E-DRUG: Commercialisation of medicine
food for thought .. [Unfortunately not only happening in countries without a
publicly funded health care system. Since Reagan and Thatcher it has spread to
the best of places. Moderator]
Date: Mon, Feb 16, 2009
*Commercialisation of medicine*
*By Murad Moosa Khan*
A FRIEND'S wife who recently had her baby at a private hospital in Karachi
spoke excitedly about the room she stayed in as well as the general decor of
the hospital. She described the hospital as a "five-star" facility and her
consultant's room as "out of this world"!
The fact that her bill was in six figures was of little consequence, as her
husband's multinational company took care of it. And this is in a country
where thousands of women die during childbirth every year. Of course, none
of their husbands are executives in multinationals.
Medicine in Pakistan has become a highly commercialised business, where the
bottom line is about profits and money. In Pakistan, there is little or no
regulation of medical practice or accountability for physicians. The absence of
an effective public-funded health system has been one of the major factors that
have contributed to our poor healthcare and the
commercialisation of medicine. Equally important is the lack of
professionalism and integrity among physicians in Pakistan.
Today, physicians work in a world where the challenges imposed by the
marketplace and self-interest are overwhelming. In the past, we spoke of
patients, doctors, illnesses and compassion; we now speak of clients,
consumers, providers, products, contracts, volumes and services.
Simultaneously, advances in medical technology are enabling healthcare
professionals to diagnose many conditions with modern investigative tools
and to cure potentially fatal diseases with a pill or a laser beam. The
physician's involvement in this treatment is often only a technical one.
What are the implications of commercialisation of medicine for the kind of
care provided to patients? Are physicians obliged to adhere to a system of
virtue and ethics that often requires selflessness when other professionals
such as bankers, businessmen, stock brokers, etc pursue self-interest and
profit in an unprecedented fashion? Or, has the kind of care outlined in the
Hippocratic Oath become obsolete? Have we reached the point where patients are
viewed as articles to buy, trade and compete for? Have we become so focused on
profits that we have forgotten that illness requires caring which, in turn,
relates to a demonstration of compassion?
Pakistani medicine is facing a serious crisis today. Every health indicator
makes sorry reading. We have one of the highest rates of infant and child
mortality, tuberculosis, hepatitis, rabies, hypertension and diabetes in the
developing world. More than a third of our adult population is estimated to
suffer from depression.
Successive governments, both military and civilian, have paid only lip
service to improving the health status of the population. National health
policies are not worth the paper they are written on; the annual health
budget is less than one per cent of the overall budget. Whatever little is
allocated is eaten up by rampant corruption, poor governance and gross
mismanagement. There is neither an understanding of nor the political will
to invest in the health of the population. Most healthcare is out-of-pocket
expenditure and government hospitals are accessed by only the poorest
sections of society.
In the absence of a public-funded health system, private medicine has
flourished in Pakistan and has now become a huge moneymaking enterprise.
There are thousands of private clinics, maternity homes and small and
medium-sized hospitals all over the country. Private medicine in Pakistan is
totally unregulated and hospitals and physicians can charge what they like and
are not accountable to any authority. A few physicians and hospitals pay the
right taxes while sporadic stories about 'stolen kidneys' or 'death during
delivery' reported in the press are merely the tip of the iceberg.
Everyday, millions of patients undergo unnecessary blood tests, CT and MRI
scans, angiograms and endoscopies that place a heavy financial burden on
patients but enrich laboratories and physicians. Many physicians get
kickbacks from laboratories and radiology centres for referring patients to
them and numerous specialists charge over Rs1,000 for a five-minute
consultation. A senior neurologist charges Rs3,000 for a five-minute initial
visit, at the end of which a buzzer goes off and every minute beyond the
allocated five minutes is charged at the rate of Rs1,000 per minute.
A psychiatric hospital is well known for its liberal use of
electroconvulsive therapy on every patient who is admitted there. IVF
centres (fertility facilities) charge hundreds of thousands of rupees for
procedures on young women, when many can conceive naturally with proper
counselling, and regulation of their menstrual cycles. None of these centres
are regulated by any professional body in Pakistan.
Medicine in Pakistan has become a business in the truest sense of the word.
Physicians in Pakistan operate with impunity, knowing they are not
accountable to anyone. While the General Medical Council (GMC) in the UK
strikes a few doctors off its register every year for reasons of
incompetence, negligence or unprofessional behaviour, rarely has the
Pakistan Medical and Dental Council (PMDC) cancelled a registration.
On a personal level, no physician has the moral right to live extravagantly,
driving gas-guzzling four-wheelers or luxury cars. They must remember that they
do so at the cost of thousands of patients; many of whom break their backs to
undergo expensive medical treatment in private hospitals. Living modestly,
being role models and remembering that medicine is a moral venture, rather than
a business enterprise, should be the enduring ethos of all physicians,
especially those working in poor countries such as Pakistan.
Ultimately, both our understanding of and personal approach to the
patient-physician relationship depends on our perception of what it means to be
human and of the purpose and meaning of human life. If there is any
profession that requires its practitioners to be truly altruistic, it is the
profession of medicine. As the medical historian C.E. Rosenberg once said,
"Medicine became distinguished when specialised knowledge was used for the
benefit of the patient. It became noble when the needs of the patient held sway
over the interests of the practitioner."
The writer is a professor of psychiatry at the Aga Khan University Hospital.