Tag Archives: Pharmaceutical

The Medical Secret Service: Unknown Angels

The Medical Secret Service: Unknown Angels
© Dr. Rajas Deshpande

“Hullo, Vishwa? Please consider this an emergency. One of my rural patients is here, she is on XXX brand of tablets, she has finished the dose, needs more immediately for another three months. She cannot get them. She has to return by an evening bus. Can you do something?” I was in a hurry, between patients.
“Yes, Sir, I will arrange within a few hours” Vishwa said, and indeed, within two hours, the nearest medical shop called, saying that the medicine was available for the patient at a discount.
That evening I called to thank Vishwa, only to be shocked.
“Sir, you were in a hurry today morning so I didn’t tell, I had a heart attack last night, and an angioplasty was done. I am ok now.” said the 30 year old to me.
Like the thousands of his community, the Medical Representatives, he is immensely contributing to the healthcare industry, unrecognized and unacknowledged. © Dr. Rajas Deshpande

“”What is your job? Just passing on bribes to the doctors? My cousin said to me, Sir, and I did not reply. You should not argue with the one who has poison in his heart. People look down upon us, but they will never understand what we do” said a 60 year old man who had spent life as a medical representative, now a national manager. “We have no choice of judgment, our job is to be the link between the doctor and the company, and to make sure our medicine is available” he said.

Millions of busy doctors, overloaded with their work, have no clue how many pharma companies exist, what medicines they make, what medicines are newly launched, what is the brand name or price etc. It is not practically possible to read the whole new drug launch book every month. This community of medical representatives alone is the link between the pharma companies and the doctors, updating us about various new drug launches in India, their availability etc. They also arrange for academic events so necessary for the doctors and medical students. © Dr. Rajas Deshpande

“Some Doctors are very good and treat us respectfully” said Janvi, who has spent over 20 years in this profession, “but some expect favours from the companies, in the form of tours, dinners and other things. Sometimes, I have had an occasional trespassing of moral lines by some doctor, but that was rare. One needs to be able to take care of one’s dignity and self -respect. Especially Indian women face a lot of difficulty and gender bias when making a career, at all levels.” she said.
“The pressure for women in this industry is immense, and like any careerist woman, I faced a lot of presumptive hate too. If a woman, and especially good looking, is successful, our society already has made its judgment as to the reasons of her success. Most Indian men do not tolerate the idea of a woman succeeding ahead of them. Of course, one must clearly set priorities as to whether one wants to make a career or family, and if both, where the compromises will be, because both are full time jobs at least for any woman. Most doctors have treated me well though, and most doctors also want to do good for their patients”. © Dr. Rajas Deshpande

In my 20 years of career as a doctor, I have never come across a Medical Representative who turned down my request to help a patient: lacs of rupees worth of medicines I have asked them to arrange free for my patients, and they have arranged without a question. Thousands of poor patients receive free / discounted costly medicines, injectables, even stents etc., thanks to the generous efforts of this community and their companies. Thousands of medical camps are arranged all over India, where patients get free check ups from doctors and free medicines by pharmas, arranged by the Medical Representatives, but there is seldom any recognition of this service.

Unlike in most other professions, this community helps out its members without bringing in the competition, and in a recent event, when a regional manager suffered a critical head injury, MRs from different companies collected funds to pay for his bills.

Very few people notice how cruelly difficult the life of a medical representative is. They have to meet a certain number of doctors every day. They often stand for uncertain hours and have days longer than 18 hours, as some doctors finish their OPDs long after midnight. Family life is screwed. They are also responsible for making available the stocks of their brand medicine at different medical shops, and have to bargain with everyone: the stockist, distributor, hospitals, and sometimes the medical shops for making their brand available. The final sale figures are their assessment at every month-end. To achieve targets is essential in pharma industry as in any business, to survive. It is the Medical representatives community that faces the brunt on both sides: company pressure and the medical profession.
Unfortunately, our hate-bespectacled society cannot see anything beyond its suspicions: that all companies offer bribes and all doctors take them, that all doctors deliberately prescribe costlier medicine to earn cuts, and that the whole medical service is driven by money. This is somewhat like a suspicious husband who has a very beautiful and loyal wife, but cannot be happy with her because of his own paranoia. © Dr. Rajas Deshpande

I know many doctors who do not ask for any personal favours from the pharma, do not accept gifts, and pass on all the benefits to their patients. But I do not know any mention of gratefulness for such doctors anywhere. Without the medical representatives playing their part well, the medical profession will be quite helpless.

This article is to salute the thousands of medical representatives who work hard day and night, live an extremely compromised life, and still contribute to the service by medical profession, making life easy for millions of patients.
© Dr. Rajas Deshpande

If a medical representative has helped you / your patient, please share this article.

Drug Quality, price and risk in India

Drug Quality, price and risk: repost

(c) Dr. Rajas Deshpande​

Sir, What about the responsibility of quality of drugs used for the treatment? These are the only weapons with which we fight a disease. Does it make pharma a share holder of responsibility in case of adverse outcome ? This is another grey zone to elaborate.

Dear Dr.
Thank you for asking this question.

