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 1 

Ethical Relation between Physicians and Pharmaceutical Industries in the 

Perspectives of Bangladesh 

 

Shahinul Alam
1
, Nahiduzzaman

2
, Monsur Hallaj

3
, Jahangir Ul Alam

4
, Shoaib Momen Majumder

5 

 

1. Dr. Md. Shahinul Alam, Associate Professor of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 
Bangladesh. Email: shahinul67@yahoo.com,  

 
2. Resident, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.  
 

3. Assistant Professor, Department of Surgery and Urology. Northern International Medical College, Bangladesh. 
 

4. Resident, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.   
 

5. Resident, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.   
 

 

Abstract:  Relation between physicians and pharmaceutical industry is required for the benefit of the patient. But it 

may turn into business and overthrow the patients’ benefit. The relation might be in question at present and in future. 

Several questions are flowing in Bangladesh. To solve these queries we have explored the situation in developed and 

developing countries. The physicians and associations of pharmaceutical industries developed several ethical 

guidelines in those countries. They have addressed the long lasting issues on gift provided to physician, cash back, 

sample, industry sponsored scientific meetings, research and hospitality. There are huge restrictions to ensure the 

right of the patient’s e.g. limitation of inexpensive gift by the pharmaceuticals, avoiding expensive medicine instead of 

equally effective low priced medicine. We are lacking behind to protect the patient right properly: regulation, 

adherence to existing guide line, lack of guidance from statutory bodies. The current scenario is far behind the right of 

patient. In Bangladesh it is not yet addressed either by professionals or by pharmaceutical associations. It is the 

immediate need to construct a guide line for physicians and pharmaceutical industry of Bangladesh. 

 

Key words: Ethics; Physician; Pharmaceutical industry; Gifts; Hospitality; Sponsorship 

 

Introduction: Our patients have to bear the expenses of medicine and other costs of treatment. Very small amount 

is served by public fund. Two third of expenditure is bored by out of pocket. The drug and its price are regulated by 

Drug Administration authority under the Ministry of Health and Family Welfare. Clinical trial is at infantile stage. 

Apprehension over conflicts of interest in medicine is rooted in a concern that professional judgments about the 

welfare of patients may be inappropriately influenced by a secondary interest — in this case; the personal gain 

derived from relationships with pharmaceutical companies
1
. A drug company’s primary interest is to maximize sales of 

its product. Physicians do not (or should not) share this goal, but they are the chief conduit for sales. Consequently, 

physicians have been the central target of marketing strategies
2
. The pharmaceutical industry and professional 

organizations should anticipate some elements of the gathering storm. Their voluntary initiatives in this heretofore 

largely unregulated area could be interpreted as an attempt to forestall sterner measures by addressing the kinds of 

activities. 

 

mailto:shahinul67@yahoo.com


Bangladesh Journal of Bioethics 2015 Vol.6 (1):1-5 
 

 2 

The promotion of medicines is very influential and needs to be carefully controlled. The pharmaceutical industry 

differs from other industries in that its products directly affect the health of patients. The sale of these medicines is 

strictly controlled through market authorization (registration), prescribing and dispensing regulations. Ethical 

promotion of medicines is important in order to ensure that medicines are prescribed and used in a rational way. 

Promotional activities that do not comply with ethical criteria for medicinal pharmaceutical promotion are an important 

factor contributing to inappropriate overuse and unnecessary costs
3
.
 

 

In the world, the rise of the pharmaceutical industry’s importance as a funder of mainstream research and education 

is increasing. Approximately 60 percent of biomedical research and development today is funded by industries
4, 5

. 

Pharmaceutical companies’ share of funding for clinical trials is more than 70 percent 
6, 7

. The industry also shoulders 

more than half of the costs of continuing medical education
8, 9

. Financial entanglement has bred close ties between 

the industry and physicians. There is hardly a physician practicing today who has not been the beneficiary of small 

“educational” gifts such as pens and memo pads or lunch for the office staff
10

.
 
 Many physicians attend dinners to 

hear a hired expert talk about a product, take educational trips to resorts, or receive funds in the form of research 

grants, trainee support, or lucrative consulting fees
11, 12

. These benefits are defended as a way to provide useful 

information for physicians as they address difficult problems in treating their patients. But at what point does the 

influence become corrosive to the good of the patient
13

? 
 

