Please read about an instance of the nexus between pharma companies and opinion leaders of the medical profession in this url
http://www.emorywheel.com/detail.php?n=25943
ഇന്ത്യ
6 months ago
Monday, November 10, 2008
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44 comments:
thank you for showing this article..
continued from earlier discussion of problems related to our health care system…
Dear friends,
We have a lot of things to do. The list will be bigger than an encyclopedia. It is obvious that we can’t do all of those things how hard we try. So we have to make some priorities. We usually try to solve more serious issues first and then move on to less serious ones. That is the basics of planning. I hope you do not disagree so far.
Lack of a government initiative may be the most serious issue as noted by many doctors and it can be solved by a simple policy making, they think so. I am agreeing it for the sake of the argument momentarily. Still there are issues where I can not agree even for a moment.
Either left or right is going to rule here in Kerala. We do not have many options in the Centre too. In this era of globalization, we are ruled by multi national companies via organizations like WTO or Local Governments of countries.
What will you do if a government policy is not coming to save our health care system?
You must answer this question to continue a useful discussion.
Your choices are
Not to vote for any already ruled governments.
Join the politics and be a part of policy making.
Do nothing, blaming the government always and be a part of the corruption.
It is obvious that our choices are limited. A quick reversal in the global scenario is a false hope. I do not have much hope in our governments too. I do not vote for any party for a long time.
But we can not let it go like that, at least for me. I am misfit with the current system. It makes me nauseating.
I thought about it a lot and I tried to look at it from another angle.
In our choices, the second one looks promising but it may not be so promising to my logic. We have many rules and regulations here, always violated by people.
The percentage of road accidents will decrease dramatically if people follow road rules, regulations or laws. People are not wearing helmets not because of an absence of law. Public smoking is still going on with all kinds of regulations, laws and other government actions. Most of the people will not protest if they have to sit or stand near a smoker in public places. You or I may protest because we know that passive smoking is injurious to our health but if we do not know that, we may simply ignore it. I do not expect people to protest for the laws but they will, of course for their health. Most of the people do not ride a bike at a speed of 120Km/hrs not because there is a law prohibiting it but they are afraid of their health.
Doctors will continue to prescribe unnecessary drugs, unnecessarily expensive drugs, unnecessarily expensive brands, unnecessary laboratory examinations even with strict rules and regulations, if people are happy to receive these drugs or tests.
There already exist a lot of WHO and other guidelines but happily ignored by our doctors. But they will be okay if our own government comes with a new guideline. They are impatiently waiting for the guidelines for many years! It is the only missing link!
But prescriptions will be thrown into waste bins and doctors will be questioned if people are aware that they are being manipulated, forced to waste precious money and time or they are not getting what they deserve to get.
Social reforms can come in many ways, but the way of awareness and education is superior to any other way, undoubtedly better than ways of force and power.
Gandhi did not wait for British to become benevolent and bless with freedom. He forced them to make a decision in favor of him, or for the people of India.
Sree Narayana Guru did not wait for a government induced castles society. He fought and won up to some extent.
Such personalities are not yet born among doctors, with a power to enlighten a mass of people.
No government can close their eyes to a powerful public protest. It is the only way, the way of public awareness and protest, where ever it may, that gave a sustainable social transform. You should better learn the history of social reforms around the world if you are skeptic of this, and if you are having a slave’s dream of master announcing freedom.
I have heard many people saying that of KSSP’s anti drug campaign or Dr.Ikbal’s protets for many years did not make any improvement. They are not living here anymore! I do not have any medical background but I am protesting, I know many people including medical shop owners and medical representative aware of the issues and protesting. A large number of people are not susceptible to betrayal anymore but we need a critical mass of people to initiate a successful public protest. The works of Dr.Ikbal or other NGOs have impact. Still we have to attain major goals but 5% vision is better than total blindness.
An immediate U turn in the trend may not be possible but we must do small things we are capable of doing. We must not sit idle and who sit idle have no right to blame those individuals who shout from the roof. A protest against a single unethical doctor or a single pharmaceutical company has its own social value. You make two protestors and hope that they make four.
I predict that any such attempts from authorities to correct the unethical practices without social awareness will result in new forms of corruption leading to endless other rules and regulations. It is the history.
I wonder why you are always confused.
People smoke in public places.
People do not wear helmet.
Loud noise and sound pollution.
People break speed limits continuously.
People drink and drive. Etc…
Do wee need more laws, rules or regulations?
Do we need new government initiatives?
It is not that simple. Our problem is complex. Government is not independent of us. A legislative step is necessary but people’s needs should act through the ruling political party to happen it. And who sincerely wish for a change should participate in the policy making process. Or should keep mum while others are trying.
It is easy to stand aside and blame all others. But once in the process, one will feel the heat. Lack of complete success is not failure!
Thank you.
Dear Ajeesh and all others,
It is true that we have to do something. But I do not know what exactly to do or how to start. Increasing public awareness is one important activity. Dr. Ekabl and KSSP had done something in this line earlier. But as it is an issue with international implications, it is really difficult. We are getting all the patented drugs by paying the cost to international patent holders which are large corporations. We need them and their scientists to find out better molecules. They spend huge sums for original research. Out of several hundred compounds only a few end up to get approval for human use. In order to recover the costs, including those of failed attempts, they price the drugs at a premium. Obvious commercial interest starts creeping in when a successful drug is being developed for large scale production. In journals of repute, they insist on publication of 'declaration of interest' to ensure transparency. At least the reader will know whether the research is funded by a company with interest in the results. Mational Institute of mnetal Health (USA) and National health Services (NHS) UK have funded some research using taxpayers' money to avoid conflict of interest. But many of the top level researchers have worked for the major drug firms. Hence personal bias cannot be ruled out. The W T O is going to make it difficult for poorer nations to get the newer molecules. The gush of new molecules in the last few years might have been an effort to bring these drugs to our country.
Personal ethics and principles are very good. But when fighting corruption in politics, no body appeals to politicians or parties. If they stop taking money from the rich drug firms for the elections, they are free from deciding things to favor the rich after assuming power. This can reduce all the organized corruption to insignificant level.
I am surprised why nobody tries to educate our Netas about this simple step. We all behave as if 'corruption is an integral part' of democracy.
