c

 




 
  


 



Anupama Sukhlecha1

A recent news item reported on the Indian Medical Association¶s decision to endorse the Tropicana
brand of fruit juices and Quaker brand of oats. The director of the Centre for Science and
Environment, Sunita Narain, has objected to the association¶s actions, calling them ³advertisement
tricks´ (1).

The Indian Medical Association (IMA), the national organisation of ³doctors of modern scientific
system of medicine´, was set up in 1928 (2). Its major objectives include: promotion and advancement
of medical and all related sciences, improving public health and medical education in India, and
maintaining the honour and dignity of the medical profession.

Actually, the IMA and other medical associations have endorsed a number of commercial products
over the years. The IMA has endorsed Eureka products and products like Lifebuoy soap. It recently
agreed to endorse hygiene products and is currently negotiating an endorsement with Dabur (1). The
Federation of Family Physicians¶ Associations of India certified Kinley, a packaged drinking water,
though it withdrew this certification following public pressure (3, 4). The Indian Dental Association
endorses Colgate toothpaste and Pfizer¶s Listerine mouthwash (5).

The manufacturers of Tropicana juice received the IMA¶s endorsement in return for Rs 5 million. IMA
sources state that the amount received will be used to conduct scientific activities, seminars and
conferences (1). For endorsing products of Eureka Forbes, the IMA received Rs 30 million (6).

If we look at the world scenario, the logo of the British Heart Association appears on Tetley tea and
the World Heart Federation logo appears on Kellogg¶s bran flakes. Muller Crunch Corner yoghurt
carries the logo of the National Osteoporosis Society. Ribena Tooth Kind states that its drink is ³the
only drink accredited by British Dental Association´. These exclusive endorsements are made even
though equivalent (and even cheaper) brands are available (7). The United Kingdom¶s market has
over 40 food products that have logos or endorsements from health charities or medical associations
(8).

The American Medical Association (AMA) paid Sunbeam Corporation US$ 9.9 million to avoid a suit
for breach of contract when the company pulled out of a five-year, multi-million-dollar endorsement
deal. The AMA was to endorse Sunbeam¶s blood pressure monitors, humidifiers and other products,
but the association withdrew from the deal after being criticised because it had no plans to test the
products. The chief executive of the AMA resigned following protest over this case (9, 10). Supporters
of fluoridation have endorsements from the AMA and the American Dental Association (ADA) to
promote their products, one of which is Crest toothpaste (11). The ADA has also approved Wrigley¶s
sugar-free chewing gum products after accepting US$ 36,000. The American Cancer Society receives
US$ 300,000 a year from Neutrogena to approve its products (12).

  


The ability of endorsements to affect consumer behaviour has been discussed in the past (13).
Advertisements and promotional strategies are based on consumer psychology and even the best
informed consumer cannot escape their influence. Their impact is heightened when medical
associations endorse brands (14). Consumers look for credible sources and opinions that cut through
the advertising hype, so they are receptive to endorsements by health organisations, and such
endorsements have an effect on their behaviour and the companies¶ sales go up (15).





 

When medical associations endorse a product, they violate the Medical Council of India¶s 2002
regulations (16) regarding professional conduct, etiquette and ethics for registered medical
practitioners. The regulations specify that a physician shall not give to any person, whether for
compensation or otherwise, any approval, recommendation, endorsement, certificate, report or
statement with respect to any drug, medicine or any commercial product for use in connection with his
name, signature or photograph in any form or manner of advertising through any mode.

The basic objectives of clinical associations are to promote medical science, and improve public
health and medical education. Are the honour and dignity of the association not being tarnished when
it accepts money to endorse a particular brand? If the brands are medicines, their efficacy should be
proved by clinical trials and the results published. Advertisements for products with endorsements
contain a line to the effect that results are not ³100 per cent proven´. Many of these products are
cosmetics or food supplements that are being sold under the garb of medicine to escape heavy taxes
- the so-called ³nutraceuticals´ and ³cosmeceuticals´, which have no meaning in the Drugs and
Cosmetics Act or in the Food and Drugs Administration.

A medical association¶s name and emblem are its pride. Using them for monetary gain is like selling
the association for a price. Medical associations do not have the authority to dispense seals of
endorsement, recognition or approval. It is not acceptable them to sell these even if it is argued that
the amount received is put to good use. We should have a ban on all medical association
endorsements and action should be taken against those who violate medical ethics. Let the glory of
medical associations shine through their work on promoting health and not as commercial advertisers

A TOOTHPASTE with the "seal of acceptance" from dentists, a shampoo used by

dermatologists or a skin -cream mentioned in the Indian arm of the reputed Journal
of American Medical Association (JAMA) ² how far can companies go while using the
medical profession to make a health claim, without crossing the ethical line?