 

Methods: For the purpose of this review we have gone through the web site of World Health Organization, 

American Medical Association, World Medical Association, General Medical Council, Bangladesh Medical and Dental 

Council, Indian Medical Council, Irish Medical Council. Necessity to follow these organizations was as because these 

organizations have already established the guidelines for their country and for the world as a whole.  Exclusive 

summary was written with the followings: Ethical Criteria for Medicinal Drug Promotion, World Health Organization, 

Geneva 1988, Self-Regulation of Drug Promotion A Cross-sectional Analysis of Pharmaceutical Marketing Codes and 

the WHO Ethical Criteria for Medicinal Drug Promotion 2007, Code of Practice for the Pharmaceutical Industry, the 

Association of the British Pharmaceutical Industry; 2
nd

 edition 2012, OPPI Code for Pharmaceutical Practices, 

Organization of Pharmaceutical Producer of India; 2012, Guide to Professional Conduct and Ethics for Registered 

Medical Practitioners. Relationships between Doctors and Industry: Frequently Asked Questions, Irish Medical 

Council October 2012, Code of Interaction with Health Care Professionals of the Pharmaceutical Research and 

Manufacturers of America (PhRMA) 2012 and Code of Practice 2012 of the R&D-based Pharmaceutical Association 

Committee (RDPAC) of China.Rarmaceutical Association Committee 

 

3. Current status in Bangladesh:  

The Pharmaceutical industries and their business are progressively increasing in the country. Country is earning 

foreign currencies by exporting drugs .There are huge assumption and speculation about the relationship between 

physician and pharmaceutical industries in the country. Several stories has been published and broadcasted in the 

print and electronic medias
14

. Though the existing Bangladesh Medical & Dental Council Act
15

 prohibit any unethical 

relation between physician and pharmaceutical industry; there are evidences that pharmaceutical industries are 

providing cash, hospitality, pleasure trips, medical equipments, books, sponsorship for conferences, workshop, 

decoration for chamber, professional and non professional gifts for doctors. Clinical trials are very few in the country 

and pharmaceuticals are not much interested to support this. Clinical trials are regulated by Institutional Review 

Board/ Bangladesh Medical Research Council. At this stage profession is losing its image and respect, though a very 



Bangladesh Journal of Bioethics 2015 Vol.6 (1):1-5 
 

 3 

small number of physicians are involve with these misconduct. If it is not addressed by professionals it could be dealt 

by state prosecution as like USA where a third party, a body of federal law dealing with “fraud and abuse” 
16

 has 

evolved to the point where it was being used by prosecutors to punish pharmaceutical companies and physicians. In 

2002, three leading professional organizations — the American Medical Association
17

, the American College of 

Physicians,
18

 the Accreditation Council for Continuing Medical Education
19

 —and Pharmaceutical Association
20

 

published guidelines regarding physicians’ interactions with drug companies. Several other guide lines have been 

published in last 10 years from Europe and Asia on the abovementioned subject except from Bangladesh. It is the 

time demand to build up a standard guide line on “Ethical relation between Physician and pharmaceutical industries” 

for Bangladesh from professionals and from pharmaceuticals. 

 

Leading issues to be addresses in the country 

a. Cash/kickback/ commission: According to the World Medical Association
21

. "The Code provides that payment by 

or to a physician solely for the referral of a patient is unethical as is the acceptance by a physician of payment of any 

kind, and in any form, from any source such as a pharmaceutical company or pharmacist”. Indian Medical Council Act 

strictly prohibit this
22

. In USA it is considered as criminal activity and prosecuted by fraud and abuse law
23

.  

 

b. Gifts provided by pharmaceutical company: Gifts are frequently supplied by medical representatives or at 

events to health-care professionals. Ethical criteria for medicinal drug promotion (WHO-ECPM) mentioned “Gifts 

offered to members of the medical and allied professions should be secondary to the purpose of the meeting and 

should be kept to a modest level” 
24  

.The code analysis demonstrates that some gifts are permitted under strict 

circumstances. The benefit for the profession or the opportunity for education of the health-care professional plays a 

key role in the permission of gifts. Apart from the permission of the supply of medical utilities or small gifts for the 

benefit of the health profession by the various codes, some offers with regard to hospitality are permitted. In the 

various national codes, requirements should be included to ensure that nothing be offered that would interfere with 

the independence of the health-care professional’s prescribing or dispensing practices. The Association of the British 

Pharmaceutical Industry (ABPI) permits the supply of promotional aids to health professionals as long as these are 

inexpensive and relevant to the practice of the recipient’s work. The ABPI also mentions a maximum cost of a utility, 

being six pounds
25

.
 
