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Pharmaceutical Industry in Pakistan: Unethical Pharmaceutical Marketing Practices

Authors:

Abstract

The focus of the study was to identify the unethical marketing practices in the pharmaceutical industry of Pakistan. Four different hypotheses were developed that were tested through Z –test, simple ANOVA, and F-test. This study indicates that the pharmaceutical industry were found to be the entity that has initiated unethical drug promotion practices in Pakistan with a mean of 3.63, followed by doctors with a mean of 2.36. However, doctors’ community is also responsible for the continuation of this practice. Qualitative analysis shows that foreign visits with a mean of 4.47 are more in demand and local visits being the second. The reasons for high preferences for local visits and foreign visits are that pharmaceutical industry could justify these expenses by linking it with the conference. Qualitative analysis also shows that majority of respondents’ of all the segments such as doctors, Pharmaceutical companies, hospitals, pharmacies, were strongly against drug promotion to the non-qualified doctors. However, despite their opinions it is a fact that the drugs are being promoted through non-qualified doctors. The majority of respondent are strongly in the favour of making some strong legislation against the unethical drug promotional practices in Pakistan. Although some legislation is already available but this research showed there is no implementation of that legislation, therefore, majority of respondent demanded that there must be strong legislation to stop this unethical drug promotion in Pakistan.
7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
“PHARMACEUTICAL INDUSTRY IN PAKISTAN:
UNETHICAL PHARMACEUTICAL MARKETING PRACTICES”
Rizwan Raheem Ahmed and Tariq Jalees
SZABIST
Karachi, Pakistan
Abstract:
The focus of the study was to identify the unethical
marketing practices in the pharmaceutical industry of
Pakistan.
In this context, the opinions of doctors, pharmaceutical
companies, government and private hospitals officials, and
pharmacies were obtained through focus group discussions
and closed ended questionnaire.
The samples size for the subject study was 120. As per
Sekaran (2003) for multivariate sampling a minimum of 20
samples per variable is required. Thus the appropriate
samples size should have been 80. However, to have a better
representation samples size of 120 was selected.
Four different hypotheses were developed that were tested
through Z –test, simple ANOVA, and F-test.
1.0.0 INTRODUCTION
Unethical marketing practices has become an essential part
of the pharmaceutical industry in Pakistan and it roots is so
strong that it may not be possible to reverse the same
[Parmar & Jalees, 2004]. However this previous study has a
limitation. It was a case study on pharmaceutically industry
in Hyderabad. In view of the findings of this study there
was a need to carry out the same on Pakistan basis. Thus this
report has been undertaken with this objective in mind.
The phenomenon of the unethical drug practices is common
worldwide but its severity is more deep rooted in developing
countries. Unethical drug practices have two dimensions.
One is drug related, and other is drug promotion related.
Extensive research on drug related unethical practices has
been carried out internationally. However, the author was
not able to find any empirical study on unethical drug
promotion practices except the one that was carried out by
[Parmar, Jalees, 2004]. Parmar and Jalees (2004) in their
study observed that pharmaceutical industry spends a
substantial portion of its budget on market research but do
not carry out the research on unethical drug promotion
practices. One of the reasons is that the industry itself is
indulged in this practice therefore it does not find any need
to carry out the research on this issue.
Lack of research on the subject does not mean that unethical
drug promotion practices do not exist. The pre-survey and
focus groups discussions indicate that unethical
pharmaceutical marketing practices have become an
acceptable norm of the pharmaceutical industry, and almost
all the pharmaceutical companies patronized these unethical
practices in collaboration with doctors, government and
private hospitals, health related agencies and pharmacies at
the cost of patients’ well being.
All the entities as discussed above appears to be corrupted,
therefore, it may not be fair to blame any one of them,
including pharmaceutical industry.
Doctors and other entities as discussed above have become
greedy, therefore, are vulnerable to Pharmaceutical industry
unethical drug promotion practices. Most of the conferences
and academic activities of doctors are sponsored by the
Pharmaceutical Industry; therefore, the industry uses the
forum to pursue its goals which at times may not be the
same as the purpose and objective of the conferences.