Even a casual viewer of television cannot be oblivious to the in -your-face

commercials using the medical profes sion to give a health slant to their products -
the Indian Dental Association endorses Colgate toothpaste; Procter & Gamble's Head
& Shoulders shampoo is said to be used by "dermatologists''; Ozone Ayurvedics
claims that its Nomarks anti -blemish cream find s a mention in medical journals like
JAMA, implying an endorsement of the product and Reckitt Benckiser's Dettol soap
has an endorsement from the Indian Medical Association (IMA).

In the past, cola-major Coca-Cola had used the doctor's endorsement route to vouch
for the safety of its bottled -water Kinley, though this was eventually discontinued,
following objections.

Recently medical practitioners spoke out against advertisements on the Hepatitis A

vaccine, stating that parents were influenced into believing that Hepatitis A vaccine
was imperative for good health.

In another form of medical endorsements, models wear the doctor's white coat while
endorsing a product, as seen in a foot wear commercial from the house of Action,
healthcare industry representatives point out.
Dr Sanjiv Malik, Secretary General -IMA, is not against "the dissemination of health -
related information that is good for the consumer provided the information has
cleared a peer-review and has gone through the necessary checks and filters."

Speaking to Business Line, he said, "IMA endorsed Dettol only after the product's
claims were scientifically checked. Besides, since washing one's hand was not a
common practise her e - the genesis of our endorsement of Dettol was to indirectly
support this public health message."

A peer-review, scientific test and an ethical committee clearance are the safety -
catches that the IMA recommends before a medial association lends its name or
promotes a public health message. The Union Health Ministry officials feel that it is
not possible for the Ministry to review health -related claims of companies and their
products. "This is an ethical issue that companies and medical practitioners need to
address," the official said.

"It is better for a dental association to test a toothpaste and endorse it, rather than
have a product that claims to work for 24 hours - implying that one may not need to
brush at night," medical professionals point out.

As for models as doctors, IMA's Dr Malik points out, "With the Medical Council of
India disallowing doctors from endorsing products, models are sometimes used, if a
claim has been verified by a medical association."

Further, he adds, "It is good for pharma c ompanies to educate consumers about
illnesses or therapies, but there is a commercial objective. In the US, even
prescription products are advertised but only after stringent verification by the Food
and Drug Administration (FDA). In India, the Government should lay down the
statute, following which a professional body could do the scientific and ethical
verification, which should be made binding."

 
After more than two years of arguments at different forums over Indian
Medical Association (IMA) endorsing two food products in violation of its
own ethics and Medical Council of India (MCI) regulations, MCI decided to
remove secretary and president of the IMA from the Indian medical register
for six months.

As a result, these doctors cannot practise for six months. MCI has also
decided to serve censure letters to all the 187 IMA executive committee
members ''to not to repeat such practices in future''.

IMA represents two lakh doctors in the country. This is the first time in
IMA's history that names of its office b earers would be removed from the
register.

The decision was taken at an MCI ethics committee meeting on November

9. This was later ratified by the board of directors. Union health minister
Ghulam Nabi Azad announced the MCI decision in a written reply to a
question in the Lok Sabha on Friday.

In April 2008, IMA had signed a Rs 2.25-crore contract with Pepsico to

allow Tropicana fruit juice and Quaker oats to use the IMA logo on their
packs for three years ending 2011. D r K V Babu, an IMA central committee
member, complained to MCI on June 6, 2008 and followed it up with RTI
applications that brought out details of this and other endorsements.

Azad's reply in the Lok Sabha set off hushed discussions in medical circles
on Tuesday about which names would be removed from the Indian medical
register: those of the office bearers at the time of signing the deal or the
present ones.

he regulatory board of the MCI has struck off the names of the President Goparaju Samaram and
the Secretary Dharam Prakash of the Indian Medical Association (IMA) from the medical register.

Imparting the information to the parliament, the union minister for health and family welfare
Ghulam Nabi Azad stated, ³The ministry received a complaint relating to endorsement of
some food products by Indian Medical Association in 2009. The complaint was forwarded to MCI
for appropriate action.
³The ethics committee of MCI, at its meeting held on November 9, 2010, considered the matter
and decided to remove the name of the president and secretary of IMA from the Indian medical
register for a period of six months and issue a censure letter to all executive committee members
of IMA to not repeat such practices in future.´

:
 
 
 


This is perhaps the first time that office bearers of IMA, an organisation with around two lakh
doctors from across the country, have been punished.

