Thursday, May 10, 2012

The drugs scam in India - and how to fix the problem

The Times of India front page article today describes the unholy nexus between the pharmaceutical industry and doctors in India.

This is an other nail in the coffin of the Indian medical profession. The reputation of doctors is now in tatters; and it's getting increasingly hard for patients to trust their doctors. It seems that all doctors are "on the take" - whether it's "gifts" from the pharmaceutical industry; or "kickbacks" from specialists, hospitals or diagnostic center for referring a patient to them.

It all seems to be gloom and doom right now. However, we do need to remember that this is a situation which is not unique to India. This kind of malpractise has been documented in the US for many years - and there have been some great books which have been written about this.  One I particularly like is - On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.

Every crisis is actually an opportunity - and this is actually a great chance for doctors to cleanse the corruption and reinvent the medical profession. When a scam is unearthed, it's usually the doctors who suffer. The pharmaceutical company has deep pockets, and can hire the best lawyers to stay out of trouble. However, individual doctors are defenceless - and will often end up losing their reputation - and even their medical license to practise medicine.

While there are a number of guidelines and laws which are supposed to prevent pharmaceutical companies from providing gifts to doctors , the fact still remains that most of these are observed in the breach. This is an unhappy situation - and it's ultimately patients who will get hurt.

What can we do to fix the problem ? There's little point in moaning about falling ethical standards in society - we need to come up with concrete practical solutions. Pontificating will not help.

Let's start with the basics. The only reason doctors accept gifts from pharmaceutical companies is financial - doctors are human, just like the politicians and policemen who take bribes are . Just because doctors are professionals does not mean that they are "above it all". To expect them to behave as superhumans is unrealistic. The best solution is to make sure that doctors are remunerate adequately by their patients, so that they do not need to resort to accepting underhand payments.

Now I am not saying that we need to make sure that all doctors become millionaires All we need to do is to empower doctors with practise management solutions, so they can run their medical practise profitably . If they can do so, no doctor in their right mind will resort to dodgy means to make a living - doctors are smart enough to realise that there is too much at stake for them if they try to do so.

We need to make it easy for doctors to get patients directly, so they do not need to pay a middleman. Remember that it's only a hungry person who will steal food - a well-fed person will never feel the need to do so !

The best way to do so it to ensure that every doctor has their own website. There are millions of patients online, who are seeking medical care. If every doctor had their own website, it would make it much easier for patients to find them. Websites will encourage transparency and openness - thus benefitting doctors and patients.

These websites can be helpful for pharmaceutical companies as well . It would allow them to stay in touch with doctors electronically - and this is much less expensive that using medical representatives ! Even better, since all communication between the doctor and the pharmaceutical company is now documented, the scope for hanky-panky is considerably reduced !



  1. Anonymous6:00 PM

    Dear Dr,

    I do not get the logic.

    Doctors are humans - OK

    You have said something about superhumans - who are they a new sub-species?

    Dr, until now I have never seen a physician who is begging for his food or who is not able to satisfy his/her basic requirements. Do not justify the greediness of doctors or for that matter any human being! Policemen and politician taken bribes and what is wrong when a doctor does the same? You have a great point to justify an immoral act inorder to defend your medical community! The problem here is not the insufficient remuneration, the real problem is avarice!

    The article in Times of India says ‘What's worse, some of India's top medicine experts - some are even head of departments - from the country's most iconic medical institutes like PGI Chandigarh; CMC Vellore; AIIMS Delhi and St John's Medical College, Bangalore had signed these recommendations.’ – So as per your view all these India’s top medicine experts are lacking proper remuneration!!!!!! True, that is why they drive Mercedes Benz!

    Our society has come to a point where we argue that majority of people are immoral and that is the norm. Persons who strive hard to hold on to moral values are designated as super humans and kept aside as a separate species! True, a hungry person will only steal the food. If a doctor who is not paid enough can resort to illegal means to increase his income why not one-third of Indian population living under the poverty line loot and do gruesome murder to increase their survival? What is so wrong in it? They are not like financially gifted doctors; many do not have food to satisfy their hunger, a place to stay, health care or education

  2. Anonymous6:01 PM

    Dr, when you say patients should properly reward their physician, you should not also forget that you live in a society where there is a Himalayan difference between the rich and the poor. The pay scale of any job depends not only on the talent of the employee but also on the financial capability of the employer. Majority of our Indian population could not afford medical expenses that are too high! Are you aware that medical expenses are one among the various factors which forces people to commit suicide in India?

    Modern version of Hippocratic oath has these lines in it ‘I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick’. – I think doctors do not have to follow this SUPERHUMAN oath but at least let them kill their covetousness and strive hard to be humans.

    The solution you have given is really good but the ‘argument’ you have put forward to justify the unethical act of your medical community is too unhealthy!

  3. I am not justifying an unethical act. Wrong is wrong.

    My only point is that taking the moral high ground and trying to preach does not really help. We need to provide practical solutions - not just pontificate about the problem.

    My worldview is that most doctors
    ( like most humans ) are decent people, and would perform the right action , rather than the wrong one, when they have a choice.

  4. Anonymous10:28 PM

    Dr, as per your view the root cause of the problem is insufficient remuneration. If that is true your solution might work. But the TRUE problem is not what you say. Doctors are highly educated, highly intelligent, ethically trained humans (as a result their conscience should be clear enough to tell them what is wrong and what is right!). They forget the ethical demands of their job and behave like a greedy layman who doesn't have any conscience control. There are only two solutions to change this happening. 1) Severe punishment 2) When students are recruited to study medicine importance should be given not only for their intelligence level but also for their social and moral aptitude. Not all intelligent students are fit to be doctors!

  5. Very amazing and informative blog. Thanks for creating such a wonderful site. this site was not only knowledgeable but also very stimulating too. Thanks for sharing.


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