The focus of the subject study was to identify the intensity
and trends of unethical drug promotion practices in Pakistan.
Ascertaining the contribution of the doctors, health related
institutions and the pharmaceutical industry in promoting
such practices.
1.1.0 BACKGROUND OF THE STUDY
Unethical marketing practices have now an integral part of
drug promotion. Unethical practices could be classified into
two segments. One is related to the medical side of the drug
i.e. the trial of the drug both on animals and the human, and
registration of indications and patent period in different
countries.
The second aspect of unethical marketing practices of
pharmaceutical industry relates to drug promotion to the
doctors and health institutions. This unethical practice is
more severe in countries like Pakistan. The data on drug
related research is available in bulk, through out the world.
However, unethical drug promotion related research is
hardly available. One such study was undertaken by [Parmar
& Jalees, 2004], but it was focused to one city. Therefore,
there was a need to carry out the same on all Pakistan bases.
Hence the same has been undertaken.
1.2.0 LITERATURE SURVEY
The findings of the previous research indicates that
unethical pharmaceutical marketing practices have become
an acceptable norm of the pharmaceutical industry, and
almost all the pharmaceutical companies patronized these
unethical practices in collaboration with doctors,
government and private hospitals, health related agencies
and pharmacies at the cost of patients’ well being.
Zaidi, et.al, (1995) observed that in the 13th national
psychiatric conference held at Abbottabad in September
1999 nine papers were read by different doctors; however,
most of the papers were not on the subject issue but were
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7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
mainly focused on their experience of administrating
specific drugs to the patients. Incidentally, some of the
foreign guests thought that the conference was not on
psychiatric issue but it was more on the specific drug
promotion activity. Two inferences could be drawn from
this incidence. One, the doctors are so much involved in the
unethical drug practices that they did not realized what was
the objective of the conference. Second is that the doctors
did not spend considerable time for developing the
appropriate paper for the conference. (Zaidi, et.al, 1995)
“Drug companies use unscrupulous and unethical marketing
tactics not only to influence doctors to prescribe their
products but also subtly to persuade consumers that they
need them.” The findings are based on the marketing
practices of 20 of the world's biggest drug companies.
([Pogo et.al, 2006]. The report alleges that “Drug
companies are promoting their products through patients
groups, students and internet chatrooms to bypass the ban on
advertising except to doctors “([Pogo et.al, 2006]. The
authors also observed that the pharma companies offer
information to the public on "modern" lifestyle diseases,
such as stress and poor eating habits, with the prime
objective that people would ask their doctors for medicines.
[Pogo et.al, 2006]
Another study investigated the relationship between the
medical profession and the pharmaceutical industry. The
author while criticizing the pharma industry observed that
the industry is responsible for corrupting the medical
profession. The report further indicated that this disease is
not only common in the developed countries but the
developing countries are also practicing the same. [Zaidi
et.al, 1995]. The findings of the second study were similar.
The author pointed out that the industry is indulged in all
sort of unethical practices to influence the prescribing habits
of the doctors for which they are rewarded through various
ways. “These include joy rides for the physicians and their
families to picnic spots within the country and overseas,
provision of costly gifts, entertainment for the families at
five star hotels, sponsoring birthday parties, wedding
receptions besides furnishing the doctors homes and clinics.
Of late even allegations of providing cars on leasing have
also been reported”. [Zaidi et.al, 1995]
A research carried out in Nepal also observed that doctors
prescribe those medicines that are actively promoted by
medical representative. The authors observed that the
pharma company uses conferences and seminars for
entertaining doctor’s unethical demand of traveling, and
lodging etc. [Bishnu & Ravi, 2005]
“It is unethical for journals that publish reports on psycho-
Pharmacology to accept drug company money for anything.