I have always felt that the best way to solve any problem is to attack the root cause of it. If our leaders and parties cannot apply restraint on themselves, how can we expect the doctors to do so?(of course the few ethicslly minded will be beyond all this). Why we (all the citizens of India) are unable to engage our parties in such a dialogue?
Obviously we all have double standards. We want the favor of some party or leader for some help. We do not want to antagonize the leaders or hurt their egos. They know our predicament very well. All of us are playing a game. A few honest men do it good for their own conscience or expecting God's favor.
Sorry to sound like a disillusioned desperate soul.
Thank you.
Yes
Society will change...tomarrow will be better than yesterday...
we can be part of the force to change ,or
we can remain silent or
we can be part of the negative forces...
the days of An Aristotle/a single person with knowledge of everything is gone..
I believe in the power and knowledge of present generation.!
I still remember the olden days...
years back I used to wait outside/watching Govt.institutions with apethetic employees with body languages which can demoralise anybody who approaches them ..
be it a Bank,
Insurance office,
Treasury,
Tourist department,
Hospital,
Bus stand..
But Today I see,a changed attitude...more competitive youngesters..
changing for a better future..
20 years down the line ,I see more people with self respect,
who believe themselves..
who believe that they are important for the society..!
As a doctor we can do small things which people will appreciate/try to emulate.
An example.
Suppose tomarrow We see a Statement by Keral mediacal association...
"Though medical profession have lot of grievences,we have taken a Bold Policy decision
'that, we will not resort to harthals/ Bundhs/lightening strike/which can harm patients,
as a method of protest.
We hope other organisations also follow our path/join us for the sake of our own society.
In return we expect
responsible decisions from our elected government withour experimenting our patients'.
Harish may be laughing..!
But I believe that this is
the response people expect from the most respected /educated /responsible section of our society.
I wish to know your responses.!
Dear friends,
Every now and then, one of the officers is arrested by vigilance for corruption. They include engineers, clerks, peons, police men etc…
None of the organizations of the above mentioned occupants did strike or protest.
Only doctors do that.
What is the role of WTO, WHO or Government in this connection?
There are corruption every where.
But where do we see the most organized form of corruption?
I am glad to know Dr.Harish and Dr.Vijayan’s stand on private practice of Government Doctors.
Thank you.
Dear Harish,
I think we have different views on the social dimension of the 'new MOLECULES' in India(marketed by MNCs).
You are starting your enquiry from the R&D centres of MNC and is following up the journey of these 'wonderful molecules' till they reach the 'neutral doctors' through highly paid/skilled market executives with unethical offers ....and then the final Target/Market(the less informed /helpless public).
The original question was ..in this scenerio what is the actual role of Indian doctors?
what should be their priority?
Can they have/show loyality to Pharmaceutical Industry?
All over the world doctors try to protect the interest of the public.!
Instead of accomplishing the duty of informing and safeguarding the public/Govt from the commercial interest of the Industry some of our Professionals are acting as mere tools of the Industry......and in the process they confuse the public by preeching for the Industry!.
One of the duty of our professional organisations is to regulate the unhealthy/unholy allience of some of their members with pharma industry...Nobody else would be able to do it in a better way...
May be because of my background,I usually view/understand things from the premises of the majority / our poor rural people based on agriculture( I cant have a MNC viewpoint).
Poor People( they are the majority in India.OR India belongs to them too.that is why we talk about them..sincerly not for personal political motives as usually alleged by educated minority) have lot of issues other than poor health !.
Their income is very low and life is miserable....
when you say all people are corrupt,you are meaning Govt.officials,business class ..(of course not this majority)
Income tax officers,Town planning Officers,Police ,Industrialists... etc
the growing correption in these offices are the real concerns for urban Middle class and upper class...
But For the majority of our people the basic issues are poverty,ignorence,torture,superstitions,lack of facilities for primary needs,communal violence,discriminations based on caste/gender...
or in short
problems are totally
different.
Regarding their health:
Nobody can deny the fact that
if our medical professionals and Govt(local/state/cental) are sincere ,
Optimum health care can be provided to all our poor patients at affordable cost...
But where is our profession?What are their priorities?
We need not confuse the scenerio...we need not feel incapacited by the size/strategies of the MNCs.
The available technology/expertsise are enough for our people..there is no confusion..
The question is ,whether the "cream of our society" is willing to be with the people or wanted to continue the pleasure of peanuts offered by MNCs!
I strongly feel ,medical professionals in our country should show maturity to say
a Bold NO
to the marketing strategies of the Companies ,rather than pretending to be still immature/retarded babies who are willing to be corrupted( with lame excuses).
The priority of these 'new molecules' for the health of our hundred million poor Indians is not worth debating..!
Do you disagree ??!!!
Dear Dr Vijayan, Ajeesh and others,
Dr Vijayan speaks as if I am the agent of an MNC. This is unfair. I am skeptical about many things including the pseudo rhetoric of our politicans and preachers of any kind. Dr Vijayan did not respond to my query on transparency in public life. I know of many instances of political leaders keeping a share of their public collection for personal use. This is even done with the election fund given by big parties to candidates. Huge sums are collected from industrialists and businessmen, this is then passed off as box or bucket collection from the masses.
I fully support the view that doctors shoud become ethical and SHOULD NOT act as distributors of some drug companies. My point is that the society is not able to stop them because no body including the political leaders have clean conscience. My next point is that isolated efforts by a few of us will not be very effective, considering the magnitude of the problem.
When I point out these simple truths, you suspect that I am agent of MNC. Earlier we had a group of extreme left youth who were branded naxalites. (I do not know whether the present naxal;ites are of the same breed). My doubt about them was "What is the point in killing one or two landlords? or liberating a panchayat or village in a country like India?". I used to say jokingly that they had not learned the geography of India. But their courage was admirable. Similarly it is admirable to be courageous and fight individually. It is even better to educate the public and form a colective of ethically minded doctors. But all this had been attempted by Dr Ekbal and others. Why there is no visible change? WHy there are advocates for supprting entrepereneurs and businessmen even from the left wing parties? I think it is a sign of changed times. Now we hear people speak of Private - Public participation. The area where such a participation is most relevant is health care and pharma industry. The drugs should be treated as a separate class. There has to be some restriction in the profit margins. Ideally there should not be any medical representatives. But this may affect the job prospects of several thousands. Hence politiclal parties won't support all this. The parties should stop taking donations from the drug firms. There should be tranparency in fund raising of political parties. I am surprised about the lack of intereest shown by Vijayan and Ajeesh to discuss this issue. The parties should at least follow the method of publishing statements of 'declaration of interest' or the list of their major sponsors.
