distribution, trade, technology and research and development.

The international codes or guidelines must require that corporations take full responsibility for the effect of their operations on the health, safety, economy and the environment of the host country. Such codes/guidelines will serve to assure the public that corporations agree top abide by the provisions of the code/guidelines which sets standards of decency, fair competition and greater honesty in the operations of businesses across national boundaries.

How effective are international codes in actual practice? Indeed there are limitations with regard to their implementation. For one thing, codes are only self-regulatory. They are recommendations of international bodies and their implementation depends on the co-operation of the companies and national legislations.

Corporations are known to violate the adopted codes even after agreeing to comply with the provisions sometimes blatantly and at other times subtly. For instance, the WHO/UNICEF International Code on Marketing of Breast Milk Substitutes adopted in 1981 is being violated by the babymilk industry which has devised new marketing techniques that create the appearance of compliance whilst making maximum use of grey areas in the Code. The reluctance on the part of the industry to adhere to the code is explained by the International Baby Food Action Network (IBFAN): "there is an inherent conflict between the aims of the international Code and the goals of the babyfood industry. The Code aims to protect and promote breastfeeding by preventing unethical marketing of breastmilk substitutes; this is bound to lead to a reduction in the market for babyfood" (29).

Nevertheless the adoption of international codes will be positive in that it will influence the companies in following better business practices. This has been demonstrated by the 10-year experience of the International Code on Marketing of Breastmilk Substitutes in the following ways:
- it has a good effect on advertising and labelling of infant formula, particularly in developing countries

- it has brought worldwide attention to the issue, and contributed to the public awareness.

- it has contributed to the recognition of the role of non-governmental organisations, and their recommendations are being considered for incorporation in government policies and regulatory measures.

- it has encouraged governments to establish suitable legislations based on the Code. One of the best examples is Guatemala which adopted the Code in its entirety in June 1983. Furthermore, in September 1987, additional Rules for implementation were issued to clarify some aspects of the law, and to establish sanctions for non-fulfillment of the law (30).

Therefore for the effective implementation of international codes, it is recommended that they be adopted with provisions for all the necessary mechanisms for their proper implementation. It is necessary that adequate funding be provided for independent regulatory agencies. Effective international mechanisms to regulate MNCs be developed for monitoring the code violations and also for imposing sanctions against violators. Only with the provisions of such mechanisms for the effective implementation of the codes, will the codes have any real meaning (see also Appendix for a more detailed comparison of the various codes on ethical marketing). In April 1997, the Indian Drug Manufacturers' Association (IDMA) came up with a draft marketing code.

References

1. Annual Report - Ministry of Chemicals and Petroleum, 1999-2000

2. Jain, Kalpana. "Malaria Unchecked, TB takes 1200 lives a day", The Times of India, 05 January 1996.

3. Annual Report - Ministry of Chemicals and Petroleum, 1991-92.

4. Indian Pharmaceutical Guide, op. cit.

5. Rational Drug Policy -Facts and Figures. New Delhi: AIDAN, 1986.

6. ibid.

7. Answer in Lok Sabha by Smt.Saroj Kharpade, Minister for Health, March 29, 1989.

8. Killer Fluids: a Report on the I.V. Fluids Contamination Case. New Delhi: VHAI, 1990.

9. Minwalla, Shabnam. "The Spurious Pill that can only make you feel worse", The Times of India, 12 Sept. 1994; Ghoshal, Sumit. "A Bitter pill for drug units, consumers", Indian Express, 12 Sept 1994.

10. Melrose, Diana. Bitter Pills: Medicines and the Third World Poor. Oxford: Oxfam Public Affairs Unit, 1982. pp. 89.

11. Chetley, Andrew. "Promoting Health or Pushing Drugs?" HAI News, No.67, October 1992.

12. Melrose, op. cit. p.67.

13. Khor, Martin. "Regulating TNCs is Biggest Gap in UNCED". Third World Resurgence, No.20, 1992.

14. Statement of Senator Long, Louisiana, Congressional Record - Senate, February 10,1966, p.2886, cited in Bautista, E.B. "Multinationals and the Drug Industry in the Philippines", in Philippine Perspectives on Multinational Corporations by A.C.Espiritu et al. Manila: Univ. of Philippines Law Center, 1978. pp.181.

15. Bautista, E.B. ibid pp.181-98.

16. Chetley, Andrew. 1992. Op cit.

17. Source: Quoted in Pharma Pulse, November 27, 1997

18. Chetley, 1992. op. cit.

19. Braithwaite, John. Crime in Pharmaceutical Industry. Routledge and Kegan Paul, 1984.

20. Towards a Rational Drug Policy: Problems, Perspectives. New Delhi: AIDAN, 1986.

21. Beardshaw, V. 1983. pp.44-45.

22. UNI Economic Services, Vol, III, No.3,5, January 1981.

23. "Glaxo's Defence Exposes Drug Authorities' Working", Times of India, January 1, 1994, "Drugs: Point, Counterpoint", Times of India, April 9, 1994.

24. Geneva Press Conference on SMON: Proceedings, April 28, 1980.

See also: Hansson, Olle. Inside Ciba-Geigy. Penang:IOCU, 1989.

25. "Glaxo Violated Law, Says FDA", Times of India, September 28, 1993 and "Glaxo: Who Won? Who Lost?", Business India, March 28-April 10, 1994

26. HAI News, October 1992. pp.2.

27. Melrose, op.cit.

28. Majumdar, J.S. and Das, S.K. Unfair Practices in Marketing Adopted by Multinational Drug Firms in India. Mimeo. n.d.

29. Breaking the Rules. Penang: IBFAN/IOCU, 1991.

30. Review and Evaluation of Measures Adopted by Countries to Implement the Goals and Principles of the International Code... Case Study Guatemala: Final Report. Penang: IBFAN, 1992.

31. For a comparison of the WHO and IFPMA codes with comments from HAI, see Kanji, Najmi. Drugs Policy in Developing Countries. London: Zed Books, 1992.

Other References

1. Report of the Commission of Inquiry (Re. Deaths of Patients in JJ Hospital at Bombay in January-February 1986 due to alleged reaction of Drugs) headed by Mr. Justice B. Lentin, Judge, High Court at Bombay.

2. Gonsalves, Colin. "The Pathetic Judicial Response to Dangerous Drugs". mimeo. pp.54.

3. a) Bal, Arun. 'Counterfact on Analgin', Economic and Political Weekly (EPW), March 4, 1989.

b) ......"Doctors and Drug Companies". EPW, February 7, 1987.

4) See for analysis of drug price increases:Rane, Wishvas."Analysis of Drug Prices, 1980-1995", EPW, August 24-31, 1997. Also, Rane's "Drug Price Analysis:April 1996 to March 1997", paper presented at the workshop on Essential Drugs in Gujarat, April 1997, Ahmedabad.

5) For a brief analysis of patents see: Keayla, B.K. New Patent Regime; Implications for Domestic Industry, Research & Development and Consumers. National Working Group on Patent Laws (Centre for Study on GATT Issues), New Delhi, Jan 1996

       
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