MUMBAI // Sales representatives for Abbott Laboratories' Indian subsidiaries know what it takes to get a doctor to prescribe the drugs they market - a coffee maker, perhaps, or some cookware, or maybe a vacuum cleaner.
These are among the many gifts for doctors listed in an Abbott sales-strategy guide for the second quarter of 2011. As laid out explicitly in the guide, doctors who pledge to prescribe Abbott's branded drugs, or who have already prescribed certain amounts, can expect some of these items in return.
Consider the guide's entry for Nupod, an Abbott antibiotic generically known as cefpodoxime. It lists a medical textbook, a mosquito repellent and a coffee maker as incentives for doctors.
It also provides a script of the social niceties for clinching the deals. Especially in India's poorer areas, says one Abbott rep, "if you give them a small gift, they are happy".
The Abbott guide is evidence of a larger problem in India. Dozens of doctors, drug representatives and other healthcare insiders said domestic and multinational drug makers routinely shower Indian doctors with gifts, trips abroad and cash payments disguised as consultancy or other types of fees.
"Indian CRM", or customer-relationship management, is what industry insiders call this system of inducements. None of the doctors or reps who described their participation in this trade would speak on the record.
Under Indian law, doctors are prohibited from accepting cash, gifts or travel from drug companies. But enforcement is rare, and drug makers may lavish gifts on doctors, though their home countries may punish the practice. In a country where doctors often earn less than Dh36,730 a year, it can be an effective strategy.
"Somebody is doing something for you," said a Delhi-based cardiologist. "Obviously you will want to return the favour."
He prescribes more drugs from companies that provided gifts and sent him on paid holidays to Thailand, Hong Kong and elsewhere.
One of those companies, he said, was the India-based Ranbaxy unit of Japan's Daiichi Sankyo.
"We do not sponsor holidays for doctors," a Ranbaxy spokesperson said. "We are viewed as a scientifically and academically orientated company and our promotional activities are built around academics and science."
Chicago-based Abbott said it complied with Indian laws and regulations, adding that company policy forbids employees to "offer or give a sponsorship, gift, meal or entertainment in exchange for an explicit or implicit agreement that Abbott Products will be used, purchased, ordered, recommended or prescribed".
The Indian market is particularly vulnerable to corruption because of intense competition. Until 2005, India flouted drug patents, refusing to rein in domestic copycats of Big Pharma's blockbusters. Brands proliferated. Today, an Indian doctor can choose from among 224 registered brands of the cholesterol-lowering drug atorvastatin, sold by Pfizer as Lipitor in the United States and elsewhere.
Foreign companies that want a piece of this crowded market "have to adapt, or they are not going to survive", said an executive with Biocon, a leading Indian biotech company. The executive said Biocon routinely gives doctors iPads, iPods, mobile phones, "you name it".
A Biocon spokesperson said the executive's statements were "incorrect and absolutely untrue", adding that the company operated "in strict compliance" with the law.
Health experts and some Indian doctors said that as a result of drug companies' tactics, drugs were dangerously overprescribed and expensive brands were prescribed instead of cheap ones.
This can be devastating for patients - physically and financially - in a country where health care is mostly private and unsubsidised, and where 400 million people live on less than Dh4 a day.
At the Amrita Clinic, a private practice in Pune, Maharashtra state, physician Vinay Kulkarni said he refused to accept gifts from reps, partly because he believes drug makers overcharge for products to recoup marketing expenses. "Ultimately, everything is being paid by the patient," he said.
As Big Pharma has pushed into emerging markets such as India in recent years, companies have been running into trouble with their home-market overseers.
Many top drug makers have warned in recent regulatory filings of potential costs related to charges of corruption in foreign markets.
Last year, Johnson & Johnson agreed to pay US$70 million (Dh257.1m) to settle US charges that it paid bribes and kickbacks to win business in Greece, Iraq, Poland and Romania.
