E-DRUG: NYT: Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell
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NYT - International Business
Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell
By GEETA ANAND and FREDERIK JOELVINGAUG. 11, 2016
Warning: THIS IS A LONG ARTICLE: Morderator
(With photos on the original webpage)
INDORE, India — Leaving his wife and two young children home on a recent
Sunday, a 27-year-old salesman for Abbott Laboratories’ operations in India —
in fact, one of the American health care company’s top performers there — rode
his motorcycle to a remote railroad track and jumped in front of a train.
In his pocket, a note in blue ink, handwritten in a mix of Hindi and English,
said, “I’m going to commit suicide because I can’t meet my company’s sales
targets and my company is pressuring me.”
Ashish Awasthi’s death last month resonated across India and through the halls
of the health care giant. More than 250 fellow Abbott drug representatives in
India walked off the job for a day, protesting what some called the company’s
overly aggressive sales policies. A national union of drug sales workers called
for new government rules to rein in sales practices industrywide, saying they
compromised patient health.
A six-month investigation by The New York Times found that in the push to win
customers in India’s chaotic and highly competitive drug market, some Abbott
managers instructed employees to pursue sales at virtually any cost — in
violation of Indian law, professional medical standards and the company’s own
Sales jobs with global powerhouses like Abbott are highly prized positions in
India. But they can also be extremely demanding, putting employees under
inordinate pressure to cut corners, according to interviews with more than a
dozen current and former sales representatives and managers and a review of
internal Abbott communications provided by two of them. In one of the most
common practices, The Times found, Abbott managers told sales staff to hold
what the company called health camps, where representatives would perform tests
on patients for various ailments in an effort to drum up business for doctors,
who would then prescribe Abbott drugs. The camps were typically held at
doctor’s offices or as community events.
Sales personnel who perform screening tests could be accused of practicing
medicine without a license, a criminal offense, said Dr. Jayshree Mehta,
president of the Medical Council of India, the country’s medical regulatory
agency. Indian medical ethics regulations also prohibit quid pro quo, Dr. Mehta
Abbott India’s public affairs director, Anand Kadkol, said the company’s
marketing policies “are aligned with applicable laws” in India. He called the
health camps “disease awareness education programs” and said that Abbott’s
policies did not allow the camps to be conducted “in exchange for an explicit
or implicit understanding” to prescribe Abbott products. The company declined
to comment on individual employees. Mr. Kadkol said Abbott was “aware of a
number of the allegations raised” and had addressed them.
But Vivek Gupta, a former manager of a sales team in northern India, said he
was fired last year under pressure to make his sales representatives do more
screenings of patients to promote a new Abbott multivitamin for nerve damage.
He tried to resist, he said, out of respect for the national rules and the
company’s own policies, which prohibit the use of health camps to influence
which medicines are prescribed.
Dhirendra Yadav, 26, a former sales agent in central India in the neurology
division, said he resigned in December 2013 under what he called “immense
pressure to conduct business in unethical ways.” He said his former manager —
who later became the manager of Mr. Awasthi, the man who committed suicide —
insisted that he use his own money to buy medicines costing nearly 15,000
rupees, or about $220, to help his group meet a sales target. That would be
more than half of a typical representative’s monthly pay.
Rajeev Khanna, who managed six sales representatives for neurology medicines in
northern India, said he was fired after complaining to Abbott’s office of
ethics and compliance that his team was submitting fake invoices to increase
sales. He described a practice of giving discounts intended for government
institutions to private wholesalers as a kickback.
Corruption, already pervasive industrywide in India, has intensified with
growing competition, according to the Federation of Medical and Sales
Representatives’ Associations of India, the largest union of drug sales
personnel, representing tens of thousands nationwide, which called for the new
regulation. Unethical marketing practices are routine in the Indian
pharmaceutical market, said Sanjeev Khandelwal, a union secretary who works as
a drug salesman at an Indian company.
