For Every Bottle Of Killer Cough Syrup Doctor Prescribed, He Got Rs 2.5 As Cut https://www.ndtv.com/india-news/coldrif-madhya-pradesh-cough-syrup-deaths-dr-praveen-soni-for-every-bottle-of-killer-cough-syrup-doctor-prescribed-he-got-rs-2-5-as-cut-9453358 via @ndtv
The syrup, manufactured by Sresan Pharmaceuticals, became the tragic link to the deaths of 23 children in the state.[10][11]
Part I: The Drug Connection
Investigations reveal that Dr Praveen Soni, a paediatrician at Parasia’s government health centre, continued prescribing Coldrif even after central guidelines banned fixed-dose combinations (FDCs) for children under four years. The syrup contained lethal levels of diethylene glycol (DEG) — the same solvent responsible for some of India’s past mass poisonings.[12][13][10]
Police allege Soni knew the risks and persisted because of the small but steady commissions he received from Sresan.
This single tragedy exposes the deceptively small incentives that fuel dangerously large consequences. From aggressive medical representatives to junkets abroad, the system routinely rewards prescription volume, not patient outcomes.
And it’s not the first scandal. Ten years ago, twenty doctors from 14 districts of Madhya Pradesh were found to have taken luxury trips to Italy in exchange for prescribing a company’s medicines — a clear violation of medical ethics that quietly disappeared amid bureaucratic fog.[11][14]
Part II: The Diagnostic Dimension
The pharma–doctor relationship is only one tentacle of a much larger beast. A second, thriving nexus binds doctors, diagnostic labs, and imaging centres.
A 2017 investigation by The Times of India found that referral commissions exceeded Rs 200 crore across just one diagnostic chain in Bangalore, while raids by the Income Tax Department exposed similar rackets in hospitals across Maharashtra and Karnataka.[9]
Doctors routinely prescribe unnecessary MRI scans, blood panels, and fertility diagnostics — all driven by referral fees camouflaged as “consultation honorariums”. Public health analysts have long warned that such diagnostic kickbacks perpetuate over-testing, delay genuine care, and inflate healthcare costs.
Maharashtra is working on a law to regulate these referrals, but in most other states, the nexus continues unchecked.[9]
Part III: Devices, Disposables, and the New Frontier
With the rise of India’s MedTech and medical devices industry, a newer, subtler ecosystem of incentives has emerged. Diagnostic consumables, implants, and single-use devices often carry margins exceeding 200% between factory gate and hospital billing.[3][4][15]
Several industry reports point out that vendors regularly offer “stocking incentives”, “equipment credits”, and “exclusive-use discounts” to hospitals and senior clinicians. This fosters concealed monopolies where doctors prescribe or implant only those device brands that sustain the highest incentives.
The 2024–25 EY MedTech report notes India’s healthcare ecosystem is at “a convergence point” where innovation meets unethical commercialization — and without stronger oversight, patient safety could easily become secondary to product placement.[15][3]
In short, the same toxin that contaminated Coldrif — greed — has seeped deep into every pore of India’s healthcare system.
Towards Reform: A Three-Point Prescription
1. Digitize and Disclose Incentives
All commissions, discounts, and benefits must be digitally logged under a unified Healthcare Transparency Registry covering pharmaceuticals, diagnostics, and devices. AI-led audits should trigger red flags where prescription or test patterns deviate from norms.[16][17]
2. Make the UCPMP Law, Not Guideline
The Uniform Code for Pharmaceutical Marketing Practices (UCPMP 2024) currently lacks legal teeth. Conversion into binding legislation — with penalties, license suspensions, and public blacklisting — would deter both doctors and companies from unethical collaboration.[14][16]
3. Extend Oversight Beyond Drugs
India’s accountability regime must broaden to diagnostics and devices. State medical councils and BIS regulators should integrate under a single Health Sector Ethics Authority. Only then can we ensure transparency across every transaction — from prescriptions to implants.[4][3]
The Real Cost of Rs 2.54
The Madhya Pradesh tragedy wasn’t only about a bottle of contaminated syrup. It was about a bottle of systemic rot — capped by complacency, shaken by greed, and swallowed by public trust.
When a doctor’s prescription becomes a transaction, healthcare turns into commerce. Patients stop being people; they become opportunities. The greatest casualty is not institutional reputation but the moral fabric that defines medicine itself.
We must decide, urgently, whether Rs 2.54 remains the price of our collective conscience — or the wake-up call that forces India’s healthcare system to heal itself.
