Monday, August 31, 2015

Pharmaceutical Industry and Sponsorship of conferences

Monday, August 31, 2015
Pharmaceutical Industry and Sponsorship of Delegates for National Conferences

I had written this article in 2002 in the official journal of our academy.
The annual budget of our national conferences has escalated to almost 20 crores( 3 million USD). If one is impassioned, and not the involved organiser or  the office bearer, one can indulge in rational analysis, one would get disappointed at the end of the day about the academic gains of such huge activity, its impact on the prescribing habits and in terms of making people more rational about antibiotics usage.
The issue remains burning more today than it ever was!
Here it is how it goes:
This issue comes up with unnerving frequency every now and then. Are we serious enough to take the bull by horns or we just want to generate some discussion and continue it to some length till the heat is over and it is once again conference time and we go through the same painful experience once again. This has been increasingly happening over last few years and it has now degenerated to all time low, where besides the conference sponsorship at organizational level, it is individual sponsorship and what is worse, the whole family sponsorship.
The not so new disturbing trend is the whole family being sponsored by the pharmaceuticals. This may be combined with a conference or may be a separate pleasure trip. The separate clandestine sponsorship as they do not come to the fore remain confined in the know of only a few select ones. The ones which are combined with the conference are really disturbing ones. They not only add on to the ever-swelling number of the delegates, they are the motivational factor behind the delegates equating these meets to social events. It makes life difficult for every one, in the foyers, in the relaxation areas, in the queue for food and in the banquets as well. How ethical is this family sponsorship, is it demeaning to the profession, which needs lots of refurbishing anyway, is a very serious matter to ponder. Any change in the behaviour calls for self-discipline, which is purely a personal matter. And the way of life, attitude, and one’s upbringing are the factors, which influence this. The self-restraints and exercise of self-control are very slow and difficult to come by, hence this menace is going to loom large over us for as long as we dare to care.
The magnitude and the quality of sponsorship at organizational level is also changing its face. Scientific sessions are sponsored and some of the speakers (not necessarily learned ones) are thrust upon the delegates. These speakers behave like loud mouth spokesperson of the pharmaceuticals.
The disturbing trend that is emerging is that the budgeting of the conference is done in a manner to suit the extravaganza. The total budget is in crore(s) now. Nobody gives it a second thought that lavish expenses should be curbed and just because there was a sponsor waiting in the wings we should escalate our expenses. The most important example of this is the amount spent on brochures. This overtly is to attract more delegates (And we say our problems is to restrict the number!) When only IAP members attend the conference and the official journal reaches every member where is the need for this mindless, mind-boggling expenditure on brochures? Again, it is some body else’s money, so no problem. By simple calculations, each brochure with postage costs around Rs. 100.00, multiply this with 12000* and three times over, it comes to Rs 36 lacs! For each of the 4000** delegates who attended the conference it comes to Rs.900.00. If this is not wasteful expenditure what is? The emphasis in these brochures has shifted from scientific information to weather report and sight seeing, the perception of organizers which the delegates share. The detailed scientific program for the just concluded conference was posted on 22nd January, a day prior to the pre-conference workshops and reached me after I was back from the conference. This goes to show the change in the perception and the priorities. The other important signal such lavish expenditure sends to the members is that it glorifies the expenditure and gives it a seal of authority. A mortal member thinks when the academy can do this why can I not?
The next important area of unproductive expenditure is erection of temporary AC halls. This to accommodate delegates who are largely not interested in attending any session seriously and at whose hands serious delegates suffer. No organizing committee is willing to restrict the number to sensibly suit the accommodation available and register dele-gate on first come first serve basis. The unmanageable number forces these confer-ences to be held only in metropolis and the cost of holding the conference escalates exponen-tially. And, proportionately the dependence on pharmaceutical industry increases.
People have talked of this dependence as symbiosis and relegated it as benign. The fall out of this dependence is visible in the increasing number of individuals vying for this sponsorship and even availing this for their pleasure trip. And to think that a company whose sole interest is sale promotion is doling out this largesse as an act of generosity is continuing to deceive oneself! Representatives of these companies start reminding the very next day the "contributions" they have made to the conference. Their grip on the matter is increasingly becoming tighter and they have started dictating the contents of the scientific sessions and the name of speakers as well. And when those, who are in a position to influence decisions, are involved in decision making and are the benefactor of this generosity how on earth a clash of interest be completely ruled out and how to believe that the custodian of faith and the advocates of children had only the interest of the children of this country in their minds.