Pfizer recently agreed to pay $60.2m to settle a US government inquiry into its use of illegal payments to win business overseas, including gifts such as mobile phones and tea sets to doctors in China who prescribed the company's products.
Abbott became the leading pharmaceuticals company in India in 2010, when it paid $3.7bn for the branded generics business of Mumbai-based Piramal Healthcare.
Its thousands-strong Indian sales force has helped buoy the parent, as sales in emerging markets rose 23 per cent to $2.59bn in the second quarter of last year - more than twice Abbott's global growth rate.
Prescriptions for Paraxin, a drug for typhoid fever, are rewarded with a hand sanitiser and an antique pen. Prescriptions for Lysupra, a multivitamin supplement, could earn a beaded car-seat cover "for the relaxation when you are travelling".
Scanners and steam irons
Abbott reps said that so far this year, they have doled out, among other things, scanners, steam irons, shoes, stethoscopes and gift vouchers worth more than $100 to doctors - both private and employed by the government.
Amitava Guha, a member of the national working committee of the Federation of Medical and Sales Representatives' Associations of India, worked as a rep for decades, including for Piramal from 1997 to 2008, when he retired.
"Everybody is doing it," he said. "I was doing it when I was in service. They said it is your job to go and give to the doctors."
He said he resisted giving anything but the smallest gifts, such as pens. Today, he said, he receives frequent complaints from reps across the country about the practice. It taints their professional image, he said.
The managing director of a large diabetes clinic in Calcutta said he saw as many as 25 reps a day.
"Whatever you like, they can provide you," the doctor said.
His interview was interrupted when a man squeezed into his office and placed a big yellow box on the table.
"Sir, this is an exquisite casserole set," the visitor said, slipping the doctor a note bearing the brand name Rostar, a cholesterol-lowering medicine from the Mumbai-based Unichem Laboratories.
Unichem did not respond to requests for comment.
UAE currency: the story behind the money in your pockets
Test
Director: S Sashikanth
Cast: Nayanthara, Siddharth, Meera Jasmine, R Madhavan
Star rating: 2/5
The specs
Engine: 3.0-litre six-cylinder turbo
Power: 398hp from 5,250rpm
Torque: 580Nm at 1,900-4,800rpm
Transmission: Eight-speed auto
Fuel economy, combined: 6.5L/100km
On sale: December
Price: From Dh330,000 (estimate)
Milestones on the road to union
1970
October 26: Bahrain withdraws from a proposal to create a federation of nine with the seven Trucial States and Qatar.
December: Ahmed Al Suwaidi visits New York to discuss potential UN membership.
1971
March 1: Alex Douglas Hume, Conservative foreign secretary confirms that Britain will leave the Gulf and “strongly supports” the creation of a Union of Arab Emirates.
July 12: Historic meeting at which Sheikh Zayed and Sheikh Rashid make a binding agreement to create what will become the UAE.
July 18: It is announced that the UAE will be formed from six emirates, with a proposed constitution signed. RAK is not yet part of the agreement.
August 6: The fifth anniversary of Sheikh Zayed becoming Ruler of Abu Dhabi, with official celebrations deferred until later in the year.
August 15: Bahrain becomes independent.
September 3: Qatar becomes independent.
November 23-25: Meeting with Sheikh Zayed and Sheikh Rashid and senior British officials to fix December 2 as date of creation of the UAE.
November 29: At 5.30pm Iranian forces seize the Greater and Lesser Tunbs by force.
November 30: Despite a power sharing agreement, Tehran takes full control of Abu Musa.
November 31: UK officials visit all six participating Emirates to formally end the Trucial States treaties
December 2: 11am, Dubai. New Supreme Council formally elects Sheikh Zayed as President. Treaty of Friendship signed with the UK. 11.30am. Flag raising ceremony at Union House and Al Manhal Palace in Abu Dhabi witnessed by Sheikh Khalifa, then Crown Prince of Abu Dhabi.
December 6: Arab League formally admits the UAE. The first British Ambassador presents his credentials to Sheikh Zayed.
