Taking any money as referral can land you in trouble!
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Not Long ago, Punjab Medical council had sent show-cause notices to 10 practitioners working there, after their IT-returns showed them to have received Financial funds from well-placed pharmaceutical companies. Speaking to BMJ on the issue, Dr GS Grewal narrated that the council began investigating 164 doctors for being "ghost faculty," a term for doctors who misrepresent themselves as full time teaching staff at medical colleges, in return for a payment. While scrutinising the tax statements of these 164 doctors, Grewal said, the Punjab council had identified 10 who had received funds directly from pharmaceutical and allied companies.
In short while looking into an altogether different issue, PMC found these 10 doctors taking money from pharma companies and began their proceedings starting with a show-cause notice.
As identified by BMJ, the show cause notice named 21 companies, including Merck, MSD Pharmaceuticals, Sanofi India, Bayer Zydus Pharma, and Novartis Healthcare and the India based companies Glenmark Pharmaceuticals, Ranbaxy Laboratories (now a part of Sun Pharmaceuticals), Intas Pharmaceuticals, Eris Life Sciences, and Lupin. The notice also named three cord blood banking companies and two insurance third party administrators which had done transactions with these doctors.
While many of the pharma companies didn't answer to BMJ, variety of reasons came up for the said transactions, some of them including
With the investigations still pending, Medical Dialogues asked a few Presidents of State Medical Councils on what is rightful under the circumstances
When asked about the legality of such transactions, Dr Jaishree Sharma, President, Himachal Pradesh Medical Council said, "If a doctor is found taking money as referrals, it is equivalent to corruption charges under the INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002. If found guilty, it may lead to suspension or even cancellation of the medical practitioner's licence.
Dr. Kishore Taori, President Maharashtra Medical Council cited that taking sponsorship deals with chap-6.8. of INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002(modified again in 2009) which clearly says that
"6.8 Code of conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry.
6.8.1 In dealing with Pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:-
a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives.
b) Travel facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship , cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc as a delegate.
c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.
d) Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.
e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii) will be an imperative for undertaking any research assignment / project funded by industry – for being proper and ethical. Thus, in accepting such a position a medical practitioner shall:-
(i) Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities.
(ii) Ensure that such a research project(s) has the clearance of national/ state / institutional ethics committees / bodies.
(iii) Ensure that it fulfils all the legal requirements prescribed for medical research.
(iv) Ensure that the source and amount of funding is publicly disclosed at the beginning itself.
(v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project(s).
(vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way.
(vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document / agreement for any such assignment.
f) Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never be any compromise either with his / her own professional autonomy and / or with the autonomy and freedom of the medical institution.
g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always:
(i) Ensure that his professional integrity and freedom are maintained.
(ii) Ensure that patients interest are not compromised in any way.
(iii) Ensure that such affiliations are within the law.
(iv) Ensure that such affiliations / employments are fully transparent and disclosed.
h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way".
Dr Taori highlighted that its important that medical practitioners should be aware about these codes to avoid any trouble.
You can get a copy of the INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002 by clicking on the link below
Ethics Regulations-2002
In short while looking into an altogether different issue, PMC found these 10 doctors taking money from pharma companies and began their proceedings starting with a show-cause notice.
As identified by BMJ, the show cause notice named 21 companies, including Merck, MSD Pharmaceuticals, Sanofi India, Bayer Zydus Pharma, and Novartis Healthcare and the India based companies Glenmark Pharmaceuticals, Ranbaxy Laboratories (now a part of Sun Pharmaceuticals), Intas Pharmaceuticals, Eris Life Sciences, and Lupin. The notice also named three cord blood banking companies and two insurance third party administrators which had done transactions with these doctors.
While many of the pharma companies didn't answer to BMJ, variety of reasons came up for the said transactions, some of them including
- Finances received on account CME's or continual medical education or a conference
- Finances received for performing clinical studies
- Finances received for performing market surveys for the pharma cos.
- Money received as a proprietor of a hospital/institution performing the CME or conference
- Money review from Cryobanks on account of professional fee harvesting stem cells from the umbilical cords
With the investigations still pending, Medical Dialogues asked a few Presidents of State Medical Councils on what is rightful under the circumstances
When asked about the legality of such transactions, Dr Jaishree Sharma, President, Himachal Pradesh Medical Council said, "If a doctor is found taking money as referrals, it is equivalent to corruption charges under the INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002. If found guilty, it may lead to suspension or even cancellation of the medical practitioner's licence.
Dr. Kishore Taori, President Maharashtra Medical Council cited that taking sponsorship deals with chap-6.8. of INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002(modified again in 2009) which clearly says that
"6.8 Code of conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry.
6.8.1 In dealing with Pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:-
a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives.
b) Travel facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship , cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc as a delegate.
c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.
d) Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.
e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii) will be an imperative for undertaking any research assignment / project funded by industry – for being proper and ethical. Thus, in accepting such a position a medical practitioner shall:-
(i) Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities.
(ii) Ensure that such a research project(s) has the clearance of national/ state / institutional ethics committees / bodies.
(iii) Ensure that it fulfils all the legal requirements prescribed for medical research.
(iv) Ensure that the source and amount of funding is publicly disclosed at the beginning itself.
(v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project(s).
(vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way.
(vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document / agreement for any such assignment.
f) Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never be any compromise either with his / her own professional autonomy and / or with the autonomy and freedom of the medical institution.
g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always:
(i) Ensure that his professional integrity and freedom are maintained.
(ii) Ensure that patients interest are not compromised in any way.
(iii) Ensure that such affiliations are within the law.
(iv) Ensure that such affiliations / employments are fully transparent and disclosed.
h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way".
Dr Taori highlighted that its important that medical practitioners should be aware about these codes to avoid any trouble.
You can get a copy of the INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002 by clicking on the link below
Ethics Regulations-2002
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