The medical fraternity is one of the most ubiquitous professions. There is a need for medication and medical treatment, wherever humans in habit. This vital necessity of mankind can and generally is open to misuse by all involved in the business of healing.
Medical care is one aspect of a developed society. Most modern progressive countries have an excellent medical care system and one can say the development of a country can be gauged by the standard of the medical facilities available there. Developed countries are at the forefront of good medical care delivery and all developed countries have a system of care that is state funded or assisted. For a good system to operate there has to be a balance of freedom and control. If a free-for-all system is allowed to function, then it will certainly be exploited by unscrupulous persons to the detriment of others. Too much control will lead to stifling of initiative and impediments in research and development which is vital for the sector to operate.
The sales model of pharmaceutical companies has bought out the conscience of medical practitioners in India.
Unfortunately, in the underdeveloped world, due to the lack of resources, it is extremely difficult to maintain a good system. A poor country by itself has massive health care needs as due to poverty, there is often malnutrition, ignorance, widespread diseases and frequent epidemics. The governments of poor countries are constrained by funds to invest heavily in the sector and are compelled by circumstances to rely on the private sector to deliver the vital functions. Even managing and monitoring progress is an expensive affair and out of the bounds of most developing countries. This is the root cause of manipulation, cheating, and dishonesty which is the bane of most underdeveloped countries.
As underdeveloped countries do not deliver cradle to grave medical facilities, the poor are left to fend for themselves. Lax oversight and ignorance is the primary factor that causes a fissure in the nation’s health. Lack of ethics amongst the privileged viz. government officials, doctors, hospitals and the pharmaceutical companies then can cause a total breakdown in health care, which leads to severe problems for the general population.
India is a prime example of such a breakdown. Being a developing country, with a huge uneducated population, rife with poverty, India is a massive breeding ground for corruption. Since the problem starts from the top, the trickle down circumstances lead to the entire system feeding itself on corruption. Greed of the individual and corporations also enables the system to continue growing without any qualms or regrets.
Allow me present some examples of such practices.
Pharma companies are the suppliers of drugs. Most are multinationals, which are constantly in the process of developing new drugs. All new drugs are a result of years of research and before being passed by Food and Drug Administration or whatever, have to undergo trials. In poor countries, such trials are done without proper safeguards and warnings. Several cases have been known of adverse reaction with persons even dying. These patients being extremely poor and mostly uneducated are unaware that experimental drugs are being provided. In case of fatalities, the victim’s family is not aware of legal recourse. Moreover, they are not even aware of legal procedures, nor are they financially able to challenge multinationals in court. The tragedy of all of it is that there is no compensation paid to the victim’s family and the case is forgotten. The number of lives lost is incalculable.
Another huge problem in poor countries is fake medication. 65% of India lacks access to medication. Branded medication of course costs an arm and a leg. Big pharmas spend a lot on research and would need to get back the research cost. However, developing countries do attempt to produce generic drugs. But, multinationals with bottomless wallets put impediments in the production and distribution of such generic drugs. Although it is fair for pharmas to recover the costs and make a profit, it is unethical to let people die or become destitute in the process. There could be a price differential which enables poor countries to manufacture generic drugs and sell at prices commensurate with the PCI of the country.
Hospitals are a big business in India. Many hospitals are built and run by corporate houses. The original purpose the hospitals are built is ostensibly social work and charity with a percentage of hospital beds being reserved for the poor with free treatment for those under poverty line. But that aim is followed more in its breach than in implementation. The hospitals are in the business of making money. On admission, one of the first questions is if the patient is insured. If a person is insured he is the sacrificial lamb and the font of wealth for the owners of the hospital. When a person is admitted, s/he has to undergo a battery of tests. Most tests not related to the illness. The meaning of this is the patient pays for unrequired tests. If insured, the insurance company pays for it and if not, then the patient has to. Very often the patient is too poor to afford the entire treatment and sells jewellery, property and assets to fund the treatment.
When such unneeded treatment is recommended, the waste of resources and wealth which is transferred from the common man to an industry is criminal and disgusting. In India its common for a person to be put into ICU immediately upon admittance. This increases costs manifold and can lead to bankruptcy for survival. There is no integrity in such action. Business and money have priority. It is not social work but pure profiteering. This is not only the fault of the hospitals. Since the hospital is run as a business, it is imperative for the owners to make profits. In order to make a profit they have to attract patients. A patient is referred to a hospital by General Physicians or the family doctors as they are called. If a hospital is recommended it is expected to pay the recommender a commission. The commission has to be recovered from the patient, so the cost of treatment has to increase.
