|
09-02-2002
At the IAP National Conference, Bangalore, little birds say that 30-45% of
participating Pediatricians were sponsored by Pharmaceutical companies which included not
only registration fees but simple 5 star accommodation, chauffeur driven cars, liquid
diets and special lavish dinners. Is there anything wrong in what we are now doing? Who
really pays for these sponsorships? Is it in anyway demeaning to our profession? May I
please have some advice with regards investigations, prevention and treatment of this
disease?
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
09-02-2002
Dear Dr Lewin, I would like to see this like this. At the IAP National Conference,
Bangalore, 60-70% of participating Pediatricians were NOT sponsored by Pharmaceutical
companies and
they paid from their own.
I believe one should always see the filled glass not the empty part of it. I would neither
blame doctors nor pharma companies of this symbiosis. If some company comes-up with some
wonder drug and don't go for any marketing strategy, will that drug survive
"No"? But it is bad if this symbiosis is not good for patient interest. To
prevent this best would be to make registration and accommodation free at least for those
who have come to present scientific material. Again this money can only be taken by Pharma
companies, but directly by organizers. To run a successful cause you need money. Or like
many who are committed to serve without sponsorship struggle for existence.
Dr Vipul Jain,
New Delhi. |
10-02-2002
Even after so many years we try to derive solace in using the phrase" if it is
not good for patient interest..." well, the writing is on the wall, it is not. The
sole interest guiding all this symbiosis is sale. And when the medical world is interested
in sale then it is consumers and strategies to push sales. The disturbing trend in
Bangalore was not only delegates but their entire family being sponsored and this was very
evident in the banquet. We are now in snow ball effect, in a down hill course. The first
step was to nip it in the bud, we failed to do that and now one after the other the things
have come to impasse. Our own office bearers have not set any examples, their own trips
are sponsored and fingers are being raised. They say Caesar should be above suspicion but
they also say you will get the kind of govt. you deserve. I sincerely feel that right
minded people (may be 50% of the 60-70%) should come together and continue to resist
temptations and raise their voice. No body addresses these issues any where in IAP.It will
be interesting to learn from pediaindia members of US and UK about situation there in.
Dr Sanwar Agrawal, Raipur, Chhattisgarh. |
09-02-2002
I know believe that the figure now approaches 75% which it makes it even more
alarming! I don't believe that the end justifies the means! AND that it is the patient who
pays for all our sponsorship. There are certain types of sponsorship which could be
considered right but certainly not BOOZE and FIVE STAR DINNERS for the education of us
poor doctors! I quote from a recent publication in the Pediscan the local IAP Bangalore
newsletter "Question 2: (Dr. Chandrakala, Raichur) Should doctors accept lavish
Pharmaceutical sponsorships to conferences? Answer: I'm afraid that Dr. Chandrakala has
opened a can of worms and is in the minority as per the grapevine following the latest IAP
National Conference at Bangalore. Stories have emerge that over 60-75% of delegates to
attend the conference were sponsored by various Pharmaceutical companies. One is lead to
believe that it was not only the registration fees footed in some cases but also the
majority received simple 5 star accommodation, chauffeur driven cars and special dinners.
But all this is hearsay and it is difficult to believe that doctors especially
Pediatricians would accept such blatant attempts at marketing by the industry. Gifts from
Pharmaceutical companies have always been a burning ethical issue and just because every
one of us accepts does not make it right. Reasons for drug companies offering gifts are
usually to enhance product recognition. "No drug company gives away its shareholder's
money in an act of disinterested generosity." There are studies in the Am J Med 1982
that conclude that doctors are more influenced by commercial than by scientific sources of
information about these drugs! Reasons for accepting drug company gifts could be since
gifts improve transmission of medical knowledge, they don't impair clinical judgment and
that refusing gifts may cause more harm than benefit (the consumer price would not be
lowered, medical education would suffer with drop in sponsorships!). Objections to
accepting drug company gifts would be that gifts would create the expectation of
reciprocity and obligation to prescribe. "The sell is more subtle". In addition,
gifts could impair objectivity, increase the cost of health care, demean the profession
and give an appearance of conflict of interest. There are recommended solutions: forbid
certain practices, allow certain practices, encourage pooled support by drug companies and
disclose gifts to patients. We should remember that ultimately our primary concern should
be the best interests of our patients, not our own personal convenience or well being. We
would love to do a study involving all 4500 Pediatricians participating at Pedicon 2002,
however we would need a Pharmaceutical sponsor!!!"
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
14-02-2002
The situation does exist in England but to a much lesser extent simply because
pediatricians practically have no private practice compared to surgeons and orthopods.
Only pediatricians in big hospitals with respiratory expertise attract attention from drug
reps because there r several almost equally effective drugs for asthma and due to huge
number of asthmatics preferential use of a drug will affect the profits of the company.
