IN BANGLADESH, the culture of gift-giving is deeply embedded in our social fabric. We give as gestures of respect, gratitude, or goodwill. Yet when these exchanges start to influence how doctors treat their patients, we cross into far more troubling territory that demands urgent public scrutiny.
Today, it is common practice for pharmaceutical companies to offer gifts to healthcare professionals, ranging from free drug samples and branded stationery to foreign trips and paid conference invitations. According to a 2022 study by Transparency International Bangladesh, over 77 per cent of doctors surveyed acknowledged receiving such gifts. What might have once been seen as an occasional courtesy has now become routine 鈥� almost expected. This is not a minor deviation but the normalisation of influence in our healthcare system.
These offerings often appear innocuous. A notepad here, a lunch there, a sponsored training session, or a speaking fee. But none of this is ever truly free. There are implicit expectations. Doctors may feel obliged to favour certain medications 鈥� not necessarily because they are clinically superior, but because they feel indebted. And in most cases, these are branded drugs, not cheaper generics. The financial burden then shifts to the patient.
That is where the real damage lies. When a prescription is shaped by commercial incentives rather than medical judgment, the patient suffers. In a country where the majority pay for medicines out of pocket, a single decision in the consulting room can mean a family skipping meals to afford treatment. Many patients halve their doses or abandon treatment entirely 鈥� not out of negligence, but because they cannot afford to comply.
The Drugs and Cosmetics Act 2023 was introduced as a corrective measure. Replacing the antiquated colonial-era legislation of 1940, it aims to modernise the regulation of the pharmaceutical industry, with explicit provisions on marketing ethics and gift-giving. But as is often the case in our governance structures, drafting legislation is one thing; implementing it is quite another.
The Directorate General of Drug Administration, tasked with oversight, is chronically under-resourced. It lacks sufficient personnel, digital infrastructure, and operational reach 鈥� especially in rural areas where regulatory visibility is minimal. Consequently, despite the law, pharmaceutical marketing continues unchecked. The technical legality of gift-giving is increasingly irrelevant when enforcement is so weak.
Young doctors are particularly susceptible. Many come from financially constrained backgrounds, entering a profession that carries immense pressure but not always adequate remuneration. A travel grant or a conference sponsorship can feel less like an indulgence and more like a lifeline. The issue is not simply one of individual integrity but of systemic vulnerability.
This is why moralistic appeals fall short. The problem is not confined to a few bad actors. It is a structural phenomenon that shapes behaviour across the board. When informal incentives become embedded in the professional environment, they alter what is seen as acceptable practice. Clinical discretion, ideally grounded in patient interest, begins to blur with commercial loyalty.
Other countries have taken steps to address this conflict. In the United States, for example, the Physician Payments Sunshine Act compels pharmaceutical companies to disclose any financial transactions or gifts to medical practitioners. The data is accessible to the public, allowing patients to see whether their doctor has a financial relationship with a drug manufacturer. While not flawless, the system sends a clear message: transparency is non-negotiable.
Bangladesh would do well to adopt a similar model. Both doctors and companies should be required to disclose any form of benefit 鈥� monetary or otherwise. This data must be made public. Patients deserve to know whether their treatment is being shaped by corporate largesse.
Simultaneously, the framework for medical education must be fortified. Currently, many pharmaceutical companies fund academic events, blurring the line between education and promotion. Workshops and lectures often serve as vehicles for marketing under the guise of professional development. This compromises the neutrality of continuing medical education. Public universities and professional associations must assume greater responsibility here, establishing independent channels of learning free from commercial influence.
Public awareness, too, must evolve. Most patients never ask their doctor why a particular brand has been prescribed, nor are they aware of the existence of cheaper alternatives. They trust. That trust, though, cannot remain blind. Widespread information campaigns could empower patients to make informed choices and foster a culture in which prescription practices are held to account 鈥� not through confrontation, but through informed questioning.
Of course, none of this is straightforward. The pharmaceutical industry plays a vital role in Bangladesh鈥檚 economy. It supplies nearly all domestic drug needs and exports to over 150 countries. However, economic strength cannot come at the expense of ethical conduct. With influence must come responsibility. A thriving industry must also be a principled one.
Doctors, too, need institutional support. Ethical practice cannot be sustained through regulation alone. It must be cultivated. Mentorship programmes, ethics training, and open dialogue between junior and senior professionals can help create an environment where integrity is valued and safeguarded.
If we are serious about ensuring patient welfare, protecting the credibility of our medical profession, and building a fairer healthcare system, then we must act. We need transparency, accountability, and reform 鈥� not in theory, but in practice. Only then can we ensure that our doctors remain true to their oath, serving not the pharmaceutical companies that court them but the patients who depend on them.
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Joydeep Chowdhury is a lecturer in law at Sonargaon University.
