Patients trapped by unethical nexus between doctors and drug representatives

Patients across Bangladesh are being driven into financial distress amid growing allegations of collusion between doctors, diagnostic centres and pharmaceutical company representatives, with many being prescribed unnecessary medicines, medical tests and even caesarean operations for commission-based incentives.

Investigations conducted in several districts revealed that government directives aimed at curbing the influence of medical representatives (MRs) in hospitals are being widely ignored, allowing aggressive pharmaceutical marketing practices to flourish unchecked in both public and private healthcare facilities.

At the gynaecology outpatient department of Shaheed Suhrawardy Medical College Hospital, garment worker Asiya Khatun, 35, arrived seeking treatment. Struggling to support her four-member family on a modest income shared with her husband, she was prescribed several diagnostic tests. Moments after leaving the doctor’s chamber, a man approached her and asked to see her prescription. Before she could react, he took a photograph of it.

A few days later, when she returned with the test reports, she noticed promotional leaflets and marketing materials of a specific pharmaceutical company placed on the doctor’s desk. At the pharmacy, she discovered she had been prescribed expensive antibiotics and multiple vitamins produced by the same company.

The total cost of her tests and medicines amounted to Tk11,000 — equivalent to her monthly salary.

“It is already difficult to run the household. I had to borrow money for treatment,” Asiya said. “We have no way of understanding which medicines are necessary and which are not. We have no choice but to follow the doctor’s prescription.”

Health sector insiders alleged that a section of doctors, diagnostic centres and pharmaceutical companies had formed an unethical nexus that was burdening patients with unnecessary expenses. In many cases, doctors are reportedly prescribing costly medicines and tests in exchange for commissions or incentives from drug companies.

Critics say a single prescription from some doctors now consumes money meant for monthly groceries, children’s school fees or emergency savings for many families.

Government directives ignored

In an effort to provide relief to patients, the Directorate General of Health Services (DGHS) issued a circular in September last year banning MRs from taking photographs of prescriptions in government hospitals.

The directive also restricted meetings between doctors and medical representatives to Mondays and Thursdays between 12:00pm and 2:30pm. Outside those hours, any attempt to disturb patients or interfere in treatment processes was prohibited.

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The circular further banned the use of private seals in government health institutions, allowing only generic-name seals without promotional branding. Doctors were also barred from keeping pharmaceutical company drug lists on their desks.

However, investigations found that these directives are being openly violated across the country. Prescription photography, data collection and unrestricted movement of MRs inside hospitals continue unabated. Representatives frequently wait outside doctors’ chambers and, in some cases, allegedly influence prescriptions.

MRs entering hospitals disguised

Major government hospitals in the capital, including Dhaka Medical College Hospital, Sir Salimullah Medical College Mitford Hospital and Shaheed Suhrawardy Medical College Hospital, have long struggled with the unchecked presence of medical representatives.

In May, a joint drive at Dhaka Medical College Hospital detained 60 people, including 12 pharmaceutical sales representatives. Yet hospital insiders say the situation remains largely unchanged.

Patients alleged that many MRs conceal their identity cards, wear masks or use female representatives to gain easy access to hospital departments. Taking advantage of overcrowded emergency wards and busy doctors, they position themselves near consultation rooms.

A doctor, speaking anonymously, admitted that some physicians had developed vested interests with pharmaceutical representatives.

“We can stop them from entering if we want, but many doctors are involved in mutually beneficial relationships with them,” the physician said. “Some prescribe medicines from specific companies in exchange for commissions. It has become an open secret.”

Lack of professionalism in pharmaceutical marketing

Syed Ershad Ahmed criticised the state of pharmaceutical marketing in Bangladesh, describing it as chaotic and lacking professionalism.

He said many companies were appointing medical promotion officers and representatives without scientific or biological science backgrounds, despite the fact that the industry required specialised knowledge about medicine composition, effectiveness and side effects.

“Instead of competing through medicine quality, companies are now competing by offering doctors expensive gifts, cash incentives and overseas family tours,” he said. “This unethical practice is destroying professionalism in the sector and turning patients into hostages.”

Allegations of pre-made prescription seals

At the 250-bed General Hospital in Brahmanbaria, allegations have surfaced regarding the use of pre-made prescription seals by doctors. Prescriptions issued to two female patients aged 65 and 58 reportedly contained nine medicines, all stamped in advance.

Local residents alleged that close ties between doctors and pharmaceutical representatives had existed there for years, including allegations of leisure trips sponsored by pharmaceutical companies.

Similar allegations were reported in Bhola, Rajshahi, Joypurhat and Bandarban, where MRs were seen entering doctors’ rooms before permitted hours, taking photographs of prescriptions and loitering inside hospital premises.

At Rajshahi Medical College Hospital, hospital spokesperson Dr Shankar Kumar Biswas acknowledged that medical representatives continued to enter emergency and inpatient departments despite restrictions.

“We are conducting drives and taking action, but they still manage to enter by hiding ID cards and wearing masks,” he said. “Doctors also need to be more cautious.”

Patients paying the price

Health rights advocates say the widespread influence of pharmaceutical companies inside hospitals is undermining patient-centred healthcare and increasing treatment costs unnecessarily.

Patients complain that unnecessary medicines and tests are pushing families deeper into poverty.

“When you enter the hospital, it feels like you need permission from pharmaceutical company people before seeing a doctor,” said patient Aklima Bibi at Kalai Upazila Health Complex in Joypurhat. “More time and money are spent on tests and medicines than on actual treatment.”

Calls for reform

The interim government’s health sector reform commission has recommended banning direct promotional meetings between doctors and pharmaceutical representatives.

The recommendations include introducing communication through email only, making generic prescriptions mandatory, restricting antibiotics to MBBS doctors, regulating medicine prices and diagnostic fees, and banning all forms of gifts and incentives offered to doctors.

Professor Dr Syed Abdul Hamid of the Institute of Health Economics at University of Dhaka called for strict punishment against doctors and MRs violating government regulations.

“Government hospitals must remain centres for patient care, not commercial marketplaces,” he said. “Aggressive marketing by pharmaceutical companies is responsible for the current disorder in the sector.”

He also recommended introducing CCTV surveillance, digital entry systems, active monitoring committees, complaint boxes and hotlines in hospitals.

Consumer rights activists seek legal protection

SM Nazrul Hossain said healthcare and pharmaceutical services should be brought under the Consumer Rights Protection Act to safeguard ordinary citizens.

“We have long been demanding this, and it has now been included in the proposed amendment to the law,” he said.

Health Directorate warns of strict action

Director (Hospitals and Clinics) of the DGHS, Dr Abu Hossain Md Moinul Ahsan, said a patient’s prescription was legally considered private and confidential.

“No one has the legal right to view or photograph a prescription without the patient’s consent,” he said. “Unfortunately, pharmaceutical representatives often use manipulative tactics or even force to take photographs from patients who are unaware of their rights.”

He warned that strict administrative action would be taken against any hospital found involved in such practices.

“The DGHS will not compromise on protecting public health rights and patient privacy,” he added.