A group of four to five men surrounded Anwar Miah and his five-year-old son Kawsar as they left the outdoor section of Shaheed Suhrawardy Medical College and Hospital. Anwar had brought his son to consult a doctor.
The men, who are medical representatives of different pharmaceutical companies, immediately took out their mobile phones to take pictures of the prescription. Anwar and Kawsar were clearly bothered. The hospital's Ansar team quickly came to their rescue and requested the medical representatives to leave, but to no avail.
This group is just one of many that were waiting outside the outdoor section. Whenever a patient comes out, one of the groups rushes to surround him and take a photograph of the prescription.
Later there is a game of cat and mouse as Ansar members try to chase the medical representatives away, only to find them surrounding another patient after a short while.
The problem is the same in almost all major hospitals and private chambers of doctors in the country, but especially so in government hospitals. What the medical representatives do as part of their duties almost amounts to harassment, but they don't care.
Tube-well repairer Ali Hossain, 55, was surrounded by two different groups after he came out of the National Institute of Cardiovascular Diseases. He told The Business Standard that the same thing happens whatever hospital he goes to.
"I have learned to tolerate this irritating practice as there is nothing I can do about it," he said.
Medical representatives, however, told The Business Standard that they only request patients to show prescriptions. If a patient refuses, they never force him.
Shahnewaz, an Ansar member at Shaheed Suhrawardy Medical College and Hospital, said medical representatives do not want to leave despite repeated requests by the Ansars.
"We have been ordered to keep the hospital premises off-limits for medical representatives until 1pm. These cunning opportunists, however, always find a way in, even as early as 08:30am. This makes our job annoying," he told The Business Standard.
A medical representative of Opsonin Pharma Ltd said his main duty is to promote his company's products to doctors and to persuade them to prescribe those to patients.
"We need to take pictures of the prescriptions because we need to make sure that the doctors prescribe our drugs. We determine the popularity of a drug based on how many times doctors prescribe it," he said.
A symbiotic relationship
It is not only pharmaceutical companies that benefit from what their medical representatives do. Doctors and hospitals ask pharmaceutical companies to support events like medical conferences or picnics for medical school students. The companies that respond positively with financial support get preference in the prescriptions.
In 2018, five doctors from Bangabandhu Sheikh Mujib Medical University and Northern International Medical College studied the morality of the relationship between doctors and pharmaceutical companies. They found that companies reward doctors handsomely with financial support, trip allowances, workshop sponsorships, chamber decorations, medicine samples, and many other professional and non-professional gifts.
Uttam Kumar Barua, director of Shaheed Suhrawardy Medical College and Hospital, said Ansar teams on hospital premises try to prevent medical representatives from disturbing patients.
"However, controlling the representatives is a difficult job. This marketing system of pharmaceutical companies is immoral," he said.
Anwar Miah also said he is aware that companies give doctors financial support if they prescribe their drugs.
"I have no option but to be treated as a pawn in this unhealthy profitmaking contests," he said.
The decisive marketing game plan
Medical representatives from different pharmaceutical companies come together to form teams and share responsibilities at hospitals or at doctors' chambers where they are assigned.
They work in two shifts – one between 08:30am and 02:30pm, and the other between 05:00pm and 07:30pm. Six to seven representatives of different companies usually operate under two area managers from two different companies to target a single hospital. A team is responsible for three to four medical departments of a hospital to try to get the doctors to prescribe their drugs.
If expectations are not met, the representatives re-engage with the doctors to persuade them again. But they cannot force doctors to prescribe a drug, an Opsonin Pharma medical representative said.
Companies allocate more funds to influence indoor section doctors than the ones treating outdoor patients, he added.
In defiance of policy
The Directorate General of Drug Administration has the 'Code of Pharmaceutical Marketing Practices' in place to regulate marketing and sale of drugs.
The code forbids companies from offering gifts, incentives or any kind of assistance to medical professionals with a view to promoting their products. Medical representatives, however, do not comply with it.
Sales representatives go to chambers and offer different forms of rewards to doctors in order to boost sales. In a good number of cases, doctors also oblige.
Md Abdul Muqtadir, managing director of Incepta Pharmaceutical Ltd, said medical representatives do not do anything that goes against the marketing policy set by the Directorate General of Drug Administration.
"The offers made to doctors do not violate the official policy," he added.