Overcoming medical malpractices

Medical ethics has long become a casualty. Ever since the pharmaceutical companies have sought to monopolise market, ethics has been relegated to the back burner. Profit motive has overtaken that of engagement in a cause for the humanity. That 10 largest drug companies currently control over one-third of the global pharmaceutical market worth US$ 300 billion is proof enough of this. Also, these companies credited with sales worth no less than US$ 10 billion boast a profit margin of about 30 per cent. What will be the reaction to the news that companies spend one-third of all sales revenue on marketing their products, roughly twice their expenditure on research and development? Quite logically the World Health Organisation (WHO) argues that there is "an inherent conflict of interest between the legitimate business goals of manufacturers and the social, medical and economic needs of providers and the public to select and use drugs in the most rational way". The WHO could not be more categorical in detecting the malaise in the global drug industry.
No wonder that the problem further compounds because drug companies are the main source of information on the efficacy of drugs. Even in the United Kingdom where publicly funded information is more independent than elsewhere, pharmaceutical companies spend 50 times more money than the amount spent on public information on health. When the WHO Ethical Criteria for Medicinal Drug Promotion, adopted by the World Health Assembly in 1988 and meant for ensuring rational use of drugs, is largely ignored not just in countries like Bangladesh but also in developed world, the total drug business cannot but be suspect. If the WHO's guidelines get ignored, it is only natural that the voluntary Code of Pharmaceutical Practices developed by the industry's own International Federation of Pharmaceutical Manufacturers' Associations (PharMA) just turns into a mere formality.   
So it is a daunting challenge to ensure rational use of drugs in countries like Bangladesh. Poor ethical standard of physicians in this country has been confirmed by a study conducted by a senior lecturer of a private university and his team. The study focused on improper prescription of drugs. Although the news carried in an English contemporary has emphasised the abuse of antibiotics, the study found a dangerous trend of prescription of 'inappropriate, unnecessary and expensive drugs' among doctors, thanks to the bribe money doled out to a section of the country's physicians. Similar abuse of drugs is not uncommon in urban areas as well.
A common complaint by patients is that doctors suggest a number of tests for minor complications. The study reveals that 44 per cent of the doctors under study prescribed antibiotics for cold, fever and acute respiratory infections without diagnosis. This certainly does not conform to the medical practice. Viral respiratory illness, particularly of children, should not be treated with antibiotics.  Misuse or overuse of antibiotics contributes to antibiotic resistance leading to creation of multi-drug resistant bacteria, informally called 'super bugs'.
The story has detailed the serious consequences of abuse of antibiotics. Here medical malpractices are as much responsible as the ignorance of patients who fail to go by the prescription once the acute syndrome is no more. They fail to complete the course in many cases and even the physicians can do little in such cases. But the physicians must take the blame for prescribing antibiotics where they have not confirmed if the illness demands application of antibiotics.
So much about antibiotics! What about medical malpractices by doctors who suggest a long list of expensive medical tests knowing full well that most of those are unnecessary? Medical ethics demand that a physician prescribe minimum drugs and those easily available at the lowest possible price. One cannot say this is the case with most of the physicians now practising at private facilities in addition to their service at a government hospital.
When pharmaceutical companies in the developed world are not averse to influencing and luring medical professionals into practices not approved by medical ethics, the majority of doctors in developing countries like Bangladesh are unlikely to resist the temptation. But there is a limit to indulging in practices that directly compromise quality of medical care. In India, anarchy in medical practices prevailed for sometime. But then the professionals themselves drew a line, 'thus far and no further'. It is because healthcare in Indian hospitals - public or private, today has earned quite a reputation.
In developed countries, some large pharmaceutical companies have undertaken medical programmes for disease eradication through private-public partnership. Against investment in research and development with an eye to maximising profit, quite a few such pharmaceutical companies have been distributing drugs free of charge in developing countries as part of their service to the ailing humanity. Local drug companies can take a leaf from their counterparts abroad. But no one company here can spend money on philanthropic service. Better it would be for them to coordinate among them to pool funds so that they can at least develop drugs locally and sell them at a low cost. The physicians on their part can learn from the Indian experience in the interest of their own reputation as well as stopping the flow of patients to the neighbouring country.    
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