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Rejoinder: Why doctor treating individual patient is no humble person these days

By Dr Maya Valecha* 

The article by Dr Amitav Banerjee on association between doctors and the pharmaceutical industry (Counterview, August 31, 2023) is based on a few important issues. First is the worry for the most concerned people -- that higher up research bodies, regulatory bodies, and even the World Health Organisation (WHO), are playing in the hands of pharmaceutical companies, and therefore opposing these higher authorities is very important. But we cannot say that doctors who are treating the patients directly are any less harmful.
The second assumption -- which is actually the reason for the first reasoning -- is that medical research, medicine production, medical practice/ healthcare system and allied industries, which are now considered important, have to be in private hands.
Dr Banerjee says, “Louis Pasteur’s work on rabies vaccine led to the rise of the vaccine industry. Alexander Fleming’s discovery of penicillin changed the course of medical history and spawned the huge pharmaceutical industry.” Indeed, he is absolutely right: the doctors helped the pharmaceutical industry. But that is not the same thing as the collaboration of the two or helping the humankind.
To quote Rene Dubos in Mirage of Health:
“. . by the time laboratory medicine came effectively into the picture the job had been carried far toward completion by the humanitarians and social reformers of the nineteenth century. Their doctrine that nature is holy and healthful was scientifically naive but proved highly effective in dealing with the most important health problems of their age. When the tide is receding from the beach it is easy to have the illusion that one can empty the ocean by removing water with a pail.”
The modern “heresy” that medical care (as it is traditionally conceived) is generally unrelated to improvements in the health of populations (as distinct from individuals) is still dismissed as unthinkable in much the same way as the so-called heresies of former times. And this despite a long history of support in popular and scientific writings as well as from able minds in a variety of disciplines.
History is replete with examples of how, understandably enough, self-interested individuals and groups denounced popular customs and beliefs which appeared to threaten their own domains of practice, thereby rendering them heresies (for example, physicians’ denunciation of midwives as witches during the Middle Ages).
However, even under the somewhat unrealistic assumption of a constant (linear) rate of decline in the mortality rates, only whooping cough and poliomyelitis have approached a significant percentage, which is only to be expected. The remaining six conditions (tuberculosis, scarlet fever, pneumonia, diphtheria, measles, and typhoid) showed negligible declines in their mortality rates subsequent to medical intervention.
Association of TB and nutrition is well known, and all of us know it, yet the Indian Council of Medical Research (ICMR) conducted a study to know that improved nutrition can reduce cases and mortality of TB. Let's tell them it's true for all infectious diseases, so that they don't waste public money on studies and vaccines. There are people who barely manage one meal, and no vaccine can save them.
There have been many other researches after this which show how almost all diseases were at their bottom-line when the vaccines were introduced. The recent example of cervical cancer declining with non-pharmaceutical interventions suggests vaccines are no full proof for prevention, and still doctors use it freely in private sector, with the government introducing it as national programme – which is an eye opener.
Dr Banerjee says, “The real conflicts of interests are upstream at the level of the WHO and ICMR rather than at the downstream where the humble doctor is treating individual patients.”
The doctor treating the individual patient is no humble person these days. He acknowledges this and tries to find some moral solution for this, which is not possible in this money-centric capitalist society. When money can buy every institution, it can buy the individuals easily. As this study suggests, doctors do not want to even answer about big gifts to them. In fact, big pharma marketing influences prescriptions of 98% doctors.
I do not believe in centralised authorities controlling the society but the example of two consenting adults having liaison harming no third person is totally misplaced. In fact, liaison between doctors and pharmaceutical industry is affecting vast number of patients getting subjected to unnecessary investigations, medicines and even surgeries.
Opposition by the Indian Medical Association (IMA) is being taken lightly, but let me ask one thing: is it not the height of brazen attitude of doctors when they say that they don't have money for their own further learning? How do other professionals keep themselves updated? 
Under the current system, Continuing Medical Education (CME) is not a compulsory thing. Thanks to influence of vulgar money from the profession, it attracts only the most genuinely interested persons. Genuine literature and conferences at low cost can only be organised with government funding, which wouldn’t help enjoy five star facilities.
The real solution lies in complete overhaul of the system with socialisation of the pharma industry and healthcare system. They need to be under complete control of the people through participatory democracy. This will solve the problem of the higher authorities colluding with vested interests and controlling the system, thereby our lives. When the system is so rotten from top to bottom one cannot change it by just dressing it up.
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*Senior physician based in Vadodara

Comments

Dr S Jagtap said…
CME is compulsory to renew registration with MMC at least!!!!

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