The symbiosis is difficult to ignore but u will have to draw a line somewhere. One of my
friends does not accept even a pen because she feels that the price of the pen is
ultimately paid by the patients. But she listens to drug reps attentively and admits the
fact that some wonderful drugs r results of research by the companies. Most of us r not so
scrupulous but probably not go beyond a sponsored lunch. Getting sponsors from drug
companies for your family to do the sight seeing while u sleep through the afternoon
session after a heavy lunch is just not defendable. But u do need money for organizing
courses and conferences and probably u won't face a serious questioning on your judgement
day if u use that for solely academic purpose. Just a matter of interest, last year I was
informed about a miraculous analgesic available in India ( can't remember the name ) by a
junior doctor who had recently come to UK for PLAB. I was pretty embarrassed and could not
find any reference in British Formulary. Later I came across some comments about that
company and IAP conference and how that drug was linked to so many side effects which were
previously ignored. This is unlikely to happen in UK because the media will simply kill us
and the health service is still monitored actively by govt. and Egos and a junior house
officer/nurse is not afraid of criticizing even the consultant which was unthinkable when
I was a trainee in India.
Dr Supratik Chakraborty,
Wigan, Lancashire, UK. |
16-02-2002
It is nothing but a shame to medical profession. People beg in different ways. I
personally think that it is a lavish way of begging (like an english begger-begs in
english). No wonder people hate doctors. When you start eating freely you look for
something else, if you can not get it you look for options. I am sure there are goodways
to practice to medicine, if not ask any medical rep he will tell you.
Dr G N Rao, UK. |
16-02-2002
Dear Dr. Chakraborthy, The wonder medicine which brought tremendous relief as an
antipyretic and anti-inflammatory was probably Nimuselide which incidentally is not
licensed in the USA and in Europe but the company has sponsored in a massive way in India
and especially the past few IAP National Conferences hence it is probably now one of
commonest drugs being prescribed by Pediatricians without knowledge of the sideeffects of
hepatic enzyme elevation and hepatotoxicity and rash! Looks like the IAP conference is
getting to be flag bearer of this mechanism of Pharmaceutical doctor nexus. Yes, we do
need inputs and you can see that you have already suggested potential guidelines for
doctors and their relationships with the industry
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
17-02-2002
Dear colleagues,
This same disease prevails also in our set up, perhaps at the same strength (75%). Very
interesting to know that more or less the TOP takes the lead. I suggest two ideas for the
eradication of this disease from the professionals:
1. Like in developed countries, the employing authorities have the proposed funds for the
attending conference and presenting papers from their institutes according to the category
of the person, our institutes should have this infrastructure, so that there should be no
burden on the professionals.
2. The registration should be free for the seniors and cheap for the young doctors to
encourage their participation. The lodging & boarding should also be at nominal rates
acc. to the area, to promote the affordable trip for learning and pleasure. Of course
there is no substitute for the SELF ROLE MODEL from all of us to discourage this practice
at all ends and also we do hope to have the same from the phrama management with some firm
policy. The role of the societies and associations is very important for the
discouragement of this and also to cancel the membership, if the person has been found to
involve this illegal and unethical way of practice. We all need to participate in a BOLD
way as this is one of the main reasons of the defamation for the MEDICAL PROFESSIONALS.
Dr Parkash Mandhan,
Hyderabad, Pakistan. |
17-02-2002
I was wondering if we should write a letter to the editor of the Indian Pediatrics
on behalf of all of us who feel this is an issue needing addressing. We have in just a few
mails even suggested great remedies to this disease process before it leads to a
malignancy and serious consequences. Could all those in favour of including their names as
authors of this simple letter to the Indian Pediatrics write in to this site and confirm.
Dont worry there is a well researched case behind us and we aren't doing anything wrong!
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
17-02-2002
First of all, thanks to Dr.Sanjiv Lewin for bringing this 'skeleton' out of the
closet. While the number of Doctors availing the good offices of Pharmaceutical companies
for having a great time at Annual Conferences may be the subject of debate, we can all
agree that it is significant, and, probably more importantly, rising. And let us not fool
ourselves into believing that sponsorships come for free, without any strings attached.
The pay-back time arrives right after, and we all know who actually collects the bill. But
what remedy is there for this situation? Unfortunately,none that I can think of.
Initially, some pharmaceutical companies started this as a business ploy to sell their
products, and now many of us are actively demanding it of them. In fact in a some-what
grotesque manner, it has even acquired a status-symbol - almost as if the worth of a
Doctor is measured by the amount a pharmaceutical company is willing to spend on him to
keep him happy! I think it is a reflection of the state of our society in general - like
dowry, selective female-feticide, corruption and in general a turning away from idealism.
The correction will only follow when society changes for the better as a whole.
