The Illness Within-Courtesy Indian Express 14.05.2018

The Illness Within

Doctors, barring exceptions, are complicit in the commercialisation of healthcare.

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Written by Sanjay Nagral | Updated: May 14, 2018 1:05:56 am

Modi was of course playing to the gallery in London, but there was a design to his comment about doctors. (Express photo/Praveen Jain)

Prime Minister Narendra Modi’s recent remark in London about unethical practices by Indian doctors has predictably raised the hackles amongst the medical community. Even an organisation known to curry favour with the powers that be, like the Indian Medical Association (IMA wrote a congratulatory letter to the Union home minister on the action against JNU students), wrote an unusually strident letter accusing PM Modi making frivolous remarks in a “foreign” country. Studied commentary, like Shah Alam Khan in these columns, attempted to say it was state policies more than doctor behaviour that was responsible for the mess Indian healthcare is in. The truth lies in between.

Modi was of course playing to the gallery in London, but there was a design to his comment about doctors. Over the past few years, sensing the growing discontent amongst citizens about healthcare practices, Modi has been increasingly taking a public stand on issues like the high cost of drugs and stents. He has also used them in the electoral arena. He even wrongly claimed credit for bringing down the costs of implants when it was a Delhi-based lawyer, Birender Sangwan, who fought a long battle with regulatory authorities — a PIL filed by him in the Delhi High Court finally led to price capping.

Much of this is in keeping with Modi’s style. But if one temporarily overlooks the intentions and populism in his approach and critically examines the role of doctors in the current crisis in healthcare in India, what is the reality? Are doctors mere innocent bystanders? Are they pawns in a larger game?

As someone who has witnessed the changes of the last few decades, it is obvious to me that large sections of the medical profession in India have blindly welcomed marketisation with open arms. They have willingly got entangled with the market by investing in hospitals, starting healthcare companies, participating in dubious clinical trials and colluding with managements in implementing many questionable trade practices. When it comes to drugs, many doctors prescribe costlier brands when cheaper generics are available. There has been no large-scale opposition from bodies including the IMA to corrupt practices including doctors’s involvement in kickbacks, irrational prescription of drugs and private medical colleges. The Medical Council of India, on the debris of which the National Medical Commission is being built, was for long led by a clique of doctors, many of whom were office-bearers of the IMA.

Thus, it is disingenuous for us to put the ball entirely in the government’s court. We have to reflect why things have come to this pass that when the prime minister makes a casual remark about questionable practices of doctors, it strikes a chord with the citizens. The medical community will need to be self-critical and introspective, without being protective of our colleagues’ misdeeds, to gain the credibility to expose the doublespeak of governments. It is true politicians often accuse doctors of playing footsie with corporates, pharmaceuticals and private medical colleges, but this is nothing new. Also, we will need to display courage and decry medical professionals who have joined the hate brigade. Many years ago, when some of us lodged a complaint in the Gujarat Medical Council against then VHP leader Pravin Togadia, a practising oncosurgeon, for his role in the communal riots, many professionals, including the IMA, refused to support it. In fact, doctors are often found fawning over local political satraps during inaugural functions in medical conferences.

If the PM Modi is being superfluous, let us as professionals trained in critical analysis go beyond posturing in our response. Agreed, there has been a colossal state failure in the delivery of healthcare in independent India. But there is also a huge conspiracy of silence, even collusion, that the medical profession is guilty of. Are we willing to think independently of state power, remove cobwebs of the medicine market and assert the primacy of our patients’ interests and ally with the rising number of courageous individuals, who while facing personal tragedies are taking on some of the bad practices of Indian healthcare? After all, the health of ordinary people is too important an issue to be left to the PM.

The writer, a Mumbai-based surgeon, is chairperson, Indian Forum for Medical Ethics