You don’t choose a medicine—your doctor does. And who chooses the doctor? Multibillion pharma companies. Till recently, doctors in India went on luxury junkets to exotic locations, were feted with lavish vacations and pricey gifts by pharma companies to promote their drugs. In August 2022, a PIL before the Supreme Court spotlighted alleged unethical pharma marketing around Dolo-650, a 650 mg paracetamol popular during Covid 19. It was reported that Micro Labs spent approximately `1,000 crore on “freebies” to doctors—covering travel, gifts, and perks—to promote prescriptions of Dolo-650. The unethical practice of pampering the medical fraternity in exchange for writing prescriptions recommending specific medicines ran into a wall. The Centre implemented a Uniform Code for Pharmaceutical Marketing Practices (UCPMP) 2024 that prohibits pharmaceutical companies from offering freebies or any monetary benefits to the Hippocrates Oath takers. No more cumshaws, sponsored trips, or lavish hospitality from the pill makers for pill pushers.
But you can’t keep a freeloader down. Unscrupulous doctors who missed the balmy holidays in exotic locations, the dinner parties and lavish gifts, all paid for by Big Pharma’s came up with a devious solution to sidestep the UCPMP. Societies. In short, a few unprincipled medical practitioners would get together to form a medical society and hold seminars. These seminars are held on Big Pharma’s tab; liberal payouts to support such ‘informed’ debates which could mean crores. It could be a Cardiologists’ Society of Greater Kailash or an Orthopaedic Doctors’ Association of Pune. The seminars would be held at a pricey location in a luxury hotel in India or abroad, and the doctors and invitees would pack their suitcases, probably take their families along and fly business class, of course, to discuss treatments on the beach.
These Continuing Medical Education (CME) programmes and perks aren’t just slippery slopes for ethics—they’re baked into the marketing budget of the medicine you are popping. Today CMEs have becomes a more “nuanced and subtle” way of pushing a pill. “Some doctors have begun organising these CME events almost every three to six months,” says a Noida-based doctor on the condition of anonymity. “Most of these conferences are held in luxury five-star hotels at popular tourist destinations. There are just a handful of lectures—followed by sightseeing and lavish parties.” With visible disgust, he adds, “Some medical societies have practically turned into event management companies.”
The Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002, forbids medical professionals from receiving any sort of commissions and kickbacks from pharmaceutical companies. The National Medical Commission (NMC) notified the Registered Medical Practitioner (Professional Conduct) Regulations, 2023 in the Gazette of India on August 2, 2023. Among the key provisions was a mandate requiring doctors to prescribe only generic drugs, not branded ones, and a ban on sponsorship of doctors for conferences, workshops, and seminars held by pharmaceutical or allied health companies. The regulations—which effectively banned CMEs and conferences—faced strong backlash from the Indian Medical Association and the Association of Physicians of India. Concerns were raised over the lack of stakeholder consultation and effectively blocking the access to new information and practices in the field of medicine through a blanket ban. After a series of post-facto consultations, the NMC put the regulations in abeyance on August 23, 2023. Little wonder that this has led to dodgy doctors and their so-called associations taking advantage of the ruling. In most of these conferences, attendees land up at the venue of choice—often a high-end resort in some touristy location—and end up simply sightseeing or being entertained by events sponsored by pharma companies. That’s the end of the conference. Full stop.
“The practice is more common among general physicians who typically organise and attend such CMEs,” says Dr Rishiraj Sinha from AIIMS, New Delhi.
The 2024 Uniform Code for Pharmaceutical Marketing Practices guidelines prohibited gifting or monetary grant in any form to a healthcare professional or their families, travel facilities and any kind of hospitality stay, to healthcare professionals or their family members (both immediate and extended) unless the person is a speaker for a CME or a Continuing Professional Development (CPD) programme. However, guidelines were more voluntary in nature and hence were not effective. The same guidelines propose, that CME or CPD or any conference, seminar, workshop, etc. should only be allowed through a “well-defined, transparent, and verifiable set of guidelines” based on which the pharmaceutical industry may undertake such expenditures. But who gets to decide the guidelines is anyone’s guess.
In April, this year, an association of Indian dermatologists decided to hold their annual conference in Shillong—an idyllic hill station nestled among the pristine peaks of Meghalaya. But while these doctors ostensibly flew in for a three-day conference, it was, in reality, a full-time vacation. The “conference” took place at the confluence of Umiam Lake, Elephant Falls, and Shillong Peak. It was an event that promised to broaden the minds of practitioners, but in truth, it provided an excuse for selfies in the sun and mountain hikes. And the cherry on top? A meticulously crafted itinerary, which highlighted the tourist destinations of Shillong, while the actual educational sessions seemed to barely hold a candle to the fun-filled activities that followed. The CME agenda? Almost an afterthought.
