📰 Set up new regulator for medical devices, says panel
Current organisation is pharma-centric, ineffective, it says
•The Central Drugs Standard Control Organisation (CDSCO) is falling short in effectively regulating the medical devices industry, the department-related Parliamen- tary Standing Committee on Health, headed by Rajya Sabha member Ram Gopal Yadav, has said. The organisation in its existing structure and expertise is more pharma-centric, it says.
•Mr. Yadav presented the 138th report on the subject “Medical devices: regulations and control” to the Rajya Sabha earlier this week.
•It has recommended more certified medical devices testing laboratories, robust IT-enabled feedback- driven post-market surveillance system and medical device registry, particularly for implants to ensure traceability of patients to assess performance of implants.
•The committee has observed that the CDSCO was originally set up to regulate pharma, related segments and medical devices. It has recommended that the new legislation should set up a new regulator at different levels for regulating the medical devices industry.
•The country has only 18 certified medical device testing laboratories that have been approved by the CDSCO and that is grossly insufficient keeping in view the size of the country, it said. The committee is of the considered opinion that having adequate common infrastructure including accredited laboratories in various regions of the country for standard testing will significantly encourage local manufacturers to get their products tested for standards and such measures undertaken will also help in reducing the cost of production which ultimately will improve the availability and affordability of medical devices in the market.
•There is a dire need for developing a robust IT-enabled feedback-driven post- market surveillance system for medical devices to evaluate their efficiency.
•“The committee recommends the Ministry to work in synergy with State governments and impart the necessary skills to the local medical device officers and also devise a mechanism to regularly designate State Medical personnel as Medical Device/Medical Device Testing Officers so that the mandate of the legislation can be implemented effectively,” said the report.
•It has recommended that the Ministry should allow the new regulator to involve institutions such as IISC, CSIR, DRDO and network of IITs to test medical devices for safety and efficacy.
•It has highlighted the multiplicity of regulations, and said that a single-window clearing platform for application of licence for manufacturing, export, import shall integrate all these bodies involved in the regulation of medical devices.
•“A single-window clearance for all the departments/Ministries would boost investment and would also reduce the time required for obtaining approvals from different Departments/Ministries,” the report said.
📰 No specific law against hate speech: EC
Poll body says it resorts to provisions under IPC, RP Act to curb such violations
•The Election Commission of India (ECI) in the Supreme Court has said that due to the lack of a specific law against hate speech and rumour mongering during polls, it has to resort to the Indian Penal Code (IPC) and the Representation of the People (RP) Act to ensure that members of political parties do not make statements which can create disharmony in society.
•“In the absence of any specific law governing hate speech and rumour mongering during elections, the Election Commission of India employs various provisions of the IPC and the RP Act, 1951 to ensure that members of political parties do not make statements to the effect of creating disharmony,” the poll body said.
•The ECI said the Law Commission of India, in its 267th Report, had not made any recommendations with regard to a specific query [from the Supreme Court] on whether the ECI ought to be conferred with the power to derecognise a political party for committing the “offence of hate speech”.
No curbing action
•Neither did the Law Commission make any recommendations to Parliament to strengthen the Election Commission to curb the “menace of hate speeches, irrespective of whenever made”.
•The poll body said hate speeches were “often interconnected with appeals to religion, caste, community, etc, during election campaigning.
•It referred to several Supreme Court judgments, among them the Abhiram Singh case, which had held that “any appeal to vote or refrain from voting for a candidate on the grounds of religion, caste, race, community or language by a candidate or his agent to the electors would amount to corrupt practice under the 1951 Act”.
•This judgment had been brought to the notice of political parties in January 2017. The parties were told by the ECI to desist from making hate statements. Hate speech and communal statements by candidates or their agents could be raised in election petitions.
•Though the Model Code of Conduct had no “legal sanctity”, the ECI said it had introduced guidelines in the Code asking parties to desist from making communal statements. In case any complaints were made, the ECI said it took “strict note” of it.
•The ECI was responding to a plea by lawyer Ashwini Upadhyay seeking directions to the Centre to take apposite steps to implement recommendations of the Law Commission Report 267 on hate speech.
•“The injury to the citizens is extremely large because ‘hate speech and rumour-mongering’ has the potential of provoking individuals or society to commit acts of terrorism, genocides, ethnic cleansing, etc. Hate speech is considered outside the realm of protective discourse,” Mr. Upadhyay’s petition said.