Dr Anil Shukla,
Allahabad, UP. |
18-02-2002
Well, this is a very relevant debate but perhaps a very difficult one. The extent
of malaise is much beyond what meets the eye. I would not hazard a guess on the proportion
of delegates who were partially or fully sponsored by the pharma companies as there exist
various grades and shades of this alliance. Yes I did meet some friends who had come with
family sans fully sponsored airfare, fivestar stay and car etc from their respective
states. There were many who had more then one suitors and had difficulty making a choice.
I am not sure how this malady became so malignant but the most recent trigger was the mass
marketing of Hepatitis B and other vaccines. The ever increasing size of the private
health sector as well as the increasing hold of some of the frontmen of the pharmaceutical
companies (leading doctors) over academy affairs has brought about a change. The large
market (unsuspecting or poorly informed population of our country) ensured that the
relations! hip between the doctors and these companies is like that of a manufacturer of
fast moving consumer goods with their dealers who are rewarded with paid holidays and the
likes with an annual convention. The similarity does not end here as many of us are
getting substantial gifts for providing a larger slice of the market to the companies. The
business men are not expected to behave any differently as the bosses of these companies
have turned their sales personnel into mercenaries who must achieve higher and higher
targets by whatever means. If we professionals do not our selves behave in a responsible
fashion, I can not see any major change in the future. For most of us the morality is as
deep as the risk of getting caught. As accepting the hospitality from the companies is no
more considered a bad thing there are no pressures or risks of getting caught in the eyes
of peers or friends. It is some of the public sector doctors who show some restraint
mainly because of the risk of getting caught. Nevertheless there are some who do not
indulge for they do not believe in it and exercise self control. I think it is only the
self control which can stop this trend as one cannot expect the "leaders" in the
academy to be role models. Have we not seen our own presidents and office bearers as the
main speakers for sponsored sessions on vapor inhalation or oil massage during the
conference. I do not see any reason why the IAP should not ban their office bearers to
directly or indirectly promote products or ideas as "learned speakers" in the
sponsored sessions.
As we realize perhaps the proverbial can of worms here is actually a bottomless pit. Today
it is very profitable to conduct CMEs / workshops/ Conferences etc for the organizers in a
number of ways. But that is a different story altogether!
Dr Varinder Singh,
Delhi. |
09-02-2002
Yes it was a disgusting affair in bangalore, doctors just moving around to collect
some plastic carry bags and some free pens PHARMA COMPANYs take doctors for a ride and
doctors enjoy the ride !! don't blame the pharma co !!
Dr Shital Shetti,
Nipani, Karnataka. |
21-02-2002
As a follow-up to my earlier comments, I wish to add that the time has come to look
into the whole business of sponsorships in the medical field as a whole. To accept, or
rather extract sponsorships for various activities like Scientific sessions, lectures,
journals, cultural events etc., during National, State and Branch level meetings of the
Academy as fair, while expecting the individual member to set high moral standards by
refusing patronage from the same pharmaceutical companies is probably neither workable nor
honest. Probably, the "All or None" rule applies. Either we reject sponsorships
in all its forms in toto, without exceptions or else bear with its consequences. Today,
conferences have become mega-events which only a few cities of our country dare organize.
The time has come to say no to all sponsorships, and let the members pay to meet all the
expenses which can be kept low, without frills. Or else, accept the current situation and
prepare "for better or ! for worse" - as one may prefer to look at it!
Dr Anil Shukla,
Allahabad, UP. |
21-02-2002
Well I couldn't attend Bangalore conf as I Was too busy with my dad's
Alzheimer's.But it seems the hidden ugliness came into the fore with all its might.But
friends we should have raised our so powerful voice much early.How many of us attend
annual IAP shows with right minds?The invitations speak more of tour attractions,climates
and so on. Many of us wander from one pharma stall to another in search of even a carry
bag.In Jaipur I saw even queues for a bag and a calendar.Human greed knows no bars.I know
colleagues attending Breast feeding week celebrations while not even hesitating to write
IMS in their prescriptions.Anyway something real serious work must be done to
progressively reduce the illness.Real difficult work.
Dr Amit Kumar Sanyal,
Kolkata, West Bengal. |
22-02-2002
don't blame it on pharma company-yes its right, they are businessmen & mean
business. what we should do?
1. don't beg for it, strictly to be prohibited.
2. don't accept the offer easily & never with any condition.
3. tell them straight forward that we may not be obliged to write down a specific drug.
4. if we feel that a drug is costly in the Indian scenario, & some other equivalent in
cheaper form is available, prefer the cheaper version, if equally effective.
5. the remedy can not be forced on each & every individual. if anyone wants to be
cheap, let him be. you can't change it.
just this sort of discussion is enough & as far as I think, any sort of representation
will be useless.
Dr Ashish A
Ganatra, Rajkot, Gujarat. |
22-02-2002
Yes, we should not blame the Pharmaceutical industry and realize that they exist to
make profit like any other good company and that doctors exist to care for the health of
their patients. It is us who need to be on guard and protect the interests of our patients
by weighing the pro an cons of each "sell" no matter how miraculous it may seem!
