Polio-free but far from corruption free

With November 14, World Diabetes Day around the corner, this issue of Express Healthcare presents different perspectives from diabetologists and other experts in the field. The Government of India is reportedly evaluating a proposal for conducting free glucose tests for the entire population, adopting a philosophy that if India can be polio free thanks to a mass polio vaccination campaign, country-wide glucose testing can take us closer to be diabetes free. Of course this cannot happen as diabetes is not a disease but a condition and can therefore be managed but not cured in the true sense of the word. But widespread testing for glucose will be a very useful step towards early diagnosis which in turn will reduce treatment cost and incidence of associated conditions like heart disease. There is also now solid evidence that diabetes weakens immunity systems and thus triples the risk of TB, which is worrying for India, as it already has a high incidence of both TB and diabetes. While the intent is commendable, we need to wait and see if the implementation lives up to the vision.

Another area where we have good intent (read guidelines) but poor implementation, is the interactions and payments between pharma and medical device companies and doctors. The issue hits the headlines after TV sting operations catch doctors red-handed, and then each side restates its position and the issue fades out, only to be resurrected after a few months. The British Medical Journal had also exposed this facet of Indian healthcare (BMJ 2014;348:g4184) and in my edit in Express Healthcare’s May issue, (http://healthcare.financialexpress.com/editorial/2879-can-we-cure-ourselves-of-corruption) I had commented on the BMJ’s plans to launch a campaign against corruption in medicine, beginning with a focus on India.

Associations of both stakeholders, pharma companies as well as doctors, already have guidelines but these are not mandatory and only binding on the members of these associations. Such self regulatory mechanisms only work if they are followed in letter and spirit and it is amply clear that this is not the case in India or for that matter, elsewhere in the world. For instance, there has been widespread criticism from pharma companies as well as doctors in the US when the Open Payments database administered by the Centers for Medicare & Medicaid Services, as mandated by the Physician Payments Sunshine Act, a part of the Affordable Care Act, went live on September 30.

We did a dipstick survey of doctors and healthcare professionals in India to gauge their reaction to this development. Most of those who shared their views in the Strategy section, (Quid pro quo healthcare, pages 32-35) agree that we need such an Act in India as well. They admit that this ‘cancer’ has spread and made Indian healthcare ‘terminally ill’ but point out there will always be ways to “manage” the law. Unless there is political push to cleanse the system, things will stay the same. Will a black list of such doctors help discourage unethical practices? But such a blacklist needs whistle blowers, from within the industry, who will be protected from the backlash. Or will the reverse strategy work better: a ‘white list’ recognising honest doctors who refuse bribes or make unrestricted declarations of all gifts/ payments accepted? But how do we go about measuring honesty? If doctors can agree that sometimes it is better to amputate a gangrenous limb to save the rest of the body, will they agree to expose the ‘bad apples’ to redeem the rest of the fraternity?

Reacting in Parliament to a sting operation conducted by a TV channel in July this year, which exposed doctors accepting commissions from diagnostic clinics for conducting MRI scans and the like, health minister Dr Harsh Vardhan promised that his ministry would crack down on such corrupt practices in the healthcare sector. Will the sun finally shine on such practices in India so that we can have a corruption-free healthcare system?

Viveka Roychowdhury
Editor

viveka.r@expressindia.com