Private practice of the govt doctors: Ajeesh may be surprised to know that the Kerala Govt medical College teachers Association (it is the only union of mc teaching staff) has been demanding ban on private practice for past few years. But no political parties are willing to enforce the ban. There are many reasons. One could be that politicans cannot extract money from doctors in the name of transfers etc. Another important reason is the current state of health care system in Kerala. There is no way to regulate the conduct of private hospitals in our state. They can virtually get away with anything. No specialist doctor is available in most specialty hospitals after 2 or 4 pm. Majority of the wrking class return home by evening and this is when they take their relatives for consultation. It wont be possible to see any doctor except the resident junior doctor at that time. The other availablke option is a governement doctor doing residence based practice. The politicians are sensible enough not to close door on this service. Residence based practice is one effective way of getting quality medical care at cheaper costs. The way the 'multi'specialisty hospital loot the hapless public is well known. But I still agree that government should ban private practice of government doctors.
Thank you
Criminal Prosecutions of Drug Companies
Dear friends,
It may be true that our politricians are accepting money from drug mafia.
It is our experience that a legislative step is not going to happen.
It is also true that majority of the doctors are not willing to stop unethical practice.
Drug mafia is not going to cut down on their dirty profits.
Medical associations won’t help.
What can we do? What are the options?
It is useless to continue blaming each others. It is not productive.
Anyone can suggest their own models of rescue plan.
My plan is to educate people about the problem and try to make an irresistible public protest. You may jump into say that Dr.Ikbal or KSSP tried and failed, and failing for many years. But we have no other choices, don’t you see? Or you come up with an alternate plan.
Many freedom struggles failed but we continued and succeeded at last. India didn’t win freedom in the first or second struggle.
We need a critical mass to initiate a successful public protest.
I hope that we can do. All ethical practitioners must join hands together to fight along with public. Spend at least 10 minutes every practicing day for patient education. I know that all of you good guys are not giving patients unnecessary medications but you must not be afraid to tell them
“I can give you many expensive drugs like all others to give immediate relief but that is harmful to your health and pockets.”
Talk to them of common tricks played by other unethical practitioners. Remember, you are going to make a lot of enemies. But you may also get a lot of right minded patients too.
Write down about all unethical practices and send anonymous email to all available email addresses. That will protect you from your own medical associations.
Thank you.
Dear Harish,
I evaded your question on politics..mainly because I agree with your allegations on politicians.
But I do not blame our political leaders ! Do you think it as a paradox!
I am of the opinion that over the last few decades our politics have improved a lot..!
what ever be the provocations, nobody expect VS Achudanadan cutting off both ears of Chennithala publically,..or
UmmenChandi will not cut off the hands of Pinarayi Vijayan..
Just 200 years ago these things were very common in our state..!
western influence make Harish and me these atrocities intolerable..!
we have to wait...Democracy was forced upon our people...
and even now in kerala our concerns regarding human rights grossly differs.
I expect virtues in educated people than in the general public.And naturally I expect more cultured behaviour from doctors , just because they are more educated..!
"Why Our politicians behave like this?"This is the question you ask again and again..!The Answer is in the in history..
You see the stages democracy in different population.!
Trivandrum.1800 AD.
Mathew Tharkan(The founder of Manorama) and Sankara Narayanan Chetty (another public figure in Trancore)were whipped, ears were cut off publically by OUR great VeluThambi ...for opposing him..!!
How Veluthambi became the ruler?
The commonest techniques applied by the rulers of those days were summoning rich people to the palace tie their limbs and beat to extract maximum wealth from them.
One day the turn of Veluthambi,then 'an ordinary' rich man .... .
The ministers demanded him to pay three thousand rupees to the coffers or face dire consequences. Three thousand rupees at that time was quite a hefty amount. Veluthambi, smart as he was signed an agreement that he will come with the amount within three days and went home.
He was successful in organizing a large army of followers within the short time of three days and marched to the palace. The King succumbed to the demands set by Veluthambi.
BC 399
Parliment..Athens.Greece,Europe
..a arguement is going on!
....hearing the arguments of both Socrates and his accusers, the jury was asked to vote on his guilt. Under Athenian law the jurors did not deliberate the point. Instead, each juror registered his judgment by placing a small disk into an urn marked either "guilty" or "not guilty." Socrates was found guilty by a vote of 280 to 220.
The jurors were next asked to determine Socrates' penalty. His accusers argued for the death penalty. Socrates was given the opportunity to suggest his own punishment and could probably have avoided death by recommending exile. ..
It is said Socrates opted for his 'suicide' as he wanted to uphold his views on Virtues of a noble citizen.
You see the status of democracy in Europe ..2400 years ago and in kerala 200 years ago.!
So please dont lose heart....
We have a long way to go...
Genetically we are not different!
Thank you
I encourage you to read a letter here.
Letter of Resignation from the American Psychiatric Association
4 December 1998
Loren R. Mosher, M.D. to Rodrigo Munoz, M.D., President of the American Psychiatric Association (APA)
Dear Rod,
After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization's true identity requires no change in the acronym…
..........................
… We seem to have forgotten a basic principle -- the need to be patient/client/consumer satisfaction oriented. I always remember Manfred Bleuler's wisdom: "Loren, you must never forget that you are your patient's employee." In the end they will determine whether or not psychiatry survives in the service marketplace.
_____________
But here it is true for all specialities.
As once Dr.Vijayan said in one of his comments, it is doctors around the world who speak of unethical practice but here we try to stitch their lips with all kinds of accusations.
……. I've heard many colleagues spout: "I'm not influenced by the drug companies; the dinners, the gifts, and the marketing campaigns don't affect my prescribing practices."
I can't make that statement. This becomes even more knotty when we see how much research and how much publishing in the professional journals are either fully sponsored or underwritten by drug companies. Of course I'm influenced by them, I'm just not sure how much and in what ways. I have my suspicions, which are reflected in such questions as, Why are we so quick to abandon old medications when the new ones come out? If people spent the same amount of time, energy, and money extolling the virtues of off-patent medications, would we switch so quickly? ………..
