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Doctors question impact of code of conduct without punishment

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The of the (MCI) for barring acceptance of gifts and other benefits from drug companies is not likely to have any impact until it imposes severe penalty on those found flouting it, say senior medical professionals.

The voluntary code of conduct, notified last month, is aimed at controlling the heavy incentives doctors receive to promote particular pharmaceutical products.

“It is important to have ethical guidelines. But the profession should enforce them. We need to develop mechanisms so that a variety of transgressions are regulated and penalised,” said President of Public Health Foundation of India Dr K Srinath Reddy. Currently, doctors accept hospitality, travel or cash from pharmaceutical companies without any checks.
 

DOSE OF ETHICS
MCI’s Code of Conduct for doctors and their families
* Can’t accept gifts from drug companies
* Can’t travel at the expense of drug companies, within or outside the country
* Can’t allow drug firms to pay for their hotel expenses
* Can’t accept cash benefits
* Can’t participate in medical research unless it has been cleared by institutional ethics committee

“Any violations to this code should be reported by peers. And not just doctors, but those who extend these favours should also be penalised,” added Reddy, a former head of the cardiology department at the All India Institute of Medical Sciences.

The challenge lies in its implementation. “How will this code be implemented and how will you check a practice that is so widespread?” asked executive director of INCLEN Trust International, Dr NK Arora.

“A monitoring mechanism with penal provisions has to be put in place,” he added.

MCI is seen to be following the American Medical Association, where the ethical code is so strict that doctors are not allowed the gift of even an inexpensive pen. In the United States, professional bodies as well as civil society help enforce the standards.

In India, MCI’s own record of taking disciplinary action against erring doctors is bleak and professional bodies do not take a lead. Transgression of medical ethics has reached a point where doctors are known to take cuts from MRI scans and unnecessary procedures are done solely for earning money.

Executive Director and Dean of Cardiology at Escorts and Fortis Hospitals, Dr Upendra Kaul, says some companies have worked out mechanisms of tracking prescriptions right up to the chemist. Doctors who favour them are rewarded with cash and cars.

The transgressions go even into academic meetings. For instance, says a doctor, even continuing medical education (CME) meetings turn out to be dinner parties where liquor flows easily and few people are interested in having academic discussions. Some companies pick up the bills of even expensive marriage ceremonies of their favoured doctors.

“A four-day academic conference in Jordan, turned out to be a sightseeing tour for over three days, with only two hours of lectures in the evening. In that time too, people wanted to spend time enjoying their liquor. Cooks were flown in from Gujarat to appease the taste-buds of participants.” It’s not the fault of companies alone, doctors are also asking for more, says Kaul.

Doctors point out to cases where open soliciting of patients goes on with hospitals putting up huge billboards advertising for services as simple walk-in and walk-out procedures.

If the MCI is interested in seeing a change, it should start by introducing these ethics at the level of early medical training. “When you are an intern, medical representatives start giving you attractive gifts,” says another doctor.

Pharmaceutical companies have been trying to evolve their own code on ethical marketing practices.

The Small Pharmaceutical Industries Confederation (SPIC) is the only industry association that is opposed to the joint voluntary code proposed by others, such as Indian Drugs Manufacturers Association (IDMA) and Organisation of Pharmaceutical Producers of India (OPPI), as they want the code to be made legally binding with penalty clauses.

Commenting on the MCI code, Lalit Jain, senior vice chairman of SPIC, said, “MCI has no control over pharmaceutical companies. How do you to stop them? What is the penalty clause if there is a violation by the doctor? Will they cancel the license of the doctor? It’s all only on paper.”

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