Ethical business needed

HIDDEN AGENDA - Mary Ann LL. Reyes - The Philippine Star

When the objectivity of a doctor’s professional judgment is compromised by a secondary interest, this could lead to a physician-induced demand for healthcare, the prescription of medicines and procedures that are unnecessary, inappropriate and more costly than available alternatives.

According to one report, in 2018, the World Health Organization estimated the global pharmaceutical market to be worth $1.4 trillion, indicating the substantial economic power that this industry has to influence policymaking and regulation at both global and national levels.

It noted how worldwide, pharma companies promote their products via medical sales representatives who use an extensive array of strategies to influence – whether consciously or unconsciously – physicians’ decision-making to boost sales and hit sales targets. Of the top 100 pharma companies in terms of sales in 2015, 64 percent spent twice the amount on marketing and sales than on R&D.

In light of the Senate’s investigation on Bell-Kenz Pharma, there is now a call for our own medical sector to reinforce ethics and to keep in mind that patients’ interests must always be above personal profit.

Bell-Kenz is facing scrutiny from authorities over purportedly operating a pyramid scheme in selling its products and incentivizing sales by providing commissions to doctors.

Medicine is one of the fields that requires practitioners to be ethical at all times.

In reinforcing ethical behavior, some entities should be praised for taking the initiative in this regard.

According to a news report, Asian Hospital and Medical Center and other hospitals under Metro Pacific Health issued an email to their staff members to remind them of absolute compliance with anti-bribery and anti-corruption laws, together with disclosure regarding conflicts of interest.

But more importantly, the government should step up as well to ensure that the healthcare system serves the interests of the Filipino public.

In the United States, they have a number of federal and anti-abuse laws that apply to physicians. One of these is the Anti-Kickback Statute, a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the federal healthcare programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).

Remuneration may include cash, expensive hotel stays and meals, and excessive compensations for medical directorships or consultancies. Taking money or gifts from a drug or device company is not justified by the argument that a doctor would have prescribed that drug or ordered that device even without a kickback.

Then there is the Physician Self-Referral Law, commonly referred to as the Stark law, which prohibits physicians from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship. This includes both ownership/investment interests and compensation arrangements.

Congress should pass our own version of these laws to curb the greed for profit and force doctors to prioritize the welfare of their patients at all times.

Penalties must be imposed on doctors who put their personal interests (e.g., in terms of earning commissions) over those of their patients and by not being transparent about their conflicts of interest. These penalties can include revocation of licenses, disgorgement of financial gains and even prison time.

The Philippines has become a signatory to the Mexico City Principles, which clearly state how healthcare professionals and pharmaceutical companies should be ethical in dealing with patients. Earning money from the profession should not go beyond what could be considered already as “bribery.”

This means putting profit above the welfare of patients, and this will do more harm than good to our society. The pursuit of profit should not come at the cost of exploiting patients.

Practices that can be considered as “bribery,” such as giving financial incentives and luxurious gifts to doctors to prescribe one product over another, should be banned as it ultimately exploits patients for the sake of earning money.

Our Department of Health recently reminded health professionals and personnel that accepting gifts from pharmaceutical companies in exchange for any act benefiting such companies is unethical.

Everyone desires a healthcare system that works for all Filipinos. However, we cannot achieve that dream if we allow a system wherein doctors can get cash and items such as high-end watches and cars as long as they reach sales quotas.

And what about the practice among medical representatives of bribing doctors with foreign trips and conferences? In some countries, this practice of visiting doctors in public hospitals to talk about their drugs or medicines is frowned upon and considered a waste of public time and resources.

What about giving gifts such as pens and writing pads with drug names inscribed, drug samples, and company-funded lunch or dinner to influence prescribing behavior? The fact that the cost involved for the pharma company in such cases is small does not make it ethical.

There should be no conflicts of interest between the Hippocratic oath and a doctor’s desire for financial gains. This is why the government needs to step in to curb such unethical practices.

Quality healthcare is a human right. All Filipinos, regardless of their standing in life, deserve a healthcare system that provides treatments in an ideal manner and at an accessible price point.

The first step in ensuring quality healthcare is transparency among medical professionals. Medical professionals must be transparent about their financial interests and must adhere to the ethical maxim that the patients’ interests must always come first over personal gains.

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