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Disputing Distribution: Ethics and
Pharmaceuticals in Nepal
Nabin Rawal , Ian Harper and Madhusudan Subedi
Pharmaceutical Industry in Nepal
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$100 million per year in Nepal and increasing
Approx. 30% of the market Nepali products,
but still dominated by India
Over 45 Nepali companies
No export (as of yet)
The Context:
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On July 19th 2007, the Government of Nepal,
through its Department of Drug Administration
(DDA) released its Guidelines on Ethical Promotion
of Medicine
The objective of this guideline is to promote ethical
promotion of medicine to support and encourage
the improvement of healthcare through the rational
use of medicine and discourage unethical practices.
(Drug Bulletin of Nepal, “Ethical promotion of medicine: Benefit to consumers”,
2007)
The guideline dwells on a number of issues, for
instance:
- information to physicians and health related
professionals
- Information to general public
- Advertisments
- Company procedure and responsibilities
- Medical Representatives (MRs)
- Free sample of medicine for promotional purposes
- Symposia and other scientific meetings among
others
But what is interesting is that the issue of ‘bonus’ has
come to take center stage.
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Antecedents of the Guideline
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In 1988, WHO had published a concept on
Ethical Criteria for Medicinal Drug Promotion.
DDA commissioned a group of pharmacists to
conduct a study on the Promotional Practices
of Pharmaceuticals in Nepal.
With the consent from all the “stakeholders”,
DDA put the guideline into effect on Shrawan
3, 2064 (2007/07/19).
Guideline:
Claims and Counterclaims
Graduate Pharmaceuticals
Association of Nepal (GPAN)
The “Why” of the Guideline
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Wide variation in bonus scheme offered
(Offers ranged from 10 percent to 100
percent depending on the product)
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No offer system in sale of some product
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Conclusion: Business practices should meet
high standards of ethics and legal
compliance
Nepal Chemist and Druggist Association (NCDA)
The Guidelines on Ethical Promotion of Medicine 2007
should be abrogated (why??)
 Drawn up unilaterally
 Reduction in bonus must give way to reduction in
prices of the pharmaceuticals ( DDA in cahoots with
producers)
 Guidelines not in consonance with the context of the
country (Regulation of “unregulated” market with
paramedics expansion into this trade)
 DDA focused on “deal bonus” but did not attend to
other issues put forth by NCDA when the president
was called just before the guideline was to be issued
Nepal Medical and Sales Representative
Association (NMSRA)
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NMSRA should be registered in the DDA
Foreign companies distributing drugs in Nepal
should either open their office in Nepal or the
importer is made responsible on their behalf.
APPON and individual manufacturing
companies want to make our job less secure.
(uniformity in salaries and benefits)
Link between pay and sales levels rescinded
Association of Pharmaceutical Producers of
Nepal (APPON)
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Rise of competition gave way to rise of gifts and
bonuses
Regulatory mechanism of Nepali pharmaceutical
market is yet to be developed.
Different pharmaceutical producers--various
companies to be consulted before developing the
code of conduct for ethical marketing in Nepal.
“Deals” make it easy to compete—open border and
Indian companies offering bonus
We will abide by the government (less bonus means
the price in medicines will decrease)
Nepal Medical Association (NMA)
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Doctors not to blame for the anomalies
Giving calendars, pens, diary is widely
acceptable all over the world
Doctors and retailers not taking gifts but
pushed by the manufacturers
A body consisting of all “stakeholders” must
work to eliminate malpractices.
DDA has started a correct move
Nepal Medical Association (NMC)
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We are bound by our own Code of Ethics
DDA responsible body for quality control
APPON should ensure fair business within the
companies.
NMC ready to punish corrupt doctors if found
indulging in malpractices
Department of Drug Administration
(DDA)
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Guideline responsibility of the companies but
no action lead to DDA’s issuance of the
guideline to control anomalies in the market
Formation of a committee to look a the issue
of fixing of prices for 22 items
Bonus has been capped to 10-20 percent
upon the request of the producers
Some companies’ “under the table” activities
have discouraged companies adhering to the
code
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Currently, trying to curb “unethical”
promoting” in the form of bonus and
substitution
Importer- Onus on imported drugs
Currently, guidelines watered down on the
bonus issue at the expense of others.
Discussion
1.
Public welfare Vs Business (The
Paradox)
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“Ethics”—a relative positioning
3. Blame game rather than selfintrospection of ones practices
5. What is at stake—In the face of
emergent Nepali pharmaceutical
industry is it about struggle and
capture of generic market?
5. Different Actors different stances– How
then should regulation be undertaken?