MCI’s New Code of Ethics for Medical Professionals:An Exercise in Vain or a Welcome Move
vIPIN m vaishistha
Consulting Pediatrician, Mangla Hospital, Bijnor, UP, India. firstname.lastname@example.org
he Medical Council of India (MCI) viaamendment to the “Indian MedicalCouncil (Professional Conduct, Etiquetteand Ethics) Regulation 2002” has broughtout the code of conduct for doctors and professionalassociation of doctors in their relationship with pharmaceutical and allied health sector industrywhich prohibit them from accepting any gifts, travelfacility or hospitality, from any pharmaceuticalcompany or the health care industry(1).According to the new rules, a medical practitioner may carry out, participate in or work inresearch projects funded by pharmaceutical andallied health care industries, but has to ensure that the particular project has due permission from thecompetent authorities. The practitioner also has toensure that the research project gets clearance froman institutional ethics body. These Regulations may be called the “Indian Medical Council (ProfessionalConduct, Etiquette and Ethics) (Amendment)Regulations, 2009 – Part-I”(1).
The fresh code of conduct has raised many issues, and both the sections have reacted sharply to abovestrictures. While many medical professionals havehailed the new initiative and dubbed it anencouraging sign to prevent rampant commercia-lization of health sector, many have criticized themove by the apex body questioning their realintentions and calling it as a trivial, non-serious issue.While the MCI maintains that the move will helpin building a healthy relationship based on self-regulation between doctors’ and pharmaceutical andallied health sector industries, and preventingunscrupulous practices by doctors; the medicalcommunity accuses MCI of playing cheap gimmickson behalf of their political bosses. They asked the body to concentrate on the ‘real issues’ faced by thehealth sector like honing the skills of doctors,improving their wages, and working conditions,ensuring deployment of doctors in remote areas, andincreasing number of post-graduate courses for them. They argue that if a doctor is paid decently, hewill lack motivation to go in for deals/commissionswith unscrupulous elements.
Pharmaceutical industry has also respondedfavorably to the MCI’s recent move and submitted aself-regulatory code of conduct to the governmentthat curbs unethical sales promotion and marketingexpenses, bans non-medical and personal gifts, payments in cash, freebies and all-expense paid junkets for doctors and their families. This code willaim at bringing in transparency in sales promotionsand ban bribes to doctors for drug promotions. Thiswill be a great deterrent for violators as it will tarnishtheir reputation and brand, which, if they dealglobally, will have a multiplier effect.The code says that pharmaceutical companiescan sponsor doctors to international scientificconferences, but companies cannot organize exoticoverseas trips for them. No company may organizeor sponsor an event for healthcare professionals thattake place outside the home country unless it isappropriate and justified to do so from logistical andsecurity point of view, and only to impart scientificor educational information. And, any sponsorship
provided to individual healthcare professionals mustnot be conditional upon an obligation to prescribe,recommend or promote a product.
Even though the intention behind framing the codeof conduct appears good, the greater issue is theenforcement of these guidelines which seems anuphill task. Who would be the ‘competent authority’and ‘institutional body’ supposed to act as a watch-dog of public interests? MCI has a very dismalrecord as far as enforcement of its own guidelines isconcerned. Laws have no meaning whenenforcement lacks. The professional ethical codesabout advertising in media about clinics andhospitals are there in IMC act since 1956, but howmany professionals are strictly following theseguidelines? On how many occasions, did MCI cancelthe practice license of an errant? MCI will also haveto indicate very clearly the mechanisms for implementing the code. On the other hand, beforeeven making any attempt to rid the medical fraternityof unethical practices, the body should first set itsown house in order. The MCI must also clear itself from the charges of corruption and should work independently as a sovereign competent body freefrom the shackles of political interference.
Until and unless, the MCI or other enforcing body isgiven enough teeth to enforce these codes,introspection and self regulation by the doctorsremain the only way to curb the ever-rising unethical practices in the health care sector. The proposed self-regulatory code of pharmaceutical companies lacksteeth and has several loopholes since it is not legally binding on companies.Even as the Government of India is still debatinga code with the drug industry to curb unethical practices, big houses worldwide have starteddisclosing payments made to physicians, includingdollars spent on consulting gigs, clinical trials andeven meals(2). So money shelled out by companiesto doctors for speaking and advising engagements,investigator-initiated research and gifts will also be posted on the companies’ websites for all to see. The pharma companies here should also take a cue fromtheir Western counterparts and publicly display their spending on drugs promotion and professionals’sponsorship.There is further need to frame new rules to dealwith other medical sectors such as maternityhospitals, pathology labs, and diagnostic centers thatare freely indulging in corrupt unethical practiceslike cuts/commissions to doctors for referring cases.On the other hand, the government and MCIshould also focus on the more serious issues faced bythe health care system of the country- particularly theissues like non-availability of doctors at remote/ruralareas, poor health infrastructure of primary healthcenters in major states, shortage of health care professionals and paramedics including nurses, etc.The grievances of doctors working in public sector must also be addressed humanely. Only then thesestrictures and coercive measures imposed by theMCI and government can be seen as sincere and just by the medical fraternity.