📰 India’s growing water crisis, the seen and the unseen
Rural-urban water disputes are very likely to occur as scarcity grows, exacerbated by climate change
•The UNESCO United Nations World Water Development Report of 2022 has encapsulated global concern over the sharp rise in freshwater withdrawal from streams, lakes, aquifers and human-made reservoirs, impending water stress and also water scarcity being experienced in different parts of the world. In 2007, ‘Coping with water scarcity’ was the theme of World Water Day (observed on March 22). The new Water Report of the Food and Agriculture Organization of the United Nations (FAO) sounded a note of caution about this silent crisis of a global dimension, with millions of people being deprived of water to live and to sustain their livelihood.
Growing water stress
•Further, the Water Scarcity Clock, an interactive webtool, shows that over two billion people live in countries now experiencing high water stress; the numbers will continue to increase. The Global Drought Risk and Water Stress map (2019) shows that major parts of India, particularly west, central and parts of peninsular India are highly water stressed and experience water scarcity. A NITI Aayog report, ‘Composite Water Management Index’ (2018) has sounded a note of caution about the worst water crisis in the country, with more than 600 million people facing acute water shortages. The typical response of the areas where water shortage or scarcity is high includes transfer of water from the hinterlands/upper catchments or drawing it from stored surface water bodies or aquifers. This triggers sectoral and regional competition; rural-urban transfer of water is one such issue of global concern.
•Increasing trans-boundary transfer of water between rural and urban areas has been noted in many countries since the early 20th century. A review paper published in 2019 reported that, globally, urban water infrastructure imports an estimated 500 billion litres of water per day across a combined distance of 27,000km. At least 12% of large cities in the world rely on inter-basin transfers. A UN report on ‘Transboundary Waters Systems – Status and Trend’ (2016) linked this issue of water transfer with various Sustainable Development Goals proposed to be achieved during 2015 to 2030. The report identified risks associated with water transfer in three categories of biophysical, socio-economic and governance. South Asia, including India, falls in the category of high biophysical and the highest socio-economic risks.
Urban water use
•According to Census 2011, the urban population in India accounted for 34% of total population distributed in 7,935 towns of all classes. It is estimated that the urban population component in India will cross the 40% mark by 2030 and the 50% mark by 2050 (World Urbanization Prospects, 2018). The urban population accounted for 50% of the total world population by the end of the last century. Although the pace of India’s urbanisation is relatively slow, it is now urbanising at a rapid pace — the size of the urban population is substantial. Water use in the urban sector has increased as more and more people shift to urban areas, and per capita use of water in these centres rises, which will continue to grow with improved standards of living.
•Examining the urban water management trajectory, it is evident that in the initial stages when a city is small, it is concerned only with water supply; in a majority of cases, water is sourced locally, with groundwater meeting the bulk of the supply. As the city grows and water management infrastructures develop, dependence shifts to surface water.
•With a further growth of cities, water sources shift further up in the hinterlands, or the allocation of urban water is enhanced at the expense of irrigation water. Almost all cities in India that depend on surface water experience this trend. City water supply is now a subject of inter-basin and inter-State transfers of water.
The case of Ahmedabad
•Ahmedabad is an interesting case in this context. More than 80% of water supply in this city used to be met from groundwater sources till the mid-1980s. The depth to groundwater level reached 67 metres in confined aquifers. The city now depends on the Narmada canal for the bulk of its water supply. The shift is from local groundwater to canal water receiving supply from an inter-State and inter-basin transfer of surface water.
•Dependence on groundwater continues particularly in the peri-urban areas in almost all large cities that have switched to surface water sources. While surface water transfer from rural to urban areas is visible and can be computed, the recharge areas of groundwater aquifers are spread over well beyond the city boundary or its periphery.
•Whatever be the source, surface or groundwater, cities largely depend on rural areas for raw water supply, which has the potential to ignite the rural-urban dispute. Available studies covering Nagpur and Chennai indicate the imminent problem of rural-urban water disputes that the country is going to face in the not-so-distant future as water scarcity grows, which will be further exacerbated by climate change.
•At present, the rural-urban transfer of water is a lose-lose situation in India as water is transported at the expense of rural areas and the agricultural sector; in cities, most of this water is in the form of grey water with little recovery or reuse, eventually contributing to water pollution. Rural and urban areas use water from the same stock, i.e., the water resources of the country. Therefore, it is important to strive for a win-win situation.