December 9: UAE joins the United Nations.
Day 5, Dubai Test: At a glance
Moment of the day Given the problems Sri Lanka have had in recent times, it was apt the winning catch was taken by Dinesh Chandimal. He is one of seven different captains Sri Lanka have had in just the past two years. He leads in understated fashion, but by example. His century in the first innings of this series set the shock win in motion.
Stat of the day This was the ninth Test Pakistan have lost in their past 11 matches, a run that started when they lost the final match of their three-Test series against West Indies in Sharjah last year. They have not drawn a match in almost two years and 19 matches, since they were held by England at the Zayed Cricket Stadium in Abu Dhabi in 2015.
The verdict Mickey Arthur basically acknowledged he had erred by basing Pakistan’s gameplan around three seam bowlers and asking for pitches with plenty of grass in Abu Dhabi and Sharjah. Why would Pakistan want to change the method that has treated them so well on these grounds in the past 10 years? It is unlikely Misbah-ul-Haq would have made the same mistake.
Emirates exiles
Will Wilson is not the first player to have attained high-class representative honours after first learning to play rugby on the playing fields of UAE.
Jonny Macdonald
Abu Dhabi-born and raised, the current Jebel Ali Dragons assistant coach was selected to play for Scotland at the Hong Kong Sevens in 2011.
Jordan Onojaife
Having started rugby by chance when the Jumeirah College team were short of players, he later won the World Under 20 Championship with England.
Devante Onojaife
Followed older brother Jordan into England age-group rugby, as well as the pro game at Northampton Saints, but recently switched allegiance to Scotland.
Where to donate in the UAE
The Emirates Charity Portal
You can donate to several registered charities through a “donation catalogue”. The use of the donation is quite specific, such as buying a fan for a poor family in Niger for Dh130.
The General Authority of Islamic Affairs & Endowments
The site has an e-donation service accepting debit card, credit card or e-Dirham, an electronic payment tool developed by the Ministry of Finance and First Abu Dhabi Bank.
Al Noor Special Needs Centre
You can donate online or order Smiles n’ Stuff products handcrafted by Al Noor students. The centre publishes a wish list of extras needed, starting at Dh500.
Beit Al Khair Society
Beit Al Khair Society has the motto “From – and to – the UAE,” with donations going towards the neediest in the country. Its website has a list of physical donation sites, but people can also contribute money by SMS, bank transfer and through the hotline 800-22554.
Dar Al Ber Society
Dar Al Ber Society, which has charity projects in 39 countries, accept cash payments, money transfers or SMS donations. Its donation hotline is 800-79.
Dubai Cares
Dubai Cares provides several options for individuals and companies to donate, including online, through banks, at retail outlets, via phone and by purchasing Dubai Cares branded merchandise. It is currently running a campaign called Bookings 2030, which allows people to help change the future of six underprivileged children and young people.
Emirates Airline Foundation
Those who travel on Emirates have undoubtedly seen the little donation envelopes in the seat pockets. But the foundation also accepts donations online and in the form of Skywards Miles. Donated miles are used to sponsor travel for doctors, surgeons, engineers and other professionals volunteering on humanitarian missions around the world.
Emirates Red Crescent
On the Emirates Red Crescent website you can choose between 35 different purposes for your donation, such as providing food for fasters, supporting debtors and contributing to a refugee women fund. It also has a list of bank accounts for each donation type.
Gulf for Good
Gulf for Good raises funds for partner charity projects through challenges, like climbing Kilimanjaro and cycling through Thailand. This year’s projects are in partnership with Street Child Nepal, Larchfield Kids, the Foundation for African Empowerment and SOS Children's Villages. Since 2001, the organisation has raised more than $3.5 million (Dh12.8m) in support of over 50 children’s charities.
