India is a country where ethics, morality and corruption come up for discussion episodically. After a few days of intense episodic debate, we suppress the intellectual turmoil, learn nothing, make no change and leave the unanswered questions for another day.
The uniqueness of our society is such that while we demand high standards of ethics and moral conduct from others, we are loathe, averse, almost brutally against the application of righteousness to our own lives and behavior.
As a user and consumer of various services, I see this duality in everyday interactions. Whether the taxi driver is shouting at others for obstructing his way and commenting on their lack of traffic sense yet jumping a red light the very next instance or a teacher lamenting on the lack of commitment to teaching these days yet telling me how tuitions to her class’ children in private (from her obviously) help them score better marks.
Doctors too are not far behind. Pointing fingers at other medical practitioners for misdiagnosis or over treatment is a favourite topic but ask them for a review of their own practices results in the shutter of denial being drawn firmly. Links with pharma companies and medicine shops are known to all, so much so that conferences where knowledge is meant to be disseminated and shared are now run almost entirely on sponsorship from medicine manufacturers or marketers.
Disappointingly, what I have experienced recently is that even to be a speaker at an educational event, you need to pay money to the organisers as sponsorship. One office bearer of the local branch of doctors association, told me nonchalantly, we sell slots of 15 min to companies or hospitals, ‘without which we can’t organise such a conference’. When I offered to speak at a local medical association’s conference, I was asked, in a matter of fact way, to pay Rs 50,000/- On expressing my inability to do so out of my pocket, I was advised to get a company to pay up. I pointed out that I will then be selling myself to the company, I was met with an amused expression and told ‘you write their medicines’!
Miffed, I proposed a workshop to the state level association but the ‘sponsorship’ cost went upto 1 lakh for their conference. No wonder, I am not able to educate my medical colleagues practicing as family doctors and general practitioners on mental illness, diagnosis and treatment. Without appropriate knowledge and lacking clinical skills in assessment of emotional and behavioral issues, almost 90% MBBS doctors miss or under treat mental disorders such as Depression, Anxiety, Panic Attack etc. The unfortunate paradox is that Pharma companies are not complaining.
The best antidepressants cost Rs 5 to Rs 15 a day, but ‘anti-anxiety’ placebos cost Rs 13 to Rs 55 or more a day. Profits are dependent on sale value, and so are rewards to prescribing doctors. Strangely, some sections of our society also seem to value more number of medicines and costly pills as the right response by a doctor to their list of symptoms and troubles. Thus it is a win win situation, everyone is happy in the short term. The only unhappy person is the ethical, moral, knowledgeable dr who hasn’t learnt or practices the ART of pragmatism, who doesn’t join the system but tries to change it and cries out for change. His voice is unheard.
Chronic illnesses keep on becoming more intense, difficult to treat and damaging in the long term.