Medical Profession – Noble or Ignoble?
Thursday, October 18, 2012
Dr O P Yadava
CEO & Chief Cardiac Surgeon
National Heart Institute, New Delhi
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