In order to ensure that such practices are not repeated in future, the MCI has also decided to
dispatch letters of disapproval to all the 187 IMA executive committee members.

A member of the MCI board said, ³It (the debarment) is unprecedented. The heads of the IMA
have never been punished before. We¶re hoping this sends out a message to the rest of the
community.´

Gerorge Thomas, a surgeon in Chennai and editor of the Indian Journal of Medical Ethics stated,
³People trust doctors, their knowledge and actions are perceived as backed by science and long
years of training. It¶s wrong for doctors to endorse any product.´

 

 

The IMA had signed a contract in April 2008 with the manufacturers of Tropicana fruit juice,
Quaker oats, and anti-mosquito cream Odomos to use the IMA logo on their packs for three years
in return for Rs 2.25 crores.

Though the deal occurred three years ago, the action came in response to a complaint filed by Dr
K V Babu, an IMA central committee member on June 6, 2008.

The MCI ethics panel decided to remove the two names on a temporary basis at its Nov. 9, 2010
meeting.
The MCI had cautioned the IMA and affiliated associations earlier this year to avoid endorsing food
and hygiene products of private companies, since it was a breach of the Indian Medical Council
(Professional Conduct, Etiquette and Ethics) Regulation, 2002 provisions.

An ethics panel has recommended banning two doctors from practising for six months because they had
approved a plan for a body of doctors, the Indian Medical Association, to endorse consumer products.

The unprecedented recommendation by the ethics panel of the Medical Council of India (MCI) awaits approval by
the regulator¶s board of governors, but it has reopened the debate whether doctors or their associations should
be allowed to endorse health-related products.

Goparaju Sammaram, president of the Indian Medical Association (IMA), an organisation of over 190,000 doctors
across the country, said he did not see why doctors could not endorse consumer products if film stars could.

But George Thomas, a surgeon in Chennai and editor of the c
   

   , said the code of
medical ethics prohibits doctors from endorsing products.

³People trust doctors; their knowledge and actions are perceived as backed by science and long years of
training,´ Thomas said. ³It¶s wrong for doctors to endorse any product.´
The IMA had in October 2007 struck deals with the manufacturers of Quaker oats, Tropicana juice and the anti-
mosquito cream Odomos that allowed the products to claim the association¶s endorsement in return for Rs 2.07
crore.

Documents extracted from the IMA by a Kerala-based doctor, K.V. Babu, show that the decision was taken by
the association¶s then national president Ajay Kumar, secretary S.N. Misra and national president-elect M.
Abbas.

The documents suggest that PepsiCo, manufacturer of Quaker oats and Tropicana, was to pay Rs 46 lakh a year
to the IMA for three years. Dabur, which makes Odomos, had agreed to pay Rs 23 lakh a year for three years.

Although the deal happened three years ago, the action comes only now after the MCI itself saw changes at its
helm. In response to a complaint from Babu, the MCI¶s ethics panel has decided to remove the names of the IMA
³president´ and ³secretary´ from the Indian medical register for six months.

Union health minister Ghulam Nabi Azad, who gave this information to Parliament today, did not specify the
names of the two doctors who would be debarred. But an MCI source said the punishment was likely to apply to
the IMA office-bearers who took the endorsement decision.

Azad said the MCI ethics panel had also decided to issue a censure letter to all the IMA¶s executive committee
members, warning them not to repeat such practices in the future.

³It (the debarment) is unprecedented. The heads of the IMA have never been punished before,´ a member of the
MCI board said. ³We¶re hoping this sends out a message to the rest of the community.´

The current IMA secretary, Dharam Prakash, told The Telegraph the endorsement decision had been taken by
the office-bearers ³on behalf of the IMA´ and not as individual doctors. ³In any case, we have not received any
official communication on this,´ Prakash said.

Sammaram, the association¶s current president, said: ³Don¶t movie actors endorse things and get paid? What is
wrong if doctors also do something similar for health-related products? In any case, the payment went to the IMA
and not to individual doctors.´

Thomas said this argument was unacceptable. ³When a film star endorses a car, the public is aware that he or
she is not an expert in that product,´ he said. ³But when a doctor or an association of doctors endorses a product,
it can mislead people.´

The Indian Dental Association (IDA) has in the past conducted joint oral health awareness programmes with the
manufacturers of Colgate toothpaste. The Colgate Total tube carries the logo of the IDA and the words: ³IDA
accepted´.