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Medical Profession – Noble or Ignoble?

Much brouhaha has lately been raised over corruption in society in general and in medicine in specific. Few months back, the Parliamentary Standing Committee on health looked at the irregularities in the functioning of the regulatory authority CDSCO (Central Drugs Standard Control Organization) and how the drugs were approved and sanctioned without adequate clinical trials and safe guards. The failure of the regulatory body, Medical Council of India (MCI), and the corruption and irregularities in its day to day functioning have been highlighted over and over again. Only last week the Hon’ble Health Minister, Mr Ghulam Nabi Azad declared in the parliament that the government proposes to bring a ‘Uniform Code of Pharmaceutical Marketing Practices’ to help control the doctor-pharma nexus, which has been much in debate lately. He further informed that 702 complaints of this nature were received in 2011-12 and hoped that this regulation would help abolish these practices.

Dr O P Yadava

Before one talks of looking at means to eradicate these malpractices, one must first understand the basis of genesis of these rather sinister activities. Corruption in medicine is definitely existent and there is no denial to that, but then every society and every walk of life has its fair share of ‘The Good, The Bad and The Ugly’ and medicine is no exemption from that. Unfortunately in current scenario, the distribution is heavily skewed towards ‘The Ugly’ and the black sheep far out number the honest ones.

Is the medical profession alone to be blamed for it? My answer is a very categoric ‘No’. Shakespeare, centuries ago, hit the nail on the head when he said, ‘Man, in the palace or pad, castle or cottage is governed by same passions and emotions’. Corruption in medicine therefore cannot be seen in isolation. It is the corruption in general, which seems to have pervaded the very fabric of society and is reflected in the medical profession also.

Second major factor, which has led to an upsurge in the corrupt practices has been the gradual deterioration of the public health system to the point of its being virtually non-existent today, at least in terms of efficiency and morale. Pari passu with it, there has been origin and explosion of corporatisation of medicine in epidemic proportions. These two diagonally opposite events, proved to be additive and their effects, or shall I call them ill-effects, have grown by geometric progression. Today the private corporate world sets target to achieve for their medical professional employees, something like selling soaps, and these targets are given on daily, weekly and monthly basis and its only when the doctors achieve these targets do they qualify for megabucks. In fact ‘Money’ has become ‘God’ and ‘Making Money’ a ‘Religion’. This was bound to happen when medicine field was declared an industry and patient a consumer, and doctors brought under the consumer forum. If that were so, there is no point of bemoaning no holds barred publicity, marketing and money making by medical doctors and pharmaceutical companies.

Is the society, which has provided a fertile field for the seed of corruption to blossom to fruition, even though it may have been sown by the doctors or by the pharmaceutical companies, to be absolved of any accountability? Today the aspiration of the patients is also not very holistic. They go to the doctors asking for instant cure and as Dr B M Hegde, famous cardiologist, puts it, “They want a pill for every ill, when in fact there is an ill after every pill”. The reductionist modern medicine of Descartes, which is cure oriented rather than holistic, unlike the spiritual medicine of yester-years, has also contributed to this state of affairs. Japanese probably follow the most holistic system of medicine available currently and are governed by the motto, ‘to cure rarely, to comfort mostly, to console always’. Our modern allopathy is looking for cure for every thing and in the bargain, we fail more often than not to even heal or console our patients and this leads to distrust between the doctors and the patients. This shows itself in form of frequent misunderstandings and medico-legal litigations, driving further a wedge and as a corollary, increasing expenditure, which at times is construed as corrupt practice.

It is naïve to believe that stricter regulation bills will extinct corruption. In fact Albert Einstein once said, “Every kind of peaceful cooperation between men is primarily based on mutual trust and only secondarily on institutions such as Courts of Justice and Police”. History bears testament to the fact that never has force been able to change societal practices and attitudes. Therefore it requires a multifaceted action plan directed not at just the pharma companies and the doctors, but at the society at large, and bring out these changes at the grassroots level in the formative years of life. It is in school that ethics and probity should become subjects of education and children should learn these attributes by example rather than by coercion and forced down the gullet through the rule of law.

I am certainly not decrying the introduction of monitoring rules and regulations but all that I am saying is, just as we introduce regulatory framework, let us also bring out some changes in our basic education and in our attitude to life which has become too mechanistic and mundane and too money centred. This charity has to begin at home, in every home and cannot come from streets. This can’t come from Anna Hazare and Ram Dev kind of movements; this has to come from within, from the heart and this has to come from education, at the primary school level and may be even before that. A Herculean task it is, but never the less, that’s the only way and only long lasting solution to this problem and the other options are just brushing the dust under the carpet.

9 Comments

  1. Yohann Yohann Wednesday, August 14, 2013

    GAMCA (GCC approved medical centers association) is a facilitator for corruption as it forces people to go to a particular medical center. It is unfortunate that in a land of thousands of medical centers only a few are “authorized”. Even then, the candidates should have the right to go the center they choose at least. If they are forced to go according to GAMCA decision, the medical centers will treat the candidates like animals.

    I have been to “Health care diagnostic center” in Trivandrum, Kerala state and the treatment is inhumane, unhygienic, derogatory, insulting and a disgrace to the medical profession, the state and the country. If this is allowed to continue, many will continue to suffer for no fault of theirs.