We should demand adequate indexed literature from these sellers and even be on guard as to
what we can take or cannot take from these industry sells. A simple guidelines for human
beings like myself would be is the "gift" educational and directly related to
the scientific aspect of the sell. Maybe then it would be relatively clean. This will
certainly bring up flack since there may be a need to stay off the slippery slope or is it
the double effect which plays a role here.
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
22-02-2002
I think the episode at Banglore in IAP conference should not surprise and shock any
one.This has been happening regularly for many years.The only remedy is that the doctors
should wake up to the fact that the backlash from the society is likely to increase as
doctors turn themselves into traders/dealers instead of Professionals.There is no use
blaming Pharma Industry.The industry's sole motive is profit and that too profit at any
cost.I do not see any chance of remedial action by the doctors or their professional
associations.We as doctors would apparently prefer to learn the right method hard way.If
the things continue the same way we should not be surprised if some new legislation is
enacted to curb this activity!Compassion,Confidence and Competence have been pillars on
which medical profession is based for generations.In our hurry/greed/avarice we have
turned these three pillars in to only one -that is CASH
Dr Arun Bal,
Editor, Issues in Medical Ethics, Bombay, Maharashtra . |
23-02-2002
As a reminder, there was a large news item in Times of India (i think it was)
during the pedicon 2001 at Patna highlighting similar issues. But we responded with a
larger loot at Pedicon 2002. What regulations can help other than self restraint I am not
sure.
Dr Varinder Singh,
Delhi. |
24-02-2002
At this point in time it is clear that there are many of us who donot feel
comfortable with the level of sponsorship and perks offered by the industry and accepted
by doctors. I would suggest that the Indian Academy of Pediatrics open an official forum
to self regulate, educate and guide its members in what is right and what is wrong. We
need to sit down and clearly outline what practices should be forbidden by the Academy
(e.g. gifts like paid holidays, etc. which are not directly connected to educational and
scientific aspects and are disproportionate to the education effort. Certain assistance
from the industry could be clearly stated e.g. CME and scientific conferences specifically
meant for the scientific content and ability to bring some of the best (as decided by the
scientific committee not by the company as happen in Bangalore this year with a gentleman
sponsored by ? Cipla who gave an unusual display of ignorance to what his Pediatric
colleagues already knew! . The company and organizing committee actually changed roles and
the company dictated scientific content of the symposium which is a no no!). The
encouragement of pooled support by drug companies is a good idea if the objective of the
companies is truly to spread education and update the professional community and not try
DIRECT TO CONSUMER DTC methods like the latest venture where GSK is to go straight to the
consumer and spread information by a booklet on available vaccines. Such material should
only be allowed through a professional body and an independent body to avoid any sell!
Gifts beyond a certain value and speakers sponsored should reveal and disclose the above
not only to patients but to us doctors so that we realize that some statements made by the
speaker or by doctor to patient/ audience may have a conflict of interest which is a must
even to publish in the Indian Pediatrics. Maybe we should do a confidential study of our
fraternity and be torch bearers in this ! ethical issue before someone else outside our
profession tells us what to do (e.g CPA).
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
24-02-2002
This is not a new debate. what is the basic question is it should pharma co. not be
involved in the prescription habits of doctors? is it if they are allowed any kind of
sponsorship is it something for everybody or a great amount for some and peanuts for the
rest? who will decide the quantum of sponsorship? luckily in Bangalore it was restricted
to simple gifts the cardiologists are taken for a group foreign jaunt to the far east over
the weekend most pediatricians want gifts and freebies , those who do not want it are few
ans far between , sitting in the registration counter I was appalled at the depths to
which our members stooped to get an additional bag. there were some who wanted lunch
coupons for their families and feigned to have lost theirs. We are a reflection of the
decay of values in our society No organization has the guts to keep the pharma cos at bay
or settle for a simple conference and refuse the grudgingly sponsored bag. the only time
that this has happened was at the Ethics workshop in nagpur in 2001 I feel that we should
emulate this workshop and accept the small nos that may attend
Dr Jagdish Chinnappa,
Bangalore, Karnataka. |
24-02-2002
We should behave like responsible human beings in the matter of sponsorship.
1.Restrict sponsorship to spread of knowledge. 2.Simplest possible meetings. 3.Not
prescribing irrational drugs of those companies. 4.Morality. These are the simple ways I
can think of to 'control' this disease.
