The Moral Decline of the Medical Profession

27 04 2010

 

Since my childhood I have been hearing that medicine is a noble profession. Doctors make great sacrifices to save lives. On the operating table, they play God. They dedicate their lives in serving the humanity. A doctor exists to serve her patients blah blah blah. All these beliefs lent doctors a great deal of respect in the society.

Yet, it seems this respect is eroding and eroding rather rapidly. The cancer of corruption and greed that has eroded most of the institutions in the society has touched the medical profession too. The recent arrest of Dr Ketan Desai, the President of Medical Council of India, the foremost professional body of Doctors, by CBI for accepting a bribe of Rs 2 crore, just proves this.  

Informal chats with professionals in the pharmaceutical marketing throws up anecdotes galore of the greed and malpractices of highly successful doctors. In the pharmaceutical trade, an amount of 35 % of the MRP of the drug is set aside for marketing expenses. A significant part of these expenses is spent on gifts for the doctors. These gifts are so devised, so that the Code of ethics for doctors is not violated.

MCI has amended the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002.

“The amendment prohibits the doctors from accepting gifts, travel facility, hospitality, cash or monetary grants or any other favors from any pharmaceutical and allied health sector industry for self or family members.”

Yet, the Health Minister has admitted in reply to a parliament question that nearly 2,000 doctors have violated professional ethics.  This is just the tip of the iceberg, because this represents only cases where the pharmaceutical companies have complained to the MCI. In most cases, pharmaceutical companies have accepted it as an occupational hazard or a cost of doing business and therefore do not complain.

In an incident which appeared bizarre to me, one pharmaceutical marketing manager was narrating how physicians deal with senior citizens. Diabetes being a rather common disorder among Indians, most senior citizens are recommended to undergo blood and urine tests for sugar. The diagnostic centre in connivance with the doctors produce wrong reports indicating diabetes. The physician then puts the patient on insulin. As the patient comes out of the chamber, he is likely to be greeted by several Medical reps (MR) asking the patient, not his well-being, but what the doctor had prescribed. Based on the brand of insulin prescribed the respective co’s MR puts a tally mark against the Dr’s name. On reaching a target of say 50 the doctor is eligible for a car. Insulin being a life-long treatment and usually patients do not change the brand, the cost of car can be recovered in the long run. In the meanwhile, the competing MRs go and complain to the Doctor about how he has been partial to one company. Then they bandy their gifts and inform the doctor where the Doctor’s score stands with respect to their company’s scheme.

One pharmaceutical company CEO made a comment that he is quite happy bidding for government tenders than dealing with doctors. Bribes in government tenders at 20 % are lower than the expenditure on gifts to doctors. In addition, he did not have to put up with the tantrums of many specialist doctors, who often insist on calls every week only from the CEO.

 Government has through various means like Drug price control order, MCI guideline etc have tried to keep the cost of drugs in check. Yet, in healthcare, medicines account for only 15 % of the total expenditure. Other heads like diagnostics, hospitals, Doctor’s fees etc account for the rest. These are all in unorganized sector and there are virtually no price controls and guidelines for these.

Most patients would have their own story to narrate about how many tests they or their family member had to undergo before the doctor pronounced his diagnosis. On many occasions an expensive MRI or a CAT scan was done but the doctor did not even spend a minute reading the report. Up to 50 % kickbacks to the referring doctors by the diagnostic centre is the norm in most metros.  The high rates of tests are not only to recover the investment the promoter has made in the equipment but also for the expenditure to cultivate a network of doctors who refer their patients to the centre.

Private sector hospitals particularly the tertiary care centers often under a corporate structure are a law unto themselves. The malpractices in pricing and dispensation of medical devices like stents or heart valves are many. Under the veneer of computerized efficiency and courteous patient care, over billing and cheating the unsuspecting patient is rampant. Most ambitious doctors today dream of owning and operating at least a nursing home , if not a hospital. Multimillionaire doctors like Dr Naresh Trehan have become role models for many doctors.

It is no surprise that increasing number of doctors are unable to resist the temptation to cheat their patients a little or be greedy with the pharmaceutical companies, so as to make a fast buck. In the bargain, they are losing their respect in the society. In honest chats with doctor friends, they will confess that they also started with great idealism, but they could not stand up to the pressures of consumerism. Now, their ideals and ethics are limited only to family and friends. For all others, it is just money, money, and more money.

– G. Mohan

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Are IPL 3 Matches Getting Fixed?

12 04 2010

IPL 3 is now at a very interesting crossroads. One month of cricket has already been played and yet the semi-final line-up is not clear. After the matches on the 11th of April, only one team Mumbai Indians (MI) has qualified for the semi-finals. But for Kings XI Punjab, who have virtually no chance of making it to the semi-finals, rest of the six teams have a good chance of making it to the semis. A look at the points table tells us that three teams are bunched at 12 points and 3 teams at 10 points at this stage in the league when most teams have played 11 matches each and 2 teams have played 12 matches each.

There are 11 more league matches between 12th April today and the semi-finals on 21st April. Each of these matches features, at least one team who has a must-win requirement to make the semi-finals. There are several matches where both the teams have a must-win requirement for example CSK vs KKR on the 13th of April. Thus making the last few league matches, a virtual knockout stage, ensuring sky high TRPs.

These matches are virtual quarter finals. Although there are no official Q/F as per the league format, in IPL 3 this has come about. The question to ask is whether they have come about by happenstance or by design ?

Whereas, one would like to believe that these Q/Fs have come about by happenstance, there are quite a few indicators which suggest otherwise. 

The league matches in the last ten days have thrown up very surprising results. Mumbai Indians which was cruising along beautifully, suddenly started losing to much lesser teams that too , two in a row. KXP which did nothing right in the first half of the league, suddenly starting becoming the giant-killer beating KKR even when they scored 200 and further beat up MI and DD which were at the top of the table. A large number of cricket enthusiasts point out to freak dismissals through run-outs, dropped catches etc to drive home the point that the script for the IPL 3 is not being written  on the ground in which it is played. 

The commercial angle to the need for Q/Fs is pretty clear. Well into the 4th week of the league, fatigue has set in among the TV viewers. The novelty of T20 namely sixes, run-outs, wickets, cheer girls has somewhat worn out already in the third year.  News is coming out that the audience for IPL in theaters across India is very low. The summer heat this year, has been very severe, making it all the more diffcult for filling up stadia.  Many new centers like Nagpur, Dharamsala are hosting IPL matches for the first time, even though they have no home teams playing.

Much that I would like to attribute the results of the matches held in the last few weeks to ‘the glorious uncertainties of cricket’, one cannot ignore the huge commercial motive. Let’s not forget IPL is in the hands of Lalit Modi, who is a brilliant marketer/organiser but also a consummate gambler.

One can never be sure whether this emergence of virtual Q/F s is by design. If indeed that is true, one should treat IPL as no different from WWF, the wrestling competition manufactured for TV audiences.

– G. Mohan








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