**7. Pharmaceutical traders**

Pharmaceutical traders including super-stockists, stockists, career and forwarding agents, wholesalers, retailers and medical representatives comprise a crucial link between pharmaceutical industry and the prescribers. They have a big stake in promoting branded medicines due to their business interests and have a very significant potential to circumvent prescribing practices towards that direction. In fact it has been observed that pharmaceutical traders pose hurdles in the implementation of generic drug policies and sometimes even resort to protests and agitation to protect their business interests owing to the fact that generics are a lot cheaper than branded medicines and therefore have little scope for the similar pharmaceutical promotion and marketing practices as are prevalent for the branded medicines. Most of such promotion practices are unethical and several countries like India had to devise rules for curbing such practices that lead to distribution of exorbitant gifts and incentives among physicians that are quite often disproportionate and unjustified [17].

In the year 2009, Medical Council of India (MCI) amended "Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation 2002" [18] and brought out the code of conduct for doctors and professional associations of doctors in their relationship with pharmaceutical and allied health sector industry that prohibits them from accepting any gifts, travel facility or hospitality, from any pharmaceutical company or the health care industry. However, even as the Government of India is still debating a code with the drug industry to curb unethical practices, big houses worldwide have started disclosing payments made to physicians, including dollars spent on consulting gigs, clinical trials and even meals. Even though the intention behind framing the code of conduct appears good, the greater issue is the enforcement of these guidelines that seems to be an uphill task. Until and unless MCI or other enforcing body is given enough teeth to enforce these codes, introspection and self-regulation by the doctors remain the only way to curb the ever-rising unethical practices in the health care sector. The proposed self-regulatory code of pharmaceutical companies lacks teeth and has several loopholes since it is not legally binding on companies [19]. Recently in the Supreme Court of India it was revealed by the Federation of Medical and Sales Representatives Association of India, while citing a report by Central Board of Direct Taxes (CBDT), that, "Over Rs 1,000 crore freebies have been given by Dolo

company for the 650 mg Paracetamol formulation and that the doctors were prescribing an irrational dose combination [Ref: Business Today dt. August 19, 2022].

Given such a dismal scenario vis-à-vis ethical pharmaceutical marketing and promotion practices being followed by pharmaceutical companies and traders particularly in developing countries that seriously impairs the implementation of generic drug policies and impedes the progress towards universal health coverage, it becomes essential to undertake sustained negotiations with not only the representatives of pharmaceutical industry but those of the pharmaceutical traders as well so that their genuine grievances, if any are addressed well in time and they are left with no reason to sabotage policy implementation at a later stage. Their involvement and integration with the pharmaceutical policy development process will go a long way in smooth and hassle-free promulgation and execution of the policy provisions and will minimize any chances of obstruction and hindrances in the policy implementation.