  2. Dr. Ramesh Vardhan Dr. Ramesh Vardhan Friday, October 26, 2012

    i am happy to say that most of teachers during my u g training were not only dedicated , but also honest . it was a common practice to talk ill about corrupt practices of the teachers by students. but it was not true during my post graduation , most of my teachers were corrupt , cunning , with perverted mind set. but they were sincere when it comes to work. we used to be neutral in our comments. it looks to me present day students have accepted corruption whole heartedly by clapping( applaud) the speeches by the corrupt speakers ( teachers\ guest speakers).when it comes to national functions – like independence day, republic day , gandhi jayanthi , it is common to see absence of students as well as teachers from these functions.mostly the crowd is by the group -d, security personals with limited number of teachers quite a few junior,students ( most probably forced out of hostel rooms . the reason could be the people involved in the system , the guests & their reputation , lack of motivation , the stale & stinking speeches.

  3. Prof. Manoj Sharma Prof. Manoj Sharma Saturday, October 20, 2012

    I have been using GCSF ( Granulocyte colony stimulating factor) in cancer patients receiving chemotherapy or chemoradiation.
    This time the drug GCSF that has come through floating of the tenders was allegedly quoted as INR 300/- when the standard companies like Reddy’s Lab and Roche do not sell it below INR 2000/- per vial.

    This hospital supply GCSF does not work and with the hope of counts raising my residents kept on giving GCSF allegedly manufactured by the INTAAS company( Cold chain allegedly maintained in the warehouse/ drug store). but the I have lost several patients before I realized …oh it is the hospital supply and thence forth in addition to hospital supply we have to ask patient to purchase at least one injection from market or get it from the charity . It is this Non Hospital Supply injection that has shown steady rise of WBC and patients were saved from the dying due to chemo toxicity. similar experiences were recorded with records to the chemo response and related side effects with many chemotherapeutic drugs that were given from the hospital supply. One reason why the employees , the insiders who know the truth and have similar experiences with regards to other drugs such as antibiotics , when they get their dear ones treat, purchase the drugs directly from the company and do not use “FREE” drug from the hospital.

    Similar story was there 10 years back when company LEMMERY quoted INR 300 for Bleomycin that was sold by the same company in the market for INR 900/- and the drug was not effective.
    The first and original manufacturers Nippon Kayaku could not bring their tender quotation below INR 500 as it was basically not possible.
    VHB was allegedly banned in many organisation when they come about with their ” ganga jal” in come other companies names.

    There should be some mechanism so the quality of medicine and the content of the vial should be criteria and not the lowest quoted tender that take away the curable cancer patients lives and meager resources they have as has been seen in my hospital.

    Who, in this case is the incharge and accountable?

  4. Kishori Mohan Ojha Kishori Mohan Ojha Saturday, October 20, 2012

    I wish the accusers or theit kins were in the profession!

  5. drd drd Saturday, October 20, 2012

    The society is hypocrite……a cricketer can tell me which brand of cement to use, an actor can tell me which brand of paint to use but when as a doctor I prescribe a partcular brand of medicine I am the biggest sinner…

  6. Ajay Kumar Ajay Kumar Saturday, October 20, 2012

    Appropriate, timely, hitting the nail on head. Time for introspection for all including ourselves, administrators, judiciary, politicians.
    I agree with all the issues raised. But it does not take us away from a proper efficient, non biased, understanding law implementing agency. But that is as non implementable in our country as any thing else.

  7. Y.Rajagopal Y.Rajagopal Saturday, October 20, 2012

    Every human being is guided by his ambitions or circumstances which may be pressure to earn more money by his family members.What many people say that it is very difficult to be honest and sometimes very risky when majority are corrupt.This situation is prevalent in all government agencies.It is said that a corrupt lawyer has chance to money from both parties.A middleman in real estate business is usually not satisfied with the commission he gets from the buyer and tries to earn as much more money as possible by inflating the actual price expected by the owner saying that he will get the price quoted by him for the house or plot and whatever excess money paid by the buyer will be a bonus for him.These are just two examples of how greed can do for the person who believed these persons.The cine actor Amirkhan is busy is dictating what doctors should not do.Without bribing,not a single work is possible for a doctor be it promotion or transfer in many state governments. Majority of doctors are angry with politicians or burocrates who want doctors to be service minded but the same should not be expected of them.Everybody in the society consider doctor as potential source of more money.When respect is not given,expecting respect is unjustified.Once I met a private practitioner and during discussion he disclosed that if I practice ethically or scientifically,I may not be in a position to pay the interest for the loan I have taken for buying the medical equipment. Not many people know that consultation fees of Indian doctors are among the lowest in the world. An average Indian spends happily for his entertinement,children education or marriage but never tries to get insurance or save money for future health problems.The quacks are flourishing in India mainly due to patient taking chance to get his health problem treated with less money.Cheap treatment by quacks are resulting in more complications and sometimes deaths in rural areas.What a patient needs to know is that an experienced and competent specialist is more valuable than gold because one can earn money later to buy gold and not the health that was lost. Naturally gold does not come cheap.

  8. Dr.Kingra Dr.Kingra Saturday, October 20, 2012

    Sad but true.The big difference between general corruption and corruption in medical care is the terrible consequences that results from spurious drugs.insincere medical advice(not so much malpractice)that it is almost dishonest to put the two situations in the same seriousness.I understand that patients want instant cure of their ailments.But often the doctors or other medical people(I won’t call them professionals)give a patient only enough medicine from their own store to last two or three days.rather than a full course of treatment.Then the poor patient has to make another trip,which may be a long trip,to get some more pills and has to pay another consultation fee.What them happens is,patient feels a little better although not completely better and neglects to go back.Would it not be better not to allow doctors to have their own dispensaries!

  9. Dr bhavesh patel Dr bhavesh patel Saturday, October 20, 2012

    Sir, I completely agree with your views. Perfectly a balaced minded article. Medical fraternity should not be seen in isolation. When almost the whole society is corrupt, some doctors can’t resist their temptation to mint money. Spiritual wisdom is the only longlasting way to improve the community.

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