India’s annual drug sales, estimated at $16 billion, may be small by the
standards of the United States or Europe, but the market is attractive because
it has been growing faster than 10 percent annually in recent years, placing it
far ahead of developed markets in terms of growth. It is also unusually
competitive. Until about a decade ago, Indian intellectual-property law let
manufacturers ignore drug patents — and thousands of manufacturers cropped up.
Today India generally honours patents, but its medical marketplace retains its
Wild West roots in the form of countless confusing brands and extreme price
competition. As a government expert panel noted in a 2011 report, “The market
is flooded by irrational, nonessential and even hazardous drugs that waste
resources and compromise health.”
In this battle for sales, employees like Mr. Awasthi are the drug companies’
front-line foot soldiers. In an email, Mr. Kadkol, the Abbott India spokesman,
said, “We are deeply saddened to learn of Ashish Awasthi’s tragic demise,”
describing him as “among the top performers in 2015.”
The ‘Perfect Life’
As multinationals like Abbott expand in India, they bring something powerfully
attractive to the nation’s emerging middle class: jobs. The positions they
offer become highly coveted, both for the prestige of working for a global
company and because India’s economy — despite its 7.6 percent growth — still
produces far too few jobs for the one million people who enter the work force
each month. This sets the stage for fierce competition for positions like
these — and a desperation to retain them. Mr. Awasthi embodied these
ambitions. Hailing from a farming town about 400 miles northeast of Indore, he
was one of the countless people who flock to India’s cities with hopes of
climbing the economic and social ladder.
In December 2013, when Abbott hired him as a salesman, he felt he had won the
lottery, said his 27-year-old widow, Anita Awasthi. He told her, “I can do
everything for you now,” she recalled recently for visitors who had come to her
home to offer their condolences. His job was persuading doctors to use
Abbott’s medicines for neurological diseases, and he was a disciplined
salesman, according to a former boss, Ramchandra Tiwari. It is a gruelling job,
Mr. Tiwari said, requiring aggressive efforts to catch doctors’ attention early
in the morning or late in the evening.
Mr. Awasthi thrived, though. In 2015 he won a top salesman award. The young
couple had made many close friends, his wife said, and maintained a busy social
life going to movies and visiting area temples. She called theirs the “perfect
life. And they began to stretch financially. Mr. Awasthi bought a car — a
sought-after symbol of arrival in the Indian middle class — and proudly carried
a snapshot of it, garlanded with flowers. And he took out a loan to buy a
one-bedroom apartment for about $20,000. The purchases meant money was tight,
Ms. Awasthi said. Her husband recently asked a friend to borrow about $70 to
pay their 7-year-old daughter’s school fees. Still, all was good, she said,
until this June, when he got a new manager. According to his previous manager,
Mr. Tiwari, the demands on the sales staff rapidly built. Mr. Tiwari described
it as “inhuman and unnatural” pressure to sell.
The day he was found dead, Mr. Awasthi had been expected to attend a meeting
with his new boss. Ms. Awasthi believes her husband — despite being a top
performer — expected to lose his coveted job that day.
Camps for Check-ups
Mr. Gupta, the 37-year-old manager for neurology products in the northern city
of Chandigarh, arrived at Abbott India from Solvay Pharma India when the two
drug makers merged in 2011. Abbott India’s parent company acquired Solvay
Pharmaceuticals, of Belgium, for $6.2 billion in 2010. From the start, a
contentious issue between Mr. Gupta and his managers was Abbott’s use of sales
personnel to perform medical tests at health camps.
In India, where many people lack affordable care, these mass screenings have
become a common way for drug makers to lift sales, according to current and
former Abbott sales representatives and managers. The industry-sponsored
camps typically focus on chronic ailments such as diabetes, thyroid disorders,
heart problems and lung disease. Sales personnel do the testing at no charge,
and participating doctors get to increase their business by advertising free
check-ups. In return, the doctors are expected to prescribe the drug maker’s
A February 2015 email from a marketing manager, Shrey Agrawal, telling sales
managers that their representatives were supposed to attend a minimum of three
neuropathy camps per quarter. (Some names and identifying information have been
redacted.) Some experts say these practices raise the prospect that people
may be inappropriately diagnosed and could receive unnecessary treatment.