Dr H K Takvani,
Jamnagar, Gujarat. |
25-02-2002
Dear Dr Lewin, You have managed to evoke enough debate on the topic of sponsorship
by pharmaceutical companies. We should remember that all research & modern advances
made in the field of medicine is through sponsorships made be these companies. Hence, in
today's world where money-power is equivalent to super-power, it is impossible to simply
boycott the pharma companies. And that is the only way to stop sponsorships. However, we
should not allow sponsors to rule our decision-making like making relevant changes in
immunisation schedules to suit a particular product, or using drugs that we know is of a
poor quality, or when cheaper and equally good alternatives are available. But
sponsorships are here to stay, especially among the big bosses of every society and
organisation. And IAP is no exception. What was more shocking in Bangalore was the number
of doctors who were interested to go for sight-seeing and tours were much more than those
attending lectures. Do we really learn anything from attending such conferences?
Dr Pallab Chatterjee ,
Kolkata, West Bengal . |
25-02-2002
Dear Dr. Sanjiv Lewin,
You are very right in pointing out towards the growing menace of sponsored trips!
Unfortunately, people are dying for such hospitality, and take pride at boasting of what
they got from which pharmaceutical company. It is all due to change in the mindset of the
doctors. Now doctors talk in terms of money and behave like a businessman. They see their
prescriptions as a tool to extract favours from pharma companies. It is just like
"cuts" accepted given and taken in private practice, and the proportion is
increasing in leaps and bounds. The remedy seems impossible, but the only heartening thing
is that there are good people around, and they will never allow reaching this figure to
100%.
Dr Pradeep Jaiswal,
Nagpur, Maharashtra. |
25-02-2002
Dear sir, in my 25 years as a paediatrician i can boldly tell you that i was totaly
against this practice. As in all professions this has of now started proliferating as in
all other pofessions.we the educated call the politicians corrupt,forgeting you are also
in the same boat. In early 1990's.this is one of the medical scandals of last
centuary,being brought to light in 2002.the figures projected should be correct,and those
who defend it will be the most noted personalitis who have benfitted most.otherwise why
are they jumping around, crying foul?guilt feeling?scared about being exposed?well the the
bell has been tied around your neck.it is time for you to dance to our tune sir. I do not
want to repeat medical netizans the same all over again.i will enlighten you on other
scandals. A)hepatitis-b.day of inaguration:1996.a doctor was given an incentive of 100
rupees per dose.the vaccine boom stated---hay day for paediatricians.now we do not hear
about the camps.or do we?couple of honest doctors started camps to provide the same, at
cost price.the bubble burst.now another scandal has broken out.give 50 rupees worth
vaccine and tell the patient that it is the brand leader and charge the brand leaders
price.if that is not sufficint buy date expired vaccine for half the price,and make little
more money.what more you can go to singapore----but hurry---offer open till early
march.offers from companies according to a weekly startes from bangles to your spouse to
white goods,and of late, expensive cars.the deal is simple.purchase a car from the
company,or an equipment---the company in turn gets a loan in the companys name.all you
have to do is purchse medicines adequate to pay the emi--do this for 3-4 years,the company
clims the deprecition for the vehicle.af! Ter a said period of time the book value will
drop to a level at whitch point it is trasfered to the doctor concerned for a paltry
sum.what if the doctor does not keep to his commitment.no problem .the financiar will
seize the car.no problem either for the doctor or the company.the iap is already seized of
the matter---read the latest indian paediatrics.first of all iap has no legal
status.secondly the iap it self is a culprite.you will not have this journal-indian
paediatrics in your hands if not for vaccine ads.over 80% of ads are vaccines.it will be a
cruel joke to complian to iap.instead try your union health minister ,the income tax
department.here again it is you lady luck.she has to smile,--or you will cut a sorry
figure.go to mci----well the chief did he disapper recently?tell me how many medical
colleges abide by the mci rules.tell me-do all the doctors have got their regitration
correct? Or are thy practicinsing on their fathers registration who are no more?well for!
