26 Flattery dulls the intellect

The Fox and the Crow: A fox noticed a crow sittingon a tree holding a piece of cheese in her beak. The fox thought of a plan to get the cheese. He praised the crow's beauty in great detail and flattered her. He told her, "If only your voice is as noteworthy as your looks, you will be the queen of birds.” The crow wanted to show the fox that her voice was sweet and opened her beak to caw. The cheese fell down. The fox snatched it and told the crow, "You have some voice. What you need is some brain."

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Advertising is the Fox of today. Advertising aims at the heart to cultivate positive feelings and tries to bypass critical cerebral faculties like logic, scepticism and judgement. Humourist Stephen Leacock has said, "Advertising is the art of arresting human intelligence long enough to make money outof it."

Does advertising really work? Frank Simoes, an advertising professional, considers it an asinine question. He has quoted the example of a highly successful Indian campaign of the 70's to promote a bust developer. It was a metal and spring device that needed strenuous effort, high pain tolerance and intense will power to make its wonders work. But the advertisements showing Before (pity!) and After(oomph!) pictures of female busts worked like magic. Thousands of women from all over India rushed mail orders. It was a resounding testament to the triumph of hope over reason (Simoes F, 1993). The silent sufferers ensured that the truth of the matter remained unknown for long (see ‘The Silent Sufferer’ in Chapter9).

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We should realise that the ethical dimension in health care advertising is different. In consumer goods, the target of advertising and the consumers of the products are the same. In contrast, the target in health care is the health professional but the consumer who pays the bill is his/her client. Can we then permit no-holds-barred promotional efforts aimed at the health profession while the consequences of such unbridled promotion are faced by unsuspecting health care seekers?

Do not think, "It is peanuts.” Allopathic drug industry spends roughly 20% of its sales income on promotional efforts. It is about ten times more than what is spent on research and development! Currently, the annual sale of the allopathic drug industry is over Rs 6,000 crores. If Rs 1,200 crores are spent in promoting drugs to about 500,000 (allopathic) health professionals, it amounts to Rs 24,000 per person. In other words, an average doctor is a target of Rs 2000 worth of promotional efforts every month and in return, prescribes drugs worth Rs 10,000 to his/her patients!

Though most health professionals believe that promotional efforts do not influence them, the sales professionals know better. Analysis of the top selling drugs of 1993 reveal that 22 of the top 100 drugs are nonessential. Most of them do not find a place in any text book or unbiased scientific literature. Yet, the total sales of these 22 drugs amount to nearly Rs 300 crores! It is entirely due seductive promotional pressure exerted on the prescribers by overt and covert means. 'No raindrop feels responsible for the deluge' and no doctor feels responsible for such a colossal waste of the society's resources. But it is a matter of collective shame. Three hundred well-equipped health centres could have been created with the money wasted on the top 22 non-essential drugs every year!

Ayurvedic drugs used to be sugar coated and were successfully marketed as pseudoallopathic or 'allovedic' drugs. Such remedies were enthusiastically prescribed by many allopathic doctors who knew next to nothing about the innumerable ingredients in each of those formulations. Under sustained promotional pressure, these drugs worth crores of rupees were prescribed while the drug regulatory agencies and Medical councils looked the other way. In 1996, the Supreme Court had to drive some sense into the minds of practitioners by declaring such cross-practice illegal (see Chapter15).

In the hard hitting book 'Deception by design', Joel Lexchin (1995) raises the query

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"How does the industry promote?” He goes on to answer it thus: "By using too many detailers with too little knowledge, by dumping 'free samples', by raising the sale-price, by offering bribes euphemistically called gifts, dinners, travel, etc., and by conducting bogus clinical trials and biased conferences."

Similar aggressive promotion is targeted directly at the public while pushing the sales of irrational over-the-counter remedies. I know of people who wished to "energise themselves with glucose" but ended with impaired glucose tolerance (an early precursor to diabetes).

Self-regulation by any for-profit industry is a myth or a mirage. Andy Chetley, in his foreword to 'Deception by design', has this to say: 'If someone proposed that those charged with a crime could form a committee of judges, enlist colleagues and good friends as lawyers and jury to hear the case and pass sentence, we would dismiss the idea as too ridiculous for words. Yet the world's pharmaceutical industry offers just such a solution to the problem of inappropriate drug promotion.'

Wasteful misuse of nonessential drugs will reduce only if all the four stakeholders act in harmony.

   robot'. 

The governmental decisions should be people oriented and consumer friendly. The public should not be gullible but be enlightened and realistic. The health professional should be ethical and rational and not a 'pill-peddling

The industry should be value based and non-exploitative.

Among the stakeholders, the role of professional groups is perhaps the most crucial. The Indian Academy of Paediatrics has shown the way for other professional groups by its two successful campaigns on oral rehydration therapy (ORT) and breast milk, and by its successful fight against unethical milk food promotion. Every Indian should applaud these collective actions taken by the child-specialists over the past two decades.

 When will the other professional bodies grow up and get out of their "5-star cradles" sponsored by the industry?

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 When will they show concern for people's welfare and tell the unethical promoters 'enough is enough'?  They can do it if they place their conscience before comfort and their hearts before their stomachs.  They can do it if they stopped being such 'gullible crows' and 'feeding the clever foxes' with their prescriptions.  But do they have the conviction and collective will-power?

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