Abbott promotes its health camps nationwide as a core part of its “corporate
social responsibility” program, which is intended partly to meet the Indian
government’s requirement that companies contribute to the social good. “If it’s
corporate social responsibility, then it shouldn’t be linked to the sales of
the brand,” Mr. Gupta said. Mr. Kadkol of Abbott India said, “Employees are
not permitted to perform diagnostic tests.” The company denies that the purpose
of the health camps is to have doctors use its drugs.
“Abbott’s procedures clearly state that disease awareness programs must not be
conducted or provided or offered in exchange for an explicit or implicit
understanding to purchase, order, recommend, prescribe or provide favourable
treatment to any Abbott products,” Mr. Kadkol said in an email.
However, more than a dozen internal emails shared with The Times by Mr. Gupta
suggest that Abbott viewed the camps as a sales tool and that the strategy came
from Abbott management. In a February 2015 email, a group product manager
informed the sales force that January sales of Surbex Star, a vitamin Abbott
promotes to treat neuropathy in people with diabetes, were “way behind the
“Now is the time to bounce back and surpass February target for Surbex Star,”
the manager wrote. “Herein below are the 6 easy steps to conduct neuropathy
The manager did not return phone calls and emails seeking comment.
In another email from last year, an Abbott marketing manager told Mr. Gupta and
other first-line sales managers that their representatives were supposed to do
a minimum of three neuropathy camps per quarter and that they were behind in
“Camps will go a long way in promoting Surbex Star,” the marketing manager said
in the email.
Several senior managers were copied on both emails. Shrey Agrawal, who wrote
that email but is no longer with Abbott, said in a telephone interview that
“there is no direct link” between camps and drug sales. Asked how this tracked
with his email about Surbex Star, he said he would respond by email. He never
In another email last year, an Abbott sales agent boasted that a neuropathy
camp he had conducted was “a big success,” noting that 30 of the 40 patients
tested positive, and that the doctor prescribed Surbex Star to all 30. He did
not respond to requests for an interview.
A Dive Into Depression
As Mr. Gupta clashed with his bosses, he says, they began calling him and
sending messages late at night and on Sundays, and he became depressed. After
one particularly intense phone call, he grabbed a hot iron that his wife had
just used and pushed it into his hand, searing his flesh and leaving a scar. He
had thoughts of killing himself, he said, and saw a psychiatrist, who put him
on an antidepressant and an antipsychotic. Soon afterward, his bosses told
him they wanted to transfer him 1,500 miles away, to the city of Chennai. He
refused to go, he said, interpreting it as an effort to make him quit.
In an email to top leaders at Abbott India in August 2015, Mr. Gupta laid out
his concerns. He told management that sales representatives were instructed to
screen patients to increase sales. As proof that the medical screening was
happening, managers were instructing sales personnel to email photos of the
tests being performed, Mr. Gupta explained — but with someone else posing as
the tester, to conceal the representatives’ involvement. He said the practices
violated Abbott’s code of ethics. Mr. Gupta sent the allegations, and
supporting documents, to the company’s office of ethics and compliance in India
as well. The Times has reviewed the documents.
Last autumn, Mr. Gupta was fired. He was told he had lost the managers’
confidence, he said. Today he works for a hospital.
In response to allegations that the camps were improperly used to induce
doctors to write prescriptions, Mr. Kadkol of Abbott India said, “That just
doesn’t happen.” He noted that such camps were “not exclusive to a company,”
adding, “They happen in many companies across many geographies.” Regarding
Mr. Gupta’s other claims, Mr. Kadkol said, “We don’t comment on the details of
internal compliance investigations.”