Noor Dubai Foundation
Sheikh Mohammed bin Rashid Al Maktoum launched the Noor Dubai Foundation a decade ago with the aim of eliminating all forms of preventable blindness globally. You can donate Dh50 to support mobile eye camps by texting the word “Noor” to 4565 (Etisalat) or 4849 (du).
WHAT ARE NFTs?
Non-fungible tokens (NFTs) are tokens that represent ownership of unique items. They allow the tokenisation of things such as art, collectibles and even real estate.
An NFT can have only one official owner at one time. And since they're minted and secured on the Ethereum blockchain, no one can modify the record of ownership, not even copy-paste it into a new one.
This means NFTs are not interchangeable and cannot be exchanged with other items. In contrast, fungible items, such as fiat currencies, can be exchanged because their value defines them rather than their unique properties.
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%3Cp%3E%0D%3Cstrong%3EEngine%3A%20%3C%2Fstrong%3E6-cylinder%2C%204.8-litre%20%0D%3Cbr%3E%3Cstrong%3ETransmission%3A%20%3C%2Fstrong%3E5-speed%20automatic%20and%20manual%0D%3Cbr%3E%3Cstrong%3EPower%3A%20%3C%2Fstrong%3E280%20brake%20horsepower%20%0D%3Cbr%3E%3Cstrong%3ETorque%3A%20%3C%2Fstrong%3E451Nm%20%0D%3Cbr%3E%3Cstrong%3EPrice%3A%20%3C%2Fstrong%3Efrom%20Dh153%2C00%0D%3Cbr%3E%3Cstrong%3EOn%20sale%3A%20%3C%2Fstrong%3Enow%3C%2Fp%3E%0A
UPI facts
More than 2.2 million Indian tourists arrived in UAE in 2023
More than 3.5 million Indians reside in UAE
Indian tourists can make purchases in UAE using rupee accounts in India through QR-code-based UPI real-time payment systems
Indian residents in UAE can use their non-resident NRO and NRE accounts held in Indian banks linked to a UAE mobile number for UPI transactions
The smuggler
Eldarir had arrived at JFK in January 2020 with three suitcases, containing goods he valued at $300, when he was directed to a search area.
Officers found 41 gold artefacts among the bags, including amulets from a funerary set which prepared the deceased for the afterlife.
Also found was a cartouche of a Ptolemaic king on a relief that was originally part of a royal building or temple.
The largest single group of items found in Eldarir’s cases were 400 shabtis, or figurines.
Khouli conviction
Khouli smuggled items into the US by making false declarations to customs about the country of origin and value of the items.
According to Immigration and Customs Enforcement, he provided “false provenances which stated that [two] Egyptian antiquities were part of a collection assembled by Khouli's father in Israel in the 1960s” when in fact “Khouli acquired the Egyptian antiquities from other dealers”.
He was sentenced to one year of probation, six months of home confinement and 200 hours of community service in 2012 after admitting buying and smuggling Egyptian antiquities, including coffins, funerary boats and limestone figures.
For sale
A number of other items said to come from the collection of Ezeldeen Taha Eldarir are currently or recently for sale.
Their provenance is described in near identical terms as the British Museum shabti: bought from Salahaddin Sirmali, "authenticated and appraised" by Hossen Rashed, then imported to the US in 1948.
- An Egyptian Mummy mask dating from 700BC-30BC, is on offer for £11,807 ($15,275) online by a seller in Mexico
- A coffin lid dating back to 664BC-332BC was offered for sale by a Colorado-based art dealer, with a starting price of $65,000
- A shabti that was on sale through a Chicago-based coin dealer, dating from 1567BC-1085BC, is up for $1,950
Bio:
Favourite Quote: Prophet Mohammad's quotes There is reward for kindness to every living thing and A good man treats women with honour
Favourite Hobby: Serving poor people
Favourite Book: The Alchemist by Paulo Coelho
Favourite food: Fish and vegetables
Favourite place to visit: London
MATCH INFO
Alaves 1 (Perez 65' pen)
Real Madrid 2 (Ramos 52', Carvajal 69')
