news details |
|
|
| The Changing Face of Pharma Engagement: Reimagining the Role of Medical Representatives in India’s Public Health Landscape | | | Dr. Manorama Bakshi | 6/7/2025 10:39:01 PM |
|  The Ministry of Health and Family Welfare recently issued a directive barring medical representatives (MRs) from visiting Central Government-run hospitals. Quietly conveyed through a memo from the Director General of Health Services (DGHS), this change of policy might well transform the shape of pharmaceutical involvement in the public health infrastructure of India.
For public health policy and practice practitioners like us, this is not just a bureaucratic directive, but a decisive turning point. It shines a light on the clash of commercial imperatives and ethical medical practice, and should make us rethink how we focus our common goals on true rational, patient-centred healthcare.
Medical Representatives in India: A Backbone With Complexities
India’s pharmaceutical sector is among the largest of the world, and it is extremely dependent on a workforce of more than 600,000 medical representatives. These MRs are the first contact people between the pharmaceutical industry and practicing physicians in the public and private sectors by providing vital information on new drugs available in the market, dosage forms, treatment indications, and new clinical guidelines among their hosting institutions.
However, their role — particularly in government hospitals — has long been steeped in ethical grey areas. The distinction between legitimate medical education and aggressive promotion can be thin at times, and even questionable, as in the case of grants extended for favouring prescriptions, gifts, sponsored travel and honoraria veiled as Continuing Medical Education (CME). This grey-area relationship has sparked controversy and suspicion from healthcare professionals, patients, and policymakers.
It is important to stress that not all MRs engage in such practices. Many are sincere conduits for the flow of scientific updates, especially in resource-limited settings where access to journals and conferences remains patchy. Yet, the absence of a clear, enforceable regulatory framework has left this critical interface open to exploitation and manipulation, undermining both public trust and clinical integrity.
Learning from the World: Regulation and Reform
The global landscape offers instructive contrasts. In mature markets like the United States, the Physician Payments Sunshine Act mandates comprehensive disclosure of all payments, gifts, and transfers of value from pharmaceutical firms to healthcare providers. The UK operates under the stringent guidelines of the Association of the British Pharmaceutical Industry (ABPI), enforcing transparency and limiting undue influence on clinical decision-making.
Conversely, many developing countries, including India, Bangladesh, and the Philippines, continue to rely predominantly on face-to-face MR engagement, particularly within private healthcare settings. Here, regulatory oversight is patchy, enforcement inconsistent, and promotional practices often remain informal and relationship-driven rather than evidence-based.
This disparity underscores a pressing need for India to leapfrog toward a more accountable, transparent, and digitally-enabled model of pharmaceutical communication—one that aligns with global best practices while respecting local realities.
Why Now? Why Public Health Facilities?
The recent ban confines MRs from entering Central Government hospitals, directing them instead to share product information via email or other digital platforms. This follows similar restrictions introduced by several private hospitals and medical colleges over the past few years, signalling a broader trend.
This policy is rooted in a desire to shield public institutions from undue commercial influence. Public hospitals, already overburdened and resource-constrained, must serve as sanctuaries of unbiased, evidence-based care. Physicians working in these settings are bound by the National List of Essential Medicines (NLEM) and often limited by essential drug procurement policies to generics and cost-effective treatments.
Allowing brand-driven MR promotion in these environments risks subverting this ethos, inserting commercial priorities into spaces meant to serve patient welfare above all else.
In candid conversations with health officials and practitioners, one often encounters a telling paradox: senior bureaucrats vocally support generics promotion while privately preferring branded medicines for their own families. This hypocrisy reflects entrenched structural challenges that reform must confront.
Who Benefits from This Shift?
The implications extend well beyond the MRs themselves or the corridors of hospitals. Several stakeholders stand to gain:
1. AYUSH and Traditional Medicine Practitioners
With reduced dominance of allopathic pharmaceutical lobbying, indigenous medical systems such as Ayurveda, Unani, and Siddha could gain greater visibility and integration within public health frameworks. The National AYUSH Mission’s objectives align well with this evolving landscape.
2. Generic Drug Manufacturers and Jan Aushadhi Stores
The diminished influence of branded drug promotion may nudge physicians back toward prescribing generics listed on the NLEM. This could boost utilization of Jan Aushadhi Kendras, reducing out-of-pocket expenditure and improving medicine affordability.
3. Health Policymakers and Advocates of Rational Drug Use
For those championing WHO’s Good Governance for Medicines (GGM) principles, this represents a landmark victory. It marks a decisive step toward strengthening rational drug prescribing and safeguarding system integrity from commercial distortion.
