Chapter 4: Drug Marketing

Examples of unethical practices in India include (20):

*	Glaxo Laboratories cited the authority of a British medical journal, the Lancet to promote its sales of Ostocalcium B-12 even though there was no such endorsement of the product in the Lancet.
*	Boehringer-Knoll quoted UNICEF and used their logo to promote the use of streptomycin-chloramphenicol combination for diarrhoea treatment, whereas UNICEF promotes simple ORT for most diarrhoea.
*	Franco-Indian Laboratories misquoted Goodman and Gilman to promote their tonic, whereas Vitamin B-12 has no role in ordinary anaemia.
*	S.G. Chemicals (Indian subsidiary of Ciba-Geigy) misquoted Goodman and Gilman and Martindale to promote a combination of two dangerous drugs analgin and oxyphenbutazone, whereas in fact the texts warn against this dangerous combination.

There also exists double standards in the information given on drugs by MNCs in the developed and developing countries. In the developing countries, warnings about the side-effects or contraindications are not given; drugs are recommended when their efficacy is not proven and even when its safety is not established fully. For instance, oral contraceptive drugs are not recommended in U.S.A. and Britain for premenstrual tension, menstrual cramps, menopausal problems and in dysfunction of the female reproductive system. The drugs' side effects include blood vessel inflammation, blood clot formation, and the exacerbation of certain pre-existing forms of cancer. Liver changes have known to occur in some cases. Women with a history of blood-vessel, heart or kidney disease should not use these drugs. However, labeling for these products are not consistent in all the countries where they are marketed.

Labels of drugs marketed in USA and Britain indicate their use only for contraception. While in Africa and South East Asia, they are marketed for other uses mentioned earlier (21).

The situation assumes menacing proportions when the manufacture, import, distribution and sale of drugs continue in our country although they are banned, withdrawn or restricted in other countries, including the country of the parent company in the case of MNCs. Despite knowledge of the ban, many pharmaceutical companies continue to market the banned drug, making false claims regarding their safety and efficacy. For example, the ban order on estrogen-progesterone drugs was challenged by certain drug companies and a stay was obtained in 1982 on technical grounds. Anabolic steroids were marketed as appetite stimulants for growing children in the developing countries. Drugs which have a sizeable stake in our country are not marketed by MNCs in their countries, e.g. cough expectorant, pain killers, growth tonics, appetite stimulants and anti-inflammatories containing phenyl- and oxyphenbutazone. Another such drug that has now acquired some notoriety is analgin and analgin-based drugs like Novalgin, Baralgan, etc. It is banned in Germany, parent country of Hoecsht, and in several countries of the West but marketed in India (Baralgan has since been banned in India by an order of the Supreme Court).

About 80 to 90 per cent of the output of some major MNCs in India consists of simple household remedies like cough syrups and vitamin preparations. But life-saving drugs account for only 30 per cent of the total value of the formulations sold by these companies.

Comparative Contribution of Different Sectors in Production of Different Therapeutic Groups (For Top 120 products) in Rs crores
		Total	Foreign	Indian
			Sector %	Sector %
1.	Total turnover	1357.97
	(for top 120 products)
2.	Essential Drugs
	2.1 Cardiovascular	21.93	29.60	70.40
	2.2Antibiotics	383.22	39.75	60.25
	2.3 Anti Bacterial	107.79	0	100.00
	2.4 Anti T.B.	62.21	12.68	87.32
	2.5 Anti Parasitic	23.56	29.00	71.00
3.	Simple Remedies, Vitamins, cough syrups, etc.
	3.1 Rubs & Balms	26.22	74.08	25.92
	3.2 Cough & Cold Prep	58.90	77.78	22.22
	3.3 Gen. Nutrients	26.45	100.00	0
	3.4 Vitamins & Minerals	117.22	100.00	0
	3.5 Topical Ointments	53.25	100.00	0
	3.6 Anti Inflammatory & Analgesic	110.96	81.94	18.06
* Criteria for essentiality is a rough iteration Source: Calculated from ORG Retail Survey, Dec.1992 From: Sengupta, Amit. "Dangerous Prescription", Frontline, Oct.21, 1994.

Consider the following facts that further show the dubious quality and promotional methods of major drug companies in India:

*	According to a survey conducted in 1980, out of 218 samples of drugs tested, 135 which were founded to be sub-standard were manufactured by MNCs (22). This disproves the propaganda that MNCs guarantee high-quality products.
	MNCs oppose the use of generic names as consumers prefer to purchase well-known brands because they are assured of good quality of the drugs particularly those produced by MNCs. MNCs proudly contend they maintain stringent quality control measures for the production of drugs. However the following instances belie their claims:
*	In 1993, Abbott laboratories was charged because the iron content in its product, Vidaylin-M, was less than the stipulated amount.
*	Wyeth Laboratories was pulled up in 1992 for selling ampicillin capsules where the content of anhydrous ampicillin was less than the limits specified by the Indian Pharmacopoeia.