Pharmaceutical companies invest heavily in promoting their products. They use a variety of promotional strategies to influence physicians' prescribing decisions. Smart and articulate young men are recruited by these companies to promote their products. Commonly known as medical representatives (MRs), these salespersons are required to convince the doctors to prescribe the products of their respective firms to the patients. They have been playing the key role in familiarising physicians with medical products and related information for many years in Bangladesh. However, the drug manufacturers engage most of these medical representatives in unethical practice for the promotion and sale of their products.
The MRs are said to offer medical samples, gifts, including air-conditioners, refrigerators, airline tickets, arrange seminars in posh hotels and even, allegedly, offer bribes to the doctors to persuade them to prescribe their products. In return, a section of doctors, allegedly, prescribe their medicines for patients both in the public and private hospitals. Many physicians help these salesmen meet their sales targets and in return receive favours including foreign tours funded by pharmaceutical companies. To check whether their medicines have been prescribed or not, these representatives wait outside the chambers of the doctors. As soon as the patient comes out of the chamber, a group of these representatives start taking photos of the patient's prescription. It causes an unexpected situation, not only for the patients but also for others. Involvement of pharmaceutical companies in affairs of some private hospitals and clinics is also on the rise. They are involved in arranging billboards and providing financial support to those hospitals and clinics. These expenses are subsequently recovered from the patients. This kind of practice raises questions about the doctors' credibility to the patients. One significant consequence of the interactions between physicians and medical representatives is the possible conflict of interest which may contribute to over-prescribing of drugs. This might negatively affect patients, both physically and financially.
Some senior doctors have already stopped medical representatives from visiting their wards and out-patient departments, arguing that there is no need to be briefed by them. They say that the pharmaceutical companies concerned, like in the United States and the United Kingdom, should keep direct contact with the doctors and inform them through medical journals and booklets about their drugs. Bangladesh is yet to develop any system, which can help doctors stay updated on new discoveries in medicine, launch of new drugs, their side effects and price change. It is the medical representatives who bridge this knowledge gap by sharing information with the doctors. But their rush-hour visits to hospitals and doctors' chamber often cause inconvenience to the patients. So, their entry should be restricted.
To deal with the nuisance caused by the medical representatives, the government should make it mandatory for the doctors to use the generic names of medicines in their prescriptions. The sale, purchase and manufacture of medicines should also be allowed under generic names.
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