These 'inducements' are treated as 'post-manufacturing expenses' (PME) and are allowed for above-the-line deductions in the company's books of accounts for the purpose of calculating the profit-before-tax (PBT). The pharma industry barons have pleaded for self- regulation to ensure implementation of the proposed code of ethics and keep the government informed about it.

The confession of the drug industry to unethical practices before the government (read the department of drugs and pharmaceuticals) was not the result of any soul searching or sudden pricks of conscience. It was inevitable after the world physicians' congress in Delhi condemned these practices in India before a full house and said it was up to Indian medical practitioners or their representative body, the Indian Medical Association (IMA), and the industry to address the ethical issue. Some of the eminent doctors and researchers at the All-India Institute of Medical Sciences (AIIMS) and the Indian council for Medical Research (ICMR) raised the matter with the government. This brought the industry at the door step of the government to prevent an official regulation to prevent such practices and the use of the drug price control order (DPCO) to curb the prices of essential prescription drugs as well as to invite action from the income-tax department.

The industry was represented by almost all its constituents. They include the Organisation of Pharmaceutical Producers of India, usually seen as a foreign (MNC) drug lobby, Indian Drugs Manufacturers' Association (IDMA) and Indian Pharmaceutical Alliance. To impress upon the government, the industry representatives went fully prepared with a draft code which sought to curtail such unethical marketing and sales promotions practices as giving personal gifts, cash awards and other goodies and full-expense paid junkets at home and abroad to doctors and their families. However, the proposed code of ethics does not prevent a company from sponsoring physicians and health administrators to international scientific conferences. It also does not seek to prevent a host of other questionable practices, including bribing doctors for clinical tests on ignorant patients and 'test-marketing' of such drugs which have not been declared 'safe' by the drug administration of their respective countries of origin.

Ironically, IMA too has done little to discipline it members against rising corruption and malpractices being indulged in by many by compromising their own code of ethics for money. The increasing greed for money and crave for high lifestyle made many doctors dump professional ethics and fall prey to various lures from drug producers and those private businessmen who are associated with the multi-billion-rupee healthcare industry. The nexus between doctors and promoters of private hospitals, nursing homes, clinics and health-check centres and suppliers of self-help medical instruments for patients suffering from diabetes and hypertension has become a nationwide social disease making a mockery of the government's oft-repeated pledge to provide healthcare to all. Ironically, neither the union and state governments nor the health insurance companies, wherever applicable, are playing their respective roles in the society as they do in advanced countries to check unethical medical practices and profiteering by dishonest drug firms and hospitals.

While the medical administration in most government hospitals and health centres has hit its nadir, private healthcare establishments are a rip-off. Both are unreliable. Neither the institutions nor the doctors take responsibility for their actions or inactions. Government hospitals are generally quick in writing death certificates for 'indoor' patients. Privately-run healthcare units would drag on treatment as long as a patient can afford to pay for it and collect the charges of hospitalisation in full before sending the dying one home to avoid writing a death certificate. The latter is justified on the ground that relatives of the dead do not, in many cases, clear the hospital dues, if any, after the patient breathes his last. Under the existing law, the hospital authorities can't detain a dead body for non-payment of dues. Either way, doctors are often willing guinea-pigs of the system. Few will disagree that most the private hospitals and healthcare centres are a disgrace to the society.

Yet, every cloud has a silver lining. In Kolkata, the fight against the malpractices in the private sector healthcare business is being spearheaded by no other than a private entrepreneur of a well-known hospital group, Anandlok, which offers top quality treatment and low-cost hospitalisation option to all. It openly displays the costs of treatment and hospitalisation outside the entrance of the hospital so that a patient is not duped or overcharged. A first class ICU bed at Anandlok costs as little as Rs. 75 per day. It charges only Rs. 10 for eye tests and Rs. 2 each for treatment of TB patients. It has created a history of sorts by offering heart by-pass surgery package at as low as Rs. 65,000, probably the lowest charged by any hospital in the country, while other hospitals charge between Rs. 2.5 lakhs and Rs. 3 lakhs. It undertakes 1,200-1,500 by-pass surgeries every year. Anandlok is a general hospital. It operates at full capacity. The hospital management has approached the state government for additional land at Rajarhat on the north-eastern fringe of the city, where the Tatas are building a giant cancer hospital.

For Deo Kumar Saraf, Anandlok promoter, the hospital has provided a launch pad to begin a crusade against exploitation of financially-challenged ailing public as well as robbing health insurers and the insured by the nexus. “Our services are not subsidized. Nor do we beg or borrow. Our charges are normal, non-exploitative. Our doctors and staff members are happy and dedicated to their respective jobs. We make reasonable surplus and not big profits,” Saraf boasts. He wants the educated section of the public and the government to wake up and fight against the corruption and malpractices surrounding the healthcare industry today.

Unfortunately, Saraf's wake-up call is yet to move the society and open the eyes of the government, our law makers and the educated public. The healthcare industry, of which the manufacturing and supply of live saving drugs and pharmaceuticals form an integral part, remains practically among the most unregulated sectors of economy despite the existence of several on-paper official inspection and control mechanisms. There are very few Sarafs in the business. And, such Sarafs are invariably hated by industry, private medical practitioners and even a section of the government, who form the nexus. (IPA Service)