[e-drug] Commercialisation of medicine

E-DRUG: Commercialisation of medicine
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food for thought .. [Unfortunately not only happening in countries without a publicly funded health care system. Since Reagan and Thatcher it has spread to the best of places. Moderator]

Dear All,

*Commercialisation of medicine*

*By Murad Moosa Khan*
http://www.dawn.com/2009/02/16/op.htm#3

A FRIEND'S wife who recently had her baby at a private hospital in Karachi
spoke excitedly about the room she stayed in as well as the general decor of the hospital. She described the hospital as a "five-star" facility and her consultant's room as "out of this world"!

The fact that her bill was in six figures was of little consequence, as her
husband's multinational company took care of it. And this is in a country
where thousands of women die during childbirth every year. Of course, none
of their husbands are executives in multinationals.

Medicine in Pakistan has become a highly commercialised business, where the
bottom line is about profits and money. In Pakistan, there is little or no
regulation of medical practice or accountability for physicians. The absence of an effective public-funded health system has been one of the major factors that have contributed to our poor healthcare and the
commercialisation of medicine. Equally important is the lack of
professionalism and integrity among physicians in Pakistan.

Today, physicians work in a world where the challenges imposed by the
marketplace and self-interest are overwhelming. In the past, we spoke of
patients, doctors, illnesses and compassion; we now speak of clients,
consumers, providers, products, contracts, volumes and services.
Simultaneously, advances in medical technology are enabling healthcare
professionals to diagnose many conditions with modern investigative tools
and to cure potentially fatal diseases with a pill or a laser beam. The
physician's involvement in this treatment is often only a technical one.

What are the implications of commercialisation of medicine for the kind of
care provided to patients? Are physicians obliged to adhere to a system of
virtue and ethics that often requires selflessness when other professionals
such as bankers, businessmen, stock brokers, etc pursue self-interest and
profit in an unprecedented fashion? Or, has the kind of care outlined in the Hippocratic Oath become obsolete? Have we reached the point where patients are viewed as articles to buy, trade and compete for? Have we become so focused on profits that we have forgotten that illness requires caring which, in turn, relates to a demonstration of compassion?

Pakistani medicine is facing a serious crisis today. Every health indicator
makes sorry reading. We have one of the highest rates of infant and child
mortality, tuberculosis, hepatitis, rabies, hypertension and diabetes in the developing world. More than a third of our adult population is estimated to suffer from depression.

Successive governments, both military and civilian, have paid only lip
service to improving the health status of the population. National health
policies are not worth the paper they are written on; the annual health
budget is less than one per cent of the overall budget. Whatever little is
allocated is eaten up by rampant corruption, poor governance and gross
mismanagement. There is neither an understanding of nor the political will
to invest in the health of the population. Most healthcare is out-of-pocket
expenditure and government hospitals are accessed by only the poorest
sections of society.

In the absence of a public-funded health system, private medicine has
flourished in Pakistan and has now become a huge moneymaking enterprise.
There are thousands of private clinics, maternity homes and small and
medium-sized hospitals all over the country. Private medicine in Pakistan is totally unregulated and hospitals and physicians can charge what they like and are not accountable to any authority. A few physicians and hospitals pay the right taxes while sporadic stories about 'stolen kidneys' or 'death during delivery' reported in the press are merely the tip of the iceberg.

Everyday, millions of patients undergo unnecessary blood tests, CT and MRI
scans, angiograms and endoscopies that place a heavy financial burden on
patients but enrich laboratories and physicians. Many physicians get
kickbacks from laboratories and radiology centres for referring patients to
them and numerous specialists charge over Rs1,000 for a five-minute
consultation. A senior neurologist charges Rs3,000 for a five-minute initial visit, at the end of which a buzzer goes off and every minute beyond the allocated five minutes is charged at the rate of Rs1,000 per minute.

A psychiatric hospital is well known for its liberal use of
electroconvulsive therapy on every patient who is admitted there. IVF
centres (fertility facilities) charge hundreds of thousands of rupees for
procedures on young women, when many can conceive naturally with proper
counselling, and regulation of their menstrual cycles. None of these centres are regulated by any professional body in Pakistan.

