Tk60 billion spent on drug promotion ends up in doctors’ pockets

While television viewers in the United States routinely see advertisements for prescription medicines detailing both benefits and side effects, such direct-to-consumer pharmaceutical advertising remains largely prohibited in Bangladesh.

Industry insiders and public health experts are increasingly questioning whether the ban truly protects public health or instead deprives patients of vital information while encouraging unethical marketing practices.

An investigation has found that pharmaceutical companies, unable to advertise prescription drugs directly to consumers, have shifted their focus to aggressive field-level marketing aimed at doctors. Medical representatives (MRs) reportedly crowd hospitals and clinics to promote products, while companies spend an estimated Tk60 billion annually on influencing physicians through seminars, foreign trips, household appliances, electronic goods and, in some cases, cash incentives.

According to research by the Bangladesh Institute of Development Studies (BIDS), pharmaceutical firms spend nearly 29% of their turnover on marketing. In 2018 alone, the industry spent around Tk65 billion on promotional activities.

Critics argue that the information gap created by advertising restrictions has strengthened the influence of MRs, leaving patients dependent on doctors, pharmacists and informal online sources for information about medicines, their effectiveness and potential side effects.

Syed Ershad Ahmed, President of the American Chamber of Commerce in Bangladesh (AmCham), said strict restrictions on pharmaceutical advertising undermine consumers’ right to information and limit public awareness. He argued that patients should have access to balanced information about both the benefits and risks of medicines before taking them.

Health economists note that countries such as the United States and New Zealand permit direct advertising of prescription medicines under strict regulations requiring clear disclosure of risks and side effects. By contrast, Bangladesh’s restrictions have encouraged companies to rely heavily on direct engagement with physicians, sometimes leading to unethical promotional practices.

The pharmaceutical market in Bangladesh is highly concentrated, with the top 30 companies controlling around 90% of the sector. Analysts say intense competition has fuelled rising marketing expenditures, which are ultimately reflected in medicine prices.

A 2022 survey by Transparency International Bangladesh (TIB) found that 77% of physicians acknowledged receiving various forms of gifts from pharmaceutical companies. A 2025 study further reported that incentives ranged from overseas travel and cash payments to employment opportunities for family members, all of which may indirectly influence prescribing behaviour.

Public health advocates have called for a review of existing regulations, proposing a controlled framework that would allow the dissemination of medicine-related information through the media while maintaining strict oversight. They argue that greater transparency could improve public awareness, reduce dependence on promotional intermediaries and help curb unethical relationships between pharmaceutical companies and healthcare providers.

However, the Directorate General of Drug Administration (DGDA) maintains that while public-interest information about medicines can be shared, any advertising that encourages or persuades consumers to use a specific drug remains restricted under current law. Officials emphasise that pharmaceutical companies should prioritise improving drug quality and affordability rather than spending heavily on marketing and incentives.