Thoughts on Pharmaceutical Companies and Gifts to Physicians
Charles Atkins, M.D.
Charles Atkins, M.D., is a psychiatrist, freelance writer, and member of the Yale clinical faculty.
.................................
I am really surprised to know that some medical association is demanding the abolition of private practice of government doctors. Why don’t they simply stop?
While I was in school, one of my classmates asked to my teacher.
“Why don’t you beat the hell out of me, you see that I am not attending classes?
dear ALL,
Yesterday while chatting over a cup of hot coffee,my friend ( was in Bangok recently) was lamenting..
telephone department is really horrible ...
he was narrating the story of his application for a telephone transfer....
no response..tried through friends..through politicians..
finally he met the clark in charge of the file in person ..who was very friendly &invited the doctor with all respect and even offered a chair to sit!..
to my friend's anguish the clark reciprocated without losing his temper .......
dear doctor, last two weeks most of the time I was in the medical college,as a bystander of may ailing mother ..her surgery was getting postponed for silly reasons...finally the doctor demanded Rs.500/-and somehow I managed to give that amount...see how difficult these days..
Immedietly my friend gave Rs.500/ and got the phone transfered.!
Corruption has a vicious cycle.... we have to break it!
Any Corrupt person will have valid reasons...
If we are talking about a better tomarrow,it is hightime that we restrain from searching blame in somebodyelse for our crimes
Thank you
!
Thank you Sashi, I will consider your suggestion seriously.
Hi Sashi,
I hope you will take a look at my comment titled The third factor of social conditioning in a newer blog post titled "Computer and Internet Addiction".
Government alone will not be able to solve this problem. There are practical difficulties from government as our problem requires a lot of professional knowledge and resources.
Thank you.
Dear Vijayan,
You seem to have a fair knowledge of history. But is it correct to say that politics has become less violent because of the virtues of the current leaders. I think not. It is the effect of several changes that took place over time. Even now, our parties are interested in aggression against nonsupporters and dissidents. I do not compliment any politician except Mahatma Gandhi and a handful of his ardent followers for holding on to the princilpe of nonviolence.
You semm to be contended with the current system prevailing in our country. You insist that doctors should voluntarily adhere to the socialist system, when even the left parties are fsvoring capitalist maket economy (though they will not admit this openly).
My point is that it is better to allow things to change gradually in stages. Forced changes do not produce any sustained effect. This is true of revolutions in Russia, China as well.
The effort should be to make the workings of the system transparent. There should be a state in which it is definite that erring leaders or officers wil be booked and punished.
If we are able to ensure this, the rest will follow. We have to identify the forces who prevent such reforms and expose them in public, even if they are of the party which you favor. I view any internal strife in any party as an opportunity for such change. Same is my attitide to internal conflicts within orgabized religions. These are opportunbities.
But in the case of doctors, I am not sure whether such a strategy will work. This is because as medical professionals we are bound by certain rules of conduct - written and unwritten. I have read all those posts (by click to see, whoever that is), long ago. Again the situation is the same. Those who protested finally left the mainstream. They can be happy that their conscience is clear, if they believe in hell after death.
I am not sure whether fighting with our colleagues can have any positive impact. Even the young interns do not have a high opinion of being an idealist. Everyone is sure that socialism is dead and you will be left out if you are an idealist.
Can you think of some practical ways to educate our own fellow men without antagonizing them?. Media cannot be counted upon always as they are after sensationalism only. Neither the organized political parties who are steeped in corruption to their nose. There is no Mahatma or Messiah in sight. Pessimism and cynicism is all around.
Bye
Click here is me, both name and the word click can not be in the same place. It is a technical issue only. I provided the link because I thought it is relevant.
Intellectual fights should not bring personal dislike though we may use aggressive language. Logic should be understood and all remaining factors must be forgotten.
I am discussing and not arguing, you may have noticed it from my changing view points.
Thank you.
Dear Harish,
As you believe ,I am not happy with the performance our current political leaders.!
To me all of them are not of the same creed!...
I have no political party to support/suggest..Because they provide less than what is expected by the electorate/or their potential.
I think Harish and majority of our people share this view...You rarely see a person who believes/boast a particular political party is perfect...
But the situation is not that hopeless.... we are progressing...and everybody contribute in the progress,including politicians.
While discussing health, I was showing some aggression while discribing the role of our professional bodies..It is because I know many of them more than political leaders....
Most of the things in your last posts are true..
.! I agree with you..!
On stopping private practice..
somehow I think it is not going to bring any drastic/even positive changes in the health care system( my original believes on private practice are changing).If all other things remain unchanged...
Even then It will improve the quality of medical education.!
But as long as Govt./health ministry is not committed to the health of our people,stopping private practice of Govt.doctors alone will have more negative effects than imagined/expected benefits....
How?
I wish..
Our health Ministry has a Vision for the new Century Kerala...
if we had an Health Minister who can talk in International platforms... WHO,UNICEF,EU parliment....and can proudly persuade them to advice other countries to follow our model of health..and......
We need leaders who can make us proud..!
*******************************
Private Practice of Govt.doctors.
The average salary of a govt.doctor is less than one fifth of an ordinary private hospital doctor.
Doctors working in Middle East get 15 times this salary..
those migrated to US/UK and other countries the salary /other facilities are much more.!
Nowadays Kerala PSC is not getting enough applications for the post of medical officers in health services...
those who have joined are in the Q with bribes for leave or are resigning..!!
Posts are remaining vaccant( for want of candidates) is almost all medical education departments..!
How many malyalee(other than doctors) will resist the temptation and work for their institution/state/country if a high salary of 15 times is offered else where.? Not more than 10% of us ! right?
Then what motivate this small group of doctors who serve their people?
Are tehy getting the recognition/respect that they really deserve..?
I would say NO..!
It is true that Our Govt.is not in a position to provide a decent salary that they really deserve for their qualification and responsibility of their job..
A substantial hike in salary in not practical( even if Govt find some alternative for finacial allocation) as other Govt servants also are important for the Govt...tax payers are also important.!
Private practice is of course is an additional source of income for those who are willing to practice at their leisure time...