Utilities for use by patients are also permitted. The ABPI requires that non professional gifts or 

other material or financial benefits should not be offered to healthcare professionals or administrative staff in order to 

induce them to prescribe, supply, administer, recommend, buy or sell any medicine
26

. 
 

 

c. Sample of Drug: According to Organization of Pharmaceutical Producer of India (OPPI) free samples of a 

pharmaceutical product may be supplied to healthcare professionals or to persons duly authorised by them who are 

qualified to prescribe such products in order to enhance patient care. Drug samples should not be resold or otherwise 

misused.
26

Irish Medical Council further clarifies that the number of such samples of each product that may be 

supplied to any one recipient in any one year shall be limited; the supply of any such sample is made only in 

response to a written request, signed and dated, by the recipient; each such sample is marked “free medical sample 

— not for sale” or words to the like effect
27

. 
 

 

d. Sponsoring and hospitality of scientific meetings, conferences, seminars and symposium: American 

Medical Association recommended conference subsidies should meet the following conditions: They should be 

accepted by conference sponsor, not physician attendees. They do not cover travel, lodging, time, or other personal 

http://en.wikipedia.org/wiki/World_Medical_Association


Bangladesh Journal of Bioethics 2015 Vol.6 (1):1-5 
 

 4 

expense of physician attendees who are not faculty. Hospitality subsidies should be limited to modest meals or social 

events held as part of meeting .Faculty honoraria and reimbursement must be reasonable. Organizers should retain 

responsibility for and control over selection of content, faculty, educational methods, and materials. Scholarships and 

special funds for trainees to attend “carefully selected education conferences” are permitted if selection of recipients 

is controlled by training institution. “Legitimate” conferences or meetings are defined as having the following 

characteristics: They are primarily dedicated (in time and effort) to objective scientific and educational activities. They 

are convened to further knowledge on topic presented. They ensure appropriate disclosure of financial support or 

conflict of interest. Payments for consulting services must be limited to reasonable compensation and reimbursement 

for travel, lodging, and meal expenses; must be “genuine” services, not “token”. Physicians may accept gifts at the 

conference from pharmaceutical companies under the following conditions: The gift must be primarily for the benefit 

of patients and be primarily related to the physician’s work. The gift must be of insubstantial value and must not be 

cash. Drug samples permitted for physicians; personal and family use of the samples also permitted, provided that it 

does not interfere with patient access to the samples.
13

These criteria are also supported in UK and Ireland
25, 27

. 
 

 

Implementation: Further background research is required for present situation and on feasibility and usefulness of 

a guideline. Motivational work, awareness through training, conference and workshop by Bangladesh Medical 

Association and other professional organization will break the ground of darkness. Directorate of Health Services and 

Drug Administration may collaborate with pharmaceutical industry and physician to construct a guide line for the 

nation and further implementation of it. 

 

Conclusion: The relationship between physician and pharmaceutical industry requires excellent ethical value. It 

might be in question at present and in future. In developed countries and our neighbor country had establish and 

published their status.  A practice guideline is essential for Bangladesh regarding this issue. Professional organization 

and pharmaceutical association could take the initiative to reflect the transparency of relationship. 

 

Acknowledgement: We thankfully acknowledge the contribution of Center for Medical Ethics Education and 

Research (CMER) for inspiring us to write this article 

 

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2002; 287:78-84. 



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NlYwNzcgRzbGsDdmlkBHZ0aWQDBGdwb3MDOA--?p=jamuna+television+prescription+360+degree 

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industry: Frequently Asked Questions. Irish Medical Council October 2012. 

 

 

Conflict of interest: There is no conflict of interest between the authors and no financial relation with any person or 

organization regarding this review. 

 

https://video.search.yahoo.com/video/play;_ylt=A2KIo9YWS79UcAQAQW77w8QF;_ylu=X3oDMTBycTlydWI1BHNlYwNzcgRzbGsDdmlkBHZ0aWQDBGdwb3MDOA--?p=jamuna+television+prescription+360+degree
https://video.search.yahoo.com/video/play;_ylt=A2KIo9YWS79UcAQAQW77w8QF;_ylu=X3oDMTBycTlydWI1BHNlYwNzcgRzbGsDdmlkBHZ0aWQDBGdwb3MDOA--?p=jamuna+television+prescription+360+degree