A change why not the bangalore conference organisers come out with the sponsorship
accounts and of the companies who sponsored the meet? Will they be bold enough to give the
list of doctors to whom the companies pay the registration fee?that will give you a birds
eye view of the whole episode.dr.vipul -are you a member of the iap?i beg to differ with
your view.dear dr sanwar,you wright in many aspects.but why this
symbiosis?dr.supratic,well you are far away from this country.but you seem to pretend that
every thing in uk is perfect.what about the orthopaedition who drew money from the
government,and never did one only to clear the prosthesis.has he come out of jail?is the
fda about whom we quote -did it not come under cloud recently?remember some people live
with fame after they die.remember hearing that somewhere?another one:a passenger on board
the plane whitch crashed in pen,usa on sept.11.2001 sent his last message to his
beloved-----"my children will live with fame after my death.well where do you want to
be? Dear doctor lewin, you have opened a the most interesting topic to date.it is useless
discussing in iap,ima,to the government agencies.i am sure you have more details.go to a
leading daily,or rreality bites-star news--burgadutta. This will cme to an end.you do seem
to have a case.who knows you may get the padmasree award next year.guess who? Dear
dr.lewin,it is afutile exercise to report to iap.the cheif benefaries are the office
beares of iap at all levels.get the accounts from the organising commitee along with the
accounts.that will be enough for the time being.rest can be decided later
Dr Merlin Sathiaraj,
Nagercoil, Tamil Nadu. |
25-02-2002
Is there anything wrong in what we are now doing? There is nothing wrong if we
accept present day practice in life.And if you are really practical and wise man!!!(not
all but 50 % or more doctor accept this so they were 30-40 %sponsership) Who really pays
for these sponsorships? Natuarally it is paid by pharmaceutical company (offcourse they
will by pass it on our society). Is it in anyway demeaning to our profession? No if you
are taking advantage of present day compition of Pharma company and not drifting your self
in maladvantage of Pharma share to y ou.(Good excuse isnot it?) Yes it is demeaning if you
are doing it to get maximum advantage!!!(maximum benefit concept will lead to malpractice)
May I please have some advice with regards investigations, prevention and treatment of
this disease? Sorry to be frank I have no exact idea how it can be prevented. I was not
sponsored as they might have felt that I may not be worth for it.Even I felt that some
body must have sponsored me. I n foreign also such ty pe of activies prevail.They sponser
doctor project of research and also provide all sort of activites. Suggestion We are part
of corrupt society and wholesale change in society is not possible. Well I can not find
reasonable answer for individual who is not ready to accept Present day corrupt(( However
it is considered routinely acceptable !)I feel this is extension of routine practice (what
we accept gifts and physician sample from pharma company in our opd and we get our medical
knowledge updated by them!!!)There is no point in discussing such issue unless we do some
solid things for it. From my side if you consider 1.Sincere attempt to prescribe only
medicine of good quality and itshould have reasonable price compare to other brands
available in market. Good ethical practice will prevent you from writing unnecessary drug.
Always keep one sentence (You are caring needy people and not representive of representive
of pharma ceutical company) Try to have ethical practice at your level( I understand we
can not control Other but we can control ourselves !) In general if we are sincere to
reduce the cost and such sort of activities. Then we should ask ourselves and ask govt to
have only generic name Instead of brand name It will reduce lot expense of marketing also
reduce burden on society (naturally cost will reduce) and also reduce your headache so you
have to remember less no of brand name. Last thing if we are not doing anything from above
then one can do Stop discussing such issue .. Suggestion and specially interested in
activities which are related to betterment and correction of infrastructure and system
related changes Movement.Can we have club on net so that we can do something Real
discussion and find real activity and movement in this regard and Other important issue
existing in our practice (routine life)
Dr Yoges Dave,
Porbandar, Gujarat. |
25-02-2002
I am just against such type of mercy! Is it Offered or Asked? solution must be
thought of!
Dr Vishram Buche,
Nagpur, Maharashtra. |
27-02-2002
I am extremely happy that the discussion on the topic which is so dear to me is
generating so much of discussion.I have been yelling hoarse against all this since almost
5 years. It is futile to go to IAP.THE malady can only be dealt with by listening to one'e
own conscience.No qualified, educated doctor of this country needs guidelines from IAP. It
will be like the "fatwa" issued by religious leaders to the unknowledgeable
voters of this country which presupposes that people need to be guided regarding the
exercising of their franchise.IAP has lot to set its own house to order. How many of us
are willing to change our mindset this is the crucial question. The conference reforms can
not be separated from the sponsorship issues. Conferences have become star tamashas. IAP
does not mind spending lavishly because it is some body else's money.For Bangalore
conference we had 3 brochures( Product cataloges?) each costing around rs 80.00 and the
postage expebditure was rs 20.00 on each, making it rs 100.00. Multiply it by 3 and 12000(
number of members) it comes to 36 lacs. This is because somebody was paying for this. This
ceratinly is not the expense for scientific deliberation,research? Only idea is to attract
more people(whom you can not possibly accomodate) to earn more delegate fee. Now, what
role model is IAP? Is it not glorifying the sponsorship?What lessons a mortal member draws
from here?IAP is advocate of children? This extravaganza is ultimately born by whom?
Typhim vi vaccine which costs less tahn Rs 100.00 to a doctor has MRP of rs 250+.This may
be a very novel advocacy. We need to initiate reforms as an individual. Let such
individuals come to a common platform,not necessarily behave like rebellions.Organise a
cme exclusively on contributions and show to peolple who matter that it is possible. let
the central theme of learning through one's one expenses spread far and wide in this
country. I am sure some thing good will come out of this. I have e-mailed the page to few
IAP presidents, including the current and the elect one and also to the IAP HQ. I would
earnestly request pediaindia to continue to persue the issue and take it to something
concrete. We have had enough of rhetorics.
