[amdavadis4ever] Are doctors doing deals for drugs?

 

Are doctors doing deals for drugs? ALTAF PATEL         The practice of big pharma offering kickbacks to prescribing physicians may not be a breach of ethics Even a free pizza can influence your doc tor's prescription... so screams a head line in Mumbai's most popular daily. The article is attributed to the Journal of the American Medical Association. It addresses the issue of 270,000 odd physicians receiving US $ 1.4 million in kickbacks, associated with four identified brand name drugs. It even goes on to state that 95 per cent of the payments were for meals with an average cost of under US $ 20. It is surprising that doctors who are in the uppermost earning brackets can be bought and sold for an amount of money that might cover the cost of bus fare for a day in New York City. The pharmaceutical companies involved have, of course, categorically denied that they offer payouts to healthcare professionals. An important multinational company claims that all it does is help doctors stay current. What if this is really true? It is certainly unarguable that many pharmaceutical companies have educational programmes--outreach for doctors to update them on research and development with new drugs. Nevertheless, mere attendance and partaking in a meal does not actually ensure that those drugs are prescribed.Many medicos will listen as the speaker gives his spiel and question him or her on the benefits and the advantages of this molecule over other sister molecules. The only time a drug introduced in this manner will get prescribed is when it has an added advantage--and that is a rare situation-or more often, when it is equally priced and as effective as its competitive molecule. The philosophy behind this is that the patient is indifferent between molecule `A' or molecule `B', as long as they equally effective and equally priced. The question that then arises is whether this is surrogate advertising. If so, then all medical journals could also be qualified as surrogate advertising. Richard Smith, the former editor of the British Medical Journal, has unequivocally said that all journals are bought and cleverly deployed by the pharmaceutical industry. In 2003, big pharma spent US $448 million to advertise in journals--it has been hypothesised that, for every dollar spent, the return on investment for medical ads is between US $ 2.22 and US $6.86. I have said this previously, in this very column space. So if we accept that as the present reality, shall we then ban journals which carry such ads? It would effectively cut out an enormous amount of research done by talented doctors, whose work is carefully vetted and ascribes to the standards of publication. In 2011, the Journal of Emergency Medicine of Australasia announced it would not accept pharmaceutical advertising, citing growing evidence that the drug industry distorts research findings and engages in dubious and unethical practices. Yet, funding ajournal without any advertisements is difficult. Just above the drugs for pizza article in the morning daily is another interesting article, which says that the tainted Medical Council of India (MCI) is set to be replaced by a Medical Education Commission. Many of the MCI members, a third if I recall accurately, are nominated by governmental authorities. Such medical professionals are often connected to powerful politicians and have their own agendas to pursue via the regulatory council. It is shameful that Caesar's wife cannot be above suspicion. When one puts this in the context of the several scams in the country--material enough to fill two large text books--this becomes even more shameful. It seems that we are in a corrupt country and this stems not only from the poverty we are beset by, but a total lack of ethics inscribed into our collective conscience. Is it optimistic to hope that education will make a difference in years to come? To return to the original question... where does one draw the line? I think big pharma has the ability and the opportunity to help educate--and I don't think that anyone who has chomped on a slice of free pizza feels compelled to prescribe a drug. Educational grants and trips, if done with the purpose of furthering the doctor's expertise, without some quid pro quo expectation, could go a long way in taking the pressure off the doctor to recover such costs from his patients. Instead of worrying if a doctor has had free food, drink or a trip, it is more important to concentrate on unnecessary procedures, tests and even surgeries, which can damage the patient and his finances. In today's times, full-time doctors are employed at enormous salaries and are expected to generate revenue. I think this is the crux of the matter, and as far as I can see, no one seems to be ready to address this issue. Perhaps we need to focus on those fissures in our ethical values, instead of trying to curb a freebie here and there.

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Posted by: Bhupendra Jesrani <jesranibd@yahoo.co.in>

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