And, I think it equally unethical that the American
Psychiatric Association allows Drug Company sponsored
symposia as part of its annual meetings.” [Fisher, Bryant &
Kent, 1993]
“All promotion by definition is information whose aim is to
market a product and as such has an inherent bias towards
showing the product in the best possible light. Globally, a
huge imbalance in the financial resources available for
promotional versus independent information exists. As a
result consumers and prescribers are generally subject to a
positive information bias: the benefits of medicine use tend
to be exaggerated, the risks downplayed.” [Lexchin, 1995]
Arun Phatak studies and concluded the drug industry [Arun,
1998], on the other hand, is profit-oriented and aims at
giving maximum benefit to share holders. The drug industry
is not bothered about consumers / patients otherwise the
market would not be flooded with irrational formulations. In
the US, it takes $9.4 million to develop a new drug and get it
approved. The only way this can be compensated for is by
aggressive promotion. An estimated 20 percent of
pharmaceutical companies’ budgets are spent on marketing;
of this money, 20 percent is spent on training and
maintaining medical representatives, 30 percent for
advertising in the scientific and lay media, and 50 percent
for special methods such as stalls at scientific meetings,
sponsored dinner meetings for invited doctors, and the
publication and distribution of books. [Arun, 1998]
Daniella, Zipkin & Michael studied the interaction between
pharmaceutical representatives and doctors in training
sessions [Daniella, Zipkin & Michael, 2005]. According to
them contact with pharmaceutical representatives was
common among residents. The majority of trainees felt that
the interactions were appropriate. A minority felt that their
own prescribing could be influenced by contact or gifts, but
were more likely to believe that others' prescribing could be
influenced. Resident prescribing was associated with
pharmaceutical representative visits and the availability of
samples. A variety of policy and educational interventions
appear to influence resident attitudes toward interactions
with industry, although data on the long-term effects of
these interventions are limited. Overall, residents reported
insufficient training in this area. [Daniella, Zipkin &
Michael, 2005]
[Parmar and Jalees, 2004] developed the distinctions
between ethical, and unethical drug promotions practices
based on the focus group discussions. “The acceptable
norms of promoting drugs through doctors are visiting them,
giving a presentation on the merits and demerits of the
drugs. Explicitly, pointing out the side effects of drugs,
giving nominal quantity of drugs sample. These gifts and
give away must not be highly expensive and restricted to
items such as dairies, calendar, year planner, etc.” [Parmar
and Jalees, 2004]
1.3.0 AN OVERVIEW OF PAKISTAN
PHARMACEUTICAL INDUSTRY
There are about 586 leading Nationals and Multinational
pharmaceutical companies operating in Pakistan. Of this
total 23 are multinationals and rests of companies are local
companies. The local companies could be classified into
three categories which are (1) Manufacturing units (2)
Importers that imports drugs in finished form, and (3)
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7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
Franchisers (not to be mixed up by the franchisors in the
FMCG). These are companies that have all the marketing
setup and facilities. These companies obtain the rights of
marketing of the drugs of other companies on profit sharing
basis. Total prevailing market size (December 2005) of the
industry is of Rs.73.11 billion. [IMS, Q3 & Q4, 2005]
The overall market dynamics are tilted in favour of national
companies as they are continuously launching new products
at a much faster rate than MNCs, a trend which is becoming
increasingly evident. In terms of new product market in
value, the sales contribution gap between multinational and
national companies has also increased over the last five
years. The products launched before 1991 are dominated by
the multinationals while after 1991 it is shifting towards the
national. However, the leading 20 products of the industry
are still those products which are launched by the MNCs
between 1970 and 1990. [IMS, Q3 & Q4, 2005]
The drugs prices of the national pharmaceutical companies
are cheaper, as they have choice of procuring the raw
material from those countries where it is available at a
cheaper rate. The other reason for the price differential is
that the national pharmaceutical industry does not invest in
research and development compare to multinationals.
Multinational companies invest a huge amount of their net
profit in R & D, therefore, when they introduce a new
molecule into the market they have already invested billion
of dollars for a new product, therefore, the price of the new
product keeps high in order to meet the total cost of the drug
in a certain time period because after patent period any
company can make its Me too or imitation at cheaper rate.
So, the national companies have twice leverage to set their
prices at the lower lever i.e. first they did not invest a single
penny on Research & Development and secondly they are
having cheaper raw material resources [Parmar & Jalees,
2004].
After partition, Pakistan did not inherit any industrial base.
