The British Medical Journal sparked off a furious debate in India’s medical fraternity when it published an article in May titled ‘Corruption ruins the doctor-patient relationship in India’, followed by an editorial written by eminent gastrointestinal surgeon Dr Samiran Nundy.
Fiona Godlee, the journal’s editor-in chief, spoke to Rema Nagarajan about their decision to launch a campaign against corruption in healthcare, starting with India
Why did you take up the issue of corruption in healthcare now?
We are a medical journal but we are not a journal for doctors in the sense that we speak out for health, in the best interest of the patients and the public. And sometimes, doctors’ interests are not aligned with patient interests. When Dr David Berger, who is a member of our editorial board, wrote of his experience of working in India we thought this is something we should pursue. We have a long-standing relationship with medicine in India. Also, we have high readership here and the likelihood of being able to make a difference seemed higher.
Is the problem particularly bad in India?
It is a global problem and not just limited to India. The problem in India is that there is a system where there is corruption in governance generally, and corruption in medicine is just one part. That created an additional challenge for doctors who might think we have got to behave this way in order to just exist. What we will be saying is that the doctors and their professional bodies need to stand up and say that this is not okay. The private medical schools burgeoning in India need to be properly overseen so that the new generation of Indian doctors has proper ethical and moral codes. And as said in the editorial, if that doesn’t happen, other countries where Indian doctors want to go and practise can say we won’t accept you unless your bodies make the necessary changes.
Why is healthcare more prone to corruption?
You have enormous pressure from the commercial world to give certain treatment. By pressure, I mean financial incentives. We know that doctors are paid to give certain treatment, paid to enter patients into certain trials, paid to speak and promote some treatments. A combination of the need for additional income, opportunity and inadequate oversight and regulation makes it possible for them to do this. And I think there is a tolerance of it within India because of the extent of corruption across the whole country in every field.
Does the system favour corrupt doctors?
A lot of it is to do with status. Doctors who get paid for providing treatments or speaking on platforms or giving advice to drug companies or helping them market drugs or devices end up getting the status. They end up being flown around the country to give talks and they are then seen as the experts in the field. So, the whole system rewards that kind of corrupt behaviour and what the BMJ (British Medical Journal) wants to do is to try and create a counter-balance to that. We want to find ways to reward people who keep themselves free of conflict of interest, to push the idea that they should be given positions of prominence in medicine.
So you believe the buck stops at the doctor?
Yes. Your professional duty is to avoid those conflicts and be very conscious of them. And also to declare these conflicts so that your patients and colleagues know that certain payments have been made and then that begins to shine a light -like the Sunshine Act in the US that’s making public a database of payments to individual doctors. It ought to become a part of their duty, a part of their annual appraisal. I think very often even colleagues would be surprised by what their fellow doctors are being paid. And certainly patients should know this so they can question the treatments being given.
What happens when people declare conflict of interest and then go on to sit in decision making positions?
They ought not to be on those or boards of organizations or guideline panels.
There is also the argument that declara tion of conflict of interest has just nor malized it. So, people say I have no conflict because I take money from everyone and that just makes eve ryone laugh and then they carry on and give that talk. But this isn’t always how medicine was.
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