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कुछ रिपोटों से उठा सवाल

शिमला/शैल। कोरोना को लेकर पूरा विश्व आतंकित है। सभी जगह लाकडाऊन और कर्फ्यू जैसे कदम सरकारों ने उठा रखे हैं। इन कदमों का व्यवहारिक परिणाम यह हो गया है कि हर व्यक्ति हर दूसरे व्यक्ति को कोरोना के वाहक के रूप में देख रहा है। सरकार द्वारा आदेशित की गयी सोशल डिस्टैंन्सिग ने सारे सामाजिक रिश्तों को इस तरह प्रभावित कर रखा कि कोई किसी की खुशी या गम में शरीक होने से भी डर रहा है। ऐसे परिदृश्य में जब किसी डाक्टर से यह सुनने को मिले कि यह बिमारी वैसी भयावह नही है जैसी की प्रचारित की जा रही है तो सारा दृश्य ही बदल जाता है। इस संबंध में डा. विश्वरूप राय चौधरी के कुछ विडियोज़ देखने और सुनने को मिले है। सोशल मीडिया की न्यूज़ साईटस ने इन विडियोज़ को प्रमुखता से प्रचारित किया है। डा.चौधरी का दावा है कि कोरोना भी अब तक आ चुके अन्य फ्लू जैसा ही एक साधारण फ्लू है और इसे आतंक बनाकर कुछ फार्मा कंपनीयों ने प्रचारित-प्रसारित किया है। कोरोना से आतंकित होने की आवश्यकता नही है। डा.चौधरी ने इस आश्य के पत्र केन्द्रिय स्वास्थ्य मंत्री डा.हषवर्धन को भी लिखे हैं क्योंकि वह स्वयं भी एक अच्छे डाक्टर हैं। परन्तु डा.चौधरी के पत्रों का कोई जवाब नही आया है। डा.चौधरी की ही तरह एक डाक्टर तरूण कोठारी ने भी स्पष्ट कहा है कोरोना एक सामान्य फ्लू है जिसे आतंक बनाकर पेश करने में फार्मा कंपनीयों का प्ले है। डाक्टरों के दावों को किसी ने कोई चुनौती नही दी है। केन्द्र सरकार की ओर से भी कोई खण्डन नही आया है। ऐसे में इन डाक्टरों के दावे सरकार के सारे आकलनों पर एक गंभीर प्रश्नचिन्ह खड़ा कर देते हैं। क्योंकि सोशल डिस्टैंसिन्ग जैसे सरकार के सुझाये कदमों का कोरोना को रोकने में कोई बड़ा असर व्यवहार में देखने को नही मिला है। हर रोज़ इसके केस बढ़ते जा रहे हैं और इन कदमों से अर्थव्यवस्था पर गहरा कुप्रभाव पड़ा है। इन डाक्टरों के दावों को 30 अप्रैल को सर्वोच्च न्यायालय में आयी People for BETTERTREANT (PBT) की यााचिका से भी बल मिलता है। इस याचिका की पैरवी अमेरिका स्थित डा. कुनाल साहा ने स्वयं की है। सर्वोच्च न्यायालय ने यह याचिका ICMR को विशेषज्ञ होने के नाते भेज दी थी। परन्तु इस पर अभी तक ICMR की ओर से कोई रिपोर्ट नही आयी है।
WP©…...D.No.10935/20
ITEM NO.4        Virtual Court 2           SECTION X
S U P R E M E C O U R T O F I N D I A
RECORD OF PROCEEDINGS
WRIT PETITION (CIVIL)..Diary No(s).10935/2020
PEOPLE FOR BETTER
TREATMENT (PBT)                             Petitioner(s)
THROUGH ITS PRESIDENT DR.KUNAL SAHA
VERSUS
UNION OF INDIA & ANR.                                 Respondent(s)
Date:30-04-2020 This petition was called on for hearing today.
CORAM :
HON'BLE MR. JUSTICE N.V. RAMANA
HON'BLE MR. JUSTICE SANJAY KISHAN KAUL
HON'BLE MR. JUSTICE B.R. GAVAI
For Petitioner(s) Dr. Kunal Saha, petitioner-in-person
For Respondent(s) Mr. Tushar Mehta, SG
                          Mr. B.V. Balaram Das, Adv.
The PIL filed by the organization People for Better Treatment (PBT) sought for changes in the treatment guidelines and expressed concerns against the widespread use of Hydroxychloroquine (HCQ) and Azithromycin (AZM) in COVID-19 patients.
Dr. Kunal Saha, President of PBT, personally appeared in the matter from USA to explain and answer relevant medical questions as a physician-scientist.
The plea asserted that the drugs being used to treat COVID-19 patients were based primarily on anecdotal evidence and not on direct scientific data  due to very little research on the new strain of Coronavirus. "Needless to say that when treating the vulnerable patients with a new and unproven drug for its off-label use, doctors should be extra vigilant about its potential harmful adverse effects on COVID-19 patients".
A Bench comprising of Justices NV Ramana, Sanjay Kishan Kaul and BR Gavai heard the matter. Dr. Saha, appearing from the US, informed the Bench that he was not challenging the treatment per se. However, Justice Ramana by placed the responsibility of choosing the right treatment on the doctors.
"Now there is no medicine, so they are trying different ways. If a particular treatment has to be given or is to be followed, it has to be decided by  the doctors".
Dr. Saha countered the statement by stating that the petition did not aver whether the treatment was correct or incorrect – "We are saying that precautions must be taken. People are dying of side effects".
He continued his submission, "There should be an informed consent. Patient has a right to know if there is a risk involved. The doctor should explain to the patient about the risks involved and if the patient is willing to take the risk". Dr. Saha also submitted that the American Heart Institute had issued serious warnings on the same.

