Fatwa ID: 06861

 

Answered by: Alimah  Saleha Bukhari Islam

 

Question:

                

A doctor is working in a private hospital. He makes a business agreement with one of the best companies in a country that exports drugs to the developed country. According to the agreement, He will write a specific drug for a specific disease that the renowned company produces. The price of the drug is similar to the price of other companies and quality is superior or similar to other companies. As an agreement, the doctor will get a monthly salary from that company.

 

Conditions of the agreement:

1. The doctor will write the drug in his prescription according to the disease condition/according to the indication.

2.    The salary should not be target-based. It will be a fixed monthly salary & it will not depend on several prescriptions.  This fixed monthly salary arrangement, rather than a target-based system, ensures that financial incentives do not influence the doctor’s decision-making. This helps maintain the integrity of the doctor-patient relationship and ensures that the doctor’s primary concern remains the welfare of the patients.

3.    The doctor will have control over the agreement and the pharmaceutical company will not be the first priority, but patients will be the first consideration.

4.    If the price of the drug increases, the doctor will consider alternative drugs for the betterment of the patient following re-evaluation of the agreement. If most of the reputed companies in the country increase the price due to a specific reason, then doctors will choose the drug that best suits the patient. The doctor will consider the acceptable price (most of the companies adopt) and quality. Due to price, quality should not be compromised. A balance of price and quality should be maintained.

5.    Each party has the freedom to come out of the agreement if any deviation of conditions is observed. This ensures that the doctor can maintain their autonomy and make decisions in the best interest of the patients.

6.    The hospital has no rule to declare any conflict of interest regarding such an issue. The hospital’s constitution did not mention directly or indirectly that such an issue should be declared. Even, the job contract did not demand directly or indirectly that the employee must declare such a relationship. Moreover, the hospital was allowed to maintain multiple affiliations without hampering the job. So, the doctors have no obligation regarding the declaration of such a relationship.

7.    The doctor will not be responsible for any obligation (rules/regulations) applicable to the pharmaceutical company. If the pharmaceutical company agrees with the above conditions, is it permissible to make such a business agreement with the company without harming the patients and earning money? Is it halal?

 

 

In the name of Allah, the Most Gracious, the Most Merciful

 

Answer:

 

Your concern with regard to the permissibility to participate in Pharmaceutical Marketing is praiseworthy. As a Muslim Practitioner, amongst the obligations of delivering a service, there is also an obligation to manage the trust (an Amanah) of your patients at all times. This requires total transparency on your part in whatever concerns the well-being of the patients who are in your care.

 

Al-Hasan b. ‘Ali said:

I have retained in my memory these words of God’s Messenger, “Leave what causes you doubt and turn to what does not cause you doubt. Truth is tranquillity, but falsehood is doubt.”[1]      (Mishkat al-Masabih 2773)

 

Ahmad, Tirmidhi and Nasa’i transmitted it, and Darimi transmitted the first part.

 

What we understand from this hadith is that the heart of a true believer is peaceful at the sight of truth and righteousness, and his heart becomes irresolute and unsteady at the sight of falsehood and wrong. At-Teebi said: if you find yourself doubting (and uncertain about) something, then leave it, for the heart of the believer is at ease with the truth and is doubtful about falsehood and wrong. Being doubtful about something is an indication that it may be untruthful and false, so beware of it, and your feeling at ease with something is an indication that it is truthful, so take hold of it.[2](Fayd al-Qadeer, v3 p529)

 

Pharmaceutical Marketing is a developing field and requires regular reviewing in terms of Halal and Haram, and engaging in collaborations of different kinds such as the one you have mentioned. Where an action concerns people directly and if it should make one uncomfortable for it to become known, then steps need to be taken to ensure this is not the case.

 

Nawwas b. Saman al-Ansari reported:

{“I asked Allah’s Messenger (ﷺ) about virtue and vice. He said: Virtue is a kind disposition and vice is what rankles in your heart and that you disapprove that people should come to know of it.”}[3]

 

According to the hadith above, if a believer finds his heart disturbed by a certain action, then he must rectify the situation so his heart is at rest. If he is unable to do so then leave it altogether.