If the doctors are able to concentrate more on teaching of students/research etc,than practising,it is more beneficial to the doctors( It improves his skill,More research papers..better Cv for better posts abroad) than (doing routine work) treating patients at his residence( less complaints!!)...More life...
How far our Govt is interested in improving the quality of of our medical education/research?
In the given situation,if everything else remain unchanged,the act of stopping private practice of Govt.doctors alone will aggrevate the problems of Govt.services than bringing the magic demedy for all the ailments..!
Medical education/research needs the best and dedicated doctors....At present the few altruistic doctors who remain in the service resisting all temptations is bearing the public wrath for lack of facilities,neglect of patient care...etc..and have to share the blame for the unethical practice of the few who struggle for survival.!!
Sashi/Ajeesh,Please Convince me that I am wrong ....as I always argued for stopping private practice..!
Dear Vijayan,
Nobody is getting enough salary compared to developed countries, it is not only doctors. But there are other facts too, it is difficult to look after a family of 4 members with an individuals salary in most of the developed or European countries. In India, a government doctor’s salary is enough to buy food, clothes, shelter and other needs for his family. In some panchayat offices and some public offices there is huge workload and the newly appointed clerks get only a salary of Rs.7000/-. I have already said that a doctor has more responsibilities than others as he is working in the priority sector. If you want to make more than enough money you need, you can start a business or join the Indian politics. But this decision should be made after your pre degree or plus two. Do not waste tax payer’s money studying at government medical colleges and not serving who paid for you. The poor people of India spend their hard earned money to educate you as a doctor. I will not be against private practice of government doctors if their attitude is same both at government hospitals and PP rooms. Corruption should be tolerated as it is a biological nature of human beings but there is a limit. I think the greed of some guys triggered this discussion. There are doctors grabbing remaining money in patient’s pockets reserved for bus fair. There are doctors who advise more than 12 to 17 drugs in single visit without any justification. There are doctors who actually make physical fights with medical/lab shop owners for not getting enough commission. There are doctors who get more than 1 lakh per month from deals. This information is told bold by a drug controller (intelligence division) in a cable TV channel interview and I hope he was not lying. You can correct me.
Doctors are the employees of patients.
Thank you.
Dear Ajeesh..
I can understand your emotions..! But what is the reality?
I will tell the medical story of calicut which is a very small town....
OBG department is one among the many of the dept in the calicut Govt.medical college..
statistics show nearly 30,000 deliveries are conducted every year... caeserain section about 20% of total deliveries ie, 6000.
The department is manned by less than 15 doctors ..many posts are remaining vaccant....
In addition to Conducting deliveries the doctors have to train post gradutes,undergraduates,nursing students,other paramedical students,adminstrative works,training programmes,reserch programmes ,thousands of OP patients daily ,Post partum sterilisations, Major Gynaecological surgeries,has to attend medico-legal cases in the hospital and later in the courts....
the overworked employees are working under tremendous pressure.! why..?
They dont has enough staff,or enough facilites,no theatre for all emergency cases,can not take leave( as leave by one staff means torturing of his/her colleuge)...i am not elaborating everything here.
What is the situation in the nearby star Hospital,where the gyneacologist is getting 10 times the income.?
Total number of deliveries..1200/year
Gyneacologists... 10
Caeserian 60% of the total deliveries.
Average Charge 10,000/- for normal delivery
20,000/ for caeserian.
So if one private hospital is getting the pt of Gyn dept of IMCH Calicut , their annual income from a single department alone will be more than 60 crores..!
So imagine the "revenue" actually would have been earned by one medical college alone if we include calculate the 'income by other more profittable departments also.. Then the income from Medical and para medical students.! Teaching is a byproduct in these medical colleges...GOvt is not spending much extra for it..it is a popular myth,which unfortunatly ajeesh also shares..
At IMCH All surgeries and deliveries ,OP care IP care..................... etc are done free of cost..!
So Govt institutions play a very important role in the health of our people which is 'forgotten' by the MEDIA/critics of our Govt.institutions..
But this is not an innocent mistake ,but part of a deliberate design by much more greedy "unholy allience " with more dangerous magnitude..
So you are giving the option of leaving the Govt.service to the few doctors who are aware of the opportunities in the same town..! Then who will serve our people?
Even Private hospitals are not getting enough doctors..that is why they have to pay more..!
Do yuo think people will afford,the charges of private hospital?
I hope you are aware that many doctors are working under trementous pressure as media is after Govt institutions(with ulterior motives),to tarnish their image in favour of the competing private hospitals! In the private hospital all treatments are either free or are at subsidised rate for all members of the press and visual media .! And as you know,there is no public relationship department for Govt.institutions..whereas all private hospitals have armies of young energentic trained staff in relations department to 'entertain'media.!They have private " Gundas' to intimidate the unhappy costumers!All private hospitals have political leaders as sponsors!
So you will see Media flooded with stories of Govt hopitals.discussions in channels..so people like you who have to give moral support to the 'demoralised' employees who are working in disadvantageous sitations percieve them as 'enemies of the public'. and order them to leave the service...for what? For whom?
I see this as a well designed plan for the change in favour of privatisation of health sector,and collapse of public sector..
this is not a cold blooded murder alone..but the the professional organisations which unnecessarily trying to protect their erring members is making it a suicide also.!
I think I can agree to the points raised by Dr Vijayan in his previous post. Banninh private practice of governemt doctors is not the solution for all the evils of pour health care system. There are agencies - medi, politicians, medical and paramedical persons etc - who try to undrmine the already weak government sector. Stides done by KSSP show thateven within the government secotr, there is a small private enterprise which acts as another group with vested interest. Ajeesh may remember the reasons behind the long delay in shifting MCH from Alleppey town to Vandanam. The private interest group within the government (this includes people who run labs, chemist shops, hotels ect close to the goverment hospital and a few doctors who support this lobby) was said to be delaying the shifting as it wu\ill reduce their business.
The list of specific isues will b elonger if we all start to share experiences. My appeal to all of you - especially Dr Vijayan, Ajeesh, Sashi etc - is to come with some practical solutions. Can we arrange a meeting to discuss our views and chalk out some strategy?
RThank you
Dear friends,
You have to notice the difference of salaries obtained in IT profession from government departments to other private companies like Reliance or TCS. Will government allow an employee to set up his own private engineering firm?
