How is Bad Quality Promoted?

There are a variety of ways substandard, subtherapeutic and spurious drugs get promoted in the market. These are some of the ways and consumers need to watch out:

1)	By ignoring basic manufacturing requirements as indicated above, that is negligence, poor ethics and a "chalta hai" (will-do) attitude.
2)	By making drugs at the lower end of the tolerance limit allowed: A 500 mg paracetamol tablet would be passed in quality control if it has the active ingredient between 450 to 550 mg (plus/minus 10%). During its shelf life the 450 mg tablet's potency may decrease and may not act as desired.
3)	By inappropriate packing: for instance, water absorbing drugs like aspirin and ethambutol should be protected from high humidity during manufacture and storage during the entire life of the drug.
4)	By committing criminal acts like putting haldi powder (turmeric) for tetracycline or sugar pill for calcium lactate. They harm the patients by not acting at the time of need. Again careless manufacture in specially IV fluids and injections have been known to kill.
5)	By consciously putting unnecessary products in the market and claiming undue benefits for them. (This can happen with essential drugs also when companies claim benefits not warranted by scientific research). Some addictive substances like alcohol may be added in tonics, and the tonic as a whole is then claimed to be a stimulant. Or promoting substances that are sedatives but have the side-effect of increasing appetite; the drug is then marketed as an appetite stimulant.
6)	By trying to bribe drug and other officials, and succeeding in evading compliance of desirable manufacturing practices. Also trying to bribe/induce doctors to prescribe one's own products, by influencing medical college departments for favourable research reports, by denying the efficacy of cheaper and safer alternatives, bad quality is ultimately promoted in the system. Everybody loses in the process.
7)	By trying to come into the market for short-term purposes only: say, merely to fulfill an export order or a government order of, say, Rs. 10 crores. This can be done by loan licence manufacture and then disappearing (the so-called fly-by-night syndrome). Every manufacturer has an obligation to disclose sources and uses of funds, balance sheets, details about promoters and who is behind the company. In short, manufacturers need to be accountable to the public.

Drug Promotion: Unethical Methods

As pharmaceutical business is very profitable, it is hardly any wonder that pharmaceutical companies spend atleast 20 per cent of their sales revenue on promoting their products (10).

Drug promotion is carried out by means of heavy advertising, frequent visits to private medical practitioners by the medical representatives of pharmaceutical companies with literature on their drugs, free sample of drugs, and even blatant bribes like diaries, posters, calendars, pens, or other gifts, and sometimes also invitations to medical conferences held in five-star hotels with lavish meals and expensive give-aways. The companies also encourage articles in newspapers and magazines, television and radio programmes, release promotional materials as news stories about latest developments in medical field and sponsoring television programmes. Thus, drug promotion is a comprehensive attempt to influence health workers and the general public to suspend their critical judgment (11).

In developing countries, pharmaceutical companies engage in such aggressive marketing that there is a higher ratio of sales representatives to doctors, approximately one representative for every 7 doctors in Bangladesh; 1:4 in Tanzania; 1:3 in Nepal and Brazil, while in Britain it is only 1:18 (12). In the absence of objective information on new drugs, doctors in many Third World countries, are fully dependent on drug information supplied by the pharmaceutical companies. And owing to the profit-oriented nature of the drug companies, the information provided in its literature is bound to be in favour of the drug.