Medicine in Pakistan has become a business in the truest sense of the word.
Physicians in Pakistan operate with impunity, knowing they are not
accountable to anyone. While the General Medical Council (GMC) in the UK
strikes a few doctors off its register every year for reasons of
incompetence, negligence or unprofessional behaviour, rarely has the
Pakistan Medical and Dental Council (PMDC) cancelled a registration.

On a personal level, no physician has the moral right to live extravagantly, driving gas-guzzling four-wheelers or luxury cars. They must remember that they do so at the cost of thousands of patients; many of whom break their backs to undergo expensive medical treatment in private hospitals. Living modestly, being role models and remembering that medicine is a moral venture, rather than a business enterprise, should be the enduring ethos of all physicians, especially those working in poor countries such as Pakistan.

Ultimately, both our understanding of and personal approach to the
patient-physician relationship depends on our perception of what it means to be human and of the purpose and meaning of human life. If there is any
profession that requires its practitioners to be truly altruistic, it is the profession of medicine. As the medical historian C.E. Rosenberg once said, "Medicine became distinguished when specialised knowledge was used for the benefit of the patient. It became noble when the needs of the patient held sway over the interests of the practitioner."

The writer is a professor of psychiatry at the Aga Khan University Hospital.

muradmk@gmail.com

Shazia Jamshed
shazia_12@yahoo.com

E-DRUG: Commercialisation of medicine (3)
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The Moderator pointed out that this thread is outside e-drug focus so this will be the final posting. Thanks Richard- Moderator

In 2005, I saw this at (nearly) first hand. I was staying with an
elderly relative in Wales, whose replacement knee was causing a lot of
trouble and pain. It was an NHS job, done for under 1,000stg. During the
course of my stay, we visited a person in Cardiff. She was an elderly
lady who had also had a knee replacement. However, she couldn't stop
talking about how good a life she was having with her new knee. The only
difference? Hers was done privately, at a cost of 23,000stg!

Richard

Richard J. Prankerd, PhD
Senior Lecturer
Department of Pharmaceutics
Monash Institute of Pharmaceutical Sciences
Faculty of Pharmacy and Pharmaceutical Sciences
Monash University
381 Royal Pde., Parkville VIC 3052

pHone: INT+613-9903-9003
pHax: INT+613-9903-9583

E-DRUG: Commercialization of medicine (2)
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[As this topic is a bit out of e-drug focus, I will not encourage further messages, but let this one from an active member pass! Moderator]

This is indeed reality today; but of course it goes far beyond medicine
alone - it is a commercialization of the world, sometimes rightly or
wrongly called "globalization"!

I was in a lift in one of these "starred" hospitals recently and my
attention was drawn to a rather captive poster headed "Hurry and benefit
from 10% discounts" or something like that. I wondered who could be
trying to target a "commercial" to a group who would probably only be
worried at the time about their own or loved one's health. As I read
further, the notice continued 'Have your angiogram done between January
15 and February 15 and save..."; the poster went on to quote the actual
costs. I was in the lift, on my way to the physiotherapy department to
enroll in a "back programme". An MRI of the spine I had been asked to
have done showed a potential problem around my L5/S1 disc which was
"compromising the nerve root...." and responsible for my pain. But the
other part of my story is that just before I left the orthopedic
surgeon's office, where he had prescribed a 3-months' course of vitamin
supplementation,including calcium, I noticed he looked rather "cold" and
uninterested and I worried that there was a major problem. When I
inquired, he responded; "No...No....No..., I do not see any major
problem and you probably won't need to come back to see me again"! -

Could this have been why he was disappointed?

Murtada M. Sesay
Senior Pharmaceutical Product/Supply Chain Officer
UNOPS
New Delhi, India
Tel.: +91 11 3041 7430
Fax: +91 11 4350 8527
Mobile: 9971992883
http://www.unops.org
MurtadaS@unops.org

E-DRUG: Ugandan president will hang counterfeiters
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Dear All,

According to the president of Uganda, individuals who manufacture, import, distribute or sell counterfeits should be executed. See:
http://www.monitor.co.ug/artman/publish/news/Hang_counterfeiters_-_Museveni_80200.shtml

The president notes that Medicines (Pharmaceutical products) are among the most counterfeited products. I hope his definition of counterfeits does not include generics.

