Doctor, Heal Thyself ! # Satyamevjayate #Aamir khan


 

Doctors asks Aamir Khan to apologise for his recent show on Satyamev Jayate

 

Rediff.com, Last updated on: June 06, 2012

The latest episode of Aamir Khan‘s [ Images ] television showSatyamev Jayate probed into malpractices that some doctors follow, looking at the way they dole out wrong treatments for monetary gains. It has understandably not gone down too well with the medical fraternity.

Dr Sanjay Nagral — a consultant surgeon, department of surgical gastroenterology , Jaslok Hospital and Research Centre, Mumbai [Images ] — explains what exactly has hurt the doctors. 

Satyameva Jayate‘s recent episode on healthcare in IndiaImages ] has created quite a stir within my fraternity. What began as benign posts on social media and closed door conversations has snowballed into a movement against what is being described as a ‘diatribe’ by Aamir Khan against the medical profession.

In an additional bizarre twist, the Indian Medical Association, the apex body of medical professionals in the country, is asking Aamir to ‘apologise’ and, in what can only be termed as an acute case of silliness, has called for ‘boycotting’ him.

The issues raised in the show, and the profession’s response to them, have important lessons. Lest they get lost in the din and drama, here is a contrarian view for the record.

What is it exactly in that episode that has hurt my colleagues?

From my reading of the various statements, it seems there are some common themes that many are upset about.

First, the show ‘exaggerated’ the extent of unethical practice in the profession. Second, it showed only the ‘bad’ side of the profession, not the ‘good’. Third, it was factually incorrect at times.

There were those who wanted to know why doctors are being targeted when the entire society is corrupt.

Finally, the one below the belt: Who is Aamir Khan to pontificate about service to the poor when he charges crores of rupees for the show?

The last one, though probably the most superfluous, is the most emotive of all.

Is it really a revelation that ‘stars’ like Aamir charge such amounts for television serials? If Aamir declares he has not charged for the show, will it in any way alter the response to the show?

Post your comments on Satyamev Jayate here.

Now, we come to the more substantive issues.

What was one of the unethical practices that the show highlighted and ‘exaggerated’? The episode talked about the practice of ‘cuts’ and ‘commissions’ that are offered by doctors, labs and hospitals for referral of patients. These are cash transactions; they are not revealed in official documents and are arbitrary in amount.

Although there is no documentation of the extent of this practice (Not surprising! How many would admit to it?), having had a ringside view in a large metropolis for many years, I would suggest it involves a large majority of referrals.

We can quibble over the precise extent, but that would just serve to obfuscate the issue at hand.

Hasn’t such ‘fee splitting’ become so commonplace and institutionalised that, as a young doctor, if you don’t participate in it, you are effectively ostracised? Isn’t this activity non-transparent and doesn’t it increase the cost of health care and affect quality? Has any medical association ever tried to build internal resistance or opposition to such a patently corrupt practice?

The show talked about the shocking state of the Medical Council of India and how its president, Dr Ketan Desai, was arrested by the CBI in 2010 on charges of corruption. He was thereafter removed from the post of MCI president by the government and is now cooling his heels in Tihar jail.

Desai amassed crores (one estimate pegs the amount of money recovered from the raid on his home at Rs 1800 crore (Rs 18,000 million)) from the lucrative business of recognition of medical colleges.

The episode also showed how Desai, who had been indicted by the courts and temporarily sacked in 2002, staged a return. What the episode did not mention is that the same individual was also the national president of the Indian Medical Association.

Thus, a convicted individual not just survived but actually thrived for an entire decade at the highest levels in the Indian medical establishment both as the president of the Medical Council as well as the IMA. Isn’t this a reflection of the permissiveness and ambivalence medical professionals have developed towards corruption in their own representative bodies?

The current president Dr K K Talwar, who appeared on the show, had no credible answer when asked why not a single doctor in India has had his licence cancelled when the General Medical Council of the UK figures showed substantive numbers every year.

