Pharmaceutical companies in Bangladesh increasingly influence medical prescriptions by offering incentives to doctors, raising ethical and medical concerns that largely go unchecked.
Sales representatives from pharmaceutical companies are often seen waiting outside clinics and hospitals, eager for a moment to speak with doctors. In many cases, they even monitor prescriptions as patients leave, taking photographs to ensure their drugs are being recommended.
Sirajul Rabi, a patient at a leading private hospital in Dhaka, experienced this first-hand. "As soon as I stepped out of the doctor’s office, I was surrounded by sales representatives. They bombarded me with questions, eager to know which medications had been prescribed. It happens every time I visit a doctor, whether in a private or government hospital. Medical representatives always ask for photos of the prescription. Once, a doctor even insisted that I purchase a specific brand of medicine from a particular company."
Dipa Kabir (not her real name), a resident of Dhaka's Dhanmondi area, faced a similar situation. Visiting a renowned private hospital for a cold-related issue, she was prescribed multiple medications, including an inhaler.
Suspicious of the extensive prescription, she consulted two other doctors, who assured her that only two of the prescribed medicines were necessary, while the inhaler was not required at all.
Despite some hospitals restricting the entry of pharmaceutical representatives, many still allow them access, exacerbating the problem.
Expert Opinions on Ethical Concerns
Medical professionals have expressed discomfort regarding the practice of prescribing medications in exchange for incentives.
Dr Gazi Nazrul Islam, Director of Ispahani Eye Hospital, acknowledged the issue but noted that hospitals could do little to prevent unethical practices by individual doctors.
"We do permit representatives from selected companies to enter, provided they carry identification. This allows doctors to stay informed about new medications, improving their knowledge. However, if this system is abused, it is unacceptable," he said.
No sale of antibiotics without prescription: Cabinet clears draft law
Many doctors, reluctant to speak publicly on the matter, admit that the practice has become deeply ingrained in the medical community. The fear of alienating colleagues who engage in such activities discourages open opposition.
Pharmaceutical marketing professionals, on the other hand, justify their actions by citing the pressures of the industry.
A medical promotion officer from an unnamed company shared, "We have strict monthly targets for prescriptions featuring our medicines. Meeting these targets is crucial for us to receive bonuses, as our basic salary is quite low."
He added that collecting photographs of prescriptions helps companies assess their market position against competitors and develop effective marketing strategies.
Unethical Practices in Medical Profession
Dr Shamsujjaman, former Professor of Microbiology at Dhaka Medical College, raised concerns about doctors prioritising incentives over patient health. "Doctors should prescribe only the necessary medications based on a patient's condition. Writing unnecessary prescriptions in exchange for gifts could endanger the patient’s health," he warned.
While acknowledging that pharmaceutical representatives provide valuable insights into new medications, he emphasised that any exchange involving gifts is unethical.
A senior professor, who requested anonymity, revealed that incentives extended beyond small gifts. "Some doctors receive expensive rewards, including cash, overseas trips, and even financial support for personal expenses such as wedding costs for their children. Despite official guidelines against such practices, they continue behind the scenes."
Regulatory Challenges
A former health secretary from the Directorate General of Health Services (DGHS) admitted that no specific law currently prohibits pharmaceutical companies from offering gifts to doctors. "While giving gifts is undoubtedly unethical, there is no concrete legal framework to prevent it."
Doctor admits to writing fake prescriptions for black market
He suggested that the Drug Authority, which licenses pharmaceutical companies, could play a key role in addressing the issue.
A former director of the Drug Administration echoed this sentiment, saying, "Although a law is supposed to be passed, it has not happened yet. Any regulatory measures should ideally come from the Bangladesh Medical & Dental Council (BMDC)."
Meanwhile, current Director of Drug Administration Dr Md Akter acknowledged the ongoing concerns but emphasised that regulation alone would not solve the problem. "There hasn't been any significant regulation yet. However, this practice must stop. Doctors should adhere to ethical principles. Awareness is more important than legislation."
Need for Reform
Despite growing awareness, the influence of pharmaceutical companies on medical prescriptions remains widespread.
Stop antibiotic sale without prescription: HC to govt
Patients are left uncertain about whether their prescribed medications are truly necessary or simply a result of industry incentives. Until stricter regulations and ethical commitments are enforced, the integrity of the healthcare system will continue to be questioned.