The real question isn’t whether these trips are “educational”, but whether they are ethical. The line between continuing education and corporate-sponsored junkets is increasingly blurry, and the consequences are real. Doctors—who we trust with our health—are being incentivised to remain loyal to brands, sometimes at the expense of patient care. “CME isn’t new; it’s been around for decades. But over the past seven to eight years, a disturbing trend has emerged,” says experienced physician Dr GS Grewal, former president of the Indian Medical Association from Delhi. “Pharmaceutical companies have begun colluding with a few unethical doctors. Since they can’t offer direct gifts or cash now, they strike deals. The doctor is invited as a keynote speaker at a conference and paid to deliver a lecture. In return, the doctor is expected to prescribe their drug or use their medical equipment for procedures.”
Pill Pushing
CMEs are perhaps one of the few ways for medicine professionals to upgrade their skills. In fact, the access and popularity of many drugs over the decades have been credited to CMEs. The introduction of four-drug fixed-dose combination regimen for treatment of drug-resistance pulmonary tuberculosis can be attributed to CMEs, says Grewal, citing it as a positive example highlighting how they have over the decades helped in medical innovation.
According to Cureus, an open-access medical journal, CMEs facilitate networking, problem-solving, and collaboration. Their importance is highlighted by the fact that most state medical councils mandate doctors attend a certain number of CMEs every year in order to renew their medical licenses. As per the National Medical Commission (NMC) Registered Medical Practitioner (Professional Conduct) Regulations, 2023, all practicing doctors below 65 years of age must complete 30 hours of CME every five years to get their license renewed in India. Doctors can earn CME credits through seminars and workshops offered by medical institutions in India. Of late, doctors can even pursue CME from various online CME education providers.
But not all doctors toe the line, as far as CMEs are concerned. In the Dolo-650 case, a PIL before a Supreme Court bench led by Justice DY Chandrachud and Justice AS Bopanna spotlighted the alleged unethical pharma marketing. Senior Advocate Sanjay Parikh, who appeared for Federation of Medical and Sales Representatives Association of India, cited a report by Central Board of Direct Taxes (CBDT), told the bench, “Over `1,000 crore freebies have been given by Dolo company for the 650 mg formulation. Interestingly, prices for the paracetamol doses under 500 mg are prescribed by the drug pricing authority. But if the dosage goes beyond 500 mg, its price control goes beyond authority. That’s why Dolo-650 was being promoted in such a manner.” The senior advocate also demanded for a statutory backing to the Uniform Code of Pharmaceutical Marketing Practices (UCPMP), arguing that currently there is no law or regulation prohibiting such malpractices.
“This is just one facet of marketing. Many consider it unethical, but practices like this exist across industries. It’s hard to label it strictly as right or wrong—people will always find ways to work around the law,” says Ahmedabad general physician Dr Krishna Makwana, adding. “Earlier it was all about cash payments and gifts, which were later banned, and then the trend shifted to international trips, and now it’s these so-called medical conferences.”
On Big Pharma’s Tab
India has long banned the direct advertising of medicines to protect ordinary citizens from being misled by flashy pharmaceutical marketing. It’s a safeguard meant to ensure that life-saving drugs aren’t treated like toothpaste—sold with gimmicks, celebrity endorsements, or half-truths. After all, most patients don’t have the training to critically evaluate complex medical claims. So, if pharma ads are banned to protect the public, the next logical question is: how do doctors—who do need this information—stay informed?
The answer is: CME programmes. But there’s a problem: the very loophole that allows doctors to stay informed is being abused, twisted into a high-end hospitality package under the guise of education. Behind the scenes, pharmaceutical companies and medical device manufacturers are footing the bill for luxury conferences in hill stations, beach resorts, and foreign cities. The message is subtle, but unmistakable: “Here’s some education... and a little something extra.”
Dr Grewal argues that banning pharma-sponsored CMEs would be a “disservice to society”—that it would cut off a critical channel through which doctors learn about medical breakthroughs, new treatment protocols, and the latest technologies. And he’s not entirely wrong. Doctors do need access to this information to deliver better care. It’s a fair point that regulation—not an outright ban—might offer a middle ground. Grewal suggests more transparency from both doctors and drugmakers. But without strict enforcement, “transparency” becomes little more than a buzzword—another fig leaf over a deeply compromised system.
Dr Sahil Goyal, Assistant Professor of community medicine from Delhi, on the other hand, sees the writing on the wall. He calls for limiting the number of conferences and tightening regulations on professional bodies that organise them. Because the truth is, without hard checks, these events are less about medicine and more about marketing. They create a dangerous ecosystem where doctors, knowingly or not, become brand ambassadors—prescribing drugs not solely on efficacy, but also on the perks wrapped around them.
As the medical profession continues to ride the wave of these sponsored indulgences, it begs the question: What’s the cost to patient trust? When “education” becomes just another marketing tool, it’s not just the doctors who are losing their way—it’s the very foundation of medical ethics that’s being eroded in the process.