Now major shares of money go to a few popular government private practitioners and they obtained their popularity through government hospitals. A lot of MBBS holders are working in oil rigs, ships, deserts or military camps to support their family. They will get an opportunity to set up their own private clinics in rural areas if government doctors stop their PP at home. Some big boys always get the bigger of piece of cake while others are starving.
There is an observable difference in the attitude of doctors in PP rooms and in hospital rooms.
Thank you.
Dear friends,
In a socialist view point, it is State’s responsibility to provide adequate health care and all other basic needs. The attempts to set up such a system failed all over the world. Any social reform forced from the state for the unwanted public will not result in a sustainable development.
We need to find a sustainable model of development and I think that will not be possible without public education. If you give a thousand rupee currency to a small kid, he may throw it away or he will use it as a toy. It simply means that we do not give anything to public that they are not aware of the value. The kid will be happy if you give him a requested toy and he will keep it safe.
The reality is not so simple. We may need specific approaches to different problems. But I think social education plays a role in everything.
Thank you.
Dear Ajeesh,
Theoretically you are absolutly correct..
I had described the situation of a single department in one of the Govt.institution and the Private hospital/Laboratory--media nexus working with smear campaign against them.!
I would like to have your practical solution( Imagine yourself the Director of Medical Education).
Gynaecology Department IMCH,Calicut.
1. Many posts are vaccant.
Present doctors are overworked and are failing to accomplish the works of the vaccant posts.Public is unhappy..optimum service is not provided..negligence is rampent..losing human life..
2. Most of the remaining employees have submitted applications for leave and are planning to leave the service,if the vaccant posts are not filled immediatly.
3.Candidates from PSC are not joining the service.
4 There is a drastic reduction in the number of applications for PSC tests..Now PSC has abandoned the written tests and is recruiting candidates directly..
5.At present the atmosphere is not congenial for research,or teaching..!
You want dedicated doctors...but even good doctor who is joining the service is getting transformed to " unscrupulous doctors" ..
Hope,you will have some intelligent suggestions/decisions which will help to reverse this trend..I am still skeptical about the value of " stopping Private practice" in this regard...
Dear friends,
I have the moral right to come up with an alternate plan when I reject the current form.
Government should enhance primary health centers and they are going to work as a gateway in our model.
Patients visit PHCs and most of the cases are treated there. Complex issues that need special care are transferred to general hospitals. Medical colleges should be reserved for cases that can’t be handled in other places. In Alleppey, Medical College Ophthalmology department and General Hospital Ophthalmology department are working in the same building. One day I visited there and I saw a very big queue in front of the MCH unit while there was not a single patient in front of the GH unit. The over load in MCH is a simple management issue and it can be solved in a single day with a policy making. Patients should not be admitted to MCH or GH directly except in true emergency cases.
Lack of interest to join government services exist in many fields. It is not an isolated problem observed in medical care. I think it is more common in IT fields. Once we registered a complaint in the BSNL to solve a problem with their broadband connection. A man came to solve the technical issue but he doesn’t even know how to hold a mouse! Probably a road worker promoted later. He doesn’t even able to read properly. He stared at the computer screen for a long time to find http! We packed him and complained to the GM. Many guys visited our office but none of them knew anything about technical matters. We disconnected BSNL broad band and reconnected a private one. If you know how the computers in government offices are repaired you will roll on the floor and will laugh for hours. Situation is much better in health care. The reason for lack of professionals in government services is of course money. It is a problem that can not be solved by governments immediately. One of my friend, working in central government service complained to me that he is getting an unnecessarily big salary. He is the only person in his department who objected their recent salary hike. He is not acting and I know his family for years. His father was also a good government employee. His wife is also well employed. He is building a small house with a single bed room and a small kitchen, criticized by neighbors and relatives for not building a big luxury house. There is enough salary in government services to meet the needs of an Indian. There is no way to meet the greed now but still I argue for a salary hike for doctors because they work in a priority sector. I voice this opinion in public. Lack of interest to join PSC due to greed can not be solved now and it will haunt Indian economy for a long while. We should stop comparing ourselves to US or Europe, they are rich enough to do any crazy things. Private sector is not fascinating anymore, workers are fired due to global slow down.
No government employees in India ever died of starvation and have a decent job security and freedom.
I think most of the problems raised by Vijayan can be solved by PHC working as a gateway to cut down the current overload in MCH and GH. This will also provide a good working and teaching atmosphere in MCH and that will revive the lost interest of some doctors to continue or join MCH.
With all these problems existing, parents are forcing their children to become a doctor!
Private practice is a psychological issue too. It will be difficult for a human being to act alike in hospital and PP rooms where he directly paid by the patient. Deal and prescription disorders are more common in PP rooms. If doctors show self constraint and kick the reps away we can discuss the issue of PP in a more friendly way. Everybody is expecting greed, betrayal, manipulation, harassment etc... but only up to some extent. There is a line of control and who ever crosses the line is asking for trouble.
A few doctors’ actions can damage the entire class. So it is your need also, to fight against wild boys. To keep a sustainable system intact, the members of the system must join hands together to keep the pests outside. Talk about it in your association meetings that you want to look after a family and demand the responsible persons to take steps to control problem kids.
Thank you.
Thank you Ajeesh,
Again all your obervations are correct,
and even the worst corrupt doctor with minimum sense will agree with you!.
PHC should be the gateway..
Referral system should be strengthened...
These are good policy decisions..
And all discussions of the past
on improving health care delivery system used to agree/unanimous on these suggestions..
But why these things are not happening ?
and why the quality is going down in Public sector?
How to strengthen PHCs?
That was the question?
The growth of Medical science
is fascinating..!
at the same time majority of our people are not able to enjoy it...
We all agree that our Govt is not able to provide adequate facilities ( which should be prompt,regular,avilable in all villages)infrastrucure/equipments/medicine/staff so that majority of our people are not satisfied with the PHCs ..
