Intended for healthcare professionals


Western medicine: a confidence trick driven by the drug industry?

BMJ 2002; 325 doi: (Published 03 August 2002) Cite this as: BMJ 2002;325:h

pharmaceutical fraud

increasingly in my practice, i see more and more medical
representatives. in fact the number of patients i see are less than them.

i find that they have a single thing in common which is to make a fast
buck. they try to run down their competitors by describing how their
products are superior in terms of quality etc. very often the drug is the
same except for a chloride molecule in the side-chain which gives it a
miraculous property hitherto unknown. however, when you read all the fine
print, you find the same very indication and adverse effects. the
difference in cost is enormous. every passing day brings a new
formulation.then there is a price war. we will be told that the drug cost
now is a quarter of the previous. so every practitioner will try to give
this benefit to their patients. in india all patients have to tend for
themselves. there is nothing for free. only those in the establishment get
everything for free. after a couple of months, when the brand is
entrenched in the market and on the pen of every single doctor, the price
is sneakily raised to its previous level without caring a hoot.
i had an interesting experience recently. a couple of multinationals who
were marketing simvastatin and not atorvastatin, brought out colorful
brochures stating with plenty of references that atorvastatin actually
raised levels of fibrinogen and therefore was thrombogenic. when i met an
executive of this multi-national, i requested him to give me in writing
that they would never be marketing atorvastatin due to this. one of them
actually gave me an assurance in writing that their company would not be
marketing atorvastatin. not surprising after 3 months each and everyone
was marketing atorvastatin and there was no mention of fibrinogen being
raised. in fact they showed rare unanimity that the fibrinogen level was
actually decreased in all the statins. a list of credible studies were
thrown in and reprints provided to all.

the other day, a marvelous antibiotic was presented to me.itwas
levofloxacin. colorful momographs were presented. it acted on
inconceivable number of organisms, many of them i did not know existed. it
was being pushed for community-based pneumonia. the monographs were
heavily highlighted with green, yellow and red at places. the message was
it was the drug of choice in most parts of the world. cost per 500mg
tablet only rs100/. i accepted the monographs and in the night went thru
it. somewhere in it in an inconspicous paragraph it said that this drug
and doxycycline were equally effective. now the cost of one day's tt. with
doxycycline is only rs10/. why should i prescribe an expensive drug when i
can get equal result at one-tenth the cost?.of course after its
introduction now the drug produced by smaller multinational is the same as

there is a plethora of insulin sensitisers in the market. these include
the glitazones.they claim that it is effective in unmotivated patients who
refuse to diet!at last the miracle drug is here. you can eat as you like
and the glitazones will take care!.

when i was a registrar in england in 1985, my consultant who had an
interest in diabetes decided to do a retrospective study on 500 diabetics.
at that time a new sulphonyl urea had come to the market since a couple of
years and was being heavily promoted. it was gliclazide. our study was
"facilitated" by the makers of this drug. all sots of references were
provided to us. the medical representative was available at all times to
help us including a verbal undertaking to provide us transport to present
our important findings at newcastle-upon-tyne.the gist of our study was
that gliclazide was no superior to the existing sulphonyl ureas. if they
did not work, so did'nt gliclazide. when i gave the medical rep. a copy of
this findings, he did a vanishing act. in fact we had to travel to
newcastle using our own vehicle! now this same molecule over the years has
acquired new micro-vascular properties and is still being marketed with
vigor. then there are a plethora of old discredited molecules given new
clothings and being marketed for their ability to correct endothelial
dysfunction etc.

how can the medical fraternity fight this fraud. 30 years ago my eminent
teacher used to say, 'beleive only what is written in the standard texts.
read about papers but wait till the claims reach the standard texts'.
my policy is to prescribe those drugs validated by such texts as
braunwald, opie and gabriel khan. if they say the drug is experimental or
it is being investigated or has a dubious role so be it. i am not in a
hurry to prescribe them.

dr.manan vasenwala md, mrcp(uk)


Competing interests: No competing interests

08 August 2002
manan vasenwala