Two steps forward
Enforcing medical ethics a long journey
The Medical Council of India (MCI) has taken a further step in improving ethical standards in the medical professional by quantifying punishments (after banning gift taking in the first place) for doctors who break the new rules of conduct. It is now necessary to take the matter forward as a long distance still needs to be traversed before a reasonably comprehensive set of rules are there to cover all angles and stakeholders. One of the less important issues raised is that no time dimension has been indicated while allowing receiving of gifts up to Rs 1,000, that is a person can keep receiving an endless stream of gifts not exceeding the limit in any given time period. While the foregoing can be easily clarified and a possible loophole closed, there are two more serious issues that need urgent addressing.
One is, while the regulatory body for doctors, the MCI, is doing its job, what about the regulator for the pharmaceuticals and medical devices industry? To crack down on gifts it is necessary to ban not just gift taking but giving too. Therefore, the MCI has written to the health ministry to take up the issue with all stakeholders. Pharma companies come under the Department of Chemicals, which is a part of the Ministry of Chemicals and Fertilisers. Clearly, pharma companies have to both declare the gifts they have made in any given period and simultaneously be placed under severe restrictions on offering gifts. This may be easier to enforce than regulations for doctors as there are far fewer pharma companies than doctors. For example, US companies are prevented by law from offering bribes to get business around the world.
But the biggest issue is how will the regulations be enforced? Who will be the policeman? The MCI has till now, for all practical purposes, been a toothless regulator, which acts only when there’s a complaint and that too by forming a committee of doctors to examine a complaint against another doctor. A small army of inspectors will be needed to enforce the regulation and address complaints, and careful thought has to be given to structuring this set-up as it should not become another self-serving bureaucracy. A key issue is whether the regulation will be undertaken at the Central or state level. Given the record of most state governments in enforcing drug quality, leaving the matter to the states does not arouse much hope. But there should be no illusion that framing rules and appointing policemen alone will do the job. If gifts and junkets are effectively monitored and countered, the business model for the pharmaceutical industry will have to change. Right now, medicines are marketed by medical representatives who visit practitioners and provide them with both literature and inducements. If the pharmaceutical industry is serious about the matter, then there should soon be an intensive discussion within it on how to market itself in an inducement-free regime. Then again, what happens to doctors receiving a payback for referring patients for tests, scans and the like. Receiving “cash” is banned but what about “fees” for “services” (referring patients) rendered? This is an important part of the present corrupt regime in which patients have to undergo unnecessary tests or scans but not specifically banned even now. So, yes, some progress has been made but there is still a long way to go.