Like other consumer items, Pakistan catered the drugs
demand through imports. The situation remained the same
up to 1960. In early sixties the multinational pharmaceutical
companies made heavy investment in Pakistan for setting up
pharmaceutical manufacturing units. National
pharmaceutical companies also got encouraged, and started
making capital investment during the same era. In 1985, the
market share of multinational and national pharmaceutical
industry was 65% and 35% respectively. The present market
share of national pharmaceutical industry is 59%. The
prevailing total market of the pharmaceutical industry is
estimated to be Rs. 57 billion. There are about 450
companies registered with the Ministry of Health. Of this
total about 350 manufacturing units are in operation,
including, 13 multinational pharmaceutical companies.
[IMS, Q3 & Q4, 2005]
1.4.0 STATEMENT OF THE PROBLEM
Is unethical drug promotion practice is common in Pakistan?
Who initiated unethical drug promotion practice in
Pakistan? Who is responsible for the continuation of the
same?
2.0.0. METHODOLOGY
The following methodology was adopted for achieving the
objectives of the study:
2.1.0 POPULATION AND SAMPLE SIZE
The population of the study comprised of doctors (General
Practitioners, Medical Officers, Consultants of different
specialties, Opinion Leaders), Pharmaceutical Personnel
(Medical Representatives, Sales Managers, Product
Managers), Pharmacists of different pharmacies, Influential
personnel of private and government hospitals..
The samples size for the subject study was 120. As per
Sekaran (2003) for multivariate sampling a minimum of 20
samples per variable is required. Thus the appropriate
samples size should have been 80. However, to have a better
representation samples size of 120 was selected. The
breakdown of the sample size was as follows:
No. Sample No. Of Samples
01 General Practitioners 17
02 Medical Officers 19
03 Consultants 11
04 Opinion Leaders 16
05 Pharma personnel 21
06 Government Hospitals 12
07 Private Hospitals 07
08 Pharmacies 17
The Hypothesis will be tested either Z-test or t-test, depends
upon the size of sample collected at the end. It has been
validated through the ANOVA test.
2.2.0 DATA COLLECTION METHOD
The questionnaires were administered in all the 8 cities
simultaneously through actual field force which is
already available in all these cities. All the
persons involved in administering the
questionnaire were given an extensive orientation
on the objective of the study.
3.0.0 SURVEY FINDINGS
The survey findings were analyzed linearly, cross section
ally in order to have a better comprehension and
understanding between the relationship of dependent and
independent variables, moderating, and intervening
variables.
3.1.0 HYPOTHESES TESTING
Four different hypotheses were developed and tested using
Z-test, simple ANOVA and F-test. The results and
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7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
interpretation of the four developed hypotheses are
presented below:
3.1.1 HYPOTHESIS 1
H1o: The level of unethical drug promotion practices in
pharmaceutical industry is high (at least 4) on the scale of (5
to 1)
The above hypothesis was tested through Z-test and the
summarized result is presented below:
TABLE 1
LEVEL OF UNETHICAL DRUG PROMOTION
PRACTICES.
Mean 4.39
Standard Deviation 0.54
Hypothesized mean 4.00
Confidence level 0.95
Critical value one tail 1.65
Critical value two tail 1.96
Z-Calculated value 7.96
The hypothesis relating to high level of unethical drug
promotion practices (at least 4 on the scale of 5-1) was
substantiated. At 95% confident level, Z critical value is
-1.65, and Z-calculated value is 7.96 that falls in the non-
critical region.
It may be pointed that the level of unethical drug promotion
practices as was ascertained by (Parmar and Jalees, 2004) in
their research was 3.56. The reason could be that the study
of (Parmar and Jalees) was case study of Hyderabad only,
where as this study is all Pakistan based, and the sample
drawn was a representative sample.
3.1.2 HYPOTHESIS 2
Focus group discussions indicate that the level of unethical
drug promotion practices is high in rural areas. Therefore
the hypothesis developed in this context is presented below:
H20: The levels of unethical drug promotion practices are
high in rural areas.
