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BW Businessworld

The Market For Sickness

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Let me go back to the state of healthcare in America. The Americans are themselves increasingly conscious of its poor state, and are investigating its reasons. One of the relentless investigators of medical fraud is Senator Charles Grassley. He has uncovered the enormous consulting fees pharmaceutical companies give to professors in prestigious medical schools. In America, drug companies are prohibited from trying out new drugs on human beings. So they pay doctors who hold dual positions as professors in universities and doctors in attached hospitals. In return, the professors try out the companies’ drugs on their own patients, and write scholarly articles claiming that the drugs are effective. Drugs have to jump a number of difficult hoops in America before they can be put in the market; apart from having to be ringfenced by patents, they have to be approved by Federal Drugs Administration. The authority of well placed professors helps in this process. There is nothing wrong in the accumulation of knowledge by or through professors. What raises questions is what they are paid to publish. The payments are not always made directly to doctors. In one case, Glaxo-SmithKline gave a grant of $3.95 million to National Institute of Mental Health, which went to a research project whose principal investigator was Charles B. Nemeroff, professor of psychiatry in Emory University; he personally got $1.35 million for overheads (Marcia Angell’s piece in The New York Book Review of 15 January 2009 is full of such information).
The result is not simply that new drugs are coming on to the market based on investigations that are supposed to be objective but have in fact been bought. The cooperation of doctors and drug companies has led to the invention of new illnesses to fit expensive drugs. There is some ailment called bipolar disorder which I had never heard of. Now, apparently, children as young as of two years are being diagnosed of bipolar disorder and being treated with drugs whose side-effects are unknown and could extend over their lifetime.
While new ailments are being invented, old ones are being given new names. One disorder I know from past experience is acidity or hyperacidity; the common name for it is heartburn. The latest name for it in America is gastro-esophageal reflux disease. Another common, and even more dreaded, disorder is impotence; it is now called erectile dysfunction. And the billion Indians who suffer from shyness had better beware: they have got social anxiety disorder. Its treatment is a growth industry in the US.
These things are exposed in the US for a number of reasons. They have more honest and courageous legislators — not all, but some. They have less oppressive libel laws, and it is possible to write about people’s wrongdoings without going bankrupt. And they have public-spirited intellectuals. We do not; but it is not true that everyone in India is a corrupt scoundrel. I have come across many honest doctors; in fact, amongst the many medical institutions I have been to, only one was a racket.
So it is not on the basis of my experience, but of responses to my column, that I am inclined to think that there is malpractice in the Indian healthcare industry. I am not talking of doctors alone; the drug and test industries are intimately involved. But I am convinced that if ever this industry is to be reformed, it is doctors who will have to do it. They are a powerful force in our country; unlike in the US, politicians will never take them on. It is doctors who should look within themselves, and find solutions that would give patients treatment that the doctors would be proud of. Change, if it comes, will come from doctors’ professional pride.

The author is Consultant Editor of Businessworld.
(Businessworld Issue Dated 18-24 Aug 2009)