Physician, heal thyself

By Zubeida Mustafa

AS inflation spirals in Pakistan, the one most seriously affected is the common man. Decent healthcare is said to be beyond the reach of the overwhelming majority. But one man’s meat is another man’s poison and some are benefiting from the misery of the poor.

One beneficiary of this state of affairs is the pharmaceutical sector. The Pakistan Pharmaceutical Manufacturers Association (PPMA) website describes its growth of the past decade as a “success story”. It goes on to add: “About half the population has no access to modern medicines. Clearly, this presents an opportunity.”

According to the PPMA, the value of pharmaceuticals sold in Pakistan was over $1.4bn in 2007 and is expected to exceed $2.3bn in 2012. Sixty-five per cent of this comes from private spending.

In partnership with some members of the medical profession and the government, the pharma industry is making hay while the sun shines. Alerts had been issued by health professionals that the incidence of disease is on the rise. That was bad enough but it was disturbing to find that those who should be sympathising with the victims in these troubled times are quite indifferent to their sufferings.

There are some physicians who are actually hand in glove with the pharmaceutical sector to exploit the poor. Others are so busy settling old scores on the Internet that the core issue has escaped them.

My email inbox is full of messages from physicians trading accusations because an invitation for a workshop had been sponsored by a drug company albeit without advertising its product. In the ensuing brouhaha, the guidelines defining the relationship between the health professionals and the pharma companies circulated by Prof Haroon Ahmed, president of the Pakistan Association for Mental Health and a member of the National Bioethics Committee (NBC), virtually fell on deaf ears.

The fact is that there is plenty of scope for corruption in the way the drug companies operate in Pakistan and the vanishing ethics of health practitioners and the health establishment.

In the name of Continuing Medical Education (CME), which should be the responsibility of the medical professional bodies and the government, the pharmaceutical companies have established direct relationships with the physicians.

As for the government it has been charging for the last 40 years the pharmaceutical companies one per cent tax on their pre-tax income in the name of research with nothing to show for it.

This crass lack of concern for the patients’ suffering is alarming. I had observed a similar mindset at a meeting held by the Sindh chapter of the Pakistan Medical Association several months ago where pharmaceutical companies met doctors and medical administrators to discuss the failure of the government to create a drug regulatory authority (DRA). In that meeting, not once did the saviours of our health raise the issue of drug prices. The focus remained on the composition and functions of the DRA.

This issue needs to be addressed carefully. The pharmaceutical industry’s relationship with the medical community is casting a dark shadow on the health sector. It calls for a more conscientious approach from both.

In the Internet debate I mentioned above, the main concern highlighted was the gifts and perks doctors are known to accept from drug companies. It is also suspected that the beneficiaries oblige their benefactors by prescribing their drugs generously to promote their sales.

This is really nothing new and is common practice all over the world. The sums exchanged are monumental. But what is disconcerting is that while other countries are trying to frame laws and mechanisms to regulate relations between the medical profession and the drug industry, we seem to be moving rapidly in the other direction.

In a document produced by the Karachi Bioethics Group (KBC) in 2008, it was stated that the gifts reported to be handed down by the industry to physicians ranged from “insignificant trinkets such as pens and coffee cups to favours such as air tickets for physicians and their families to resorts ostensibly for CME events, payments of monthly dues for leased cars and even refurbishing of private residences”. Still worse is the fact that physicians in Pakistan “have come to expect such perks as their right”.

First the KBG followed by the NBC drew up some guidelines to make the relationship between the physicians and the drug industry transparent. They forbid physicians from accepting personal gifts, insist on full disclosure and encourage academic institutions to take responsibility for CME events which could be held in auditoriums rather than five-star hotels with a meal included.

This looks appealing because it is designed to bring ethics and morals back into the professional relationship, which is important if doctors’ prescription practices are not to be influenced by their dealings with the pharmaceutical companies.

According to a knowledgeable source, billions of rupees are spent on ‘indirect sales’ (a euphemism for unethical practices) which account for 15 per cent of the sales budget of drug manufacturers. Inevitably, the manufacturers pass on these costs to the consumers In other words, if these were restricted by law or voluntarily by physicians adopting ethical guidelines the prices of drugs would be reduced considerably.

