Whether doctors indulge in malpractice or medicine manufacturing companies bribe the government officials and ‘potential’ physicians, or laboratory owners use various tactics to earn more money, it is the patients who suffer ultimately.
Health and education sectors are the most neglected areas and the government seems to be least bothered about improving the lot of the impoverished citizens apart from spelling out embroidered slogans in the media. On one hand, the government comes up with an ambitious idea of curtailing private practice of senior doctors, and confining them to the public hospitals; then one could see the plan fizzling out into thin air. Private practice is still a nuisance beyond any control. On the other hand, education is given ‘priority’, but only for the consumption of either readers or viewers, that is, through constant one way bombardment of ads in the print media and television. The despicable state of health and education sectors remains unameliorated. It seems as if we have reached a stage where people are expected to take care of their health and educational needs on their own – ‘if you are rich pay for the best facilities, and get your children educated in the best of institutes.’ Period. The government cannot take the responsibility.
Pakistan is becoming a state of sufferers with every passing day. On one hand, its citizens do not have the basic amenities necessary for a healthy living; on the other, if one gets sick, he suffers at the hands of doctors, laboratory owners, and medicine manufacturers. Doctors over-prescribe costly medicines, laboratories charge huge amounts of money without providing the standardised tests and drug manufacturers keep on increasing prices. Who suffers! Only the uninfluential lot of people, whose pocket is ever-shrinking due to constant inflation and high cost of living. Under the prevalent circumstance, getting sick is a virtual ‘the last nail in the coffin’.
Pricing is an extremely important factor, which is constantly adding to the miseries of people. According to a survey available, from 1983 to 2000, "under vigilant control of the Ministry of Health in 1980s, the prices rose by 30 percent. While under the liberal policy of leaving it up to the market forces and hoping that the increased competition will bring (or keep) the price under common people's reach, these rose by almost three times more (compared with 80s to 87 percent. The Study shows that price of every third drug was doubled during the 90s. The last four years of the 90s experienced 15 percent increase compared with 66 percent of the first six years."
Did the various governments help the masses? No they didn’t! Rather they tried to make their life more difficult. The present regime imposed 15 percent General Sales Tax on medicines in April 2002 – expecting to generate Rs 4 billion – but after a lot of hue and cry, it withdrew the GST in September 2004. How it could be justified? Probably, medicines are a luxury for the taxation authorities.
Educating a patient about pharmacology is an impossible task, as it is tough even for the doctors to understand and explain various chemical reactions and anticipated physiological changes of any medicine. Quite a large number of doctors are taking advantage of the ignorance of patients. Probably, it has nothing to do with the education of a patient. "I don’t read the leaflet accompanying the medicine even when I am using it for quite a long period. I cannot figure out the reason behind this act, but I think I do trust my physician and act upon his advice," said a lecturer of a local college Muhammad Abid. "This is a general rule of this society – we trust someone to the last limits and when it is breached, then we love to cry over it. That is why, we never question our doctors. I think it is a high time that we must initiate a debate about ‘Bad Doctors vs. Good Doctors’. If the government cannot do any thing about it, then some NGOs must come forward to save this nation," he maintained.
Local medicine manufacturing companies are making headway in the medicine industry, but they cannot compete with the onslaught of the multinationals due to huge resources at their disposal, monopoly over the market – both domestic and international, strength in the power echelons, and many other factors. So far the market share is equal in Pakistan, but it is believed to be 60–40 percent in favour of the local industry. On the other hand, Information Medicine Statistics (IMS) is a book about medicines registered with all the countries and related pharmaceutical information, costs about Rs one million. "If a company get its annual subscription, then it gets a better name in the book; in case one fails to do so, the profile of the company is damaged. It is all about creating a class and branding a company," said a CEO of a local medicine manufacturing company on the condition of anonymity. "On the other hand, we have resources and technological constraints whereas the multinationals are pretty rich and technologically advanced. They create ‘Generation’ facade of medicines and manipulate prices in all the countries, whether developed or underdeveloped. The present scenario is meant for the survival of the fittest and it is a corporate culture," he said.