We must demand as doctors that we will only prescribe local medicines / stents/ catheters, needles etc., but then make it compulsory for everyone including the ministers, govt officials, the actors who comment irresponsibly etc. to only use Indian / cheap healthcare products. Let us see how many rich and famous want to use local drugs / stents / caths for themselves or their families!

We have a society so immature that it does not blame the government for allowing production and sale of low quality medicine / not guaranteeing and monitoring quality of each drug locally produced and marketed, and banning the costly drugs, but thinks that the Doctor should take responsibility of their “Multimillion Health” by prescribing cheapest drugs and tests available, produced locally without any knowledge of their quality!

There are set international standards of quality control for manufacturing of Medicines / Drugs. These apply with minor legal (but not scientific) variation to all pharmaceutical companies. Along with the major international players, there are also major/ minor Indian players in this industry. Many major international pharmaceuticals have been legally tried and punished for manipulating drug related information / bribing or compromising upon its quality: billions of dollars worth such punishments have been on record. There are no examples like this in India, which must mean, the entire industry and the government’s arms dealing with it must be absolutely innocent and honest, and all drugs produced in India must be absolutely good!

Secondly, the control over quality is not over with production of the drug. The transport, storage, sales and instructions given to the patient with each single drug also matter.. You know very well how many Indian drugs even have “readable” information printed upon them.. Leave aside the separate printout/ labels about precautions that must accompany every sale.. All this information is left for the Doctor/ Nurse / Pharmacist to tell the patient, forget the waste of time. This reduces the price of the medicine at the cost of the Doctor’s / Nurse’s time, while everyone else in this chain of sale earns their profit..

Then the after-sales feedback and documentation of serious adverse effects / ineffectiveness of each single drug marketed has to be recorded and reviewed / analysed. We all know this system does not exist in our country… there have been no cases about the drug quality at all: in fact the Doctor is automatically presumed responsible for either greed or guilt of prescribing any drug, either way! If you know the horror of real life story called “Rosche Versus Adams”, it will blow your mind to think what must be going on in a country widely infamous for corruption in all fields..

Always in shortage and underpaid, shouldering all nonmedical aspects of healthcare (which are social / govt. responsibility), the Indian doctor does not have the time / money / power / authority to monitor / report / check / complain against any medicines. If he / she does, we know what might happen. There are mighty, powerful, political, medical, corporate, international, kingmaker people who own much of pharma sector, some mafia too. Can we imagine a simple doctor will be able to fight these?

I am not accusing anyone, but these two links are enough embarrassing, and we can understand that money and power can gag almost each and everyone in India from a ministers to media, so these news will be rare.



There are some good and standard pharmaceuticals, who tell the doctors about their quality control, ask for feedback, and also update the certifications, accreditation etc… so we know they are standard. There are those whose brands have been internationally reviewed, those which are in the market for decades, with established safety. There are new ones with no data, where the only trust is about the maker’s reputation. The onus is upon the doctor to choose. I know most doctors would prefer the best for their patients, and some would consider a relative safety if price can be reduced. Honestly, no doctor can assure the quality of a given medicine, he / she has no way to assure that. But if you prefer Indian made smartphones, Indian made clothes / perfumes / cars, etc. etc., you may also rely upon Indian made drugs/ stents / catheters. The difference is then you absolve the doctor about the responsibility of what he thinks is best for the patient. I know some Indian pharma which have excellent quality of drugs, but most also have heard of frauds. Knowing this, a good doctor cannot vouch for the safety of any drug, Indian or International. The patient must make a choice.
There are umpteen examples of ineffective / low quality Tuberculosis and other drugs scandals (sold in some Govt hospitals) some years ago, but there was never any case decided against this. There were / are examples of doctors making and prescribing their own medicines, which they may know the quality of.
The effective percentage of the active ingredient, its purity, its binding with the excipients, its bioavailability after consumption, its effects on the liver / kidney, brain, eyes, heart etc are all also linked to how much and how rapidly it is absorbed and metabolized. The doses we use are all western-standardised, and we Indians have a tendency (even in Medicine) to presume that those biostats will exactly apply to our population, irrespective of genetic / ethnic/ cultural (food) differences.

A drug may kill (either by its action or inaction) if its quality is not accurate, and this “quality” NO doctor knows. Doctors can only go by their own experience about that particular drug and the company that makes it. So if the patient insists upon buying a certain medicine brand produced in a certain country, it is his / her prerogative and responsibility.

We call many things “ Chinese” and usually mean it as a cheaper / “no guarantee” quality.. We cannot blame if some western / other countries felt same about Indian made medicines, even after the racist / competitive aspect is excluded. Pharma industry has good and bad in ALL countries, including India. The only difference is that we know the levels at which corruption works in our country : Every!

It is easy for filmstars who shoot outside India, drive foreign cars, endorse foreign brands, wear foreign clothes and run to foreign countries for every health issue to cry on national TV and urge everyone to use :Generic” / local drugs. It’s not their life, and if something happens there’s always the Indian Doctor to blame!
We must demand as doctors that we will only prescribe local medicines / stents/ catheters, needles etc., but then make it compulsory for everyone including the ministers, govt officials, the actors who comment irresponsibly etc. to only use Indian / cheap healthcare products. Let us see how many rich and famous want to use local drugs / stents / caths for themselves!

© Rajas Deshpande