Rising Concerns Over Pharmaceutical Influence on Prescriptions in BD

Sales representatives from these companies can often be seen waiting outside clinics and hospitals, eager to speak with doctors. In some cases, they even track prescriptions, photographing them as patients leave in order to ensure their medications are being recommended.

Sirajul Rabi, a patient at a top private hospital in Dhaka, recounts his personal experience. "Every time I step out of the doctor's office, I’m surrounded by pharmaceutical representatives, asking which medications were prescribed. This happens whether I visit a private or government hospital. They even request photos of my prescription. Once, a doctor insisted that I buy a specific medicine from a particular company."

Similarly, Dipa Kabir (a pseudonym), from Dhaka's Dhanmondi area, visited a well-known private hospital for a cold. She was prescribed several medications, including an inhaler. Suspecting over-prescription, she consulted two other doctors who confirmed that only two of the prescribed medicines were necessary and that the inhaler was unnecessary.

Although some hospitals have restricted the entry of pharmaceutical representatives, many still allow them access, further exacerbating the issue.
Ethical Concerns and Expert Opinions

Medical professionals have raised concerns about the growing trend of prescribing medications in exchange for incentives.

Dr. Gazi Nazrul Islam, Director of Ispahani Eye Hospital, acknowledged the problem but noted that hospitals face challenges in regulating individual doctors' behavior. "We allow representatives from selected companies to meet doctors, provided they carry proper identification. This helps doctors stay informed about new medications, enhancing their knowledge. However, any abuse of this system is unacceptable," he stated.

Despite some public discomfort, many doctors privately admit that the practice is widespread and deeply ingrained within the medical community. Fear of ostracism from colleagues involved in such activities discourages open opposition.

Pharmaceutical marketing professionals defend the practice, citing industry pressures. A marketing officer from an unnamed company shared, "We are under strict pressure to meet monthly prescription targets. Hitting these targets is essential for receiving bonuses, as our basic salary is relatively low."

He explained that photographing prescriptions helps companies gauge their market share and formulate more effective marketing strategies.
Unethical Practices in the Medical Profession

Dr. Shamsujjaman, former Professor of Microbiology at Dhaka Medical College, voiced strong concerns about doctors prioritizing incentives over patient health. "Doctors should prescribe only the necessary medications based on a patient's condition. Prescribing unnecessary drugs in exchange for gifts can jeopardize a patient's health," he warned.

While acknowledging that pharmaceutical representatives can offer valuable insights into new medications, Dr. Shamsujjaman emphasized that any exchange involving gifts is unethical.

A senior professor, who asked to remain anonymous, revealed that some doctors receive far more than small gifts. "Some doctors are offered extravagant rewards, including cash, foreign trips, and even financial assistance for personal events like weddings. Despite official guidelines prohibiting such practices, they persist behind closed doors."
Regulatory Challenges

A former health secretary from the Directorate General of Health Services (DGHS) revealed that no specific law currently bans the practice of pharmaceutical companies offering gifts to doctors. "Although giving gifts is undeniably unethical, there is no clear legal framework to stop it," he acknowledged.

He suggested that the Drug Authority, which regulates pharmaceutical companies, could take a more active role in addressing the issue. A former director of the Drug Administration echoed this view, stating, "Though laws have been proposed, they have yet to be implemented. Regulatory measures should ideally come from the Bangladesh Medical & Dental Council (BMDC)."

Dr. Md Akter, the current Director of the Drug Administration, expressed concern over the issue but emphasized that regulation alone wouldn't suffice. "While there is no significant regulation yet, this practice needs to stop. Doctors should adhere to ethical principles. Raising awareness is more important than simply passing laws."
The Need for Reform

Despite growing awareness, pharmaceutical companies’ influence over medical prescriptions remains widespread in Bangladesh.

Patients continue to face uncertainty about whether their prescribed medications are genuinely necessary or merely a result of industry incentives. Until stricter regulations and ethical reforms are enforced, the integrity of the healthcare system will remain in question.

As the issue grows, the need for both regulatory action and a cultural shift in the medical community becomes increasingly urgent. Without addressing the root causes, the ethical and medical concerns surrounding prescription practices in Bangladesh will continue to undermine patient trust and healthcare quality.