A large number of doctors accept "gifts" from drug companies, admitted S M Shafiuzzaman, president of the Bangladesh Association of Pharmaceutical Industries.

He declined to comment further on the practice. But some salespeople or medical representatives -- as they like to be known -- are prepared to provide more information.

Four representatives from different pharmaceutical companies, multinational and local, told The Daily Star that bribing doctors in order to increase use of particular drugs was widespread.

"We are giving doctors almost everything, from paperweights to cash," admitted one.

Other "incentives" include free air ticket for foreign trips, computers, mobile phones, air conditioners, table lights, telephones, towels, calendars and pens. The representatives said that the value of gifts depended on the "quality" of the doctor.

"Quality" is defined by the number of patients the doctor sees every day.

An "A" class physician treats at least 30 patients a day. Because these doctors prescribe so many drugs, pharmaceutical salesmen visit them seven times a week, offering not only bribes but drug samples worth a minimum of Tk 500 on every visit.

Free samples are an investment for the company, because the doctor is likely to prescribe the drug for many patients.

A "B" class doctor, who treats 20 patients daily, will get three or four visits a week by salesmen, who hand over samples worth at least Tk 300 a visit.

The bribers also target senior physicians "because when a senior professor prescribes an item, the juniors follow him," one representative explained.

Some of the representatives argued that that the samples are simply designed to show the doctor what is available. But a professor from Bangabandhu Sheikh Mujib Medical University, requesting anonymity, disagreed. "It is of course bribery," he commented, "and ultimately patients have to pay."

The samples may not be the best or cheapest on the market, and doctors may be encouraged to prescribe them for other illnesses and conditions, for which the drugs are not ideally suited.

"Doctors often feel obliged to prescribe our products. So they sometimes prescribe drugs which the patient doesn't need," admitted one young medical representative.

It is not a one-way traffic: the medical representatives interviewed by The Daily Star claimed that some physicians ask them for money in exchange for a promise to prescribe particular products.

Giving an example of unnecessary prescribing of costly drugs, a teacher from the pharmacy department of Dhaka University said: "Pure vitamins fall under the government's price control system. One out of 500 patients might need a bit of zinc, which would cost, for example, Tk 1. But vitamins mixed with the zinc solution are not under price control and could cost, say Tk 50, even though the real value may be not more than Tk 2. In such a case, a pharmaceutical company makes an extra profit of Tk 48 just by persuading the doctor to prescribe that product."

A Dhaka Medical College professor said that physicians who asked for money to prescribe products, or who advised patients to buy drugs merely because they had been paid to do so by pharmaceutical companies, were failing to live up to their social responsibilities.

"The government should form strict laws to control the practice," he said.