Above test was carried out through by Z-two samples
variables analysis, and the summarized result is presented
below:
TABLE 2
LEVEL OF UNETHICAL DRUG PROMOTION
PRACTICES IN RURAL AREA
Rural Urban
Mean 4.66 3.83
Known Variance 0.44 0.54
Observations 120 120
Hypothesized Mean Difference 0
Z 9.19
P(Z<=z) one-tail 0
z Critical one-tail 1.64
P(Z<=z) two-tail 0
z Critical two-tail 1.95
The hypothesis relating to higher level of unethical drug
promotion practices in rural areas was substantiated. At 95%
confidence level the Z-critical value is -1.64 and Z-
calculated value is 9.19 that fall in the non-critical region.
3.1.3 HYPOTHESIS 3
An important aspect is who was responsible for initiating the
unethical drug promotion practices in Pakistan. Doctor,
pharmaceutics companies, hospitals and pharmacies all have
different opinions. In view of this disparity the developed
hypothesis is presented below:
There is no significant difference on the opinions of doctor,
pharmaceutics companies, hospitals and pharmacies on who
initiated unethical drug promotion practices in Pakistan.
The above hypothesis was tested through simple ANOVA,
and the summarized results are presented below:
TABLE 3
OPINION ON WHO INITIATED THE UNETHICAL
DRUG PROMOTION PRACTICES
Groups Count Sum Average Variance
Pharmaceutical
company 120.00 436.00 3.63 2.52
Doctors 120.00 283.00 2.36 3.12
Hospitals 120.00 138.00 1.15 0.46
Pharmacy 120.00 130.00 1.08 0.18
Source of
Variation SS df MS F
P-
valu
e
F
crit
Bt. Groups 521.56 3.00 173.85 110.6
40.00 2.62
Within
Groups 747.93 476.00 1.57
Total 1,269.48 479.00
The hypothesis relating to no significant difference of
opinions on who initiated unethical drug promotion
practices in Pakistan was rejected. At 95% confidence level
and (3, 476) df the calculated F value of 110.64 is greater
than F- critical values of 2.62.
The above analysis also indicates that the pharmaceutical
industry were found to be the entity that has initiated
unethical drug promotion practices in Pakistan with a mean
of 3.63, followed by doctors with a mean of 2.36.
3.1.4 HYPOTHESIS 4
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7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
In the previous hypothesis, it was found out that the
pharmaceutical industry initiated unethical drug promotion
practices, in Pakistan. However, an important issue is that
who is more responsible for the continuation of this practice.
Based on the previous hypothesis the following hypothesis
was developed.
H40:The contribution of the pharmaceutical industry in
continuation of unethical drug promotion practices is higher
than the doctors.
Above test was carried out through by Z-two samples
variables analysis, and the summarized result is presented
below:
TABLE 4
OPINION ON WHO CONTINUED THE UNETHICAL
DRUG PROMOTION PRACTICES
Pharmaceutical
company Doctors
Mean 2.78 3.72
Known Variance 3.43 2.56
Observations 120.00 120.00
Hypothesized
Mean Difference -
z (4.18)
P(Z<=z) one-tail 0.00
z Critical one-tail 1.64
P(Z<=z) two-tail 0.00
z Critical two-tail 1.96
The hypothesis relating to a higher contribution of
pharmaceutical industry in unethical drug promotion
practices was rejected. At 95% confidence level, the Z
critical value is -1.64 and Z-calculated value is -4.18 that
falls in the critical region.
3.2.0 QUALITITVE ANALYSIS
The qualitative analyses of determinants such as (a) tools
of unethical drug promotion practices (b) drug promotion to
the non-qualified doctors (c) Legislation for unethical drug
promotion (d) eradication of unethical drug promotion is
given as below:
3.2.1 TOOLS OF UNETHICAL DRUG PRACTICES
As was discussed in the literature survey that the commonly
used tools for unethical drug practices were, monetary
rewards, local visits, and foreign visits etc. The summarized
results are presented below:
TABLE 5
Monetary Foreign Personalized Chamber Home
Rewards
Local
visits Visits gifts decoration decoration
4.04
4.23 4.47 3.58 2.07 1.48
GRAPH 1
Tools used for enethcial drug prmotion practices
4.04
4.23
4.47
3.58
2.07
1.48
-
1.00
2.00
3.00
4.00
5.00
1
Monetory Rewards Local visits Foreign Visits
Peronalized gifts Chamber decoration Home decoration
It was discussed in earlier section that the doctors are the
ones that are responsible for the continuation of unethical
drug promotion practices. The above table and graphs shows
that foreign visits with a mean of 4.47 are more in demand
and local visits being the second. The reasons for high
preferences for local visits and foreign visits are that
pharmaceutical industry could justify these expenses by
linking it with the conference.
