Are Doctors and Pharma Industry Bedfellows ?
Senaka Bibile’s Drug Policy Reminds of Bernard Shaw’s ‘Doctor’s Dilemma’
The butcher and the baker are not expected to feed the hungry unless they can pay; but a doctor who allows a fellow-creature to suffer or perish without aid is regarded as a monster.
- Irish playwright
Hypocritic oath, humanity, professionalism all weighed against pecuniary interests leads to conflict of interest, pushing doctors to a catch-22 situation. With little options, naturally they would choose the economic alternative; select the affluent patient over the most deserving case.
A century ago in 1906, George Bernard Shaw borrowed the title from a contemporary writer to name his Drama ‘Doctor’s Dilemma’ where for the first time in Medical history, he raised the issue of professionalism in medical practice.
Writing his own preface to the literary work, Shaw states, ‘Unless a man is led to medicine or surgery through a very exceptional technical aptitude, or because doctoring is a family tradition, or because he regards it unintelligently as a lucrative and gentlemanly profession, his motives in choosing the career of a healer are clearly generous. However actual practice may disillusion and corrupt him, his selection in the first instance is not a selection of a base character.’
Out of his poverty and dependence, the doctor becomes a ‘competitive private tradesman’.
Doctors take no notice of their own health and comfort which results from the fact that they are, by the nature of the profession, an emergency being. In an emergency nobody thinks of doctors except as healers and rescuers. They may be weary, sleepy, run down by several successive nights disturbed by calls, the night bell; but we never think of these in the face of sudden sickness? In other professions night-work is specially acknowledged and provided for. But a doctor is expected to work day and night. In addition to such cruel situation, the constant risk of infection. The actual woes of the doctor are the cruelty of ignorant patients, the work-day of 24 hours, and the uselessness of honestly prescribing what most of the patients really need: that is, not medicine, but money. ‘Doctor’s Dilemma’-Storyline
Bibile policy introduction of drug price reductions implemented by the authorities with the cooperation of the Big Pharma was effected after providing an opportunity for the industry to gradually increase the prices of several ranges of products over a period of one-and-a-half years prior to the launch of the new scheme
Jennifer Dubedat, wife of Louis loves him and idolizes her artist husband who is dying of tuberculosis. She convinces physician Sir. Colenso Ridgeon who declared that he found a cure for tuberculosis. [for which he was honoured with a knighthood] The doctor can keep only so many patients, and must decide who is worth saving. Dilemma that occurs as the doctor only has enough of his new cure for tuberculosis for one more patient. He inevitably is faced with a difficult moral choice.
Though Louis’ artistic talents make him worthy of saving; he and several co-workers meet Louis; they learn that he is in fact a smooth-talking scoundrel who has a mistress too. The doctor was in a dilemma: should he let Louis pass away, leaving the wife with her idealized image, or save him for his artistic talents, but compel her to face his bigamy and other blemishes? The doctor’s choice is further complicated by the fact that he falls in love with the sick man’s wife.
Since the birth of the pharma industry there has been an fundamental worry at the thought of doctors and drug companies as bedfellows. ‘Big Pharma’ in States spends over 25 billion dollars annually on marketing [Medical profession]. It is obvious sponsorships by these giants have a direct impact on their prescribing habits. The companies need to make money; they use a variety of techniques, starting with free gifts, travels, family excursions, five star holidays, looking after the education of doctors children, to mention a few.
Research has shown that no one is immune to such advances, their habits change, and they tend to recommend their products. Big pharma sponsor research to get the results they want, creating a natural bias. The representatives are always very personable, and they take time to study the professional and get to know them and their practices, before developing a professional relationship. Even if the doctor is not biased still he will start to favour the company. Nothing is truly free, gifts and perks creates relationships. Instead of looking out solely for their patient, the doctors will start to think about the loyalty of the company. The professional will move away from best practices to the easy solution. This conflict of interest will impede their ability to serve the patient faithfully.
Abusing ‘Bibile policy’
Bibile advocated a State-controlled pharmaceutical procurement plan often referred to as ‘rationalisation’ of medicinal drugs and the development of a national drug policy. The so-called Bibile policy introduction of drug price reductions implemented by the authorities with the cooperation of the Big Pharma was effected after providing an opportunity f or the industry to gradually increase the prices of several ranges of products over a period of one-and-a-half years prior to the launch of the new scheme.