This vicious circle cannot end unless there is regulation by the government. If the private sector is encouraged to provide primary health care, it is difficult to regulate as individual costs cannot be dictated by government. If attempted, the authority that fixes such prices will be open to bribery and enticements. The authority would have to rule and fix prices for thousands of services and supplies. How does a hospital price the cost of cotton wool or gauze? If the price of surgery is fixed then the hospital will increase the charges for incidentals etc. The whole process becomes very cumbersome and subject to bureaucracy and red tape. A popular talk show on the national television- “Satyamev Jayate” is known to be a show of, by, and for the “common man”. The show talks about the sensitive social issues prevailing in the country and the massive effects they all throughout the world.
One of the episodes that was aired on 27 May 2012, known as “Does healthcare need healing?” hits aptly on the loopholes in the medical system in the country. A guest on the talk show Mr. Samit Sharma, IAS, Managing Director, Rajasthan Medical Services Corporation- India, cited instances which were an eye-opener. When an undercover agent bought some medicines from a self-standing drug store and the same ones from the generic-medicines store, the ones bought from the former cost the customer for 6-8 times more than from the latter.
There are many studies done that claim that the medicines from generic stores and the private ones are of the same contents. In fact, India’s stake in the exports of generic medicine is $ 26 billion (US), and it exports the generic drugs to more than 200 countries all over the world. The issues of bribery, corruption, and red-tapism were brought out to be the key challenges of the medical industry. Tempting and enticing doctors by the sales representatives is commonplace.
Another major issue is medical education. In an underdeveloped country, the lack of medical graduates is a hindrance towards good health care. With exponential growth in population, the per capital availability of doctors is reducing drastically. The government has too much on its hands to open a large number of medical colleges. Hence it has allowed private institutions to open. Sadly the main criterion for admission is not ability but the ability to offer a “donation”. This ranges from 35 lakhs to 60 lakhs Indian Rupees (approx $60,000 – $ 100,000).
This is only for admission. The term fees are to be added. The huge initial investment obviously means the person who graduates has to recover the costs. How else would s/he do that unless one indulges in unethical practices? The patient has to pay for the person’s education ultimately. Hence the doctor will recommend unnecessary tests and surgeries. The answer is simple. If you do not want to undergo the tests or surgeries, it is you that will suffer and die. This is the unfortunate state of affairs in India.
•Dr. Samit Sharma has started the revolution by planning to open up about 105 drug stores selling generic medicines in the state of Rajasthan. The Government of India should not let the fire die and set up more such stores in each state. •More people should endorse the efforts of doctors who intend to provide better medical facilities with not a blemish of unethical practices. Dr. Devi Shetty, founder of Narayan Hridayalay in Banglore, India, instituted a “Yashaswini Scheme” for farmers which lets them invest Rs. 10 per month added to the contribution of Rs. 30 per year by the government. This fund acts as a financial bank in itself to support the patients for any surgeries. Because of the huge number of operations per day (about 35), the cost per operation goes down and many more patients can benefit.
•The Medical Council of India (MCI) should have stricter laws in place to cease the licence of those medical practitioners who involve in bribery. An important point brought forward in the talk show was that the Constitution of India has a clause that calls for legal action against the one who pays bribe and the one who asks for it, but in the Medical Code of Ethics there is no such clause. The MCI should promote the health of Indian, rather than promoting the “Allopath”. •Most importantly, health must be considered a priority by the government, and statistics suggest at least 6% of the GDP must be allocated to the health sector for a reasonably healthy living.
In conclusion, this sensitive issue of unethical behaviour has repercussions that go beyond the monetary or fame loss: they indulge in loss of lives. Such behaviour of doctors and hospital administrators is nothing less than a fraud, as they act disrespectful, dishonest, and illegitimate in their acts. As mentioned by a guest speaker in the talk show, that even after 65 years of Independence, if a child suffering from Diarrhoea can die because his mother cannot afford the “branded” medicines, the idea of re-building the East India Company is despaired.
1.http://www.satyamevjayate.in/issue04/learnmore/detail/19/ 2.http://www.indicine.com/movies/bollywood/satyamev-jayate-episode-4-with-subtitles-watch-online/ 3.http://m.theglobeandmail.com/news/world/drug-companies-watching-indias-drug-patent-case/article534381/?service=mobile 4.http://www.safemedicinesindia.in/government18.php