Pharmaceutical giants Abbott and Sun Pharma are providing dangerous amounts of antibiotics to unlicensed doctors in India and incentivizing them to overprescribe. In August 2019 the Bureau of Investigative Journalism (BIJ) reported that these unethical business practices are leading to a rise in superbugs, or bacterial infections that are resistant to antibiotic treatment. Bacteria naturally evolve a resistance to antibiotics over time, but the widespread and inappropriate use of antibiotics accelerates this process. Superbugs are killing at least 58,000 babies each year and rendering a growing number of patients untreatable with all available drugs.
India’s unlicensed medical practitioners, known as “quack” doctors, are being courted by Abbott and Sun Pharma, billion-dollar companies that do business in more than one hundred countries, including the United States. The incentives these companies provide to quack doctors to sell antibiotics have included free medical equipment, gift cards, televisions, travel, and cash, earning some doctors nearly a quarter of their salary. “Sales representatives would also offer extra pills or money as an incentive to buy more antibiotics, encouraging potentially dangerous overprescription,” a Sun Pharma sales representative revealed to an undercover BIJ reporter.
India offers free healthcare to its poor citizens, but its healthcare system has an estimated shortage of 600,000 doctors and millions of trained nurses. India’s 2.5 million quack doctors vastly outnumber its one million certified doctors. As a result, patients without access to better care often turn to quack doctors for treatment, and many are unaware that their local medical “professionals” have no formal training and are being bribed to sell unnecessary antibiotics.
In September 2019, the BIJ reported on similar problems with broken healthcare systems, medical corruption, and dangerous superbugs in Cambodia. Their account describes how patients often request antibiotics for common colds, to pour onto wounds, and to feed to animals. Illegally practicing doctors and pharmacists in Cambodia admitted that they would often prescribe based on customer requests rather than appropriate medical guidelines. As the BIJ noted, “This kind of misuse speeds up the creation of drug resistant bacteria, or superbugs, which are predicted to kill 10 million people by 2050 if no action is taken.”
Although India is generally acknowledged as the epicenter of this growing global threat, there has been little coverage on the shady business practices in India by companies like Abbott and Sun Pharma. In 2017, HuffPost discussed the findings of a 2016 PLOS Medicine study on antibiotic resistance in India, but only briefly mentioned the role of pharmaceutical companies and their sales representatives, failing to identify them as a driving force in the growing problem. A 2019 Telegraph article identified the role of doctor shortages in the rise of antibiotic resistance, but did not discuss pharmaceutical companies as being part of the problem.
The only substantial corporate reporting on the unethical sale of antibiotics came from a six-month investigation by the New York Times in 2016 that found pharmaceutical representatives from Abbott pressuring their India-based employees to sell to quack doctors, plainly in violation of Indian law and the company’s own ethical guidelines. However, the article did not make any connection between these practices and the rise of superbugs in India.
Although superbugs have attracted some attention, their cause and importance remain poorly understood by the public. The Independent and BuzzFlash republished the Bureau of Investigative Journalism’s report; otherwise, the role of pharmaceutical companies in the rise of dangerous superbugs has been drastically underreported.
Madlen Davies, Rahul Meesaraganda, and Ben Stockton, “Drug Company Reps Give Quack Doctors Fridges and Televisions to Sell Antibiotics,” Bureau of Investigative Journalism, August 19, 2019, https://www.thebureauinvestigates.com/stories/2019-08-19/drug-company-reps-give-quack-doctors-fridges-and-televisions-to-sell-antibiotics.
Student Researcher: Allison Rott (North Central College)
Faculty Evaluator: Steve Macek (North Central College)