The entire health services of the third-world nations since late 20th century were controlled by the pharmaceutical industry, or ‘Big Pharma’ [as coined by the Western medical journalists]. They feared three giants—the World Health Organisation [WHO] affiliated to UN; the Food and Drug Authority [FDA] of United States and of course our legendary Pharmacology Professor Senaka Bibile and his drug policy which received the support of the WHO.
The Mafia spend Billions of Dollars through their agents to buy over high ranking men involved in the former two organizations taming them and bringing them under their realm of authority: however, they failed in their attempts to win over the Professor, who was a ‘threat’ to the influential Trans-nationals. His untimely mysterious death in 1977 while on a mission to Guyana under a UN sponsored project for introducing his policies, remains unsolved to date. The famous conspiracy theory says, that Prof. Bibile was put to death by inducing cardiac arrest by means of a medicine. They believe one of his contemporaries was involved in the assassination to make sure that he would not make progress from the ‘heart failure’ by not taking quick action or taking a belated course of action. Was Pharma Mafia involved in Prof. Bibile’s assassination?
Hypocrite oath against pecuniary interests; a century-old phenomena
In the UK, it is suspected that Novartis representatives discouraged doctors from carrying out comparative trials, with the mistrust that some were presented money for research if they avoided this head-on assessment. This episode highlights the dangers of becoming too friendly with drug companies. In the West, the doctor-industry relations are varied, ranging from a free key tag to million-Dollar research gift. There are sponsored teaching or training sessions throughout the year at which the drug company representatives distribute their promotional material , sumptuous meals and cocktails, after delivering their speeches on products. It is immature to think that this does not have an effect on prescribing habits.
In doctor’s chambers, as the doors are opened for patients you find drug company men who will pursue them offering gifts and a sales pitch. The primary concern of the practitioner, though not governed by a code of ethics, should be patients welfare and society’s benefit. The doctor should understand what all these companies are all about. True, they play a critical role in medicine by providing products that help patients. Research clearly shows that no one is immune to such offers.
Some may argue that medical profession and drug companies should be kept at a distance— however without funds medical advancement may decline; without them no innovation. Similarly training sessions and research conferences are essential, especially for new recruits. Vital research could not be carried out without funding. Therefore it is a matter of how best we can handle this conflict of interests while safeguarding the partnership on which medical progresses depend? When the medical representative present data the doctor should be critical. They provide excellent access to pharmaceuticals the patient needs. However their goal is to make money. The medical profession should never compromise their integrity and create a conflict of interest. They must focus on their practice and keep commercial interests at bay, and then they can protect their carriers and their patients.
Bernard Shaw’s century-old dream
Shaw believed that at the beginning of the 20th century people had become helplessly dependent on the unauthentic cures of doctors. Shaw’s intention was to see a time when doctors as aggressive tradesmen were substituted by a medical profession that had been brought under meticulous and effective state control. Until the medical profession is “educated and rewarded by the state to keep the country in health it will continue what it is at present: a scheme to abuse popular gullibility and human suffering”.
Dr, Ridgeon loves Jennifer, the patient’s wife who loves her husband Dubedat, in the 1906 drama. Dubedat loves himself, while the doctors around him love their profession. All are deceiving themselves. The romanticism of love fills the drama. ‘There are two things that can be wrong with any man,’ says Shaw. ‘One of them is a cheque; the other is a woman.’ Both these wrongs find a welcome home in the talented Louis Dubedat.
In fact, Shaw was looking forward to the establishment of a National Health Service— the same way Prof. Bibile looked forward to set up a national Medicinal Drugs Policy with the State Pharmaceutical Corporation [SPC] channelling all imports, calling for worldwide tenders [limited to the approved drugs listed] in the national formulary. The public and private to obtain all their requirements from the SPC. The drug trade was to be regulated by this body forcing vendors to compete with each other and with generic producers based only on costs. This programme was perceived to have resulted in a quality drug at an affordable price.
Did both fail miserably?
I got the bill for my surgery. Now I know what those doctors were wearing masks for.
-James H. Boren