Appendix: Key Sources and Reports
| Source | Year | Focus |
|---|---|---|
| NDTV, For Every Bottle Of Killer Cough Syrup Doctor Prescribed He Got Rs 2.5 | 2025 | Cough syrup tragedy, doctor commissions[10] |
| India Today: ED Busts ‘Babu-Baby Killer’ Nexus | 2025 | Enforcement investigation into cough syrup deaths[12] |
| Moneycontrol: Rs 2.54 per life | 2025 | Madhya Pradesh children’s deaths, doctor incentives[11] |
| EY Report: India’s MedTech Industry – Renaissance of a Sector | 2024 | Device and diagnostic incentive structures[15] |
| Economic Times / Medical Dialogues: UCPMP 2024 | 2025 | New rules against pharma gifts and inducements[16][17] |
| SCC Online: The Doctor–Drug Company Nexus | 2022 | Legal petitions on unethical pharma relationships[1] |
| Times of India: While Doctors Make Money, Nexus Drills Hole in Patients’ Pockets | 2017 | Diagnostic referral kickbacks, Karnataka and Maharashtra cases[9] |
| EY–OPPI Report: Viksit Bharat@2047: Pharma Powerhouse Vision | 2024 | Policy and sustainability recommendations[3] |
| India Employer Forum: Pharma Industry Outlook 2025–2030 | 2025 | Growth trends, manufacturing incentives[4] |
| PMC: Incentivisation Practices and Their Influence on Physicians | 2023 | Empirical evidence on commissions and behavior[18] |
MedicinMan Commentary
Ethical practice in medicine isn’t a tradable commodity — it cannot be bought, delegated, or outsourced. Whether it’s prescribing drugs, ordering diagnostic tests, or recommending surgical implants, integrity and transparency must guide every medical decision. Only through such honesty can India not just be known as the “pharmacy of the world,” but also as a beacon of ethical medical practice. [3][4][10][11][15]
All Images are AI Generated for Illustration Only. E&OE.
Sources
[1] The Doctor – Drug Company Nexus: Diagnosis and … https://www.scconline.com/blog/post/2022/08/27/the-doctor-drug-company-nexus-diagnosis-and-treatment/
[2] Doctor-Pharma Nexus Part II: What drives drug prescription … https://www.moneycontrol.com/news/trends/health-trends/doctor-pharma-nexus-part-ii-what-drives-drug-prescription-in-india-9209041.html
[3] India’s Way to Global Pharma Powerhouse by 2047 https://www.ey.com/en_in/insights/health/what-will-it-take-for-india-to-become-a-global-pharma-powerhouse-by-2047
[4] Pharma Industry in India: An Outlook for 2025-2030 https://indiaemployerforum.org/world-of-work/pharma-industry-in-india-2025-2030/
[5] 10 challenges facing the pharmaceutical industry in 2025 https://blog.i-nexus.com/10-challenges-facing-the-pharmaceutical-industry
[6] India’s Pharma Sector Gets a Shot of Growth at 7.8% in April https://www.pib.gov.in/PressNoteDetails.aspx?id=154488&NoteId=154488&ModuleId=3
[7] Budget 2025 | Reimagining India’s healthcare future https://indianexpress.com/article/business/budget/budget-2025-reimagining-india-healthcare-future-9810486/
[8] The New Leap of Indian Pharma Export in 2025 https://www.svhealthcare.in/the-new-leap-of-indian-pharma-export-in-2025/
[9] While doctors make money, nexus drills hole in patients’ … https://timesofindia.indiatimes.com/city/bengaluru/while-doctors-make-money-nexus-drills-hole-in-patients-pockets/articleshow/61940183.cms
[10] For Every Bottle Of Killer Cough Syrup Doctor Prescribed … https://www.ndtv.com/india-news/coldrif-madhya-pradesh-cough-syrup-deaths-dr-praveen-soni-for-every-bottle-of-killer-cough-syrup-doctor-prescribed-he-got-rs-2-5-as-cut-9453358
[11] Rs 2.54 per life: Madhya Pradesh doctor got commission … https://www.moneycontrol.com/news/india/rs-2-54-per-life-madhya-pradesh-doctor-got-commission-each-time-he-prescribed-coldrif-cough-syrup-that-killed-mp-kids-13616337.html
[12] ED Busts ‘Babu-Baby Killer’ Nexus: Raids Over Deadly … https://www.indiatoday.in/india/video/ed-busts-babu-baby-killer-nexus-raids-over-deadly-cough-syrup-in-chennai-ytvd-2802101-2025-10-13
[13] Can scapegoating doctors ever end India’s deadly cough … https://www.indiatoday.in/health/story/can-scapegoating-doctors-ever-end-indias-deadly-cough-syrup-tragedies-coldrif-madhya-pradesh-deaths-2798431-2025-10-06
[14] pharma doctor nexus News and Updates from … https://economictimes.indiatimes.com/topic/pharma-doctor-nexus/ampnews
[15] India’s MedTech industry: The renaissance of a sector https://www.ey.com/content/dam/ey-unified-site/ey-com/en-in/insights/health/documents/2024/11/ey-india-s-medtech-industry-the-renaissance-of-a-sector.pdf
[16] UCPMP 2024: Govt Details Stricter Rules to Curb Gifts, … https://medicaldialogues.in/news/industry/pharma/ucpmp-2024-govt-details-stricter-rules-to-curb-gifts-incentives-from-pharma-to-doctors-153296
[17] Medical representatives banned from visiting doctors in … https://economictimes.com/industry/healthcare/biotech/healthcare/medical-representatives-banned-from-visiting-doctors-in-govt-hospitals/articleshow/121579223.cms
[18] Incentivisation practices and their influence on physicians … https://pmc.ncbi.nlm.nih.gov/articles/PMC10309616/