•Such a situation is possible through a host of activities in the rural and urban areas, which is primarily a governance challenge. A system perspective and catchment scale-based approach are necessary to link reallocation of water with wider discussions on development, infrastructure investment, fostering an rural-urban partnership and adopting an integrated approach in water management.
•Institutional strengthening can offer entry points and provide opportunities to build flexibility into water resource allocation at a regional level, enabling adjustments in rapidly urbanising regions. In India’s 75th anniversary of Independence, it is time to examine the state of its water resources and ensure that the development process is not in jeopardy.
Home Ministry to promote use of language for official work in foreign countries
•The Ministry of Home Affairs (MHA) has written to the Ministry of External Affairs to promote the use of Hindi for official work in banks, public sector undertakings, embassies and other government offices located in foreign countries.
•On August 30, the MHA asked the Ministry of External Affairs to provide a list of all the government institutions in foreign countries and constitute an Official Language Implementation Committee that would oversee the progress of Hindi in official work.
•This was one of the several steps taken by the BJP government since 2014 to promote Hindi in government business.
•In 2017, MHA accepted most of the recommendations contained in the 2011 report of a parliamentary standing committee on Hindi. Some of the recommendations were: option to write exams in Hindi, minimum knowledge of Hindi must for government jobs, 50% government advertisements in Hindi, railway tickets should be bilingual with Hindi being one of the languages and announcement at railway stations in “C” category (non-Hindi speaking) such as Tamil Nadu, Karnataka, Andhra Pradesh, Telengana and Kerala should be in Hindi.
•In 2017, the Ministry said that the websites of all the Union Ministries and the offices under their control should be bilingual and the Hindi pages should also be compulsorily uploaded while updating the website.
•Most government websites are bilingual now- Hindi and English. However, the websites of organisations such as the Central Reserve Police Force (CRPF), the Border Security Force (BSF) and even the National Crime Records Bureau (NCRB) open in Hindi by default.
•After the Union Home Minister joined office in July 2019, additional staff was engaged to translate the files into Hindi. In the past two years, most press releases by the Union Ministries were released first in Hindi.
•As per the MHA’s April 26 notification, more than 80% staff in at least seven offices under the Ministry including the Directorate of Census Operations in West Bengal and the Delhi Police’s Commissioner office had attained the working knowledge of Hindi.
📰 Cabinet approves addition of four tribes to ST list
Move will benefit communities in Himachal Pradesh, Tamil Nadu, Chhattisgarh: Tribal Affairs Minister
•The Union Cabinet under the chairmanship of Prime Minister Narendra Modi on Wednesday approved the addition of four tribes to the list of Scheduled Tribes (ST), including those from Himachal Pradesh, Tamil Nadu and Chhattisgarh.
•Demands for the inclusion of the communities had been pending for decades, Tribal Affairs Minister Arjun Munda told reporters after the Cabinet meeting.
•The Hatti tribe in the Trans-Giri area of Sirmour district in Himachal Pradesh, the Narikoravan and Kurivikkaran hill tribes of Tamil Nadu, and the Binjhia tribe in Chhattisgarh, which was listed as ST in Jharkhand and Odisha but not in Chhattisgarh, were the communities added to the list.
•The Cabinet also approved a proposal to bring the Gond community, residing in 13 districts of Uttar Pradesh, under the ST list from the Scheduled Caste list. This includes the five subcategories of the Gond community: Dhuria, Nayak, Ojha, Pathari and Rajgond.
•Mr. Munda said the demand for the Binjhia tribe to be added to the ST list in Chhattisgarh had been pending for around 15 years.
•Sports Minister Anurag Thakur, who also attended the press briefing, said the Hatti tribe had been seeking their inclusion for around 50 years. Like the Binjhia community, the Hatti tribe had been in the ST list in Uttarakhand but not in Himachal Pradesh.
‘Historic decision’
•“It is a historic decision. I thank Prime Minister Modi for this,” Mr. Thakur, who is an MP from the poll-bound Himachal Pradesh, said.
•Mr. Munda said the inclusion of the Hatti community would benefit around 1.6 lakh people of this area-specific tribe in Himachal Pradesh. He said the Cabinet had also approved the inclusion of synonyms for 11 tribes in Chhattisgarh and one tribe in Karnataka so that variations in their spellings and pronunciations do not result in beneficiaries being left out of schemes.