One of the ‘errors’ repeatedly pointed out by those outraged by the show is the numbers that were quoted about private and public medical colleges in India. One wonders, though, what is more important — the precise number or the fact that India can be counted among the countries that have the highest number of private medical colleges in the world? Isn’t the crass commerce of medical education in these colleges, where seats are sold at high prices, the real issue?

Isn’t it true that private medical college empires have grown because they have managed to hire and retain medical teachers, set up arrangements with hospitals to provide ‘clinical material’ in the form of patients and get recognition for postgraduate courses from inspection teams consisting largely of doctors?

Of course, there is a large industry supported by politicians at work here but the collusion of the profession is substantial.

Did the episode show examples of ‘good’ doctors and the positive side of things?

To be fair, the show did profile alternative models quite extensively. The issue of generic drugs and the work of Dr Samit Sharma in Rajasthan [ Images ] were highlighted in some detail.

That they predictably chose media favourite Dr Devi Shetty, when they could have profiled any of the hundreds of brave, committed doctors who have chosen to work under harsh  conditions in rural India to come up with alternative models of people-centric health care, is a pity. But some of this is inherent to the medium and its compulsions.

And, finally, a very old complaint — why should doctors be ‘targeted’ when the entire society is commercial and corrupt?

It is obvious that, unlike other professions, health care has a huge social dimension and hence will inevitably be scrutinised more intensely. But it is exactly this aspect that also gives doctors more visibility (don’t many of our colleagues enjoy a lot of media publicity on a regular basis?).

Historically medicine has a social contract which allows it a unique form of self-regulation in the form of medical councils, a front on which we have failed miserably. So whether it is the killing of the female foetus or the sale of kidneys, the state has had to step in with new laws because self-regulation failed.

The principle of market economics have been rejected by most societies, including western nations, as inappropriate to health care. In a strange paradox, India has one of the most privatised of health care systems.

Now, before my colleagues say that this is a result of state policy, which it essentially is, we have to admit India’s medical profession is a willing and enthusiastic participant in this process. Witness in the current boom of market medicine a new entrepreneurial spirit that is sweeping the profession. But the same market medicine, which uses media and television to sell its wares, is disturbed when the medium turns around and asks disturbing questions.

Was the show free of blemishes? Of course not.

There were occasional moments, like when the rather improbable allegation of a ‘liver transplant’ being advised for gastroenteritis was made by a member of the audience. Or when a family alleged that they did not know that a pancreas would be transplanted with the kidney in a large private hospital in Bengaluru [ Images ]. But these aberrations should not distract from the big issues that the show managed to raise.

Rampant commercialisation of the practice and of medical education, hard selling by pharmaceuticals, the high cost of drugs and the shocking price differences for the same drug from different brands are all highly disturbing parts of our healthcare policy.

That a popular film star with a huge audience articulated on prime time television what health activists have been saying for years is perhaps what has disturbed some in my fraternity.

Organisations like the IMA should actually seize the moment and ask Aamir to commit to a sustained public campaign on universal health coverage and the right to health. That would also test Aamir on a charge that has been made about him; that he raises social concerns transiently to stimulate interest in an ongoing release.

As for the boycott call, I would suggest that Aamir doesn’t really need to worry on that count. He has to just sneeze or cough and there will be a bevy of doctors running to attend on him.

After all, being a film star’s physician counts a lot in a doctor’s professional trajectory in India.

Immediate Release- Illegal Clinical Trials and Death Continue …


SWASTHYA ADHIKAR MANCH

6, BIJASAN ROAD, OPPOSITE MAHAVIR BAGH, INDORE, MADHYA PRADESH-452005.

