Thursday, November 13, 2014

Quid pro quo healthcare in India

This article appeared in Express Healthcare
In India can there be transparency around the financial relationships of manufacturers (pharma products and devices), physicians, and hospitals? Are the Indian physicians willing to disclose payments they receive from pharma and device manufacturers? Industry answers these tough questions By M Neelam Kachhap
This was my answer.

Yes, of course there can and there should be transparency around the financial relationships of manufacturers (pharma & device), physicians, and hospitals. After all, this was the norm until a generation ago. This secrecy was introduced in order to hide underhand dealings and has gone completely out of hand. It has spread like a cancer. Sadly, it has become the norm, and distorts the care patients get today. The healthcare system has become sick because of these distorted incentives, and we need to heal the system.

Manufacturers use medical representatives to try to influence doctors to prescribe their products. Sadly, because so many of the products are “me-too” products, they are forced to resort to bribes in order to persuade the doctor to prescribe their brand. Rather than spending money on innovation, the companies find it much easier and more lucrative to bribe doctors for prescriptions. Targets are set for medical representatives, who believe that the only way they can succeed is by giving the doctor whatever he demands.

Companies are extremely smart and they are very clever at disguising these bribes as “educational grants” or “payment for travelling abroad to attend medical conferences.” They manipulate doctors and these payments lead to unethical behaviour on the part of medical professionals.

The ones who are ashamed of the money they receive will refuse to disclose these payments. They know that they are guilty and their conscience pinches them, but they are smart and are able to rationalise their behaviour. A common justification is – “After all, if the senior doctors do it, why shouldn’t I ? I’d be a fool to refuse this easy money.”

Yes, there is scope for a law like the US Physician Payment Sunshine Act (PPSA) in India and because medical corruption is so much more prevalent in India, we should implement a similar measure to encourage honesty. Good doctors will appreciate a law like this.

If a database of payments were created in India what would show that often it’s the most respected doctors – the “KOLs or knowledge opinion leaders” – who are the ones who take the most money from pharma. After all, they have the most clout, which is why pharma wants to pander to them. This list would literally be a “ Who’s Who” of Indian doctors – and would feature many who are extremely influential, and are considered to be the leading lights of the medical profession.

The Indian healthcare system has become sick and openness and transparency can be powerful healing measures. Indian patients deserve a better deal!

Dr Aniruddha Malpani, Medical Director, HELP – Health Education Library for People

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