It is shocking that the noblest profession in the world has been corrupted in this manner. The ethical guidelines have evoked no response from the medical practitioners, Dr Haroon Ahmed tells me. But the NBC is persisting and has asked professional bodies to place the guidelines on their agenda. It is time the pharma industry also studied them.

Source: Dawn

7 thoughts on “Physician, heal thyself

  1. Excellent article – thank you so much for writing on this issue. Situation in rural areas, particularly Sindh is worst where doctors and pharma company jointly fleece on patients in clear violation of bio ethics. Really we need many more articles like this to raise awareness of the issue in public and put pressure on govt to check on this malaise.

  2. Great article. But the NBC guidelines were violated by the PAMH itself by having its invitation cards sponsored by a pharma company. One does not know who paid for the remaining expenses, but the invite was conspicuous by a prominent logo of Hilton Pharma.

    Glad to see your articles being translated into Urdu.

    1. The guidelines prepared by the NBC say:

      Attempts should be made by the Healthcare professionals to generate resources from within their institutions and from personal contributions. Since continuing medical education (CME) or scientific and educational conferences or professional meetings can contribute to the improvement of patient care, therefore, financial support from healthcare companies in its organization of such meetings / CME is permissible. Cash transactions or direct payment to the conference organizers from the Pharma trade and industry should be
      discouraged. Direct payment may be made to the catering firms, audiovisual service providers etc. Financial support and donations should always be in the form of certified cheque/draft deposited in the institutional/association/organization accounts. Funds generated must be declared on website and /or published and is able to withstand public and professional scrutiny.

      I am not clear whether putting the drug company's name on the invitation card is a violation of the guidelines. I concede that the guidelines need further finetuning. But why are more doctors not taking any interest in the guidelines?

  3. You have raised the important issue concerning to all patients worldwide. Manufacturer and Doctors are into hand and glove relations. Poor patient suffers.

    Apart from detailed measures one should also adopt preventive measures. It has been wisely said PREVENTION IS BETTER THAN CURE. No doubt now-a-days we are more dependent upon medicines whereas I remember fully the days of my childhood when my mother would keep some first aid medicines without the notice of relatives and neighbors.

    @ Ms Zubeida: In your this POST you should have advocated some measures to maintain a good health to keep some (if not all) medicines away from life!!!!!

  4. dear zubeida
    congrats once again for the inter national award.
    Ref your article in dawn on relationship between med.profession and industry,it was apt,focussed and timely,though the debate was on for a long time in serious quarters..In pakistan attention has been given to the issue by a section of profession. The national bioethics committee has been working on it for a longtime.About three years back it was finalized and circulated but the critics popped up once in awhile without trying to take innitiative.
    The NBC document is an ideal draft not applicable as it is, but need serious discussion by sub specialities and parent bodyPMA itself.The situation in certain quarter has shamelessly worsened.An active and dedicated group has to take it up to make a begining.
    Yet the collusion between professional and industry if viewed nationally only a fraction of specialists are targetted. GP by and large is given few tablets which is practically not enough even for a patient,leve aside trips oe three piece suit.How many doctors are in pakistan and what proportion work in hospitals?
    Targets are hospital based doctors and popular practicing specialists.
    So where yo begin?First the proposed document should be reviewed by secialist societies and recomendations made.This will need a little effort ,time and ptience.I invite the so called habitual critics to step forward and spare time for a cause.
    There one thing which can be started right away ie discourage GP taking few tabs as sample.Need a small movement.Just shouting about is joining a sizeable lobby against the profession.Easy and noticeable.
    Best wishes Zubieda.Keep it up
    Dr haroon ahmed

  5. A news item appearing in Times of India of today is worth to refer. Read at:

    The news says from Oct Indian Govt will spend more on medicines to treat all patients almost free.

    As corruption is at its peak and Honorable MP and Officers do not care for the public sense and money and it is likely that the major part of the allocated funds will land into wrong pockets. But still it is a correct decision in keep Doctors and Pharma Comapnies under check.

    Pak Govt and citizen must accept the concern of Ms Zubeida as Health issue is a concern of all including terrorists.

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