[Marxism] Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell
lnp3 at panix.com
Thu Aug 11 08:05:26 MDT 2016
NY Times, August 11 2016
Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell
By GEETA ANAND and FREDERIK JOELVING
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 ethics guidelines.
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
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 said.
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
The company declined to comment on individual employees. Mr. Kadkol said
Abbott was “aware of a number of the allegations raised” and had
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
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
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 honors
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
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 grueling 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 Checkups
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
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
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 checkups. In return, the
doctors are expected to prescribe the drug maker’s product.
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 favorable treatment to any Abbott products,” Mr. Kadkol said in
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 expectations.”
“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
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 that goal.
“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 did.
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
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
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
“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
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 behavior 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 cellphone and wallet.
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 Delhi.
More information about the Marxism