•The Cabinet approved ‘Betta-Kuruba’ as a synonym for the Kadu Kuruba tribe In Karnataka. In Chhattisgarh, the Cabinet approved synonyms for tribes like the Bharia (variations added include Bhumia and Bhuyian), Gadhwa (Gadwa), Dhanwar (Dhanawar, Dhanuwar), Nagesia (Nagasia, Kisan), and Pondh (Pond).
📰 The future of old times in India
Near-universal social security pensions would be a good start to a radical expansion of public support for the elderly
•Life expectancy in India has more than doubled since Independence — from around 32 years in the late 1940s to 70 years or so today. Many countries have done even better, but this is still a historical achievement. Over the same period, the fertility rate has crashed from about six children per woman to just two, liberating women from the shackles of repeated child-bearing and child care. All this is good news, but it also creates a new challenge — the ageing of the population.
•The share of the elderly (persons aged 60 years and above) in India’s population, close to 9% in 2011, is growing fast and may reach 18% by 2036 according to the National Commission on Population. If India is to ensure a decent quality of life for the elderly in the near future, planning and providing for it must begin today.
Pensions help
•Recent work on mental health among the elderly in India sheds new light on their dire predicament. Evidence on depression from a collaborative survey of the Abdul Latif Jameel Poverty Action Lab (J-PAL) and the Government of Tamil Nadu is particularly telling. Among persons aged 60 and above, 30% to 50% (depending on gender and age group) had symptoms that make them likely to be depressed. The proportion with depression symptoms is much higher for women than men, and rises sharply with age. In most cases, depression remains undiagnosed and untreated.
•As one might expect, depression is strongly correlated with poverty and poor health, but also with loneliness. Among the elderly living alone, in the Tamil Nadu sample, 74% had symptoms that would classify them as likely to be mildly depressed or worse on the short-form Geriatric Depression Scale. A large majority of elderly persons living alone are women, mainly widows.
•The hardships of old age are not related to poverty alone, but some cash often helps. Cash can certainly help to cope with many health issues, and sometimes to avoid loneliness as well. The first step towards a dignified life for the elderly is to protect them from destitution and all the deprivations that may come with it. That is why old-age pensions are a vital part of social security systems around the world.
•India has important schemes of non-contributory pensions for the elderly, widowed women and disabled persons under the National Social Assistance Programme (NSAP), administered by the Ministry of Rural Development. Alas, eligibility for NSAP is restricted to “below poverty line” (BPL) families, based on outdated and unreliable BPL lists, some of them are 20 years old. Further, the central contribution to old-age pensions under NSAP has stagnated at a tiny ₹200 per month since 2006, with a slightly higher but still paltry amount (₹300 per month) for widows.
•Many States have enhanced the coverage and/or amount of social-security pensions beyond NSAP norms using their own funds and schemes. Some have even achieved “near-universal” (say 75%-80%) coverage of widows and elderly persons. That is now the norm, for instance, in all the southern States except Tamil Nadu — an odd exception since Tamil Nadu has been a pioneer in the field of social security.
Beyond targets
•“Targeting” social benefits is always difficult. Restricting them to BPL families has not worked well: there are huge exclusion errors in the BPL lists. When it comes to old-age pensions, targeting is not a good idea in any case. For one thing, targeting tends to be based on household rather than individual indicators. A widow or elderly person, however, may experience major deprivations even in a relatively well-off household. A pension can help them to avoid extreme dependence on relatives who may or may not take good care of them, and it may even lead relatives to be more considerate.
•For another, targeting tends to involve complicated formalities such as the submission of BPL certificates and other documents. That has certainly been the experience with NSAP pensions. The formalities can be particularly forbidding for elderly persons with low incomes or little education, who are in greatest need of a pension. In the Tamil Nadu sample, eligible persons who had been left out of pension schemes were found to be much poorer than the pension recipients (by more than just the pension). Moreover, even when lists of left-out, likely-eligible persons were submitted to the local administration, very few were approved for a pension, confirming that they face resilient barriers in the current scheme of things.
•The problem is generally not a lack of effort or goodwill on the part of the government officials. Rather, many have absorbed the idea that their job is to save the government money by making sure that no ineligible person qualifies by mistake. In Tamil Nadu this often means, for example, that if the applicant has an able-bodied son in the city, they may be disqualified, regardless of whether they get any support from their son. In their quest to avoid inclusion errors, many officials are less concerned about exclusion errors.