Mulumba, Moses
mulumba_mos@yahoo.co.uk

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Emmanuel Gyezaho, Kampala

Individuals who manufacture, import, distribute or sale counterfeit should be executed, President Museveni has proposed.

He said such individuals endanger lives of millions and create revenue loss to the government.

The President made the remarks yesterday in Kampala while opening a workshop organised by Africa Matters, a pan African investments group, led by Baroness Lynda Chalker of Wallasey.

Mr Museveni said he would be comfortable employing the harsh communist Chinese strategy of hanging culprits who profiteer from counterfeit goods, to deter individuals from indulging in illicit trade.

“I think in China they’ve got some good solutions because you remember the other man who sold milk which killed children, I think he was put on firing squad,” said the President. “If somebody kills children, do you think the Chinese are very wrong?”

Last month, a Chinese court sentenced three people to death and two others to life in prison for their roles in the country’s tainted milk scandal which killed at least six infants and sickened nearly 300,000 others.

The health of Ugandans and other African citizens came under sharp focus as participants heard that anti-malaria drugs, anti-retroviral drugs, foods and beverages, plus other consumable goods are the prime pirated goods.

“We know that more than half the anti-malaria medicines in Africa are counterfeit,” said Ms Chalker. “This is an evil in our society.”
The severe effects of consuming substandard products are what could have inspired Mr Museveni to propose the death penalty as punishment for dealers in counterfeit goods.

He was, however, mindful of the global liberal stance on the death penalty and quickly quipped: “Now I don’t know whether you want to think of such a solution...but I can see my liberals from the West shaking their heads.”

His idea of sending offenders to the guillotine was only part of the proposals of punitive measures that formed the highlight of discussions to rein in the dishonest trade.

Outgoing trade minister Janat Mukwaya told delegates that the government had finally come up with a new draft law-The Anti-Counterfeit Bill 2009, detailing stringent punitive measures against offenders.

Top of the punishments is a fine not less than five times the market value of the genuine products and a minimum five year jail sentence to culprits found in possession of pirated goods.

But individuals who manufacture, produce or make the counterfeit goods, Ms Mukwaya said, will be liable to paying a fine 10 times the value of the genuine goods, an order of permanent closure of business premises and a jail sentence.

“The Bill is now going to cabinet,” said Ms Mukwaya.
Participants heard from new Finance Minister Ms Syda Bbumba, that the Ugandan market is flooded with counterfeit goods, manufactured primarily from the Asian continent with China as the leading culprit because “of their low cost of labour, cheaper prices, size and proximity of markets.”

“Uganda’s market is one of the largest recipients of counterfeit products and this is because they are cheap, people are poor and will go in for the cheapest,” said Ms Bbumba.

Uganda Revenue Authority boss Allen Kagina admitted that URA was finding it “very difficult” to identify and withdraw fake products once the goods manage to go through the porous borders.

“URA needs to be aware before the goods arrive,” said Ms Kagina, adding that the revenue body is currently relegated to relying on information from owners of trade marks about product imitation or replication.

Drinking from Museveni’s spring of knowledge

- Supports Chinese execution of counterfeiters. “If the person is killed, he won’t use the money gained from counterfeiting.”
- Has stopped eating kaalo (millet bread) because sub-standard grinding mills used leave metal in the flour.
- Shelling groundnuts and leaving them in the open is dangerous, exposes them to fungus which destroys liver.
- Ministry of Health should launch radio campaigns, advising public against keeping shelled groundnuts overnight.
- Ugandans surviving by chance like wild animals. Zebras are not treated but they survive.
- Counterfeits in the past were confined to luxuries like watches, but the evil now has gone into milk products for babies and into drugs for human treatment.
- We must act now, we must act fast and we must act decisively

Most counterfeited products

Electric cables
Electronic equipment
Cosmetics
Toothpaste
Medicines (Pharmaceutical products)
Pens
Plastics
Foods and Beverages
Soap