By Zubeida Mustafa
THERE was a time when the physician was like god to his patient. His word was gospel truth not to be flouted. No longer so. It is partly the trust deficit between them that has eroded their relationship. At the root is the commercialisation of the medical profession. Once monetary considerations determine a doctor’s decisions, the results can be disastrous. Instances of deaths due to medical negligence are legion.
When it was more assertive in playing its regulatory role, the state would routinely correct many aberrations in public services before matters reached the brink. But today the growing empowerment of the private sector has prompted the government to shy away from its responsibility of protecting citizens’ rights and checking excesses by private facilities. Its vulnerability stems from its failure to get its own dysfunctional institutions in running order.
In a milieu when it is acceptable to look the other way and condone corruption and profiteering, the public is the sufferer especially if private entrepreneurs gain a monopoly of sorts. In this scenario it is no less than a miracle to see individuals who are prepared to swim against the tide and correct the wrongs. That is how one would see the small group of medical professionals – preponderantly women – who joined hands four years ago to form the Karachi Bioethical Group. Speaking candidly about the need for health professionals to regain public trust and reestablish their credibility, the KBG stresses the need for their actions to be “grounded in ethics and morality” and their conduct be “guided by a personal sense of integrity and professionalism”. They have bravely decided to combat the “rampant commercialisation that is rapidly turning medicine into a business enterprise”.
One outcome of their exercise to translate their commitment to these principles into action is a paper titled “Ethical Guidelines for Physician Pharmaceutical Interaction”. In a nutshell the document exposes the unethical practices of physicians who become willing partners in the pharmaceutical industry’s unscrupulous marketing strategy aimed at boosting sales by influencing the physicians’ judgment in prescribing medicines. Whether they are cheap giveaways such as coffee mugs and free samples of drugs, or bigger offers involving the financing of lavish conferences and holidays for the health professional and his family, the net result is the same.
As the first step, the KBG document adopts an institutional approach requiring hospitals and academic organisations to discourage a one-to-one interaction between individuals and the pharma industry. Individual doctors are asked to reject offers of gifts while the drug industry would be required to send what it wishes to give to a common pool in every hospital where a bioethical committee could decide how the funds would be used with transparency being observed at every stage.
The KBG deserves our gratitude for taking up this issue which is fast assuming the form of a social evil while bringing a bad name to the medical profession as well. But will the endeavours of the 27-member group bring positive results?
The guidelines do not focus on private practitioners although stories about the favours some of them receive from the drug manufacturers are shocking. A spokesperson of the KBG explained that the group had agreed that the private practitioners should be addressed at a later stage. It had to make a beginning somewhere and it is easier to start on the institutional level because hospitals can draw up rules and enforce them. Making a distinction between an ethical principle that must be observed by an individual voluntarily and a law that is enforced legally by coercive means, the KBG says it wants to create awareness among doctors that the medical profession is regarded above all other professions “a moral enterprise based on a covenant of trust”.
The KBG’s idea is to start a debate within the medical community on an issue that affects so many but is not talked about sufficiently. Some major private hospitals have ethics committees to look into patients’ and doctors’ complaints. But the pharmaceutical companies’ role that leads to corruption of doctors does not figure in there. The KBG feels that all hospitals should have such committees that should display sensitivity to patients’ rights. The positive development is that the KBG says it is striving to take as many hospitals on board as it can and also mobilise doctors through presentation in medical conferences and on a personal level.
There are many laws on the statute book – the leftovers of yesteryears, such as the Drug Act of 1976 — which could be used by the authorities to check wrong practices. Thus the PMDC is mandated to cancel the license of professionals proved guilty of malpractices. But it is not doing so. Hence the KBG’s activism. Given the medical and dental council’s past performance, can one really be faulted for not reposing confidence in it?
After having mobilised the medical practitioners and winning their cooperation, the KBG hopes to initiate this thought process within members of the pharmaceutical industry as well. Thus it eventually expects an open dialogue with the drug companies to enlist their cooperation as the next stage of the KBG campaign.
The doctors in the KBG want to revive professionalism in medicine and give the doctor-patient relationship an ethical underpinning. May they succeed in their mission. This is the need of the hour, especially at a time when the moral image of a medical practitioner appears to have lost its glow. The young medicos of today are thrown into the deep side of commercialism that robs them of their idealism from the start.
Postscript: The medical students I wrote about last week learnt their lessons in ethics from their ideological moorings. Dr Mohammad Sarwar, founder of the DSF, it was pointed out to me, did not abandon his activism after graduation as I wrote. He carried his ethical principles into his medical practice and the PMA which emerged as the main source of dissent against military rule in the Zia period. Sarwar was twice elected the secretary general.