Business As Usual! IMA Makes NMC Swallow Pressure Pill

Barely three weeks after the NMC released the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023, last month trying to address concerns about corruption and conflicts of interest within the medical profession, vehement opposition from the Indian Medical Association (IMA) forced the NMC to withdraw it.

The NMC regulations made it mandatory for doctors to prescribe only generic medicine, which is cheaper but as effective as any other branded product. It also prohibited doctors and their families from receiving any gifts, travel facilities, hospitality, cash or monetary grants, consultancy fees or honorariums, as well as access to entertainment or recreation from pharmaceutical companies or their representatives, commercial healthcare establishments, medical device companies, or corporate hospitals under any pretext.

“Every RMP (Registered Medical Practitioner) should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets,” the NMC said.

The IMA, India’s largest association of medical doctors with more than 350,000 members, opposed the mandatory generic medicine clause, stating that less than 0.1 per cent of drugs manufactured in India are tested for quality, and hence, “prescribing drugs without assured quality would be detrimental to patient’s health.”

While the NMC justified the move by noting that generic medicines on average are 30% to 80% cheaper than branded ones, thereby improving access to quality care, doctors argued that this would lead to substitution by pharmacies, exposing patients to the risk of variation in the quality of generics.

Agreeing partially with the IMA’s stance, a drug manufacturer, who did not wish to be named, said, “I disagree with them that only 0.1 percent of drugs are tested for quality in India, but there is a concern in a few states where implementation of regulatory provisions is not robust.”

The NMC also stipulated, “RMPs should not be involved in any third-party educational activity like Continuing Professional Development, seminar, workshop, symposia, conference, etc., which involves direct or indirect sponsorships from pharmaceutical companies or the allied health sector. RMP should be aware of the conflict-of-interest situations that may arise.”

Many doctors, in their individual capacity, resented the prohibition from participating in events sponsored by pharmaceutical companies, saying that it would hamper their exposure and interaction with the industry.

Lacking Intent

Health activists and lawyers fighting cases of medical negligence have slammed the health ministry and the NMC for caving under pressure from the powerful doctors’ lobby.

When medical treatment in India is totally commercialized and when the whole ecosystem of patient care is corporatized, small measures like coming out with a regulation to mandate generic drug prescription by doctors was a farcical exercise, said Vikas Bajpai, Assistant Professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University.

“I will call it a propaganda strategy of the government to show its pro-poor face, but in reality, it is always pro-corporate. If the government really wants to change something, there are a whole lot of initiatives required in the government healthcare sector,” Bajpai said.

“The argument that generic drugs are not regulated doesn’t hold any ground because all drugs manufactured in India are regulated by the same law. Even branded drugs have caused issues abroad recently,” he added.

Another senior health professional, working with a government hospital, agrees with Bajpai. If the government was indeed serious about enforcing the new regulation, it shouldn’t have succumbed to such pressure tactics, he said, on condition of anonymity.

“In government hospitals, we prescribe generic medicines. Do patients not recover from illness? It looks like the health ministry was aware that the regulation would come under challenge from the doctors’ lobby, and they immediately put it on the back burner,” he added.

Generic medicines are widely recognized for their affordability and ability to ease the financial burden on patients. “Physicians have an obligation to prioritize the best interests of their patients. Opposing a law that promotes generic medicines raises ethical concerns, as it might appear to place financial interests ahead of patient welfare, undermining the principles that guide medical practice,” said Sachin Jain, a Delhi High Court lawyer, who has been fighting several medical negligence cases.

Instead of opposing, the IMA should have used the opportunity to inform both doctors and patients about the advantages and safety of generic medicines, he added.

Health activists said that despite the potential influence of pharmaceutical companies or financial incentives, the IMA’s opposition raises concerns about corruption and conflicts of interest within the medical community.

“To restore the ever-eroding public confidence in the medical community, it is imperative that the association reconsider its stance and prioritize the principles that define the noble profession of medicine,” Pankaj Jain, a health activist, said.

“By resisting this regulation, the medical association could inadvertently obstruct efforts to make healthcare more accessible to a larger section of the population. It is all the more shocking to witness how the NMC has succumbed to the IMA pressure and withdrawn the regulation,” he added.

Mute Spectator

The corporatization of healthcare services in India has adversely impacted affordable medical treatment and the government has remained a mute spectator, activists say.

The most recent instance is the healthcare facilities offered during the COVID-19 period. When hospitals began charging exorbitant fees in Delhi and the National Capital Region, the government stepped in and fixed charges for hospitalization based on various categories of beds. But none followed these norms because there was no grievance redressal mechanism put in place. “If a hospital doesn’t adhere to these norms, where will a patient complain?” asked Jain, whose petition before the Supreme Court is still pending.

“Covid has gone, but my petition is still pending. The court had issued notice and the health ministry didn’t come up with any workable suggestions. The matter didn’t come up for hearing for a long time,” Jain said.

Lawyers dealing with healthcare cases say that all big hospitals like Apollo, Fortis, and MAX have got land from the government on concession and they are supposed to treat economically poor patients free of cost, but they don’t do it.

Cases of medical negligence against doctors at top hospitals go unnoticed as the health ministry has failed to abide by the judgment of the Supreme Court in the Jacob Mathew case. The top court had asked the government to work out plans to deal with medical negligence cases in 2005, but nothing has been done even after 18 years.

“In India, private hospitals are running to make profits, just like private companies. Foreign investors and firms have made huge investments. They have a nexus with big pharma companies,” advocate Ashok Aggarwal, a well-known health activist, said.

“The government has failed to build up the public hospitals to that level in terms of numbers and facilities offered. Private hospitals are so big that they can influence any decision of the government.”

As for the IMA, it is business as usual.

(Prakash Sharma is a New Delhi-based independent journalist. Views expressed are personal)