Medico-pharma nexus: Still alive and kicking
The Medical Council of India (MCI) in February had
framed stringent ethical guidelines to demolish the doctor-pharma nexus that
undermines the best interests of a patient. Seven months later though, most
feel the rules have had little or no deterring effect.
The guidelines mainly elaborate the quantum
of punishment for doctors, based on the value of favours or perks received from
pharma companies. They state that the doctors found accepting gifts or monetary
grants of any kind worth Rs 5,000 to Rs 10,000 would lose registration for
three months. The tenure would jump to six months if the value of gifts is more
than Rs 10,000 and Rs 50,000. For anything priced up to a lakh, the doctor will
lose the licence to practice for one year. “Thanks
to the guidelines, the entire unholy affair has only become more clandestine,”
said a senior physician with a leading public hospital. He said that at least
three surgeons, including one from the public setup, went on an
all-expense-paid trip to Europe in August. “The
surgeons were asked to make their own travel arrangements, which were
reimbursed later. Earlier the bookings were more blatant,” said the doctor,
who did not wish to be identified. In an HIV/AIDS conference in Durban that was
held in July, a contingent of doctors flew to Australia with their families for
a vacation, much before the event was over. Lavish trips to foreign
destinations have been the norm for the last couple of years, say industry
insiders. A pharma representative told TOI how doctors from metros and even tier
II cities outrightly reject Asian destinations. “It has to be an expensive European destination. Of course, the
bargaining power of the doctor depends on how many strips of a drug he is
capable of selling,” said the representative. It has graduated from buying
cars to funding marriages of doctors themselves or their children. For small
towns, free medicine samples, lunches, home theatres and car down payments
still do the trick. The implant and stent industry is huge, where kickbacks are
mostly monetary, said the source who has been in the industry for 17 years.
Dr Abhay Shukla, who co-authored a book highlighting
the menace of unwanted tests and procedures, said that the medical councils
have to work jointly with the income-tax departments. “The balance sheets of pharma companies ought to have details about the
money spent on doctors. That information should be used to prosecute doctors,”
he said. He lamented the fact that medical associations as well as councils
have done little to address the disturbing issue.
Medical councils, however, say they cannot
act till there are actual complaints. “Till
the time there are no direct complaints against specific doctors, how can the
councils act?” said Dr Shivkumar Utture, former member of the Maharashtra
Medical Council. In 2014, the MMC suspended over 50 licences in the state after
400 names came under the scanner for accepting bribes. “All of them have got stay orders from the courts and are back to
treating patients,” he said.
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