Dr Sanwar Agrawal, Raipur, Chhattisgarh. |
01-03-2002
Friends, That is an excellent issue to discuss. I am definitely not supporting any
such obscenely extreme dependence of professionals on industry. But morality is highly
elastic. For a person who never even allows interviews to Medical Reps., accepting a pen
or paper weight might appear as falling standards in profession and taking bribes. (aren't
they?) For a person who is highly dependent on RMPs for his practice, giving some 'cut' to
them never seem to be of any thing illegal. But to others who do not - it simply is a '
Kick-Back'. Well no one is absolutely pure. As some of us have already pointed out, even
our office bearers and our beloved organization itself has some thing to ponder. What can
be done ?? We should look in to these aspects? 1. Can a conference or CME be conducted
without ANY involvement of industry ? [ My answer in present circumstances is - NO. (But I
may be wrong and I wish I am wrong). 2. Can't we minimize the involvement of industry to
the minimum - at Organizational level? [ My answer is - YES. ( If it is possible at
organizational level, it should be very much possible at individual level) 3. Can't we
make the annual mega event a more pleasant (academically) and less disgusting (
extra-curricularly)? - Definitely YES. As we can not climb the mountain in one big leap,
may I humbly suggest that we may make an attempt to normalize the situation by reducing
the lavishness of our Mega Events! After all no one should come to these events just for
fun and frolic, but more for academic satisfaction. Let us not at this moment bother about
the individual members getting the sponsorship from industry for their travel or
accommodation purposes. This simply can not be stopped. (Pl. do not call me pessimistic. I
am only trying to be realistic.) Once the National Conference becomes more academic and
less jamboree, that will be a beginning for what might be a real good change in the
attitudes of many a pediatricians.
Dr C.S.N.Vittal,
Vijayawada, AP. |
01-03-2002
To all paediatricians, let me point out two forthcoming cme/workshop.one by the
department of devolopemental paediatrics,cmch,vellore,another by the department of
devolpemental paediatrics,thiruvananthapuram medical college.in both events course
material,accomadation,food,probably simple will be provided.course fee:rs.2000/=the takers
will be low without medical sponsors.well it is good idea to curtail the number as in the
thiruvanathapuram workshop.note:families excluded.i think i will get a feed back from the
organisers of these meets.well the medical reps are professors of phamacology,and brokers.
Recently alembic distributed a booklet on medical websites.takers in my district were only
40 out of 940 doctors.the medical netizans are very few in india.well the famous anlgesic
is nimuliside---banned in west,and the comment on vaccine is also true.there are many
more.commisions from labs,medical shops,scan centers.the list is neverending.
Dr Merlin Sathiaraj,
Nagercoil, Tamil Nadu. |
01-03-2002
The melady can be curbed, though not cured at this moment. Let the process begin at
organizational level. Stop the Lavishness. If our needs are less, our modes would not take
skewed courses. Well, morality is a very elastic issue. Each one has his own definition
for it. There are no saints amongs us. Even accepting a pen or a paper weight is Bribe.
Then, what is wrong if it is a 5 star accommodation ? Well, the argument can go anylonger
like this. So, let us not try to Solve this nw- for it is impossible. But a good beginning
can be made to resolve it to some extent.
Dr C.S.N.Vittal,
Vijayawada, AP. |
01-03-2002
Dear Dr. Sanwar I think your simple idea of holding a true National CME where
sponsorship will be clearly laidout, facilitators (speakers/discussants) will be the best
teachers/true experts and participants actually in it to learn from each other as
colleagues not as teacher to student. We will have no office bearers only slaves and we
will discuss protocols for various diseases/ health issues which are of importance to our
practice of good medicine. We can even publish true unbiased recommedations and
scientifically argue out cases or or against certain practices. Are there any wonderful
people out there willing to participate in such an endeavour once in a year?! We coudl
travel IInd class in Winter hence keep cool and a local host could assist in arranging
simple accomodation using academic institutions as venues with simple working fare! Does
anyone dare to dream simple and ideally out there?
Dr Sanjiv Lewin,
Bangalore, Karnataka. |
03-03-2002
"Hypocrisy is the lubricant of society" As goes famous saying. Add
'association' too in this proverb and, lo, now you are at the crux of all the ills
surrounding us. Over the years people seem taking solace blaming system, politicians,
government, organizations etc. for all the ills surrounding them. So is the case with
pediatricians of our genre. Blaming IAP for all the malaises, unethical practices, and
misdeed of ours has become vogue. Moral values, ethics, and principles have become the
virtues of a bygone era. And when polity of the nation has discarded them, it'd be
preposterous to expect a handful of us-constituting the academy, to behave differently!
Remember friends; faultfinding is one of the easiest forms of unskilled labors, and when
you weigh the faults of others keep your fingers off the scale! Events of past few years
have numbed my sensibilities to some extent. No more debates and discussions like these
evoke great passions in me. Further, this is not a new phenomenon. Nor a new debate
altogether. We are having discussion on the matter for quite some time now- both in the
GBMs and Executive board meetings of the academy. Coming to the specific instance of
Bangalore Conference, the Organizing Secretary, Dr Jayoji Rao had to literally plead his
case before the EB to allow him to have his way to organize the event. However, it was
altogether a different story considering the mind-boggling extravaganza witnessed there.
