Thursday, July 12, 2012

Rot in our medical system:- 8.6.12 - The Pioneer


Aamir khan’s television show on the unethical practices by doctors indulge in, has expectedly rattled the medical community. Some doctors have even sought an apology from the actor for projecting profession in bad light. They may protest, but they can’t  deny they grim  reality.     
Doctors are angry. Why? Aamir   Khan has targeted them in two of   his first four shows. And why not?   After all, the show is called Satyamev Jayate.   And the first and most important responsibility   of a civilised society towards its citizens   is that of giving them a good healthcare   system (followed by education,   employment and judiciary, in order to   make a good democracy), that too in a   country like India where an estimated 17   per cent of the population dies before the   age of 40. The reality, however, is shockingly   quite worse. The reality is that in this   country, medicines for treatment of cancer   patients — in one of the cases, 5,50,000   Morphine and 52,00,000 Morcontin tablets   sent by the World Health Organisation —   that were supposed to be distributed free   at all the hospitals in India, were dumped   beyond their expiry dates in the stores of   hospitals . These were expensive medicines;   Morphine is typically meant to relieve   patients from intensive pain. It basically   meant that in this particular case, patients   who could not afford to buy such costly   medicines from the market must have suffered   immense pain, with some of them   dying too without proper treatment. the   WHO has, of course, demanded an explanation.   But what is more important for the   masses is that the medical mafia keeps   engaging in such acts to enhance the profits   of pharmaceutical establishments.   I can easily cite scores of such examples   from reports on the miserable conditions   existing in hospitals all over India.   Although examples of the opposite nature   are becoming rarer by the day, there are   sparkling exceptions, and it gives me   immense pleasure to write about one such   example — the Shramjibi Hospital in   Belur, West Bengal. When the hospital   admits a patient, it never asks the patient   to deposit any money. Patients are almost   always surprised to receive a very low bill   (almost always one-fifth of the amount   charged in other hospitals) when the treatment   is over. For example, a coronary bypass   surgery for the heart costs _25,000 at the   hospital, inclusive of pre-and post-treatment   charges. In the unfortunate case of the   patient expiring during treatment, the   management of this hospital never presents   any bill to the relatives of the patient.   Elsewhere, a bypass surgery may cost   upwards of _1,00,000 to _3,50,000.   Since patients can easily be blackmailed,   life-saving drugs are priced exorbitantly.   AIDS patients in US and Europe   are charged up to $30,000 for one year of   treatment. Cipla in India, for an equally   effective medicine, charges only one dollar   a day. It is so unbelievable and so noble   a n act that even former US President Bill   Clinton negotiated for an annual supply of   drugs costing around only $100 per   patient. This is exactly what Aamir Khan   tried to point out. His contention was,   “When a student sits for the MBBS exams   and is asked what the medication for a   patient suffering from diabetes is, he   might write Glimepiride. This is the salt   commonly used to treat diabetes. When   this student becomes a doctor — and a   patient who has diabetes comes to him for   treatment — he might write the medicine’s   name as Amaryl. So, is that young doctor   prescribing the wrong medication? No.   Amaryl happens to be one of the brand   names by which the salt Glimepiride is sold.   So what is the difference between the two,   apart from the names? Well, a strip of 10   tablets of Amaryl costs around _125,   while a strip of 10 tablets of the salt   Glimepiride costs _2. Both are essentially   the same. We pay approximately _123 more   for the brand name.”   However, doctors rarely prescribe a   generic drug to a patient. In West Bengal   for example, the earlier Health Minister,   Surya Kanta Mishra, used to repeatedly   request doctors to prescribe generic medicines,   but to no avail. The drug industry   spends on an average _2,00,000 per doctor   per year in soliciting business and promoting   branded medicines. It is no wonder   that branded medicines are so expensive   and doctors love them. They are often   paid commissions on drugs sold directly   or indirectly through quid pro quo reimbursements   of various kinds — sponsorships   to participate in international conferences,   for instance.   Investigations for diagnostic purposes   are often superfluous and are priced high.   One of the reasons is the commission (which   can even be up to 40 per cent of the total   amount) paid to the doctors who recommend   such investigations. Even surgeons,   whatever the degree of skill acquired by   them, do not hesitate to extract prices that   can be described only as brutal, ruthless,   merciless and heartless. Also, since foreigners   from developed countries are coming in   droves for treatment in India, globalisation   has led to an increase in the cost of treatment   in Indian hospitals. The average cost   of hospitalisation has increased by more than   five times in a span of just 10 years. This can   explain surely why hospitalisation costs are   now beyond the reach of not only the common   man, but also of the upper-middle class.   We must take up the fight against reservation   of treatment in modern hospitals for   the creamy layers of Indians, whatever the   caste. The only way to get rid of our very   own ‘merchants of death’ is to devise a   National Health System geared to Indians   of all castes and classes, inclusive of people   at starvation level and destitution   level. More than a lifetime of an average   Indian has passed after India achieved   Independence. It is high time we did away   with the famine of food as well as of medicine.   It is high time we built in each blocklevel   unit at least one hospital, modeled on   the lines of the Shramjibi Hospital, humanised   and efficient.   No doubt, Aamir Khan’s show is garnering   a TRP of only three or so and even   the masses want him to be more combative   than the ‘now school teacher, now teary’   mode of his, since unlike an Oprah Winfrey,   Aamir is known to be an actor so his tears   will often be looked upon by the public as   mere melodrama.   Also, his programme almost looks like   a deglamourised version of The Oprah   Winfrey Show, with poorer looking Indians   vocalising their pains; Indians who give the   TRPs now appreciate glamorous looking   shows, especially if they have to get up early   on Sunday morning.   But Aamir’s case against the doctors is   absolutely praiseworthy and specifically so   in the light of our existing health system.   (The author is a management guru and   the honorary dean of IIPM Think Tank.)  

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