•A better approach is to consider all widows and elderly or disabled persons as eligible, subject to simple and transparent “exclusion criteria”. Eligibility can even be self-declared, with the burden of time-bound verification being placed on the local administration or gram panchayat. Some cheating may happen, but it is unlikely that many privileged households will risk trouble for the sake of a small monthly pension. And it is much preferable to accommodate some inclusion errors than to perpetuate the massive exclusion errors we are seeing today in targeted pension schemes.
Widening the net
•The proposed move from targeted to near-universal pensions is not particularly new. As mentioned earlier, it has already happened in several States. Of course, it requires larger pension budgets, but additional expenditure is easy to justify. India’s social assistance schemes have low budgets and make a big difference to large numbers of people (about 40 million under NSAP). They are well worth expanding.
•An example may help. In Tamil Nadu, social security pensions (typically ₹1,000 per month) are targeted and cover about a third of all elderly persons and widowed women, at a cost of around ₹4,000 crore per year. If, instead, 20% were to be excluded and the rest eligible by default, the cost would rise to ₹10,000 crore per year. That would be a modest price to pay to ensure a modicum of economic security in old age to everyone. It would be a fraction of the ₹40,000 crore Tamil Nadu is expected to spend this year on pensions and retirement benefits for government employees – barely 1% of the population. If the transition cannot be made in one go, there is a strong case for starting with women (the widowed or the elderly), who often face special disadvantages. This would also be a step towards the fulfilment of the Tamil Nadu government’s promise of a “home grant” of ₹1,000 per month for women.
•The southern States are relatively well-off, but even some of India’s poorer States (such as Odisha and Rajasthan) have near-universal social security pensions. It would be much easier for all States to do the same if the central government were to revamp the NSAP. The NSAP budget this year is just ₹9,652 crore — more or less the same as 10 years ago in money terms, and much lower in real terms. This is not even 0.05% of India’s GDP!
•Social security pensions, of course, are just the first step towards a dignified life for the elderly. They also need other support and facilities such as health care, disability aids, assistance with daily tasks, recreation opportunities and a good social life. This is a critical area of research, policy and action for the near future.
📰 SCO fights ‘anti-West dictators club’ tag
It is not against any country or bloc: Indian envoy
•The Shanghai Cooperation Organisation (SCO) is not a military bloc nor is it aimed at any one country or group, said officials here, underlining that this week’s SCO Summit will bring together 15 regional “strongmen”, including Russian President Vladimir Putin, Chinese President Xi Jinping, Iranian President Ebrahim Raisi, Turkish President Recep Tayyip Erdogan and Prime Minister Narendra Modi, to Samarkand on Thursday.
•This will be the first such summit with Mr. Putin since the Russian invasion in Ukraine, which has sparked sanctions by the U.S. and the EU and their partners, and the first time that Mr. Xi is stepping out for a multilateral conference since the COVID-19 pandemic.
•Both Russia and China came in for severe criticism on different issues at the G-7 Summit in June, and the optics of the SCO this year will be that of a counter to the western coalition: as all countries particularly targeted by the West — Russia, Iran, China, Belarus and Turkey — find a common cause. In an opinion piece, the U.K.’s Sunday Times even dubbed the meet an “anti-West ‘dictators’ club’”.
•Asked if India, as the next Chair of the SCO, which will host the summit in 2023, was worried by the label, India’s Ambassador to Uzbekistan Manish Prabhat said the perception was unfounded. “India is very clear that the SCO is not an organisation which is against any other bloc of countries or any other country. The SCO is a venture for constructive cooperation and peace and stability in the world. There could be concerns of different countries on various kinds of issues, but the forum is there to talk about these issues,” he told presspersons ahead of the summit.
•Clearly aware of the optics, Uzbekistan President Shavkat Mirziyoyev wrote in an editorial article this week that the SCO’s non-bloc status was important.
•Referring to the summit declaration that is being worked on, he said the “Samarkand Spirit” would launch a “new format” in a world where the present international system has begun to “falter”.
•The stipulation of “non-interference” in internal affairs will, no doubt, strike a chord with the leaders of the SCO who are accused of human rights violations and domestic anti-democratic moves in the West.