People who are attending subcentres,PHCs,CHS,Thaluk hospitals,District hospitals are distressed by the quality of the care ...our middle class who always respected/depended the PHCs have been let down by our elected Govts........
the absolute neglect of the department /ignorence of ministers .... their the failure to live upto the ever increasing expectation of the rapidly changing Keral society ....the entry of big corporate giants with huge capital investments, transformation of health care as a good profit making business , the total control of the media and opinon formers by the corporates ,success of this unholy nexus to paint all politician /politics as greedy/foolish/unscupulous bands to the elite/intellectuals/middle class ,thereby nullifying the remote chance of the ordinary citizen to air their helplessness,low esteem of professionals (similar to that of political leaders).........
there are lot of things/facts to suggest for the present situation.. ..and are irrefutable also ..
But we have milliions who need care..now...not in the remote future..!
I find no ACTION in your analysis niether in mine.!
Are we helpless?
I dont believe,that we have no option.
As long as our society have an educated ,rational youth( our biggest investment) we have a future which will be better than today.......
I believe demystification of medical profession is essential...because of many reasons...
Profession should be open to any sort of audit.!
I believed in Decentralisation of health care delivery system..but it seems to be discarded in half way or neglected by recent Govts...
We need our best/most efficient leaders as rulers in the Govts...
All these require attitudinal change..again it comes back to the importance of discussion...we have to go on talking ....in democracy all are answerable/responsible ..even the ordinary citizen who is casting his vote, as well as the one who is abstaining from the electoral process is "responsible".!
Dear friends,
What is the ACTION?
There is no quick fix to our problems. Any such attempts will be failed and those rare attempts that some how win will not sustain.
I can’t sell distilled water or Rudraksham to Dr.Vijayan but I can sell it to many other people, even if there is a law prohibiting it. There is only one reason for this that he is educated.
The action is to education people. Talk to your children, neighbors, friends, relatives or any available public about the issues and solutions.
It will take time. Do not expect an immediate result. But do not stop, continue your social works at your own comfortable speed.
A total revamp in school education is necessary and I believe it should be the first step.
Thank you.
Dear friends,
Decentralization of power, diversity and a sustainable eco friendly model of development should guide us.
Thank you.
Finally we are back to square one. It is better to clarify on thing first This is
"Is health care a priority secotr? Does it need a different approach? Or can we view healthcare as just another avenue for commercial activites/?"
This question is the foremost. Everything depends on how we answer this question. I am highlighting the usual exclusionary statement given by political parties while calling for a hartal / BADH.
They say 'Hospitals, media and milk suppliers are excluded'. What will happen to a doctor or even an ambulance, if someone dares to take their vehicle out on road is clear. This is the attitude with which we say healthcare is a priority sector. We only pay lip service.
It is very important for all our political parties to accept that health care is a priority sector. If they accept this, the rest of their actions should reflect this. But I am not sure that we will be able to enforce any sort of discipline on these leaders.
All our discussions end at this point. People including doctors, who are ethical continue to be so. Othes coninue and get away with their wrong practices. Ajeesh, Vijayan and even me will continue to believe in the common good and try to educate the publlic. Even our colleagues and relatives will brand us some one 'who has not learned the tricks of the trade' 'paavam (poor guy)'or 'one without survival skills' (if you prefer terms with an evolutionary halo).
Bye
Dear friends,
Basic knowledge about health and related problems should be provided in school. Our curriculum is outdated and it should be updated immediately.
Public awareness programs should be initiated to educate people and health must be a priority subject. Rules and regulations should be implemented at the exact timings to support the mass protest.
Priority should be given to public health, sanitation, drinking water supply, shelter, education etc… India does not have any priority of nuclear weapons or lunar landings. Tax payer’s money should be spending in public interest and not in glorifying the nation.
All students who wish to join MBBS should be understood about a doctor’s responsibilities. It is a profession which requires sacrifice, hard work, dedication and a little bit of altruism. It is not a place to make money. People who want to own a private jet should either start business or join the numerous human gods in India.
Government should stop spending money for less competing or useless medical practices.
Thank you.
Medical education.
As we wont be able to discuss everything ,it is better to share our idea on selected area..like
Criteria for selection to MBBS course.
To me also ,the present system of selecting the candidate with maximum marks in the MCQs or reservation based on caste/mangement seats/NRI seats etc are useless.
I prefer a system in which maximum one candidate is selected and sponsored by one punchayath..selected by the local body,based on the criteria which they feel important ..in such a system the local people will make sure that his service is available to the panchayath or his service can be rendered to some other purpose, like working for an Institute or reaserch etc....he should be accountable...in such a system money making alone willnot motivate families or candidate to join medical schools!
Govt. medical colleges can be used to train such candidates with right aptitude and not the ones who dream/plan to migrate to some other countries or unlimitted finacial gains from his/her poor fellow beings..!
wish to have your comments..!
Dear friends,
Time of the bond should be increased to meet the necessary staff requirements.
We do not have to pay for a person who is going to settle in some other countries to serve other nations. The persons who are not ready to serve India should study at their own expenses. It is an unhappy truth that students who study in our government colleges later become an American citizen and to be a part of the conspiracy against developing nations including India.
Thank you.
Is this true?
Is it safe to take Neurobion forte for a year?
Q. I am a 23 years old female. I was told by a doctor that my body is deficient in vitamin B12. He prescribed Neurobion forte to be taken once a day for almost a year. Does this medicine have any side effects? Is it safe to take it for such a long period?
A. If at all your body is lacking in vitamin B-12, then only this vitamin should have been prescribed which is available under the trade name of Methycobal that contains 500mcg of B-12. You need to take Methycobal for just two months. Neurobion forte contains just 15mcg of B-12 which is not adequate to correct deficiency states. Besides Neurobion was banned several years ago; in order to evade the ban order, additional ingredients of hardly any clinical value (nicotinamide and d-panethenol) were added and the name was slightly changed to Neurobion forte. In no advanced country such a combination is permitted.
-- ajeesh
Hello,
There are guidelines banning fixed drug combinations (except a few combinations premitted)...based on scientific reasons.
More over it makes identifying and reporting of adverse drug reactions impossible!
It is a shame that the drug contoller of Cental Govt. who is supposed to moniter all the unethical/mal practices of pharmaceutical companies are acting as blind in situations like this...their passive attitude/apathy is disgusting!
In India most of the complaints against pharma are reported and faught by agrieved patients than by any experts in the medial field;making the appearence in the court a formality for the panel of international lawyers (of Pharma)!
