Punjab Medical Council investigates doctors for alleged payments from drug companies

The Punjab Medical Council has sent notices to 10 doctors for receiving funds from pharmaceutical and allied healthcare companies, alleging that the doctors violated the code of ethics of the Medical Council of India.

The code forbids doctors from accepting funds directly from drug firms, and any payments for services such as clinical research must be routed through institutions.1

The Punjab Medical Council’s president, G S Grewal, said that the doctors named in its order to show cause had received funds through their personal bank accounts from drug companies, thus violating the national rules.

The doctors have until 28 October to explain the payments. If the council is not satisfied it can begin proceedings against the doctors, which could result in a penalty such as the suspension of their licences.

The show cause notice named 21 companies, including Merck, MSD Pharmaceuticals, Sanofi India, Bayer Zydus Pharma, and Novartis Healthcare and the India based companies Glenmark Pharmaceuticals, Ranbaxy Laboratories (now a part of Sun Pharmaceuticals), Intas Pharmaceuticals, Eris Life Sciences, and Lupin. The notice also named three cord blood banking companies and two insurance third party administrators.

Grewal told The BMJ that his council identified the 10 doctors after scrutinising the tax records of a longer list of doctors who had previously been questioned for other ethical violations.

In March this year the council began investigating 164 doctors for being “ghost faculty,” a term for doctors who misrepresent themselves as full time teaching staff at medical colleges, in return for a payment.2 This misrepresentation allows these medical colleges to notch up their staff numbers and meet the requirements of the Medical Council of India, the regulatory body that gives these colleges permission to operate each year. While scrutinising the tax statements of these 164 doctors, Grewal said, the Punjab council had identified 10 who had received funds directly from pharmaceutical and allied companies.

Of the companies The BMJ contacted, nine responded to the allegations. Bayer Zydus Pharma and Glenmark Pharmaceuticals confirmed that they had made the payments but said that their actions did not violate the Medical Council of India’s ethics code. Glenmark did not specify what the payment was for, but Bayer Zydus Pharma said that it had paid the doctor named in the show cause notice to conduct a clinical study on the safety and efficacy of its Glucobay-M tablets for type 2 diabetes. “We confirm that the conduct of study and our interaction with the medical expert comply with the Medical Council of India guidelines and other applicable laws and regulations of India,” the company said in a statement.

However, Bayer did not respond to a follow-up question as to why the payment was made directly to the doctor rather than to an approved institution.

Novartis India, Sanofi India, and Merck India did not confirm the payments but said that all their payments were legitimate. A Merck India spokesperson said that the company was running an internal inquiry into the matter. MSD, Lupin, Sun Pharmaceuticals, Intas Pharmaceuticals, and Eris Life Sciences did not respond to The BMJ’s questions.

One of the doctors named in the notice, Kulwant Singh, a cardiologist at the Kulwant Heart Centre in Ludhiana, said that his hospital had jointly organised a continuing medical education conference with MSD, for which he received the money. “It is an honorarium. It is within the rules of the MCI [Medical Council of India],” he told The BMJ.

Singh, who the Punjab Medical Council lists as receiving money from eight companies, said that he had also carried out clinical research and market surveys for the companies and conducted education programmes for patients about the benefits of various treatment options.

George Thomas, an orthopaedic surgeon in Chennai and a former editor of the Indian Journal of Medical Ethics, said that Medical Council of India rules prohibited doctors from being paid individually by drug companies for conducting or attending continuing medical education [CME] events. “For example, if the Indian Orthopaedic Association [IOA] is conducting a CME, they can take sponsorship from a pharma company, but an individual cannot take it,” he said. “Then, if the IOA wants a speaker to come to the conference, it is open to them to pay the speaker.”

But documents in possession of the Punjab Medical Council and seen by The BMJ show that the payments from drug companies were made into the account of an individual named Kulwant Singh and not to a company.

When asked about this, Singh said that he was not breaking any Medical Council of India rules because he had not accepted any of these payments in his individual capacity but on behalf of Kulwant Heart Centre, as its proprietor.

Singh also added that apart from an advisory notice from the Medical Council of India, no action had been taken against him in the ghost faculty issue, because he had resigned from the medical college before the Punjab Medical Council issued a notice to him.

Meanwhile, the third party administrator companies and cord blood banking companies named in the Punjab Medical Council’s show cause notice said that their actions were legally sound. Rajeev Babbar, chief financial officer of Cryobanks International India, a cord blood banking company named in the show cause notice for making several payments to doctors, said that Cryobanks routinely paid doctors for harvesting stem cells from the umbilical cords of babies during delivery. “What we are technically paying them is the professional fees for these services. This is all paid in white; that is the reason we have deducted the TDS (tax deducted at source) and paid this amount. None of this is for promotion.” Babbar said that couples expecting a baby typically approached Cryobanks directly for cord blood banking. After they entered a contract with the company, the couples were free to choose their own obstetrician, who would then harvest the cord blood after ascertaining the health of the mother and child.

Vaneet Kaur, a gynaecologist who was sent a notice from the Punjab Medical Council for receiving money from Cryobanks, among other cord blood banking companies, confirmed that she had received money for collecting cord blood but said that her actions were not unethical because she had not recommended the procedure to any parents. She said that the decision to store the child’s cord blood was entirely that of her clients.

Another cord blood banking company named in the show cause notice, Life Cell International, also clarified that the payments had been made to doctors to collect cord blood from clients during deliveries.

Private banking of cord blood, in which a child’s cord blood is collected for potential future use by the same child, is highly controversial the world over, because unless the child is at high risk of certain diseases it is very unlikely that the cord blood will ever be used. Several associations of medical professionals the world over, such as the American Academy of Pediatrics and the Royal College of Obstetricians and Gynaecologists in the United Kingdom, recommend against private cord blood banking. But India does not have any guidelines.3

Genins India, a third party administrator named in the show cause notice for having paid Kulwant Singh, told The BMJ that it had paid Singh to reimburse him for rendering cashless medical services under the state government run insurance scheme Bhagat Puran Singh Sehat Bima Yojana. “Card holders of this scheme took treatment in the hospital and payment of the claims were made to the hospital in the name of Kulwant Nursing Home after the approval of Insurance Company,” the company said.

Commenting on the matter, Thomas said that there was no obvious ethical violation in doctors collecting a fee for harvesting cord blood or for providing medical services under cashless insurance schemes and that it was premature to pass judgment on these cases. “[Punjab Medical Council] has only given them a show cause notice right now, and they have a right to reply. On the basis of reply, some judicial mechanism needs to take place. Only at the end of it can a finding be made over whether they have actually violated the code or not,” he said.