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Pingali Venugopal and Sravan Pingali

A Framework for Responsible Medical Detailing in India

Healthcare expenditure increasing around 3-6% annually is expected to reach $1.9 trillion by 2027 globally. India with an above average volume and expenditure growth is expected to grow at 10% by volume and over 30% by expenditure between 2023 and 2027. With the introduction of newer treatments, Oncology with 13-16% growth is forecasted to have the highest healthcare spending. Pharma companies and doctors, the main service providers in this sector, play a vital role in the well-being of the society. While both co-exist, the pharma companies interested in maximizing shareholder value focus on pushing their brands and on the other hand the doctors need to prescribe drugs considering the patient’s condition. This duality in objectives could lead to a “problematic relationship” between the pharma companies and doctors creating a conflict situation wherein the professional judgement concerning the patients’ welfare could be “overshadowed by secondary interests like financial gain”. This problem would be higher in highly competitive “generic drug markets” like India. Though detailing is a good source of information for the doctors, studies however believe that such interactions could unduly influence the prescription in favour of the companies. Studies also show that innovative ways are being devised to incentivise doctors. While Pharma industry is governed by several regulations for the production and advertising of drugs, the medical representatives have only clause 4.3, of the “Uniform Code for Pharmaceuticals Marketing Practices”, Department of Pharmaceuticals, Government of India, which only restricts the use of unethical practices to get access to a healthcare professional and nothing beyond. So, the detailing and sales promotion tactics that pharma companies adopt raise concerns. Overtime, this has led to a situation where consumers not only question the ethics of pharma companies, but also are sceptical about doctors’ motives behind prescribing certain drugs. In this context, it is important for companies to redefine their detailing strategies for not only providing functional and technical information on a product's potential uses, benefits, side/adverse effects etc, but also help build a long-term trustworthy commitment with the doctors and help ensure a disease-free society. By conducting a detailed literature analysis of detailing, relationship and commitment, this research conducted a qualitative study with pharma company executives to understand their role in marketing drugs. Based on the findings, the research developed a framework for responsible medical detailing, wherein detailing is going beyond its objective of a “win” situation (increase prescriptions), to a “win-win-win” situation (win for company, doctor and patient). Here the objective is not only to ensure a two-way bond (commitment) between the doctors and the company for regular knowledge updation but also help in identifying new solutions to help build a healthier society. The framework for “Responsible Medical Detailing” would help increase long term shareholder value for companies, enhance the patient’s trust on the doctors and increase their “hope” for a healthier life.