Two doctors campaigning for ethics in healthcare have decried a pharma panel’s decision to only “reprimand” a firm for flying 30 Indian doctors to Monaco and Paris while recommending “action” against the doctors who had accepted the hospitality.

The doctors — a gynaecologist and an ophthalmologist — have said the decision by the Department of Pharmaceuticals (DoP) Apex Committee for Pharma Marketing Practices highlights the toothless code of marketing practices imposed on the industry and the lack of penalties for violators.

In a December 23 order, the DoP committee reprimanded Abbvie Healthcare India for “unethical marketing” but asked the National Medical Commission (NMC), the country’s apex medical regulator, to act against the 30 doctors who had accepted the travel and hospitality for breaching ethical regulations.

The committee, acting on an anonymous complaint to the DoP, found that Abbvie Healthcare had violated the uniform code for pharmaceuticals marketing practices (UCPMP) by funding travel and accommodation for 24 doctors to Monaco and six doctors to Paris in February-March2024.

The DoP’s UCPMP 2024, an updated version of a 2015 notification, prohibits gifts, travel, hospitality or other pecuniary benefits from pharmaceutical companies to doctors. But sections of doctors and patients’ rights advocates had earlier this year described the code as “toothless” because it is not mandatory.

"The December 23 order exposes double standard," said K.V. Babu, the ophthalmologist in Kannur, Kerala, and a founding member of the Association of Doctors for Ethics in Healthcare (ADEH). "We see voluntary guidelines for the pharma industry and enforceable rules for doctors for the same offence."

The ADEH and other patients' rights advocates have long argued that unethical marketing practices by pharmaceutical companies can influence doctors' prescription practices, at times imposing additional costs on patients and exposing them to medicines they do not require.

If the NMC decides to apply the rulebook on the doctors, Babu said, some or all of them may lose their licence to practise for at least a year.

The anonymous complaint received by the DoP alleged that Abbvie had provided travel tickets and hotel accommodation to the 30 doctors for "extravagant pleasure trips under the guise of a conference" connected to medical aesthetics and anti-ageing.

The supporting documents included Abbvie’s "internal records, featuring a sales and expense tracker, outlining the expenditures for each doctor’s travel and copies of flight tickets and hotel booking vouchers", the committee noted.

The total expenditure for the doctors’ trips amounted to ₹1,91,24,991 and represented an explicit contravention of the code’s provisions, it said. Abbvie claimed that it had entered into professional service agreements with the doctors to compensate them for their services, with the services defined as a "knowledge dissemination activity" in a manner required by Abbvie.

"There seems no justifiable reason for 30 healthcare professionals to journey to Monaco and Paris for this purpose, nor can any prudent person overlook the conclusion that such preferential treatment or largesse towards the healthcare professionals will not aid in promotion of Abbvie’s products, regardless of the terms of the agreement," the committee noted.

The committee said it had given an opportunity to Abbvie to take remedial action by supporting underprivileged patients in government hospitals for an amount equivalent to the violations. The firm was also given latitude to figure out mechanisms to provide such aid, whether financially or otherwise. But Abbvie "chose to reject" the committee’s offer.

"There is nothing surprising about this order. The UCPMP and the NMC rules taken together create a paradox-like situation," said Arun Gadre, the gynaecologist in Pune and another founding member of the ADEH. "We are not defending the doctors who accepted the trips. When two hands are caught in the same wrongdoing, both need to be penalised. But the UCPMP allows firms to be reprimanded, while the NMC can punish doctors with suspension of licences."

What action, if any, the NMC might take against the doctors remains unclear, the ADEH members said.

Muralidhar Venkiteswaran, professor of surgery at the Chettinad Medical College, Chennai, said pharma-sponsored trips and conferences for doctors were a "microscopic issue" and India's healthcare and medical ecosystem had much bigger challenges.

"A company-sponsored trip is unlikely to change the mind of a doctor," Venkiteswaran said. "A good doctor is likely to remain a good doctor, a bad doctor is likely to remain a bad doctor. A good doctor is one who will provide the best possible service or treatment, taking into account the context, resources and other circumstances, always with empathy for the patient."