Bonded obligation of medical UG and PG students have become a controversy. The government has now come out with new guidelins. Only time can tell whether it works.
I know of instances where the bond was not enforced a few years ago, just because some of the students were relatives of SOMEBODY BIG in politics or administration.
A better option is to give the student an option to decide whether he will serve in the government or not, at the start of the course itself. If he agrees to this his education can be partly subsidised. Other he will be treated at par with a self financing student. There should be stringent and enforcable rule (like a judicial bond executed before thr magistrate by the student and parent) regarding this, which should not be left to the politicians to decide.
I fully agree that the present selection system has to be modified. Merit should have a definite role, as this is one thing that has made Indian doctors acceptable and even in demand all over the world. But attitiudes and emotional skills need to be assessed before the selection is confirmed.
May be we are engaging in our own world of private fantasy or wishful thinking. All this will work only if somebody is in a key position and is able to influence government decisions at higher levels.
.......................................................The aggressive efforts to use drugs at the drop of a hat are due to the inseparable marriage between the pharmaceutical lobby and the medical profession. In the words of one of the leaders in the field, Marcia Angell, a former editor of the famous New England Journal of Medicine, says that “the ties between clinical research and industry include not only grant support, but also a host of other financial arrangements. Researchers serve as consultants to companies whose products they are studying, join the advisory boards, and the speakers’ bureaus, enter into patent and royalty arrangements, agree to be listed authors of articles ghost written by interested companies, promote drugs and devices at company sponsored symposia, and allow themselves to be plied with expensive gifts. Many also have equity interest in companies. Academic medical institutions are themselves growing increasingly beholden to industry.”.............
Manufacturing new health problems to sell more products and specialties is the strategy now.
DTC ads are used to create more demand for drugs. Neurotic persons who read DTC ads get into problems like medical student syndrome or their hypochondria get worsened. A lot of ads are displayed in front of the PP rooms. Is it really for patient education?
Click on the above link to read on an emerging industry.
A recent article in TIME explores the rise in female genital surgery -- labiaplasty, clitoral un-hooding, G-spot augmentation, and hymen reconstruction (also known as revirginization). From 2005-2006, females going under the knife increased by 20% in the U.S., and between 2002-2007, these stats more than doubled in the UK.
-- ajeesh
Dear all,
It was reported earlier that many members of the various DSM-V working groups / task forces have been receiving money from pharma industries. No wonder that they are trying to bring in newer diagnostic categories. The category of Adult ADHD (attention deficit hyperactiviy disorder - usually this is diagnosed in childen. It was presented to the profession with modified criteria for diagnosis in adults. Personally I found it difficult to use these criteria because of overlap with some other categories). Similarly newer indication (many of them are off label indications) are added on to rrhabilitate drugs which have not been able to grab market share.
It is really difficult to find a solution. Cooperation of professional bodies, social agencies, media, government and political parties is the need of the hour. Bye
Dear friends,
I would like to know the opinion of all readers here about one important question. Are you confident that all brands (sold in Kerala) are of equal quality? Are you comfortable when patients substitute brands? Do you advise generic versions?
Thank you.
"Every year, tens of millions of prescriptions for antibiotics are written to treat viral illnesses for which these antibiotics offer no benefits," says David Bell, M.D., the CDC's antimicrobial resistance coordinator. According to the CDC, antibiotic prescribing in outpatient settings could be reduced by more than 30 percent without adversely affecting patient health. - FDA
"In my opinion" Medicines manufacured in India and abroad are of different qualities....Many a time the same company is not able to bring medicines with same qualities..Random checking have proved it several times.
But as our Drug controller is in 'disabled'mode the quality control is left to the public and the treating physician.....who are not scientists to comment on..
Dear Ajeesh,
I was a bit busy and hence could not reply earlier.
Your questions on brands are very pertinent. Strictly speaking, we do not have brands in India. For example olanzapine is internationally marketed as Zyprexa by its original manufacturer Eli Liy. Flouxetine is Prozac and risperidoen is Risperdal (Jaanssen). The drgs sold in India are generics. Hence we do not have the international brand names here.
Studies done in USA show that there is significant variation in the clinical eficacy of brands versus generics. The US FDA has put an upper limit by how much a generic can differ from the brand of the same molecule.
The manufacturers in India use some other processes to get the final drug. But there are some limitations here. The degree of purity may be less. Bioavailablity of the drug (how much of the content in a pill actually gets into your system) may be lower. It may also contain some other chemicals as remnants of the several intermediate steps the drug undegoes to escape from the process patent.
The larger companies are actually selling their molecules as brands. If you analyze carefully, you will come to know that there are only a handful of original manufactures in India. Only few have the necessary linceses to important the intermeidate compunds and produce the final drug. All the others are just me too drugs. Ajeesh makes risperidone and sells it as Ajiperidone. I can buy the same stuff from you and sell as Hariperidone. As our country is not able to fund much of original research needed to discover a drug,and undergo the necesary testing to get it certified for human use, we are playing this game. But the new WTO regulations will end all this games, as we are forced to submit to the regime of product (the effective final chemical manufactured using any process). The deadline for this is being extended, this is why we see a flurry of drugs entering our markets. Another confounding issue is the import of cheaper drugs - final products or intermediary chemicals form other third world countries like China.
There has been very few actual chemical analysis of the same drug sold by different pharma companies. It is easier to understand who is supplying the 'brand' that you prescibe. The same 'manufacturer' may be supplying for the company whose brand you think is not useful. Government used to insist on a certificate of potency or purity etc for firms who are quoting rates for government supply. But as everything in the government sector has dubious credentials including ths firms, we cannot give much credibilty to these reports.
I have heard many colleagues complaining of lack of efficacy of 'brand x'compared to brand Y. But no evidence other than anecdotal reports. Personally, I have seen patients on antipsychotics from governemt pharmacy developing neurological side effects after they swith over to same dose of drugs bought from outside sources. It may be due to lack of content or lack of bio availablity.
In realty there is no need for this much formulation and so many manufacturers. The governemt should enact laws limiting the license only to firms which have adequate infrastructure, and permit selling under a price ceiling.
I am all for allowing practice of doctors wherever they are, at hospital or at residence. They should do their duty at the specified time and do whatever they want outside.
Please surf my online newspaper www.ojnewscom.com for further reports.
O.J.George
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