डा. चौधरी और डा. कोठारी ने जिस तरह से इसे फार्मा कंपनीयों का प्ले करार दिया है उस पर 10 फरवरी 2017 को पंजाब के भठिंडा कोर्ट में आयी याचिका से भी बल मिलता है। इसमें पता चलता है कि किस तरह से प्राईवेट अस्पताल मरीजो़ से खिलवाड़ करते है।

This most inhuman case is now being heard in the  Punjab's Bathinda court. The Court has issued summons to three persons, including two doctors and a manager, for “declaring” a living person dead and advising his kin to “cremate the body”.
According to the case history, on February 10, 2017, the son of ailing man took his father to local Jindal Heart Hospital, from where he was referred to the Delhi Heart Hospital. But at Delhi Heart Hospital a doctor on duty declared him dead.
However, the "dead' man was taken to another hospital, where a compounder found him alive. After this he was then taken to another heart caring Global hospital. Here after three days of treatment, he was discharged and now  he is  hale and hearty
The most shocking was the efforts of Delhi Heart Hospital officials. When they  came to know about this, they reached Global Hospital with the “intention that the patient should not revive” as it would damage the image of their hospital.

फार्मा कंपनीयां अपने बिजनैस को प्रोमोट करने के लिये क्या कुछ करती हैं इसको लेकर अजी़म प्रेम जी के सहयोग से एक पूणे स्थित एनजीओ ‘‘साथी’’ ने एक अध्ययन करवाया था। डा. अरूण गाद्रे और डा. अर्चना दिवेत की 72 पृष्ठों की रिपोर्ट में जो चौकांने वाले खुलासे सामने आये हैं उनसे हर आदमी यह मानने पर बाध्य हो जायेगा कि फार्मा कंपनीयां अपने व्यापार को बढ़ावा देने के लिये किसी भी हद तक जा सकती हैं। इन खुलासों से डाक्टर चौधरी और कोठारी तथा डाक्टर कुणाल साहा के दावों को झुठलाने का कोई आधार नही रह जाता है। एनजीओ साथी के अध्ययन के कुछ तथ्य पाठकों के सामने यथा स्थिति रखे जा रहे हैं ताकि पाठक स्वयं अपनी राय बना सकें।

Over the past decade in India, the Medical Council of India (MCI), pharmaceutical manufacturers and the government have instituted regulatory advisories to medical professionals and pharmaceutical and allied  health sector industries for their conduct with the intention to curb unethical promotional practices. These are voluntary codes and anecdotal experience reveals that often these codes are not adhered to.
Taking a clue from the anecdotal experience, SATHI carried out a study with the aim of exploring ground level realities of promotional and marketing practices of the pharma industry and the implementation status of related regulatory codes in India. The study is qualitative in nature, 50 In-depth interviews were conducted with various key informants in six selected cities across the country. The study primarily focused on interviewing medical representatives because they are the ones who are involved as front-line key persons lon the actual field to promote drugs to doctors.
The key findings are –
Changing Trends in Promotions Practices-Inducements and New Innovations of Temptations:

• Trends in promotional strategies have changed from providing scientific information to doctors to only focusing on     generating business by any means.
• The ethics and values which were  followed in the past are getting bypassed to achieve business.
• Tactics like an inducement, emotional appeals, persuasions,  serving family members, sponsorships for national and international conferences, pampering doctors, etc. are used as a norm.
• New innovative mechanisms have emerged over the years such as-providing debit cards/credit cards, petro cards e-vouchers for online purchasing on Amazon and Flipkart.
• Different strategies are used for different categories of doctors. Doctors are categorized as core doctors and secondary doctors, in which core doctors are those who give business to the  company. Additional categories include but not restricted to - specialists, doctors with a good reputation, opinion leaders. The doctors who set the prescription pattern in the field are sought after and looked after well.
• For the pharma company, the doctor's educational background doesn't matter as long as he or she gives business to the Company. There is no hesitation to promote allopath drugs to the Bachelor of Ayurvedic Medicine and Surgery (BAMS), Bachelor of Homeopathic  Medicine and Surgery (BHMS), Rural Medical Practitioners (RMP).

• In order to generate the prescription, the pharma companies conduct direct deals with the doctors.
• Over the years’ the competition of companies is rising as anyone could enter the market freely. As a result, me-too drugs, irrational drugs, irrational. Fixed Dose Combinations (FDC) are being poured in and hence the pressure on MRs to get business for his/her brand among many other competing ones.
• There is evidence that the roles have reversed now. Earlier Pharma companies   used to induce/tempt doctors  proactively. Now doctors are in driving seat. They demand and pharma companies succumb.
• Some Doctors who give huge business demand women for entertainment and  these demands are met.
• There is influence of these promotional inputs on generating business as MR's clearly pointed out that in their work-experience they had observed that, based upon incentives, prescriptions get generated from the doctor.
• It  was  also  observed  that  there  were instances when despite incentives being provided to the doctors, the doctors did not generate business. The reasons for this were that the doctor could not fulfill or satisfy each company.
• In many deals involving high value offers such as installment on the purchase of a car; the company threatens  the doctor of dire consequences if the targeted business is not achieved.
• Most common inducement is sponsoring doctors for national and international conferences.

In fact, the competition among a large number of private pharmaceutical companies has led them to depend on "the tried and tested 3Cs: convince if possible, confuse if necessary, and corrupt if nothing else works"