Mr. Gupta’s former boss, Anup Ray, said in an interview that the purpose of the
health camps was for doctors to prescribe Surbex Star. That made Mr. Gupta
“uncomfortable,” Mr. Ray said. “I was also against it.”
Suspicions of Kickbacks
Mr. Khanna, the former Abbott manager who said he was fired after complaining
about questionable sales made at discounted government rates, oversaw a team of
neurology-medicine sales representatives in Lucknow, in northern India. Now 48,
he had worked for 25 years for Abbott, Solvay and a company it acquired.
In 2013, he said, he began to notice the rapid rise in sales at the government
discount. Suspicious that the sales were a form of a kickback to wholesalers,
to induce more orders, he asked his sales staff and the wholesalers to produce
original copies of the orders from government institutions, which they failed
to do, Abbott emails show. Mr. Khanna stopped approving the transactions, he
said, but another manager then began approving them.
Mr. Khanna wrote to Abbott’s ethics office in December 2013, laying out his
concern that government purchasing rules were being violated. He said, “I am
afraid if I will continue to resist these unethical practices anymore I may get
transferred or may lose my job.” On July 25, 2014, he says Abbott asked him
to resign and accused him of a conflict of interest involving his wife. She had
obtained a license the previous year to operate a wholesale drug business in
case he left Abbott, where he felt increasingly insecure. Mr. Khanna said that
opening a drug company would have violated Abbott’s rules but that his wife had
not started a company. He says he refused to resign. Abbott fired him.
Asked about Mr. Khanna’s allegations, Mr. Kadkol cited the company’s policy of
not discussing individual cases or investigations into internal complaints.
Mr. Awasthi’s Final Days
Sitting on the floor of her tiny living room just days after her husband’s
suicide, Ms. Awasthi recounted the final few weeks of her husband’s life.
“He told me, ‘The company is pressuring me,’” she said, wearing a pink sari,
her two young children playing among the mourners. “I said, ‘Change jobs.’ He
said, ‘How will I get another job?’”
Work pressure built quickly in June after the new boss, Inder Kumar, took over
managing Mr. Awasthi’s sales team. His previous manager, Mr. Tiwari, had been
asked to transfer to a city in southern India, more than 1,000 miles away from
Indore. He declined the transfer and lost his job. According to two former
employees of the new manager, he could be a tough boss. One of them, Mayank
Pandey, said he felt so desperate to meet sales targets that he bribed doctors
with his own cash to get them to prescribe Abbott drugs. Mr. Pandey quit Abbott
this year, describing himself as “mentally broken.”
Mr. Kumar declined requests for interviews, referring questions to Mr. Kadkol,
Abbott India’s public affairs director, who cited the company’s policy not to
comment on individual employees.
In general, Mr. Kadkol said, “retaliatory or denigrating behaviour of any kind
is not accepted” at Abbott, which encourages an environment “devoid of any
harassment or undue pressure.” He said any suggestion that Mr. Awasthi “was
singled out for poor performance is without merit.”
Ms. Awasthi said Mr. Kumar had summoned her husband to a Monday meeting. The
day before, she says, Mr. Awasthi was unusually quiet. He swept their
apartment, bathed both of the children and fed them. Then he napped by his
wife’s side. At about 6 p.m., he went out, leaving behind his cell phone and
Police found his body the next morning along the railroad track.
After Mr. Awasthi’s death, Abbott gave his family a check for 345,000 rupees,
about $5,000, which included his salary and allowances for July, various
reimbursements, as well as a “gratuity.” Though Ms. Awasthi does not work and
needs money, she has refused to cash it.
“He died because of them,” she said. “They must take responsibility.”
Geeta Anand reported from Indore, India, and from New Delhi and Mumbai, and
Frederik Joelving from Copenhagen. Suhasini Raj contributed reporting from New
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