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Speakers call for upholding professional ethics by Medical Profession and Pharma Industry.

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Leadership of the Jinnah Postgraduate Medical Center and members of the organizing committee of 51st annual symposium deserve to be commended for selecting Ethical Medical Practice" as a theme for this year's symposium. Unethical medical practices by some doctors and medical conference organizers are bringing lot of bad name to the doctor's community. Similarly unethical marketing practices by the Pharma industry bribing the doctors to generate sales by influencing their prescribing practices has now crossed all limits. This has attracted attention of conscious healthcare professionals with the result that now medical ethics is being discussed at various forums and at conferences as well.

This Plenary session devoted to ethical medical practice had speakers drawn from medical profession, pharmaceutical industry and the civil society. Dr. Asim Ahmad Consultant Nephrologist from Kidney Center was the first speaker who talked about the qualities of a good doctor. He pointed out that now even some institutions were also involved in unethical practices. He suggested that the industry should deal with the institutions rather than approaching the individuals. We also lack good role models which the healthcare professionals and the younger generation in particular can follow.

Dr. Amir Jafary from CBEC said that physicians are very powerful, they enjoy lot of respect and people have blind trust in doctors. Doctors are taught honesty, integrity, fairness and Akhlaq. Physicians are supposed to have high moral standards. But the physicians are under trained, underpaid, overburdened and they have no institutional support for CME. They are easily accessible and their CME is dependent on medical representatives, they are provided expensive gifts and other inducements to influence their prescribing habits. With the passage of time our expectations have also increased but now change is coming and one can see it. Issue of medical ethics is being discussed and debated at medical conferences, institutions are training physicians in ethics offering Diploma and Masters programme and they will definitely make a difference.

He supported engagement with the Pharma industry but suggested more interaction between the institutions and industry rather than individuals and it should be the institutions who should independently select people for CME, participation in conferences at home and abroad, he added.

Former Senator and former Federal Minister Mr. Javed Jabbar commended the working of healthcare professionals in public healthcare facilities. Despite some shortcoming, they are doing a commendable job. We also need honest, ethical people in politics, he remarked. We generally have lack of accountability and do not know how to produce good leaders. They also come from the society. We have to re-examine the whole issue in all is perspectives but I am delighted that now ethics is receiving more and more attention, he added.

Mr. Arshad Hussain from Abbot Laboratories who represented the Multinational companies and the Pharma Bureau said that MNCs have 40% share of Pakistan's Pharma market. We are trying to create right environment to provide right information to the healthcare professionals. We have an IFPMA Code of Pharmaceutical marketing, follow ethics but things are becoming difficult with the every passing day. This is one of the reasons that many MNCs have left this country. We are mindful of our legal, moral obligations but let us not let this industry become a victim of slow death, he added.

Mr. Haroon Qassim Managing Director of PharmEvo addressing the participants said that whatever he was saying was his personal views. He then referred to the system of self-regulation in UK and USA. He also referred to the PIMA and NBC Guidelines but remarked that it was a fact that many doctors along with their families enjoy pleasure trips abroad sponsored by the Pharma industry. We need more interaction with the society. Mr. Haroon Qassim was of the view that self-regulation by the pharmaceutical industry will be in its own interest rather than being regulated by some agency. Quoting late Dr.Maqbool H.Jafary he said that interest of the patients should be given preference by everyone whether we are from the medical profession, Pharma industry or the drug regulators.

The presentations were followed by lively discussion. This session was chaired by Prof. Anisuddin Bhatti Director JPMC along with Prof. Nadeem Rizvi. Participating in the discussion Mr.Shaukat Ali Jawaid Chief Editor Pulse International remarked that multinationals were the pioneer of unethical practices in Pakistan which they started in late 60s but now national pharmaceutical companies have assumed the leadership in unethical marketing practices. MNCs had some checks and restrictions but in the absence of any monitoring and accountability, some of the national pharmaceutical companies have crossed all limits in bribing the medical profession. As regards Pharma industry's interaction with the institutions only and not individuals, it will create another medical bureaucracy hence it was not practical. Moreover not all the healthcare professionals were affiliated with institutions.

He suggested that all academic activities including CME programmes should be organized at medical institutions and expenditures of conferences organize at Five Star Hotels should also be reduced. Now organizing a conference has become a money making business for some and the conference tariff now starts from rupees two lac to twenty lacs and in some cases it is more than crore of rupees which is all eventually paid for by the poor patients as the industry passes it all to them in the share of more cost of drugs and medicines. Guidelines by the National Bioethics Committee (NBC) on Physicians interdiction with the Pharma Trade and Industry, he further stated, has taken into account all such issues and suggested feasible, practical guidelines which needs to be implemented in its letter and spirit. It is based on honesty and transparency.

He further stated that unfortunately medical profession lacks the courage to name and shame the individuals and institutions involved in unethical practices.. He also suggested that those Pharma companies who provide millions of rupees to the doctors and funding for conferences at Five Star Hotels with lavish arrangements should be refused new registration and their drug prices should also be reduced so that they are not able to bribe the medical profession.

Dr. Ali Imran referred to the state of affairs in PMandDC and also named the former President and Vice President for destroying this institution. I learnt about medical ethics when my supervisor stopped me form putting his name as one of the authors on a study conducted by me saying that it was unethical. But what happens in Pakistanis known to all of us, he added.

A representative from the nursing profession wished that the medical representatives while detailing the doctors should also visit the senior nurses and provide the details about the drugs. At this Dr.Amar Jafary said that we do not support interaction with individual doctors what to talk of nurses. Dr.Asim Ahmad said that organizing CME was the responsibility of the institutions. It was also pointed out that there has been a moral degradation of the society as a whole and doctors are part of the same society. Prof. Anisuddin Bhatti opined that we need to identify the problems and then find some solution. Prof. Nadeem Rizvi remarked that we should not forget the ground realities while talking about ethics and making any recommendation. In public hospitals a lot of work is being done with the help and assistance of the Pharma industry and other donors, philanthropists.

At times even paper is not available to write prescriptions for the patients and Pharma industry help is sought for various services. Prof. Anisuddin Bhatti also referred to lot of development work being carried out at JPMC with the help of Pharma industry equipping, furnishing of the library, CME programmes and workshops for the professional capacity building of the healthcare professionals. Due to shortage of time, the discussion remained inconclusive and the organizers might draw some recommendations based on the discussion.
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Publication:Pulse International
Geographic Code:9PAKI
Date:Jan 15, 2016
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