Driven To Suicide


Leonard Zwelling

         In an exquisitely concerning article in the NY Times on August 11, Geeta Anand and
Frederik Joelving describe a system of high pressure sales promotion in the
Indian drug market. Executives at Abbott Laboratories press the sales force to
run “health camps” where the sales reps test patients for specific disorders
for which Abbott has drugs that the doctors who host the clinics can prescribe.
And do. It is a wholly unethical way in which to boost sales.

pressure to produce actually drove a young salesman named Ashish Awasthi to
throw himself in front of a train rather than continue to pursue the career he
had so coveted at one time.

         His death led to a sympathy protest by 250 of his fellow
sales colleagues. They walked off the job for a day. These sales pressure practices violate
Indian law and Abbott policy. None of that stopped the push for more health
camps and more sales by Abbott management.

         The first thing this brings to mind is the wholly unethical
practice that occurs in the United States and New Zealand only of marketing
prescription drugs directly to consumers. It is just plain wrong to sell
Viagra, Cialis, Humira, Xarelto or any other drug requiring a doctor’s
prescription to patients on television. It’s time for the FDA to step in and
ask Congress for the power to ban these ads under the Commerce Clause of
Article 1, section 8 of the US Constitution, the portion of our law from which
the FDA derives its power to regulate drugs across interstate lines. If
television isn’t across interstate lines, I don’t know what is and don’t give
the free speech tripe any thoughts. The patients cannot buy the stuff anyway.
It is just a ploy to drive demand once removed like selling Cocoa Puffs to

         It is also vaguely reminiscent of the recurring saga of the
leadership of American health care facilities, including academic ones,
encouraging their faculties to see more and more patients, and “move them
through” and “see another for the team” and “don’t forget to do the extra
consult.” Sound familiar?

         People don’t come to academic medical facilities to be
treated like numbers. They are often desperate, particularly when the facility is
a cancer center, for help and the very first thing each of them needs is time
and the belief that the physician and the staff gave his or her problem
complete attention. That takes lots of time. This is inconsistent with assembly
line medicine and rapid fire clinics is no way to deal with patients having the
complex disorders that bring them to an academic center.

         This “ business” that we are in should not be a business.
Few of us entered it to make it a business and surely those in academia did not
for the medical “business” is best pursued in the private sector (preferably in
plastic surgery) not the “non-for-profit” sector. Of course, calling academic
centers that constantly worry about their margins “non-profits” does stretch credulity.

         What you see around you in American medicine is on steroids
in India. The drug companies are completely out of control and the sales jobs
so coveted that the managers get away with driving the sales force to death.
Yet, even in India, 250 of the colleagues of the man who committed suicide
staged a one-day walk out.

         What are you waiting for? When will you turn Wednesday into

Leonard Zwelling