KARACHI: Experts for emphasis on indigenous values: Development of bioethics
By Nizamuddin Siddiqui
KARACHI, Feb 17: In too many instances the Pakistani health care system fails the people it purports to serve and protect. Too many patients bleed to death and too many of them are administered tainted blood. On top of that, an unacceptably high number of people living with HIV and Aids are ostracized and discriminated against by the health care professionals.
In short, too many lapses are recorded every year on the clinical side of the health care practices. Yet, professionals undertaking research work in biomedical ethics attach too little importance to such unethical practices. Instead, they concentrate on drug trials.
Taking issue with this, Prof Farhat Moazam — who chairs the Centre for Biomedical Ethics and Culture (CBEC) of the Sindh Institute of Urology and Transplantation (SIUT) — underscored on Friday the need for Pakistani health care professionals to revisit their priorities.
Delivering a keynote address at the Seventh Global Forum for Bioethics in Research at the Aga Khan University, she also called upon local professionals to “indigenize” the concepts in contemporary biomedical ethics.
Reverting to the question why an inordinate number of drug trials were undertaken by Pakistani professionals as investigators, she said one reason could be the “high” they got from such endeavours. Then there was the issue of “fame and glory”.
Prof Moazam was of the opinion that a practising physician’s act of enlisting as an investigator for a drug trial in itself threw up several ethical questions, as there was a potential clash of interest involved. Pakistani people revered health care professionals, thereby burdening them with a lot of responsibilities.
Hinting that global pharmaceutical giants benefited a lot by outsourcing drug trials to professionals in the developing countries, the chairperson of CBEC said that such initiatives made a lot of economic sense. Lower regulatory barriers and lower costs make these endeavours particularly attractive, she added.
Prof Moazam pointed out that the percentage of drug trials carried out outside the US by pharmaceutical companies had jumped from 0.9 per cent to 27 per cent within a relatively short period of time. And recently it was announced that a multinational wanted to carry this percentage further to 50 per cent in the next couple of years.
Pakistan, she said, was a traditional and collective society where Islam was a way of life. Among the first sounds that the children born in the best hospitals of Pakistan heard was that of the Azaan. Every child who grew up in a seemingly modern household was taught the Holy Quran.
In such a setting, it was imperative that Islamic values and norms were reconciled with the secular concepts of contemporary bioethics, said Prof Moazam. Adopting imported concepts would simply not do.
She was of the view that even in the West, people found it difficult to follow consent forms that were often ten pages long. Merely translating the same in Urdu and expecting the masses to follow them would prove to be counter-productive.
The academic, who has a PhD from the University of Virginia in the United States, asserted that bioethics was in danger of becoming an “intellectual sport”, with a number of Pakistani hospitals and medical schools expressing interest in organizing seminars and workshops on the subject but few people realizing the importance of applying the relevant concepts wholeheartedly.
“There is a dire need to fashion bioethics in a manner that fits into the contours of our needs, as otherwise it would only remain a good topic for discussion.”
In his speech, AKU President Shamsh Kassim Lakha spoke of the divide separating the haves and have-nots in the country.
He said that $5 was of little value to a pharmaceutical giant which wished to outsource drug trial to the developing countries.
However, to an impoverished Pakistani family the same amount translated into Rs300, an amount that was often difficult to refuse, he said.
“In such situations we should ask ourselves the question if the said amount is just an incentive for the family to volunteer for a drug trial or a bribe for them.”
He claimed that his university had attached significant importance to ethics right since its inception. When we began setting up our varsity many people told us that ethical issues were important in Pakistan but they were not critical for developing countries, AKU president said.
“Many people also told us that dialogues on ethics would fall on deaf, even hostile, ears. But we knew from the very beginning that health delivery was incomplete without sound health education and research was incomplete without ethical considerations.”
He underlined the importance of widely accepted codes of conduct, though formulating such documents was often “risky and difficult”.
Mr Lakha also urged the government functionaries to strengthen their capacity in the area of biomedical ethics.
The dean of Aga Khan University, Prof Mohammad Khurshid, informed the audience that biomedical ethics had been included in his institution’s curriculum both at the graduate and undergraduate levels. Certificate courses were also offered in the discipline.
Prof Khurshid added that his varsity and its hospital had two ethical committees, one of which was meant to safeguard the patients’ rights and the other one to look into the rights of animals.
Dr Zulfiqar A. Bhutta, the chair of the forum, presented the welcome address. He said the global forum was an informal partnership established by a number of organizations with a shared interest in the ethics of conducting research involving human beings in developing countries.
The vote of thanks was given by Dr Arshi Farooqui who pointed out that professionals from 20 countries were taking part in the forum. The event was presided over by the director-general of the federal health ministry, Dr Abdul Majid Rajput.
