A cardiologist friend of mine recently went to the exotic Bali island for a conference sponsored by a pharma company. His wife too got a business class ticket to accompany him on the jaunt.
When asked, he retorted, ‘this is standard procedure in the healthcare industry, so why am I surprised’. This sums up the unholy nexus between doctors and pharma companies in our country.
The Satyameva Jayate episode on medical ethics has gone down well with aware, suffering people. But doctors’ associations are not amused. Indeed, there are some doctors who are ethical or even socially well disposed, such as Binayak Sen. But most doctors that I know are corrupt — degrees may vary.
The quality of the medical profession in India has touched new lows, causing suffering across all sections of the society, irrespective of caste, age and income. A number of these challenges can be addressed through a comprehensive policy overhaul in the healthcare sector.
Having worked in this area for long at CUTS, I believe that many of the existing problems can be addressed by revising policies, effective regulatory institutions and empowering consumers. For instance, by just announcing prescription audit in Saudi Arabia in the 1980s, sales plunged by 40 per cent.
burden on consumer
In spite of doing several empirical studies, we have not been able to convince policymakers to rein in the medical profession on how they prescribe medicines or tests. This is one area where the consumer does not have decision-making ability; he/she has to take whatever the doctor prescribes.
Over the last few years, the healthcare sector has degenerated into an industry which works in collusion with pharma companies and diagnostic labs.
The ultimate burden of such collusion falls on the consumer — inappropriate, excessive or costly medication; unnecessary and expensive diagnostic tests; and prolonged and expensive hospitalisation.
Caesarean deliveries have now become the norm. Headache is another common symptom, for which doctors ask for an MRI of the brain at the drop of a hat. Likewise, a simple anxiety can be associated with angina or heart disease. The monetary gains are handsome in such situations.
Many hospitals prescribe profitable products, medicines and tests, and force patients to buy them from in-house stores at higher than market prices. Such bad practices need to be incorporated in the definition of ‘malpractice’.
The Medical Council of India has prepared a list of acts of medical misconduct that can be brought before it, yet it does not specify punishments.
This makes the institution toothless, even against very serious grievances. As the Satyameva Jayate show points out, the number of doctors stripped of their licence in Britain is far more than in India, a pointer to the lax regulation of malpractices.
The problem is that on receiving a complaint MCI does not take action against its members, like the Bar Council of India.
Unethical drug promotion is an emerging threat for society. The Government provides few checks and balances on drug promotion.
The overarching aim of corporate drug promotion, therefore, is to increase profits by raising consumer demand for them. Pharma companies choose to spend more on drug promotion than research and development because drug promotion is what earns them money, and easily. That’s the reason why medical salespersons get good salaries and huge incentives on achieving their targets.
The Department of Pharmaceuticals last year introduced a code for pharmaceutical marketing practices but it is voluntary in nature without any teeth.
The problem of Unethical Drug Promotion can be countered to a great extent by preparation of treatment guidelines, conducting periodic prescription audits, generating consumer awareness and regulating continuing medical education.
The Monthly Index of Medical Specialties (MIMS) has pointed out that private medical colleges in India are at the root of unethical practices. Nearly 50 per cent of medical colleges in India are run by private parties.
As students have to pay very high fees, they take the unethical route to recover their money. A possible solution could be to reward and honour individuals practising ethical medicine, penalise and rigorously discipline unethical doctors and restore ethics in the medical curriculum.
But, the odds are heavily in favour of strong ‘vested interests’, which have been able to resist the development of a strict regulatory framework.
The way forward
Why is the health sector full of imperfections, despite huge investments and increasing literacy rates?
There are a number of factors responsible for it — lack of public financing, huge information asymmetry between consumers and the providers, lack of coherence in policy formulation between the Centre and States on the subject of healthcare and absence of proper regulatory oversight.
The Government and private sector have to work together to make healthcare access available and inclusive. Improving budgetary allocation to public healthcare; and reducing the urban/rural, male/female, rich/poor divide vis-a-vis healthcare delivery, are some steps that should be prioritised.
A standard pricing policy is required in the healthcare sector to reduce costs. A proper regulatory system with strong enforcement mechanisms needs to be introduced (overcoming the Centre and State Government opposition to each other’s initiatives) to improve the quality of service delivery and keeping unscrupulous elements at bay.
Local authorities at the State level should be properly empowered to ensure that minimum standards of services are offered across healthcare institutions. A speedy adoption of Clinical Establishment (Registration and Regulation) Act 2010, by the States would bring some uniformity in quality of healthcare services across private and public sectors.
Last but not the least, as consumers we should be concerned about our rights and also our responsibilities.
(Mehta is Secretary General, CUTS International. Bikash Batham of CUTS contributed to the article.)