title: Qualitative insights into promotion of pharmaceutical products in Bangladesh: how ethical are the practices?
abstract: BACKGROUND
  The pharmaceutical market in Bangladesh is highly concentrated (top ten control around 70 % of the market). Due to high competition aggressive marketing strategies are adopted for greater market share, which sometimes cross limit. There is lack of data on this aspect in Bangladesh. This exploratory study aimed to fill this gap by investigating current promotional practices of the pharmaceutical companies including the role of their medical representatives (MR).
  
  
  METHODS
  This qualitative study was conducted as part of a larger study to explore the status of governance in health sector in 2009. Data were collected from Dhaka, Chittagong and Bogra districts through in-depth interview (healthcare providers and MRs), observation (physician-MR interaction), and round table discussion (chief executives and top management of the pharmaceutical companies).
  
  
  RESULTS
  Findings reveal a highly structured system geared to generate prescriptions and ensure market share instituted by the pharmaceuticals. A comprehensive training curriculum for the MRs prepares the newly recruited science graduates for generating enough prescriptions by catering to the identified needs and demands of the physicians expressed or otherwise, and thus grab higher market-share for the companies they represent. Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc. are used. The type, quantity and quality of inducements offered to the physicians depend upon his/her capacity to produce prescriptions. The popular physicians are cultivated meticulously by the MRs to establish brand loyalty and fulfill individual and company targets. The physicians, willingly or unwillingly, become part of the system with few exceptions. Neither the regulatory authority nor the professional or consumer rights bodies has any role to control or ractify the process.
  
  
  CONCLUSIONS
  The aggressive marketing of the pharmaceutical companies compel their MRs, programmed to maximize market share, to adopt unethical means if and when necessary. When medicines are prescribed and dispensed more for financial interests than for needs of the patients, it reflects system's failed ability to hold individuals and entities accountable for adhering to basic professional ethics, code of conduct, and statutory laws.
authors.affiliation: University Press Limited, Dhaka, Bangladesh. mahrukh@uplbooks.com.bd.
authors.forename: Mahrukh
authors.initials: M
authors.lastname: Mohiuddin
authors.affiliation: James P Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh. sabina@bracu.ac.bd.
authors.forename: Sabina Faiz
authors.initials: SF
authors.lastname: Rashid
authors.affiliation: Mainstreaming Nutrition in Bangladesh, Dhaka, Bangladesh. mofijul.islam.official@gmail.com.
authors.forename: Mofijul Islam
authors.initials: MI
authors.lastname: Shuvro
authors.affiliation: James P Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh. nahitun.naher@bracu.ac.bd.
authors.forename: Nahitun
authors.initials: N
authors.lastname: Nahar
authors.affiliation: Centre for Equity and Health Systems, icddr,b and Centre of Excellence for Universal Health Coverage, icddr,b and JPGSPH, icddr,b and JPGSPH, BRAC University, 5th Floor(Level-6), icddrb Building, 68 ShahidTajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. ahmed.sm@icddrb.org.
authors.forename: Syed Masud
authors.initials: SM
authors.lastname: Ahmed
mesh_terms: D001291:Attitude of Health Personnel; D001459:Bangladesh / Q000453:epidemiology; D004345:Drug Industry / Q000941:ethics* / Q000379:methods; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D040541:Marketing / Q000941:ethics* / Q000379:methods; D010565:Persuasive Communication; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000941:ethics* / Q000706:statistics & numerical data; D036301:Qualitative Research