The Indian Medical Council (IMC) has revised its 2002 regulations for professional conduct and ethics to fill a glaring gap by taking into account doctors’ dealings with the pharmaceutical and allied health care industries. It bans taking of gifts from firms or their representatives, travel benefits for attending conferences, seminars and continuing medical education programmes, hospitality, cash or grants in their individual capacities and endorsing a drug or product. Any research finding should be disclosed only through scientific bodies and publications. What is more, the regulation says doctors can work for research projects funded by industry but enjoins upon them to ensure their right to publish research results in the greater interest of society by inserting a suitable clause in the agreement to do such research. All this is in sharp contrast to the earlier provisions of the rest of the code which is full of motherhood statements, though then also self-advertisements and endorsing products were disallowed.
However, any regulation is only as good as the teeth it has, and sections of the profession in favour of such rules have said that for them to be effective, breaking them should invite penalties. Under the regulation, IMC has the right to “award such punishment as deemed necessary” but in reality, the only action taken so far has been taking away a doctor’s registration, temporarily or permanently. However, regulatory teeth are a necessary but not sufficient condition for enforcing higher public standards. There is strong sanction against corruption in India but it is still rampant. For regulation to work there has to be public sanction against it and both public opinion and vigilance have to be spearheaded by civil society watchdogs. A case in point is a 2006 article in the Journal of the American Medical Association, which reported research indicating that even small gifts like pens, notepads and coffee mugs can influence prescriptions. The Pew Charitable Trust founded the Prescription Project to advocate the recommendations contained in the article to combat aggressive marketing among physicians by the pharmaceutical and medical device industries. The campaign has prompted many health care organisations to adopt strict conflict of interest policies such as banning gifts.
This is not all. Last year, two US Senators introduced legislation requiring drug and device-makers to disclose anything of value given to physicians. In response, leading pharma companies came up with proposals for voluntary disclosure on their websites which prompted watchdog organisations to allege that the aim was not really to disclose but ward off legislation. This is the way public debate and opinion build up and once that happens, legislators take the cue. They US Senators went beyond payments, gifts, paid travel and hospitality to also include medical education grants. This has relevance to India where the regulation enjoins medical practitioners to go in for 30 hours of continuing medical education in every five years.
Gift giving and taking in various forms, be they actual gifts or de facto ones like “conferences” at resorts, all expenses paid, are rampant in the Indian health care industry. There is an urgent need to bring down the cost of private health care which most have to rely on because of the largely appalling state of public health care. One way of doing this is to fight against the corruption in the system whose bill is eventually picked up by the public.