•In particular, both Mr. Putin and Mr. Xi are likely to use the presence of the record number of 15 leaders coming to the conference as evidence that they have not been “isolated” on the world stage, despite the West slamming their actions in Ukraine and the Taiwan Strait, respectively.
•India will look closely at the Samarkand declaration for language on terrorism and the listing of terror groups such as the LeT and the JeM that target India, as well as the mention of connectivity initiatives involving the Chabahar port which Mr. Modi is expected to push during his address.
📰 Examining the Dolo scandal
The story stands on shaky legs, but the controversy lays bare the problem of the pharmaceuticals-doctors nexus
•Recently, a controversy bubbled up regarding the marketing strategies of Micro Labs, a Bengaluru-based pharmaceutical company. Micro Labs, the maker of Dolo-650, was charged of having bribed medical doctors with freebies worth ₹1,000 crore in one year to promote Dolo-650.
•Dolo is an analgesic and antipyretic — a non-steroidal anti-inflammatory medication to help with fever and mild pain. It can be purchased from a chemist without a medical prescription. It is actually plain paracetamol, which is a particularly crowded market and fairly competitive too, in a manner of speaking. The Drugs (Prices Control) Order (DPCO) has established ceiling prices for over 850 medicines, including of brands of paracetamol. The ceiling price for a single 650 mg paracetamol tablet is ₹1.83 and for a single 500 mg tablet, it is ₹0.91. It is naturally more profitable for 650 mg to be sold. But how profitable, exactly? Do the incentives work out for the firm? In particular, does the economics work out in terms of giving away ₹1,000 crore of freebies?
The likelihood of freebies
•The paracetamol API is mostly imported from China. There has been significant upward pricing pressure, mostly because of the difficulty of ensuring regular supply from China. But given the price ceiling and the level of competition, investing in the level of ‘freebies’ reported is unlikely. We are not suggesting that the problem of ‘freebies’ doesn’t exist. But the supply chain for freebies is much easier to manage for specialty drugs such as chemotherapy drugs, or when products such as stents and knee and hip implants are directly sold to hospitals. For paracetamol, given the price ceiling and the number of competitors, tracking prescriptions and rewarding doctors is challenging.
•You might argue that Micro Labs may have been willing to take a hit on their margins in order to bump up sales. Perhaps the freebies could be justified if there are other benefits? Well, higher sales at lower margins to the selling company might make sense, but this is a strategy usually employed to beef up the financials, in order to make the valuation look better. The truth comes out eventually. Or you may argue that this was a brand-building exercise in anticipation of higher over-the-counter sales, to help push through a sale of the brand to a pharmaceutical major. Without these angles, the story stands on shaky legs.
Legal provisions
•Yet, thinking about this scandal is still instructive, for it lays bare the extent of the problem, beyond the paracetamol segment, let alone the specific product (Dolo). The Uniform Code of Pharmaceuticals Marketing Practices explicitly prohibits gifts, payments and hospitality benefits to doctors on the part of medical representatives. Pharmaceutical firms have been declaring their compliance with, and adherence to, this code since 2015, if not earlier. The kicker? This code has been fully voluntary since 2015. There is also no enforcement mechanism. The Indian Pharmaceutical Alliance, which is meant to “enforce” the code, has promptly given Micro Labs a ‘clean chit’.
•That being said, there are provisions that detract pharmaceutical firms from offering incentives. And they come from a somewhat unexpected source: the Income Tax Act, 1961. The Act explicitly disallows deductions for payments to doctors. Moreover, tax deducted at source (TDS) is applicable for all payments made to doctors. Workarounds are possible, but this acts as a huge financial disincentive for pharmaceutical companies.
•There’s more. Para 1.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 states that every physician should, as far as possible, prescribe drugs with generic names. It also states that there is both a rational prescription and use of pharmaceutical drugs. This is, of course, rarely done and there is no enforcement. This regulation also prohibits the disbursement of gifts. In this case, there is potential for enforcement — a reprimand, at the least — and even for cancellation of license, though this happens very rarely.
•The solution is two-fold. First, a move to prescriptions without brand names should be the default practice. Doctors will then have no incentive to promote particular brands and pharmaceutical companies will have no incentive to give freebies to doctors. But even if doctors are not able to recommend a certain brand, pharmacists are. And their incentive is to recommend brands that give them the highest trade margins, which are based on the maximum retail price (MRP). We can remove this incentive by introducing a flat dispensing fee, regardless of MRP. This will restore agency to the patient.
