Doctors & Pharma Industry – Part 1 of 2 – Asrar Qureshi’s Blog Post 1217

Doctors & Pharma Industry – Part 1 of 2 – Asrar Qureshi’s Blog Post 1217

Dear Colleagues! This is Asrar Qureshi’s Blog Post 1217 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to pharmaveterans2017@gmail.com  for publishing your contributions here.

Credit: Thirdman

Preamble

Few relationships in modern healthcare are as debated—or as misunderstood—as that between pharmaceutical companies and doctors. To critics, it is a story of undue influence, conflicts of interest, and distorted prescribing. To defenders, it is a necessary partnership that enables medical innovation, education, and patient access to life-saving therapies.

The truth lies in between.

Pharma Companies and Doctors –  A Relationship of Necessity, Value, and Risk

The relationship between pharma and physicians is structurally unavoidable in a system where:

• Drug development is complex and expensive

• Clinical knowledge evolves rapidly

• Doctors must stay informed about therapies they did not create

The challenge is not whether this relationship should exist, but how it should be governed, bounded, and made ethical.

Why the Relationship Exists (and Why It Matters)

Essential Knowledge Sharing – Pharmaceutical companies invest billions in research & development, clinical trials, and regulatory approvals. 

Once a medicine is approved, its value depends on whether doctors understand how it works, know which patients benefit, and therefore, use it correctly.

Doctors are not passive recipients of information. They are clinical decision-makers, and without structured engagement, new therapies risk being underused, misused, or misunderstood.

This makes pharma-doctor interaction a bridge between science and bedside care.

Continuing Medical Education (CME) – Medical knowledge doubles rapidly. Formal medical education cannot keep pace. Pharma-supported education has historically enabled conferences and workshops, supported disease awareness programs, and helped disseminate trial data.

When done transparently and independently, such education can improve clinical competence, especially in fast-moving fields like oncology, cardiology, and infectious diseases.

Improving Access to Medicines – In many health systems, pharma companies support patient assistance programs, free or subsidized starter therapies, and diagnostics linked to treatment access. For patients who cannot afford care, these programs, when properly governed, can be the difference between treatment and none at all.

Where the Relationship Goes Wrong

Despite its legitimate foundations, the pharma-doctor relationship has serious ethical vulnerabilities.

Conflict of Interest in Prescribing

When marketing incentives influence prescribing decisions, the core principle of medicine, patient interest first, is compromised. Problems arise when prescribing is linked to gifts or travel, certain brands are favored without clinical justification, and costlier medicines are used where cheaper generics suffice. Even the perception of influence can erode trust.

Promotional Bias Masquerading as Education

Not all “education” is education. When only positive trial outcomes are highlighted, risks are downplayed, and alternative therapies are ignored. Doctors may unknowingly receive incomplete or skewed information, affecting clinical judgment.

Erosion of Public Trust

Patients increasingly question, “Why was this drug prescribed?” or “Is it best for me, or best for the company?” Healthcare runs on trust. When the pharma-doctor relationship appears opaque, the credibility of the entire system suffers, even when most doctors act ethically.

Global Lessons: What Works Better

International experience shows that the relationship improves when three principles are enforced.

Transparency – Mandatory disclosure of payments, sponsorships, and benefits reduces suspicion and encourages ethical behavior.

Separation of Promotion and Education – True CME should be independent, evidence-based, and free from product branding

Professional Self-Regulation – Medical associations that set and enforce ethical codes create peer accountability, often more effective than punitive regulation.

The Core Insight

The pharma-doctor relationship is neither inherently corrupt nor inherently virtuous. It reflects the rules, incentives, and culture of the health system in which it operates.

This brings us to Pakistan, where these rules and incentives are uniquely shaped by systemic constraints.

Pharma–Doctor Relationship in Pakistan – Reality, Risks, and Reform

Pakistan’s Healthcare Context Matters – To understand pharma-doctor dynamics in Pakistan, context is everything. Pakistan’s healthcare system is characterized by high out-of-pocket patient spending, limited public healthcare coverage, weak institutional funding for CME, and rapid expansion of local pharmaceutical manufacturing. 

In this environment, the pharma industry has filled gaps that the state and institutions often have not.

Why the Relationship Is More Intense in Pakistan

Doctors Depend on Pharma for Education – Unlike high-income countries, hospitals rarely fund structured CME, universities offer limited post-graduate learning, and independent medical education is scarce. As a result, pharma companies often become the primary sponsors of learning opportunities, especially outside major cities.

This creates dependency, not always by design, but by necessity.

Marketing Pressure in a Competitive Generic Market – Pakistan has over 700 registered pharmaceutical companies and thousands of branded generics for the same molecule. With limited differentiation, competition often shifts from science to relationships, increasing the risk of unethical promotion.

Weak Enforcement, Not Lack of Rules – Pakistan does have ethical guidelines and codes under the Drug Regulatory Authority of Pakistan and professional councils. The problem is not absence of regulation; it is inconsistent enforcement, limited audits, cultural normalization of grey practices.

Negative Consequences in the Pakistani Context

Cost Burden on Patients – When brand loyalty overrides cost-effectiveness, patients pay more than necessary, adherence drops, and outcomes worsen. In a country where most healthcare is self-paid, this is not a theoretical issue—it is an economic and ethical one.

Uneven Prescribing Quality – Evidence-based prescribing competes with promotional messaging, habit, and peer pressure. This can lead to overuse of antibiotics, inappropriate polypharmacy, and delayed adoption of rational treatment guidelines.

Public Cynicism Toward Doctors – The vast majority of Pakistani doctors are ethical and overworked. Yet public perception often paints them with a broad brush, undermining respect for the profession and damaging the doctor-patient relationship.

The Positive Side – Often Ignored

A balanced discussion must acknowledge what pharma has contributed in Pakistan:

• Disease awareness campaigns (TB, hepatitis, diabetes)

• Access programs for expensive therapies

• Introduction of international treatment protocols

• Emergency medicine availability during crises

In many cases, pharma involvement has expanded access, not restricted it.

Part 1 Concluded.

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For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, any claim is lodged, it will be acknowledged and duly recognized immediately.