3.2.2 DRUG PROMOTION TO NON-QUALIFIED
DOCTORS
Opinions on drug promotion to non qualified doctors were
obtained. Ethically, the firms should not promote their drugs
through them. The respondents’ opinions are presented
below:
TABLE 6
Pharmaceutical
company Doctors Hospital Pharmacy
2.19 1.19 1.53 1.29
GRAPH 2
5
2.19
1.19
1.53 1.29
-
0.50
1.00
1.50
2.00
2.50
1
Drug promotion to non-qualified
Doctors
Pharmaceutical company Doctors
Hospital Pharmacy
7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
6
7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
Majority of respondents’ of all the segments such as doctors,
Pharmaceutical companies, hospitals, pharmacies, were
strongly against drug promotion to the non-qualified
doctors. However, despite their opinions it is a fact that the
drugs are being promoted through non-qualified doctors.
3.2.3 LEGISLATION FOR UNETHICAL DRUG
PROMOTION
Respondents’ opinions were obtained on the prospects of
strong legislation against unethical drug promotion
practices. The respondents’ opinions are presented below:
TABLE 7
Pharmaceutical
company Doctors Hospital Pharmacy
4.76 4.51 4.42 4.35
GRAPH 3
4.76
4.51
4.42
4.35
4.00
4.20
4.40
4.60
4.80
1
Respondents'
Legislation for unethical drug promotion
Pharmaceutical Companies Doctors Hospitals Pharmacies
Inference could be drawn from the above that the majority
of respondent are strongly in the favour of making some
strong legislation against the unethical drug promotional
practices in Pakistan. Although some legislation is already
available but this research showed there is no
implementation of that legislation, therefore, majority of
respondent demanded that there must be strong legislation to
stop this unethical drug promotion in Pakistan.
3.2.4 ERADICATION OF UNETHICAL DRUG
PROMOTION
Opinions on eradication of drug promotion in Pakistan were
obtained from the respondents’. The respondents’ opinions
are presented below:
TABLE 8
Pharmaceutical
company Doctors Hospital Pharmacy
1.67 2.08 1.58 1.71
GRAPH 4
1.67
2.08
1.58
1.71
-
0.50
1.00
1.50
2.00
2.50
1
Respondents'
Eradication of unethical drug promotion
Pharmaceutical Companies Doctors Hospitals Pharmacies
Above graph shows that the majority of the respondents’ i.e.
doctors, pharmaceutical personnel, hospitals and
pharmacies, strongly disagree about the opinion that the
unethical drug promotion practices cannot be stopped now.
Majority of respondents’ agreed upon that these unethical
practices can still be stopped.
4.0.0 DISCUSSIONS & RECOMMENDATIONS
The major findings and recommendations are discussed
below:
4.1.0 CONCLUSIONS
We have concluded the overall results and found that both
doctors and pharmaceutical companies are equally
responsible for unethical drug promotion practices in
Pakistan. But most important and interesting findings are,
basically pharmaceutical companies are responsible for
initiating these unethical drug practices in Pakistan but now
in continuation of these practices the doctor’s community is
actually responsible for these unethical drug promotion
practices in Pakistan. Now the doctors have become
demanding and pharmaceutical companies are responsible to
fulfill their ethical and unethical demands. Now, this has
become an acceptable norm of the pharmaceutical industry
and doctor’s community for the promotion of drugs in
unethical ways. The monetary rewards, local and foreign
visits in the name of scientific activities offered by the
pharmaceutical companies for unethical promotion of the
drugs are extensively used as a tool of promotion of their
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7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
drugs. The entire above conclusion is evident from the four
hypotheses that were tested through simple ANOVA, F-tests
and Z-tests.
