Taking on medical misconduct

New legal framework makes it mandatory for doctors to prescribe generic drugs to poor patients.

A cancer hospital is said to be a great educator in matters of life and death. For me, it was more than that. I learned something important about the much maligned profession called medicine. I discovered that for every three indifferent and uncaring doctors, there was always one who stood out as exceptional.

This happened in the office of an oncologist. “Shall I prescribe the generic version which will cost less?” she asked.  
 
I told her I preferred the branded one.  She nodded and wrote her prescription saying “it’s going to be very expensive.” She then reached for the telephone. She called the local distributor for Pfizer – one of the world’s largest pharmaceutical companies.

“A terminally ill patient needs Tarseva,” she told him. “How much will it cost?” He quoted an alarming figure. In a persuasive voice, she continued: “What will be my share if I prescribe?” Another striking figure was mentioned. “You can pass that on to my patient,” she told him curtly and hung up.
I have related this episode in the light of the central government’s recent decision to frame laws that will put an end to the nexus between doctors and pharmaceutical companies.

The new legal framework will also make it mandatory for doctors to prescribe generic medicines to poor patients who can ill afford branded ones. This is a bold decision that will face tremendous opposition from one of the most powerful lobbies anywhere - the drug manufacturers.
These lobbies extend beyond this country. They are big names in the international market as well. Sadly, they are also the manufacturers of life saving drugs.

These drugs make it more difficult for terminally ill patients to refuse their medicines when the doctor prescribes them. It is a truly bold step taken by the Centre and is bound to counter severe opposition.

Generic drugs are excellent options for patients who need treatment which they cannot otherwise afford. In a country like India where the population is outrageously large and public healthcare facilities shockingly inadequate, it seems the only viable option. 

Since generic medicines are the same as branded ones in terms of dosage, strength and quality if they are properly tested and approved, their use in public healthcare systems is the best  option  for poor countries.

While they cannot be forced upon those who can afford alternatives, the new law will ensure that doctors leave the choice to their patients and not compel them to buy costly branded medicines only.

It is no secret that nearly 80% of the pharmaceutical market is dominated by branded medicines. It will not be surprising if the government’s move causes enormous dissent among chemists, druggists and the medical fraternity who are already seething with the government’s earlier cap on stents and 700 essential lifesaving medicines. 

All those who stand to lose if the proposed law is enforced may offer a stiff resistance while millions of families who are left impoverished after a major illness will have something to rejoice about. Medical expenses have especially taken a toll on elderly citizens with no income.

The new laws will also set a cap on the freebies that pharmaceutical companies offer to hospitals and doctors. Once again, it is no secret that the Indian pharmaceutical industry spends lavishly on seminars and workshops for doctors in five-star hotels and fancy resorts to coax them to sell their goods.

No wonder it is said to be the world’s fastest growing market with an annual profit of Rs 1,00,000 crore. It woos private doctors to push its branded ware into the market by offering luxurious vacations, cruises and other attractive incentives.

Unscrupulous companies
Whether it is a hospital, doctor, chemist or distributor, the manufacturing companies stop short of nothing to market their products. The mere passing of laws will not stop this malpractice.

When governments abroad are unable to stop unscrupulous drug companies from paying research labs and scientists for the same purpose, it will require more than legislation to cure this evil.

Perhaps, the cure lies in the education that made the doctor in the first place. The cost of medical education is prohibitive, and hundreds of substandard medical colleges in this country churn out substandard doctors who don’t care about the ethics of their profession.

If the Centre establishes medical institutions of excellence like the IITs and IIMs where merited students enrol, we may build up a whole generation of good doctors who will not succumb to malpractices. Medical malpractices need long-term solutions.

We need to create doctors like that remarkable oncologist who asked the distributor to pass the discount to her patient. Her conduct proved that we do have doctors with exceptionally high ethical standards.

Unfortunately, they are few and tarred with the same brush as the bad apples that have sneaked into this profession.