We have to very seriously consider who is ultimately paying for all the fun and the merry making that goes with this sponsorship. We are taking out the money from the pocket of the unsuspecting patient and putting in to the pharma’s coffers. And also partaking a part of it.
When relations in today’s materialistic world develop and are endured on give and take basis every pharmaceutical company is rightly looking for the returns. I do not know how many of us are aware of a particular product when written in stipulated quantity entitled the prescribing doctor to get a car. There are number of such cars plying on the roads of many cities in the country. The company borrows loan from bank and pays the EMI. If the doctor stops prescribing the drug short of his "commitment" the car is seized by the company. We should not continue to think that this sponsorship is without harm or does not influence our decision-making or our prescriptions.
IAP’s uninhibited promotion of Nimuselide has seen this drug emerge as one of the leading antipyretic. Today we know about some side effects but at a point of time when we became the launching pad, how little did we know about this.
Once a snow balling effect starts it is difficult to stall the slide. I do not know how it affects self esteem or self image. People who have enjoyed the hospitality are better equipped to take up these moral issues.
If the pharmaceutical companies are interested in betterment of the mankind as they claim they are and have made many of us believe they are then let them spend this money on researches and training. Let this research be carried out without any strings attached and let the results see the day of light irrespective of what they are. There is increasing fear (I honestly do not know substantiated or otherwise) that the research is being influenced and adverse results are suppressed.
Here are my suggestions to initially minimize and ultimately end the pharmaceutical companies involvement.
• The office bearers of IAP should take a pledge that during their term of office they will NOT accept any sponsorship. This will set example, will glorify the stand and act as a deterrent to other members. This will also avoid any conflict of interests.
• No scientific session will be handed over to any pharmaceutical company. And obviously they will not be allowed to choose the subject or the speaker.
• The number of delegates should be restricted to match the accommodation available. This will encourage conferences at "lesser" venues and cut down drastically expenses on venues and food, leaving us less dependant on sponsored money. This will also allow serious minded delegates to get into the halls.
• The expenses on brochures should be totally stopped; a pull out in the Indian Pediatrics should be the means for communication. This will save lot of money and again save us the ignominy of "contribution" from the companies. If this attracts fewer delegates, the organizers can live without the compunction of refusing some one.
I am willing to organize a CME of around 1000 delegates purely on the money generated by delegate fee and no funding by the pharmaceutical. The book houses and the manufacturers of equipments will be roped in only if need be. And I shall hand over all the savings to IAP. I sincerely wish to explode the myth that CME cannot be organized without funding.
There was a committee formed by IAP for conference reforms. I do not know what came of it. The conference reforms are intimately and intricately interwoven with the issue of sponsorship. If we are seriously interested in reforms and wish to make what conference should be, the opportunity to learn and equip oneself better to serve ultimately the patients better (this is my personal perception of the conference) then all of us need to sit up and do something serious about it. The time for rhetoric is over and some action is called for. Otherwise, we would continue to find ourselves outside the conference hall with overstuffed carry bags with lots of trash literature or standing in winding queues for the luncheons. And I can vouch for myself that I did not pay my hard earned money for this, nor did I forgo a week of my precious practice for this extravaganza.

Sanwar Agrawal,

Ekta Institute of Child Health,
Shantinagar, Raipur 492001, India.
* Now the strength is 20000
** Delegates attendance is now 7000-8000
*** IAP is abbreviation for Indian Academy of Pediatrics

Key Messages
• Sponsorship of the conference at personal and organizational level has influenced conferences in a big way, the quality is under tremendous pressure.
• The availability of funds has to do a lot with the associated extravaganza and funfare.
• The new dimension of the sponsorship is the family sponsorship which is threatening to reduce the academic exercise to social outing.
• A concerted effort at organisational and individual level is needed to curb the menace. Holding the dignity of the profession, self restraints and discipline and willing to pay for one’s own learning are the short and long term remedial measures.