Decline of Pakistan’s bioethics
The writer is a doctor based in Islamabad. He tweets @drkhalidshab
The whistle has blown towards a new health crisis. Drug regulators and local administrators are once again going to have a long night. This time because of an injection named Avastin.
We are well versed and sadly immune to medical negligence, malpractice and lack of medical ethics in Pakistan. Only when there is a loss of life or limb do we start raising questions about the very fabric of our healthcare system and existence altogether.
Let me take you back to 2019, where we lost a nine month old baby named Nishwa to medical negligence when she was allegedly administered an injection wrongly. In 2017, the scam of low-quality and expired cardiac stents shamed us. Not long ago, in 2022, a pregnant woman lost her life allegedly because she was given an expired dose of anaesthesia medicine during delivery. This time people have lost their eyesight because of an injection which was manufactured locally in a faulty and illegal manner.
Avastin is a drug used to slow down the growth of cancer cells by blocking certain enzymes in the body that are involved in the growth and spread of cancer cells. It is an FDA-approved drug primarily indicated in cancers of the brain, lungs, breast and colon. Avastin also finds its role in diabetic eye disease where it blocks the growth of abnormal blood vessels along with blocking leakage of fluid from faulty blood vessels. This fluid leakage can affect vision. In eye disease Avastin is considered an “off-label” drug which means that the FDA has allowed its use if doctors are well informed about the product and studies prove the drug as helpful.
Investigation, so far, has revealed the market price of Avastin injection to be 28 to 40 thousand rupees. Local manufacturers were extracting almost 80 doses from one injection, each of which was being sold for approximately 1500 to 2000 rupees. This low price injection was sold to low-income individuals, generating a profit of about 1.5 lakh from each injection. These substandard and non-sterile injections were distributed to different eye hospitals across Punjab.
Decline of Pakistan’s bioethics is quite evident. Patients in government hospitals are told to buy medicines from specific pharmacies. The profit from the purchase is shared by pharmacies and doctors prescribing those medicines. Another ethical concern is the relationship between pharmaceutical company and doctor. Doctors are given personal benefits such as foreign trips and home/clinic renovations, to name a few, in exchange for prescribing the company’s medicine. Moreover, we all know which pockets are filled every year by the health budget allocated for uplifting government hospitals.
The developed world invests heavily in ethical education, but unfortunately Pakistan does not incorporate this subject in its curriculum. What more can be said about our ethical corruption when even the Medical and Dental College Admission Test (MDCAT) could not be spared. Just recently, we were shamed by a scandal in academia where students, aiming to become future doctors, used wireless Bluetooth gadgets to secure marks and cheat their way through the system.
The stain on our character and mindset is only getting darker. The first corrective step is a strong accountability system. This will plateau out the rising tide of malpractice and negligence allowing us time to revisit problems at the grassroots level.
So far almost 70 people have lost their eyesight to the fateful Avastin injection. Let us hope the investigation committee does not lose its sight this time around. The lizard’s tail will grow back no matter how many times it is cut. It is time to go for the jugular to save our healthcare system.
Published in The Express Tribune, October 13th, 2023.
Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily pieces.