All these issues like lavish spending on the brochures, erecting air-conditioned halls,
inadvertent meddling of pharmaceutical houses in the scientific programs etc were taken up
for the discussion at the Bangalore EBM. And believe me, more are in the offing at the
mid-year June meeting. But, at the same time, we must be prepared to accept this fact
that! today the liaison between pharmaceuticals and medical fraternity has reached to a
level where it is rather impossible to do away with this alliance. Whether one would like
it or not, the instances discussed in the debate are at the most be termed as trivial ones
considering the greater threat posed by the pharma world where they are seen intimidating
researchers who publish results unfriendly to them! In other words, even clinical trials
are now in danger of becoming commercial ventures. Then what is the remedy now? A mid path
approach is to be evolved. Accept the contribution, but use it judiciously for the
betterment of the section of the society, we all pretend to serve! And above all, be
always conscious of your integrity on self-examination, and of course, listen to your
conscience first. Forgive me friends to sound a bit clichéd!
Dr Vipin M
Vashishtha, Bijnor, UP. |
04-03-2002
Dear Dr Levin, You have my emphatic YES for the intent expressed. I am willing to
contribute in which ever way I can, I am willing to put extra hours to see this happen and
to show it happening will dispell many doubts. Many times I have worked out that if you
cut down on lavish expenses,you can hold a cme on delegate fee only, I can give the
details as well. Even if we start it on a smaller scale, let us do it. The only rigidity
will be that no delegate should accept any personal sponsorship. If there are takers I am
willing to do whatever extra is required of me to do this
Dr Sanwar Agrawal, Raipur, Chhattisgarh. |
04-03-2002
I recently attended a PALS course conducted by Jabalpur Medical college.The course
fee was 1000/-and duration was two day.What impressed me most was that this event did not
have a single sponser.The instructors were Pediatricians with busy practise in Nagpur
Mumabi pune.The lunch and breakefast were very simple and prepacked.The venue was the
department itself.The atmosphere was in contrast to the "Mela" like atmosphere
which I witnessed in a couple of National Conferences I attended.Though I have been never
involved in organising any CME programmes I feel these events can be organised without
obligations from the pharma companies.
Dr P Murthy,
Allahabad, UP. |
04-03-2002
Dr.Sanjiv Lewin, there one more colleague in me that you can count on.
Dr C.S.N.Vittal,
Vijayawada, AP. |
06-03-2002
I am glad that a good discussion has started on sponsorship by pharmaceuticals.
Unfortunately we have got used to sponsorship at various levels, be it monthly meetings or
conferences. There is a strong feeling amongst organisers, that unless a good and lavish
meal etc follows, attendence will be poor. Of late I have been noticing that if a talk is
not likely to be interesting, may be because the topic is being repeated, or the speaker
may not be good, attendance remains poor despite good food. So may be we should get
started with arranging meetings budgeted within collections from members and do have food,
but keep it simple (should be tasty). If some one wants to have a drink following a
meeting I am sure he would be willing to pay for it. This may lead to thin attendance, but
I am sure this will be for a short while. At national conferences reduction in numbers may
be a boon. Organising would be easier. I am sure if one was asked why he attended a
national ! conference, meeting friends and having a good time would come above learning.
If pharmaceutical sponsorship is stopped attendance at a national conference could drop
from 4000+ to 1000+, and we may have to pay more, but then we can have conferences at
smaller cities. I am sure my friend Sanwar has a workable strategy ready.
Dr Shankar Hegde ,
Bangalore , Gujarat. |
07-03-2002
The menace of "personal" sponsorships is now becoming very palpable.I do
agree that like minded people can implant a seedling for an effective solution that may
not be immediately forthcoming.Its true that small CMEs and Workshops are in sharp
contrast to our National Megaevents which are more like a Carnival than an academic
feast.I fail to understand that why year after year the Organizing Committe wants to swell
the number of delegates and boast of successful events.it may be good idea to raise the
delegates fees to really tempt the ones who are keen on the academic gains and not on the
pleasure aspects.Would it not be a fair idea to restrict the number of delegates (say may
be 2500 ) or so that we have more people inside tha halls rather than more in the foyers
and the lawns outside.This may be done on first come and first serve basis as is done in
many CMEs and Updates.The money saved can be utilized to send the Proceedings in forms of
abstracts and CDs on subs! idized rates to desirous IAP members.Just as a thought can it
not be made compulsory to accept all the fees directly from the delegates through a credit
card or cheques or even ask them to provide their PAN numbers?Post graduate students and
freshners may be exempted from these.
Dr Niranjan Shendurnikar
, Baroda , Gujarat. |
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