[Marxism] Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell

Louis Proyect 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 
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 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 
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 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 
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 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 
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 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 
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 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 
neuropathy camps.”

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 
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 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 mailing list