 

Halal and haram have clear distinctions and as a Practitioner, you will have knowledge of pharmaceutical products available in the market and whether Halal options are available or not, this is another aspect to factor in when considering contracts with Pharmaceutical companies.

 

Usually in Pharmaceutical Marketing, there is a level of transparency provided as the doctor is listed as having received a payment from a certain company, therefore implying that the doctor does not have “a major conflict of interest.” This level of transparency can also be beneficial to pharmaceutical marketing as it helps raise awareness of new products that may treat disease better and improve chances of survival with fewer side effects than older or generic drugs.

 

If point 6 on your list can be reviewed and altered to include the declaration of such relationships to be open to patients then this would provide the transparency in your role as a prescriber of the medication and permissibility to operate on this basis. Otherwise, it is best to avoid such contracts as it can be seen as a breach of trust.

 

Provision (Rizq) has been determined by Allah ﷻ and will not diminish by remaining on the straight path and treading with caution. Allah ﷻ says in the Quran:

 

“If the people of the town had believed and been righteous we would open upon them the blessings of the sky and the earth.”^[4]

 

(Surah Al-A’raf 7:96)

 

 

 

Only Allah (عز و جل) knows best.

Written by Alimah Saleha Bukhari Islam

Checked and approved by Mufti Mohammed Tosir Miah

Darul Ifta Birmingham

 

 

 

 

 

 

 

[1]  وَعَنِ الْحَسَنِ بْنِ عَلِيٍّ رَضِيَ اللَّهُ عَنْهُمَا قَالَ: حَفِظْتُ مِنْ رَسُولِ اللَّهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ: «دَعْ مَا يَرِيبُكَ إِلَى مَا لَا يَرِيبُكَ فَإِنَّ الصِّدْقَ طُمَأْنِينَةٌ وَإِنَّ الْكَذِبَ رِيبَةٌ» . رَوَاهُ أَحْمَدُ وَالتِّرْمِذِيُّ وَالنَّسَائِيُّ وَرَوَى الدَّارِمِيُّ الْفَصْل الأول

 

[2]  ٤٢١٣ – (دع ما يريبك) أي اترك ما تشك في كونه حسنا أو قبيحا أو حلالا أو حراما (إلى ما لا يريبك) أي واعدل إلى ما لا شك فيه يعني ما تيقنت حسنه وحله (فإن الصدق طمأنينة) أي يطمئن إليه القلب ويسكن وفيه إضمار أي محل طمأنينة أو سبب طمأنينة (وإن الكذب ريبة) أي يقلق القلب ويضطرب وقال الطيبي: جاء هذا القول ممهدا لما تقدمه من الكلام ومعناه إذا وجدت نفسك ترتاب في الشيء فاتركه فإن نفس المؤمن تطمئن إلى الصدق وترتاب من الكذب فارتيابك من الشيء منبيء عن كونه مظنة للباطل فاحذره وطمأنينتك للشيء مشعر بحقيقته فتمسك به والصدق والكذب يستعملان في المقال والأفعال وما يحق أو يبطل من الاعتقاد

 

[3] قَالَ سَأَلْتُ رَسُولَ اللَّهِ صلى الله عليه وسلم عَنِ الْبِرِّ وَالإِثْمِ فَقَالَ ‏ “‏ الْبِرُّ حُسْنُ الْخُلُقِ وَالإِثْمُ مَا حَاكَ فِي صَدْرِكَ وَكَرِهْتَ أَنْ يَطَّلِعَ عَلَيْهِ النَّاسُ ‏”‏

 

[4] وَلَوْ أَنَّ أَهْلَ الْقُرَىٰ آمَنُوا وَاتَّقَوْا لَفَتَحْنَا عَلَيْهِمْ بَرَكَاتٍ مِنَ السَّمَاءِ وَالْأَرْضِ