"Treat medicine manufacturing companies as the market forces and equate them to the beverage companies. These carbonated water selling companies use celebrities to popularise their products; on the other hand, medicine companies purchase doctors. It is not at all ethical, but it is not that bad either. This business is not meant for welfare. It is about making money," he explained. "What is ethical? Can you draw a line? Probably it is difficult. That is why the multinationals do indulge in exploitation and use various tools to enhance their sales," he concludes.
The concentration of the medicine companies is to ‘develop a parchi (prescription)’ and on convincing and ‘persuading’ the doctors to prescribe their medicines. It does not bother them how to get it done rather they want it to be done either by hook or crook.
"Doctors are part of the society; so they are as corrupt as the rest of the society is," said a Deputy Medical Superintendent of a local hospital on the condition of anonymity. "If they see corrupt politicians and police, they justify their indulging in dubious ways. No doubt, they play havoc with the lives of their patients, but they are part of the social order. They do get the targets, and over-prescribe medicine under the garb of allied or supplementary medicines to meet targets," he said.
"No doubt it is unethical and at least all such doctors deserve to be banned from practising medicine; then about half of your physicians will of out of service. Being corrupt has nothing to do with being rich or poor. It is a state of mind. For instance, a doctor from Sargodha has invested Rs 15 crore in a mill, but he has taken a car from a medicine company. They are all part of the Mafia looting, plundering and playing havoc with the health of patients, both the rich and the poor," he maintained.
"Keep one thing in mind! The patients ultimately pay for this value-addition because none of the medicine companies will pay from their own budget. They must sell their medicines to meet all such expenses," he concludes.
‘Unjustified surgeries’ are yet another addition to this dismal scenario. "You visit Punjab Institute of Cardiology to ascertain this fact. Almost all the patients have to go through angioplasty if they experience any sort ‘left-side pains’. Doctors and surgeons of PIC are earning huge sums of money every month. ‘Share List’ can prove this," said a senior doctor demanding anonymity.
On the other hand, laboratories are making huge sums of money again with the help of doctors and at the expense of patients. "Doctors have their share of recommendations. They do not hesitate in recommending patients to their ‘good’ labs because those lab owners had already promised them a good kickback in the booty," says a consultant radiologist, who had a comparatively ‘empty’ clinic on the busiest ‘treatment bazaar’, that is, Jail Road. "Except Agha Khan, Shaukat Khanum and Zeenat Labs, I cannot name any other, which is enjoying good reputation among the community of doctors. These three laboratories give the actual results as compared to others which are there to earn money only through manipulated results," he said.
"I used to receive calls from various doctors to ‘develop’ a stone in the kidney of their recommended patients, but on my decline, they all have gone other diagnostic labs for which I don’t feel sorry because I am already getting my fair share," he said.
"A few laboratories in Lahore are earning huge money by declaring many patients Hepatitis C positive. They are also offering treatment, obviously in their chosen hospitals and clinics. For instance, a hospital is giving Hepatitis C positive report to almost each person whosoever goes for the tests there. The same hospital is also offering treatment," he revealed.
From unjustified surgeries to over-prescriptions, from manipulated test reports to hazardous treatments, the suffering continues unabatedly for the patients with no end to their miseries in sight.
The list of misappropriations, misconduct and malpractice by all related to the field of medicine is pretty long. Whosoever indulges in misdoings, gets his share. But the cost is really high. Every individual of this society is virtually hurt and damaged by them. Interestingly, they are the only individuals who do not differentiate between the rich or the poor, and the influential and the resourceless. Patients are paying hefty amounts for no illnesses and relatives are stranded in hospitals for months. Where is this society heading to? No body knows apart from suffering.
On condition of anonymity
I went to talk to five individuals from various sectors of medicine – a medical representative of a multinational company, a highly placed doctor at a local hospital, a chief executive of a local drug manufacturing company, a pharmacologist at a local hospital and a ‘medicine seller’ (an unqualified pharmacist) heading a public pharmacy. These all wanted to share information and their experiences, but ‘on the condition of anonymity’ ascribing to various pretexts of either ‘I’m not for publicity’ or ‘I don’t want to create bad blood in the community’ or ‘I don’t’ want to put my job at stake’. Only a local medical store-owner Jamal Akbar was not worried about the mentioning of his name. Why is it like this? Think about it!