Amjad Hossain, a retired government official in his sixties, recently visited a medicine specialist at a private hospital in Dhaka for a minor backache. The doctor prescribed nine medicines: two painkillers, two gastric medications, an antibiotic, two vitamin supplements, a sleeping pill and a muscle relaxant.

As soon as he left the consultation room, pharmaceutical sales representatives reportedly began insisting on photographing the prescription.

According to Amjad’s son, Asif Iqbal, “Why would my father need nine medicines for back pain? On top of that, he was prescribed an antibiotic despite having no fever or infection. Have we come for treatment, or have we become part of a business scheme?”

The incident reflects a widespread reality in Bangladesh’s healthcare sector. Weak regulatory oversight, legal loopholes, inadequate monitoring and unethical pharmaceutical marketing practices have trapped ordinary patients in what many describe as a “prescription trade”. The result is increased health risks, rising financial burdens and declining public trust in medical professionals.

Experts warn that unless ethical standards are enforced in the pharmaceutical market, one of Bangladesh’s most successful industries could face a growing crisis of confidence.

Lack of Monitoring and Data

Industry stakeholders say that most prescriptions in Bangladesh are still handwritten. There is no central database or software system capable of tracking which doctors prescribe the most antibiotics, favour particular pharmaceutical brands or deviate from clinical treatment guidelines. As a result, identifying irregularities remains difficult.

Medicines Account for 26% of Treatment Costs

Research by the Bangladesh Institute of Development Studies (BIDS) shows that medicines account for up to 26% of the total cost of hospital treatment, while diagnostic tests represent another 17%.

The average Bangladeshi household spends Tk3,454 per month on healthcare, equivalent to around 11% of total household expenditure.

“Many people are unable to seek medical treatment despite needing it because of financial constraints,” said Dr Md Abdur Razzak, a Research Fellow at BIDS.

Regulatory Challenges

The Directorate General of Drug Administration (DGDA) is responsible for regulating medicine production, marketing and quality control. However, experts say its workforce is far too small relative to the size of the pharmaceutical market and the country’s population.

Limited field inspections and slow laboratory testing allow substandard medicines to enter the market while making it difficult to tackle unethical promotional activities by pharmaceutical companies.

Healthcare experts note that the DGDA focuses mainly on licensing medicines and overseeing manufacturing processes, with far less attention paid to how medicines are promoted to doctors and ultimately prescribed to patients.

Dr Humayra Ferdous, a biomedical researcher and Associate Professor and Head of the Department of Physics at the American International University-Bangladesh (AIUB), said post-marketing surveillance should be strengthened to monitor how medicines are used after entering the market.

She argued that conflicts of interest between physicians and pharmaceutical companies can influence prescribing behaviour. The DGDA should therefore regularly publish updated lists of over-the-counter medicines, maintain information on medicines by generic name and closely monitor pharmaceutical advertising, she said.

An Invisible Trade Hidden in Legal Loopholes

Bangladesh’s pharmaceutical sector is governed by the Drug Act 2023, which provides strict penalties for the production of counterfeit, adulterated or substandard medicines.

Although previous legislation and pharmaceutical marketing codes prohibit unethical promotion, enforcement remains weak. Existing guidelines ban pharmaceutical companies from offering doctors cash, expensive gifts or personal benefits.

A senior DGDA official, speaking on condition of anonymity, said: “Without specific complaints, it is difficult for us to take action. Moreover, because there is rarely written evidence of transactions between doctors and pharmaceutical companies, stopping this invisible trade under current laws is challenging.”

Complaints about aggressive pharmaceutical marketing and overprescribing by some doctors are regularly submitted to the Bangladesh Medical and Dental Council and the DGDA, yet disciplinary action remains rare.

Industry observers attribute this partly to the influence of powerful vested interests. Bangladesh’s pharmaceutical industry is a major economic sector that supplies 98% of domestic demand and exports medicines worldwide. Consequently, pharmaceutical companies wield significant influence in policy circles.

Many firms sponsor medical conferences, seminars and even personal leisure trips for physicians. Critics argue that allegations of unethical practices are often suppressed through political and economic influence.

Antibiotic Misuse Becoming a Major Threat

Perhaps the most damaging aspect of the prescription trade is the misuse of antibiotics.

