Holding healers accountable

Frustration with acne that just would not go away is not particularly an unusual phenomenon in youth or their parents. Millions of adolescent boys and girls, the world over, go through the phase of dealing with stubborn acne problems. Some in my family recently faced a similar challenge. It was not the problem of acne itself, but the proposed treatment from several highly regarded dermatologists in the city that caught me off guard. For starters, the costs of a single visit to the doctor and associated treatment ranged in tens of thousands of rupees per visit. Equally troubling was the fact that several different dermatologists recommended entirely different treatments, each costing more than the one before. What was common in all of the treatment option was not the nature of the treatment, but the fact that each doctor recommended a course of six to eight sessions, each costing tens of thousands of rupees. Little did my family know that the treatments in and of themselves were also dubious (or scams). One of them was skin whitening — a problematic, caustic and dangerous practice. When none of the treatments resulted in any real change, and made the matters worse, and the family had already spent well over a hundred thousand rupees, some family friends connected them to doctors outside the city and the country. It was then that they learned that widely practised approaches in the city were scams. There was no evidence in recent medical literature about the efficacy of the common practices, and there were serious doubts about the ethics of those practices and treatments.

My family was fortunate to have access to other doctors who were kind and generous with their time and advice, but millions of others do not have such resources. What if it was more than acne, and the issue was a life-threatening ailment? What if the doctor was prescribing a dubious treatment only because there was money to be made? Who should the patient or their family go to if there are serious issues of malpractice? In such instances, a functioning system of checks, balances and ethics is supposed to keep a watchful eye on the doctors and healthcare providers. Unfortunately, such a system remains a distant dream for millions of vulnerable patients in the country.

A systematic study of gaps in ethics in medical practice in the country is lacking. There are only a few studies that identify issues associated with ethics of medical practice and malpractice in the country. A recent study led by Noor et al published earlier this month (Health Sociology Review, 2022) is one of the few on the subject and sheds light on some of the longstanding issues including the influence of pharmaceutical sales agents on doctors, the maximisation of profit in the private sector, and the impact of the lack of a robust regulatory framework. The study discusses not just the incentives of sales agents, but also why general practitioners are willing — perhaps eager — to accept gifts from pharmaceutical companies, how they help pharmaceutical sales agents reach their quotas, why the doctors feel that they need to maintain a certain social status to sustain their practice, and above all why we desperately need a more robust regulatory framework.

There is little headway in addressing widespread medical malpractice in the country. There is little appetite, at the federal or the provincial level, to tackle a problem that ruins the lives of countless people in the country. The fact that medical malpractice happens the world over is no reason for us to accept status quo. We cannot escape from our own failures because there are other parts of the world where this also happens. The solution here is not particularly complicated, and is one that we all can agree on. It is rooted in ethics in practice, accountability of those in power, human dignity at the centre of all our actions, and equitable treatment of everyone. The harder question, however, is who is willing to take that first step?

Published in The Express Tribune, November 22^nd, 2022.

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