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Commerce 'shaping' medical practice in India, as academic research loses innocence

By Dr Amitav Banerjee, MD*  

Decades ago, when test matches were the dominant form of the game, I, like most of my peers, was addicted to cricket, both playing and watching or rather listening as those days we did not have TVs but the transistor.
During the test matches be it in Australia, West Indies, India, England, or anywhere else, there used to be groups of young and old around “paan” shops trying to catch the running commentary. Students and office goers, young and old had their ears glued to the transistor following the ups and downs of the two teams and individual players over the course of the 5 days test match, with one day break for rest in between.
Even if the match ended in a draw, and quite a number of them did, the cricket lovers were never disappointed. We admired the finer nuances of the game and admired the skills of each player be it a bowler, a batsman or even an extraordinary fielder like our Eknath Solkar or the South African Jonty Rhodes. 
Who can forget the class and style of Tiger Pataudi, who faced the fastest bowlers of his time like the duo of Connolly and Mckenzie down under, laudable and courageous, considering he was visually handicapped having lost one eye in an accident when he was just 21 years old.
The cricketers those days played for the love of the game, if not the country. Few played for money or to get rich. They never signed huge contracts for commercials nor had any sponsors to back them. The players wore whites’ symbolizing gentlemanliness both in attire and attitude. Cricketers were as pure as the whites they wore without any “conflicts of interest.” They took the umpires decision sportingly even if they sometimes erred. There was no concept of third umpires.
Clouds hovered over this Garden of Eden (the Cricket Stadium in Kolkata is still called Eden Gardens). Commerce entered the gentleman’s game of cricket heralding the loss of innocence. This was in the form of Kerry Packer, an Australian media mogul who entered the cricket arena in the late seventies. While not a cricketer of any reckoning his stepping in was a game changer. 
Primarily a businessman, he lured the players with lucre and fame, weaning away the players and people from test cricket and feeding them the fast food of shorter versions of the game, the one day internationals (ODI) to start with which replaced test matches. The players discarded the whites symbolizing the loss of innocence. 
The transition from a gentleman’s game to a spectator sport was rapid and unchecked with shorter and shorter forms of the game becoming popular. T20 has become the most popular form of cricket today. The complexities and finer points of the game appreciated in test matches by the connoisseur of the game became a thing of the past. Commercial interests raised the stakes which in turn brought in third umpires and action replays.
A gentleman’s game degenerated to business and big business.
Similar fate has befallen the noble profession of medicine which was more of a calling in an earlier era.
The family physician was adequate for a lifetime of care. His experience and skills were developed more by first hand clinical experience of seeing real world patients in real world settings. He was part of the culture of the family and the community and could individualize treatment depending on the patient’s background. 
He rarely asked for costly laboratory tests as frequently diagnosis could be arrived by a proper clinical history and examination. His or her wisdom, skills and intuition were far ahead than what could be learned within the covers of textbooks or medical journals. And like the test cricketers of yesteryears these doctors earned more fame than fortune.
A gentleman’s game, cricket has degenerated to big business. Similar fate has befallen the noble profession of medicine
Clouds hovered over this Garden of Eden too. Over the past few decades the landscape of medicine like that of cricket has changed. Advances in medical technology while enabling some miraculous cures, have for the most part raised the cost of medical treatment exorbitantly both for the individual and the state. Technology drove specialization and sub-specialization. 
The family physician became an endangered species. Specialist and super-specialist doctors called the shots some even acquiring the status of “celebrity doctors” who came on TV and spoke often without doing any homework. Such acts glamorized medicine and raised people’s expectations from medical technology and newer drugs. The pitch became perfect for the pharmaceutical industry to influence medical practice.
Like Kerry Packer, who had little background in cricket but changed the game beyond recognition, Bill Gates, without any background in medicine, influenced medicine beyond recognition. Gates foundation is one of the largest funders of the WHO which is the bellwether of global health policy. Presently this organization is trying to grab unlimited powers by way of the proposed pandemic treaty which will spell an end to democracy as we know it today.
Just like in cricket where people wanted instant results making the T20 most popular, patients have become impatient (pun intended) and expect instant cures. The limits of medicine are ignored. Craving for instant results in cricket as well as in medicine has become a sign of the quixotic times we live in. These cravings are fed by career scientists and academics sponsored by research grants from private players. 
The pharmaceutical industry offers the highest grants to the career scientists who carry out research to their advantage. Something like auction of T20 cricketers! And both play to the gallery! Sincere researchers who challenge the mainstream fall by the wayside.
With advances in technology the doctor-patient relationship got strained. Diagnostic machines replaced the doctor’s hand examining the patient. Doctors literally lost touch with their patients. Corporate model of health care has given rise to a growing medical industry. From a noble profession and a calling medicine has become a business and a big one at that. Most doctors work in corporate hospitals nowadays. Technology has converted hospitals to factories and doctors into assembly line workers with little autonomy.
Multiple stakeholders generate multiple conflicts of interests. As in cricket today, commerce is influencing medical practice and policy. Even academic research has lost its innocence. During the pandemic the high end medical journal Lancet had to retract a highly publicized paper which was based on fake data, reminiscent of “match-fixing” allegations against some famous cricketers.
Medicine too has become a spectator sport like T20 cricket. The twain has met. Vaccines which used to take decades to develop are getting ready within a year, a laudable feat cheered by the people befitting a spectator sport if not science. When earlier vaccines and drugs were administered on advice of the personal physician, nowadays, celebrity and superstars, including cricketers are often promoting them today, like they do unhealthy cola drinks and fast foods.
The India versus Pakistan match in the ICC Men’s Cricket World Cup is scheduled on October 15, 2023 at the Narendra Modi Stadium, Ahmedabad. In this context there is amusing news, “Fans book hospital bed due to skyrocketing tariffs at hotel rooms for India Vs Pakistan World Cup match!” 
Hotel room prices have reached Rs 50,000 at the venue. Cricket enthusiasts are instead booking hospital beds in corporate hospital which are cheaper with comparable amenities! Cricket and Medicine do make perfect bedfellows, literally as well!
I lost interest in cricket once the test matches started getting phased out. I am also losing interest in medicine as practiced today.
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*Post doctoral in epidemiology who was a field epidemiologist for over two decades in the Indian Armed Forces. He was awarded for his work on Tribal Malaria and Viral Hepatitis E. He is currently Professor at DY Patil Medical College. Pune and an Academic Editor at PLOS ONE

Comments

Prof.S.T.Patil said…
Thank you for an excellent article that holds a mirror of what is happening across the world. Have shared this article with relatives and friends.🙏

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