Doctors frequently prescribe high-powered antibiotics for common ailments such as fever, colds and coughs. The use of antibiotics without laboratory confirmation has contributed to growing antimicrobial resistance, allowing bacteria to develop resistance to treatment.

The World Health Organization has repeatedly warned that antimicrobial resistance could become one of the most serious health threats of the future. Experts say the problem has already become widespread in Bangladesh.

Health Risks and Financial Burdens

In medical practice, prescribing more than three medicines for a single condition is often considered excessive or irrational unless clinically justified.

The average prescription in Bangladesh contains four to five medicines—nearly double the figure seen in many developed countries.

This increases the likelihood of harmful drug interactions and places additional strain on patients’ liver and kidney functions.

The financial impact is equally significant. Around 68% of healthcare expenditure in Bangladesh is paid directly out of patients’ own pockets. Unnecessary medicines often push low-income families into debt.

The Need for Reform

Experts argue that restoring transparency and ethics to healthcare and the pharmaceutical industry requires comprehensive policy reform rather than simply imposing penalties.

AHM Safiquzzaman, former Secretary of the Ministry of Labour and former Vice-President of the Consumers Association of Bangladesh (CAB), said that although direct pharmaceutical advertising is tightly regulated, competition among companies to secure prescriptions has become an open secret.

“When pharmaceutical companies provide unethical benefits to doctors, a clear conflict of interest arises,” he said. “Alongside public awareness, strict enforcement of existing laws is essential.”

He added that technology must play a central role in protecting both patients’ finances and their health.

International Examples

Many developed countries—and even some Indian states—have introduced strict systems to regulate pharmaceutical marketing and prescribing practices.

In the United States and Europe, legislation such as the Physician Payments Sunshine Act requires pharmaceutical companies to publicly disclose any payments, gifts, meals or research funding provided to doctors through centralised databases.

Generic Prescribing and Digital Solutions

Experts suggest Bangladesh should move in a similar direction by making it mandatory for doctors to prescribe medicines by their generic names rather than brand names.

Such a measure would significantly reduce pharmaceutical companies’ incentives to influence prescribing behaviour because doctors would no longer be promoting specific brands.

Syed Ershad Ahmed, President of the American Chamber of Commerce in Bangladesh (AmCham), said that the Bangladesh Association of Pharmaceutical Industries should take firm organisational action to end what he described as unhealthy competition involving the expenditure of 20–25% of industry turnover on unethical marketing.

E-Prescriptions and Central Databases

Healthcare specialists also recommend the nationwide introduction of electronic prescription systems in both public and private hospitals.

Under such a system, prescriptions would be stored in a central database. Software could automatically flag prescriptions that deviate from international guidelines, involve excessive medication or include unnecessary antibiotics.

This would improve accountability and enable regulators to identify problematic prescribing patterns.

Mandatory Disclosure of Benefits

Experts also advocate legislation requiring doctors to disclose any gifts, sponsorships or financial benefits received from pharmaceutical companies.

Patients, they argue, should be encouraged to ask questions about their treatment, while doctors should be required to spend sufficient time explaining the purpose and effects of prescribed medicines.

No Solution Without Reform

According to healthcare experts, maintaining public confidence in both the pharmaceutical industry and the healthcare system will require urgent reforms. Stronger prescription monitoring, wider adoption of e-prescriptions, stricter antibiotic policies, mandatory disclosure of conflicts of interest and more effective regulation are all essential.

Dr Akhtar Hossain, Director of the Directorate General of Drug Administration, said field-level monitoring and administrative enforcement are already under way to curb irregularities and unethical practices.

“To ensure one-stop monitoring, district-level action committees led by Deputy Commissioners are currently operating across the country,” he said.

“We are committed to strengthening this monitoring system further. If we receive specific information and evidence of wrongdoing, immediate and strict legal action will be taken.”

Meanwhile, Dr Abu Hossain Md Moinul Ahsan, Director (Hospitals and Clinics) at the Directorate General of Health Services, emphasised that prescriptions are considered highly confidential documents under Bangladeshi law.

“No one has the legal right to view or access a patient’s prescription without the patient’s consent,” he said. “If evidence emerges that any hospital—public or private—is violating this principle or harassing patients, strict administrative action will be taken against that institution.”

Source: Kaler Kantho