Press Note

New Delhi, 26th March 2012 : The Writ Petition filed by Swasthya Adhikar Manch came up for hearing today before a bench consisting of Justice R.M. Lodha and Justice H. L. Gokhale. The Senior Counsel appearing for the Union of India sought time to file counter affidavit. The Medical Council of India as well as State of Madhya Pradesh also asked for time and were granted six weeks. Thereafter, petitioner Swasthya Adhikar Manch has been granted time to file Rejoinder Affidavit.The counsel for Swasthya Adhikar Manch, Mr Sanjay Parikh, pointed out that it has been acknowledged by Minister of Health and Family Affairs, that illegal trials have been conducted and some of them are even without approval of the DCGI. He also mentioned that no Placebo Trials should be conducted in the country. The Hon’ble Judges remarked that the situation is serious and deaths are taking place. On the application for impleadment filed on behalf of Contract Research Organizations, the Supreme Court sought information about their legal status for operating in the Country. The Counsel for the petitioner pointed out that these Contract Research Organizations outsource and offshore the clinical trials on behalf of the multinational drug companies and ensure one window solutions for getting approval of the DCGI.

Meanwhile, the issue, being of national importance has been raised in MP Vidhan Sabha and the Rajya SabhaIn response to a question in the Madhya Pradesh Vidhan Sabha, it was stated that out of 81 patients who had suffered serious adverse effects, 33 persons have died. A list of names and addresses was provided which indicate death of 33 persons including children. No action has been taken by State of Madhya Pradesh inspite of such shocking state of affairs.

The Union Minister of Health and Family Welfare in a recent answer on March 13th to a question in Rajya Sabha pointed out that during the last 3 years 2009, 2010 and 2011 a total of 1229 trials were conducted in which 1743 deaths occurred in last 3 years and 2163 deaths in last 5 years as per data collected from Rajya Sabha and RTI documents. It was also mentioned that only in 22 cases of death in 2010 that the compensation has been paid by sponsors / clinical research organizations. The Petitioners – Swasthya Adhikar Manch are extremely concerned at this situation and further increasing number of deaths. We urge that even during pendency of the Writ Petition, the Union Ministry of Health and Family Welfare should take steps to stop the illegal clinical trials.

Amulya Nidhi, Chinmay Mishra

(9425311547), (9893278855)

(amulyabhai@gmail.com) (chinmay.saroj@gmail.com)

Drug trials: A father moves Drug Controller General of India (DCGI)


Feb 12, 2012 INDORE : In yet another complaint against the unethicaldrug trials that took place in the city, a local resident lodged a complaint with the Drug Controller General of India (DCGI), Medical Council of India (MCI) and National Human Rights Commission on Saturday accusing some city-based doctors with a clinic of making his son a trial subject after keeping him in the dark.
Om Prakash Agrawal, a resident of Rajmohalla here, alleged that the people involved in the controversial drug trials kept him in the dark. He alleged that the drug had severe side-effects and the health condition of his son, Nitin, continued deteriorating. “After my son failed in examination, his mental health became unstable. He was not a healthy volunteer. Then, how could the doctors conduct trial on him,” asked Agrawal.
The complainant stated that a medical store owner referred him to Dr Abhay Paliwal at his clinic in Geeta Bhawan. “Nitin was admitted in May 2010 and we were told that he would be alright in a few days. They asked me to sign on some forms, which were in English. Though I could not understand the content, I signed on it trusting the doctors. My son was admitted to the hospital for 10 days,” stated Agrawal in his complaint.
Informing that the ‘treatment’ did not yield any result as per the promise, Agrawal complained that the doctors used to take blood samples 8-10 times a day.
“We even opposed when doctors collected blood samples frequently but no one listened,” alleged Agrawal.
The complaint alleged that an Ahmedabad-based company, Intas, sponsored the trial for which approval was taken from city-based Naitik independent ethics committee and ethics committee of CHL-Apollo Hospital.
Nitin was also not insured against clinical trial liability and is still taking the medicines for his ailment. He was not given patient information sheet and a copy of informed consent form, the complainant added.
However, the doctor involved in the particular case clarified that no trial was conducted without informing patient or family member. “I do not remember the case. I have to check the records. However, no trial was conducted without taking consent of the patient or family members,” added Dr Paliwal.
After my son failed in examination, his mental health became unstable. Then, how could the doctors conduct trial on him.

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