Pharmaceutical sales representatives are screening people in India in return for prescriptions for their products, finds a special report published by The BMJ today.
Free 'health camps' for poor people in India have grown popular, writes author Frederik Joelving, a journalist based in Denmark.
Local residents are invited to the camps that may include medical testing done by drug representatives or technicians, he explains. Some camps take place at temples or schools near slum areas and tend to attract hundreds of visitors, while smaller 'patient camps' can be at a hospital or in the waiting room of a doctor's office.
The BMJ has evidence that unlicensed employees from several Indian drug firms and from the Indian arms of Abbott, Bayer, GlaxoSmithKline, Roche, and Sanofi have tested patients at health camps.
The Medical Council of India says the practice is unauthorised and that only a registered medical practitioner can perform screening and diagnostic tests.
Likewise, for doctors to prescribe specific products in return for testing services from a drug company is not only 'totally unethical,' said K L Sharma, joint secretary at the Ministry of Health and Family Welfare; it also violates MCI regulations.
Cipla acknowledged that its employees test patients, reports Joelving. A Roche spokesperson said that Roche Diabetes Care India donates testing supplies to diabetes education camps but added that "people with diabetes who attend the camp test on their own, after having signed a written consent."
Ransom D'Souza, a GlaxoSmithKline India spokesperson, said: "Our sales representatives are not permitted to perform tests on patients in India" and added that GSK "at no point in time" has "sought prescriptions from [healthcare professionals] in reciprocation and that last year the company removed individual sales targets for its representatives."
But Pinaki Dutt, a GSK sales rep from Bankura, West Bengal, told Joelving in 2013 that he and his colleagues were required by 'company policy' to do blood sugar tests at regular health camps.
"This kind of behavior can actually lead to harm to patients -- overdiagnosis, misclassification [of healthy people as sick], iatrogenic harm of drugs," Glyn Elwyn, a primary care clinician-researcher at The Dartmouth Center for Health Care Delivery Science in Hanover, New Hampshire, USA, told The BMJ.
The Indian subsidiaries of Abbott Laboratories have been particularly active in the push for screening, says Joelving, with each of the company's business divisions organizing health camps.
In 2011 alone, the company says it screened more than 240,000 people for thyroid disorders. Meanwhile, sales of its flagship product Thyronorm (thyroxine) raced ahead of cheaper competitors in India.
"I would call it market penetration with a label of corporate social responsibility," said Hans Hogerzeil, a professor of global health at Groningen University in the Netherlands and until 2011 director for essential medicines and pharmaceutical policies at the World Health Organization.
Abbott told The BMJ: "Health camps must not be supported in exchange for an explicit or implicit understanding to purchase, order, recommend, prescribe or provide favourable treatment to any Abbott products."
But an Abbott rep who does screening at diabetes camps said that his services are an investment in the doctor and have nothing to do with charity. "The only objective is the business transaction," said the rep, who spoke on condition of anonymity from fear of losing his job.
Finally, Leena Menghaney, a lawyer and India manager of Médecins Sans Frontières' Access Campaign, said: "This is nothing but selling privatised health care, whether it's medicines or diagnostics," adding that she discourages her family from going to the camps.