4. Digital Health Platforms and Innovators
India’s rapid digital health transformation, through initiatives such as eSanjeevani, Ayushman Bharat Digital Mission (ABDM), CDSCO’s Sugam portal, and the National Health Systems Resource Centre (NHSRC), offers unprecedented opportunities. Digitally mediated pharmaceutical engagement—rooted in transparency, evidence, and provider-friendly workflows—can replace outdated face-to-face detailing.
The Digital Pivot: A New Paradigm for Pharma Engagement
The move to restrict physical MR access in public hospitals dovetails with a larger, systemic pivot toward digital health. Electronic health records, real-time prescription audits, and AI-enabled clinical decision support tools are increasingly available and offer the means to ensure drug information reaches clinicians as unbiased, guideline-aligned prompts rather than persuasive sales pitches.
MRs, re-envisioned as Medical Science Liaisons (MSLs), can serve as genuine educators, well-versed in clinical pharmacology and pharmacoeconomics, delivering value beyond sales. Pharma companies must invest in developing credibility and trust, pivoting from visibility-driven marketing to knowledge-driven engagement.
While skeptics question the viability of purely digital interaction, a hybrid “phygital” approach—blending ethical digital detailing with limited, well-regulated physical presence—may be the most practical path forward, particularly in private sector settings.
The Human Dimension: What About the MRs?
We must not lose sight of the human element. Six hundred thousand livelihoods depend on the MR profession. The majority are honest professionals operating within industry norms. The problem is structural, not personal.
The absence of a robust institutional framework outlining ethical boundaries, standard operating procedures, and continuous professional development is the root cause. Rather than blanket bans, structured reforms that define clear roles, responsibilities, and ethical codes could better serve all stakeholders.
Transitioning MRs into knowledge brokers and clinical educators, supported by technology and oversight, would be a win-win: preserving employment while enhancing healthcare quality.
Historical Lessons: Influence, Incentives, and the Gray Zone
India’s health policy ecosystem has long wrestled with subtle yet pervasive influence. Historically, global donors, private industry, and government officials have engaged in relationships where technical collaboration sometimes blurred into patronage. Invitations to foreign conferences, “study tours,” fellowships, and post-retirement positions in aligned organizations created a soft web of influence affecting programmatic and procurement decisions.
While outright corruption was not always the norm, these gray zones compromised impartiality and transparency. Today, India’s increasing transparency initiatives—including stronger RTI regimes and digital public spending disclosures—are helping to close these loopholes.
The MR ban is consistent with this larger ethical realignment, demarcating clearer boundaries between information and influence, marketing and medicine.
The Cost of Inaction: Why Momentum Matters
If this reform momentum falters or succumbs to lobbying pressures, India risks slipping back into business-as-usual—where marketing masquerades as medicine, and prescriptions are influenced by incentives rather than efficacy.
This is not merely an MR problem; it is a systemic challenge. Pharmaceutical companies must critically review and reform their compliance models. Hospitals need to enforce transparency and accountability. Policymakers must maintain vigilance and hold all actors responsible—regardless of stature or affiliation.
Waiting for scandals or whistleblower exposés is a luxury India’s healthcare system cannot afford. Ethical practice must become the default, not the exception.
In Closing: A Moment of Opportunity
The DGHS directive banning MRs from Central Government hospitals marks a watershed moment. What begins here may soon extend to district hospitals, medical colleges, and even private chains. This is not an attack on the pharma workforce but an invitation to rebuild trust and integrity in public healthcare.
To the pharmaceutical industry: this is not the end of engagement; it is an opportunity to engage better—smarter, ethically, and with evidence at the forefront. To the MRs: this is not a rejection of your profession but a redefinition of your relevance and responsibility. And to the patients—often silent in these debates—this step heralds the promise of more affordable, transparent, and trustworthy care. Let us seize this moment to build a future where medicine serves people first, commerce second.
Dr. Manorama Bakshi is the Director & Head of Healthcare & Advocacy at ConsociaAdvisory, Founder of the Triloki Raj Foundation, senior visiting Fellow IMPRI . A public health strategist with two decades of experience working across government, multilateral agencies, and grassroots movement |
|
|
|
|
|
|
|
|
|
|
|
|
| |
| |
|
|
|
|
 |
|
|
|
|
STOCK UPDATE |
|
|
 |
| BSE
Sensex |
 |
| NSE
Nifty |
|
|
| |
CRICKET UPDATE |
|
|
|
|
| |
| |
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
