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The unholy nexus

December 03, 2017

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A MEDICAL conference scheduled for early next year is expected to host at least 100 specialists from all over the country. Roughly, if the overall cost for one participant is Rs70,000, then the estimated budget of the conference is about Rs7 million. Who will pay for it?

Like many other countries where healthcare is poorly regulated, the pharmaceutical industry and doctors have a well-established symbiotic relationship in Pakistan. Although personal gifts ranging from knick-knacks to cars or even funding family weddings are extremely common, they usually remain undisclosed, at least for the public, for it clearly reflects greed and bribery.

What is perhaps not so well understood by the general public is how the façade of medical research and training is manipulated for legitimising corrupt practices between the pharmaceutical industry and physicians.

Some common strategies include sponsoring doctors to attend conferences around the world, engaging senior professionals to conduct multi-centre drug trials, organising medical conferences and training events, etc. These conferences are nothing more than platforms for self-promotion and superfluous, usually unpublished, research entitlements.

Pharma and doctors have a symbiotic relationship.

Many of the targeted physicians are influential medical leaders and their practices have a direct impact on setting trends. For every favour the industry bestows, the physicians promote their products by prescribing them to hundreds of patients. This is where the conflict between a doctor’s primary responsibility (to act in the patient’s best interest) and that of the industry (to maximise profits) arises and the physician-pharma partnership becomes controversial.

So, any inducement from the pharmaceutical industry constitutes a conflict of interest for the physicians. Patients trust their physician will always act in their best interest, be objective in offering advice and not be influenced by external factors. When physicians are influenced, not only are patients denied the benefit of an impartial prescription, they also end up paying for the product and profits behind it. This is how patients will pay the expenses for doctors to spend the four days at the upcoming conference.

Since these corrupt practices have been legitimised, senior physicians have no shame in inviting junior colleagues to join their engineered drug trials and the doctors have no shame in sharing self-glorifying photos on social media of sponsored foreign trips. Other well-meaning businesses do not hesitate to partner with the industry to support these ‘conferences’.

As an example, an online taxi company recently offered its services to participants of an industry-sponsored event in Peshawar. The foul play is rationalised at all levels: that accepting a favour doesn’t affect physicians’ objectivity; the primary goal of the industry is to support academic activities; travelling to conferences is essential for professional development; academic activities cannot be organised without industry support, etc. But there is a vast body of scientific evidence to refute these defences.

Healthcare here faces a serious crisis with a severe dearth of resources and political will to address the gaps. Millions continue to be devoid of basic healthcare; countless others suffer the indignity of being treated in poorly resourced public hospitals and subjected to unregulated private medical practice.

The physician-pharma nexus is just one example of an overall dysfunctional healthcare system crippled by malpractices. There is no authority where patients can take their complaints. Against the background of lack of accountability in the system, the onus on physicians to conduct themselves ethically becomes paramount. Doctors have an enormous responsibility to exercise their powers with integrity. Jung (2002) writes “once you have sold your soul, it can be a hard item to retrieve”.

A concerted effort at all levels of our healthcare system is essential to address corruption in the medical profession in Pakistan. In most developed healthcare systems, physician-pharma transactions are regulated for transparency and accountability. The Sunshine Act in the US is one such example, whereby all financial transactions between physicians and pharmaceutical companies or medical device manufacturers have to be disclosed.

Until that happens, all public and private medical institutions and hospitals must have effective ethics committees and mechanisms to check malpractice. It is paramount that the subject of ethics be formally introduced in medical education in Pakistan. The Centre of Biomedical Ethics and Culture at SIUT in Karachi has formulated a comprehensive curriculum for this purpose. The PMDC needs to implement it. Awareness campaigns for the public and health professionals are crucial. The culture of corrupt practices in the medical profession in Pakistan must be condemned and curtailed.

Dr Asma Humayun is a consultant psychiatrist. Dr Murad M Khan is Professor of Psychiatry, Aga Khan University.

Twitter: @AsmaHumayun

Email: muradmk@gmail.com

Published in Dawn, December 3rd, 2017