The results of tested hypothesis are presented below:
1) The hypothesis relating to high level of unethical
drug promotion practices (at least 4 on the scale of
5-1) was substantiated. At 95% confident level, Z
critical value is -1.65, and Z-calculated value is
7.96 that falls in the non-critical region.
It may be pointed that the level of unethical drug
promotion practices as was ascertained by (Parmar
and Jalees, 2004) in their research was 3.56. The
reason could be that the study of (Parmar and
Jalees) was case study of Hyderabad only, where as
this study is all Pakistan based, and the sample
drawn was a representative sample.
2) The hypothesis relating to higher level of unethical
drug promotion practices in rural areas was
substantiated. At 95% confidence level the Z-
critical value is -1.64 and Z-calculated value is 9.19
that fall in the non-critical region. Therefore, it has
concluded that the unethical drug practices are
higher in rural areas as compared to urban areas.
3) The hypothesis relating to no significant difference
of opinions on who initiated unethical drug
promotion practices in Pakistan was rejected. At
95% confidence level and (3, 476) df the calculated
F value of 110.64 is greater than F- critical values
of 2.62.
The above analysis also indicates that the
pharmaceutical industry were found to be the entity
that has initiated unethical drug promotion
practices in Pakistan with a mean of 3.63, followed
by doctors with a mean of 2.36.
4) The hypothesis relating to a higher contribution of
pharmaceutical industry in unethical drug
promotion practices was rejected. At 95%
confidence level, the Z critical value is -1.64 and Z-
calculated value is -4.18 that falls in the critical
region. Therefore, it has concluded that
pharmaceutical industry is not responsible in
continuation of unethical drug promotion practices
rather the doctors community is more responsible
for the continuation of unethical drug practices in
Pakistan.
The qualitative analyses of determinants such as (a) tools
of unethical drug promotion practices (b) drug promotion to
the non-qualified doctors (c) Legislation for unethical drug
promotion (d) eradication of unethical drug promotion is
given as below:
a) As was discussed in the literature survey that the
commonly used tools for unethical drug practices
were, monetary rewards, local visits, and foreign
visits etc. Qualitative analysis shows that foreign
visits with a mean of 4.47 are more in demand and
local visits being the second. The reasons for high
preferences for local visits and foreign visits are
that pharmaceutical industry could justify these
expenses by linking it with the conference.
b) Majority of respondents’ of all the segments
such as doctors, Pharmaceutical companies,
hospitals, pharmacies, were strongly against drug
promotion to the non-qualified doctors. However,
despite their opinions it is a fact that the drugs are
being promoted through non-qualified doctors.
c) The majority of respondent are strongly in the
favour of making strong legislation against the
unethical drug promotional practices. Although
some legislation is already available but this
research showed there is no implementation of that
legislation, therefore, majority of respondent
demanded that there must be strong legislation to
stop this unethical drug promotion in Pakistan.
d) Qualitative analysis shows that the majority of
the respondents’ i.e. doctors, pharmaceutical
personnel, hospitals and pharmacies, strongly
disagree about the opinion that the unethical drug
promotion practices cannot be stopped now.
Majority of respondents’ agreed upon that these
unethical practices can still be stopped.
4.2.0 RECOMMENDATIONS
The focus groups discussions and survey findings suggest
that strong legislation must be developed, implemented and
enforced by the government. However, the regulations and
legislation actually works when they are supported by the
norms and values of the society.
In this particular case, these unethical practices are
considered as the norms of the pharmaceutical industry and
the doctor’s community; therefore, it could only be
addressed by educating both the segments for realizing their
social responsibilities with the focus on the patients’ well
being. Furthermore, there must be strong check and
monitoring by the Ministry of Health both on
pharmaceutical industry and the doctors.
8
7th National Research Conference on Management, Computer and Social Sciences & Economics, Szabist,
Karachi, Pakistan
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9
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