At a meeting on developing the pharmaceutical industry at the end of the last week Prime Minister Vladimir Putin emphasised that Russian doctors should not be paid for promoting medicines or lobbying for the interests of pharmaceutical companies. Doctors and pharmacists are now scared by what a new "doctors' plot" could mean for them. In their opinion, lobbying is not prospering in hospitals and outpatient clinics but in the offices of those officials who compile lists of discounted medicines and treatment standards.
"We cannot tolerate a situation where pharmaceutical concerns pay bonuses to medics for prescribing the medicines they produce," Putin said at the meeting.
He noted that "an obviously abnormal practice in relations between the drug producers, including foreign ones, and a part of the medical community" has developed in Russia in the past decade.
"It goes without saying that pharmaceutical companies have the right to promote their products but they ought to do this in a civilised manner and in full conformity with universally recognised ethical norms and Russian law," Putin said. He noted that drug producers "are sponsoring corporate events and all kinds of seminars, some of which are held at warm seaside resorts". "Thousands of specialists in Russia take part in such events; multi-tiered systems of lobbying for the interests of major pharmaceutical companies are in the process of being created or have already been established. This vicious practice has to be stopped," Putin said.
"We need to impose a legal ban on this income and to introduce tougher standards of medical ethics. I hope the medical community will heed this," Putin said. In his opinion "medical institutions should get rid of those so-called pharmaceutical representatives". "In Russia this institution of pharmaceutical representatives sometimes goes awry. To begin with, this activity should be limited and made more transparent." He added that "expert councils on new drugs should not include specialists who receive money from those who produce these drugs."
"These are very sensitive issues. Domestic and foreign drug producers are very subtle when defending their interests. They quickly attract the agencies they need to their side, find support and set up all kinds of committees," he said.
Putin emphasized that to protect the interests of Russian citizens it is necessary to "be guided by national rather than corporate interests." "As for civilised dialogue between the medical community and pharmaceutical companies, a special market council can be established for this purpose modeled on similar agencies in the energy sector or other areas of the economy," Putin advised.
Doctors believe that a new "doctors' plot" is not prompted by concern about the health of patients alone. A ban on lobbying is sooner linked with the desire to increase the share of domestic medicines from its current 20% to 50% by 2020. Chief nephrologist of the Leningrad Region Sergei Borovoy observed: "If we exclude dubious food supplements, a ban on the promotion of new drugs is pointless and will do more harm than good." In his opinion potential restriction of imported drugs will make no sense if they prove more effective than their domestic counterparts.
Pavel Vorobyev, deputy chairman of the Formulary Committee of the Russian Academy of Medical Sciences, observes: "If the government regulates its own market properly and removes dubious placebo drugs from it, pharmacists no longer have any motivation for paying doctors extra. For the time being officially endorsed lists of subsidised or vitally needed drugs contain dozens of dubious preparations."
"There should be no bribery on the pharmaceutical market. Doctors ought to receive unbiased information about the properties of all accessible medicines but there should be no lobbying in outlining treatment standards. Organisations endorsing these standards should not lobby for pharmaceutical companies. I hope the national medical chamber that Russia is setting up will protect patients' rights and make the entire way drugs move from their producers to patients transparent," Leonid Roshal, chairman of the Public Chamber's Commission on Healthcare, said.
Experts emphasise that in practice it will be very difficult to carry out Putin's wish. Ivan Danilov, editor of the pharmaceutical website Pharm-MedExpert.ru, said: "There is no way of distinguishing lobbying from a doctor's honest recommendations. This issue entirely depends on the doctor's conscience. Practice shows that the vast number of doctors in this country have either been engaged by medical companies or influenced by them. Prices for drugs are constantly rising and their sales continue to yield additional profits. Even the introduction of sanctions for such violations is unlikely to change much."
As before, Russian doctors do not make much money and it is difficult for them to turn down additional sources of income, useful medical literature or sponsor support for a trip to an international congress. "Working with doctors is an inevitable part of the activities of pharmaceutical companies and they will not give it up even under the threat of serious government sanctions," Danilov concluded.
For all that the Russian market remains very attractive for foreign producers even despite the crisis. Nastasya Ivanova, director of the National Distributor Company, said on this score: "In 2006 the Russian pharmaceutical market registered significant growth of 30% and became particularly attractive for foreign investors. Nothing has changed in practice since then except for the evening out of the growth rates which were approaching global growth rates and grew by another 5% to 10% per year. Foreign investors are well aware that the Russian market has a great potential capacity because per capita medicine consumption is much less in value terms than in other countries."
"A ban on lobbying is not limited to concern for patients' health. It is also aimed at protecting domestic producers and restricting imports. But the main reason lies in very low purchases of domestic medicines at government auctions. The authorities are concerned that healthcare organisations are not interested in purchasing domestic preparations. It is believed that the blame for this rests with major international companies, which have special budgets for developing relations with physicians. Doctors foster patients' demand for medicines, which is affecting the purchase of drugs by the state. As a result, only foreign producers win many auctions for the purchase of medicines under government programmes," Danilov concludes.
Mikhail Sergeyev
