22 July 2016

Good governance, 'good medicine' and relevant ethics

This article was first published in the 'Daily Mirror six years ago (July 24, 2010), long before many yahapalanists heard of 'good governance' and long before its most ardent users robbed it of meaning.  It was titled "Further cuts into the business of medicine and treatment."

The language of resistance or contestation is typically appropriated by the resisted/contested for fairly pragmatic reasons.  Word is weapon and therefore it makes perfect sense for oppressor to pickpocket the lexicon of the oppressed.  So when ‘sustainable’ was used by those who proposed a different, objecting and opposite paradigm to the dominant frames of reference pertaining to democracy, the gurus of the non-sustainable quickly started using the terminology of the objectors.  Today strategies that are clearly harmful to the earth, to life, livelihoods and lifestyles are given ‘sustainable’ tags.  That’s ‘politics as usual’. 

A few decades ago, there was no talk of ‘good governance’.  When it arrived, it was pinned on those Governments that were not interested in or resisted furthering corporate capital interests.  Tyrannies that saluted the mighty dollar (or the Euro, later) were spared the sanctimonious lectures on good governance.  It didn’t take for people to say what was known all along, that if governments are bad, the corporate entities they buttress and/or which make them, are as bad.  That’s how ‘corporate good governance’ started appearing in the annual reports of big names in business. 

Now, at the level of the ‘everyday’; i.e. the seen and heard, the tangible, the things that have a face and whose thieving fingers can on occasion be caught by vigilant gaze; the ‘bad’ of the big boys and girls are hardly ever seen.  Even when someone slips and things are turned inside out, there’s a way in which money (robbed of course) can bring back some white to the dirty linen.  Happens in the courts and happens outside too.  Wimal Weerawansa trespassed, then went on a protest fast; he was rescued by no less a person than the President; those who had been short-changed out of their life savings by Golden Key were attacked when they protested. 

‘Good governance’ is made of a lot of things, but basically its about having checks and balances so that there is transparency, accountability and defenses against hanky-panky.  One of the cardinal principles is of course ensuring that there is no conflict of interest.  You can’t have a naduth haamuduruwange baduth haamuduruwange situation.

Conflict of interest is of many kinds. The worst, to my mind, is the abuse of entrusted power for private gain by academics.  Perhaps it has something to do with the fact that I grew up learning to respect teachers, believing that it was a noble profession.  Perhaps it is because I think of people like Louis Pasture, Galileo Galilei and others who spent lifetimes investigating something without ever once compromising their integrity.  Perhaps it is because I have heard of Senaka Bibile.  I don’t know.   It irks me therefore when I hear of academics being guilty of conflict of interest. 

There are degrees of culpability of course.  At the low level, there are gifts, meals, trips to students, house-staff and faculty from industries that could benefit from particular kinds of research that the particular academic is carrying out.  Then there are speaking fees, consulting fees etc.  At the top level senior faculty, medical school and university leaders are paid by for-profit healthcare corporations, are invited to sit on director boards, paid fees and offered stock options etc. 

The proper way of dealing with such situations is to desist.  Or else disclose.  If an academic fails to disclose the nature, size and intensity of a relationship with a company, then not only is that person’s scholarship suspect, he/she brings disrespect to profession, area of ‘expertise’ etc but lacks integrity and is guilty of fraud. 

All of this was evident in the actions of the Chairman, Department of Psychiatry, Stanford University with respect to research on treatment of depression. He gave talks, wrote articles and did research on treating depression with Mifepristone, a synthetic steroid compound used as a pharmaceutical even as he sat on boards and held millions of dollars worth of shares in companies that sought to get approval to market this compound.  He failed to reveal the nature and intensity of his financial relationships. 

There are other strategies. Companies recruit physicians who could influence colleagues for peer-to-peer marketing; rope in ‘thought leaders’, ‘key influencers’ and ‘movers and shakers’ (Department Chairs, Vice-Chairs, Directors of Academic Programmes etc), and of course fund ‘research’ that ‘yield’ happy conclusions.

Ask around.  It won’t be stated aloud of course, but there will be enough decent people in the medical profession (this is not limited to that field of course) who will speak about unethical behaviour, corruption and even criminality. They will reveal that the phenomenon is largely unstudied and that it will remain so because physicians don’t want their core values to be threatened by an external source.  Some would think it’s an isolated issue or that their knowledge of abuse was unique.  Few would see it as a systemic problem. 

A couple of weeks ago I pointed out that an Ophthalmologist performs cataract operations using the least expensive lens (costing Rs. 800) while other ‘persuade’ patients to purchase lenses for Rs. 12,000-15,000 that actually cost only Rs.6000.  Don’t we need to identify the collaborators in this scam, separate traitor from patriot?  Should not the innocent and unsuspecting patient who can be robbed of his life savings (who would not pocket out everything if it was a choice between life and death, sight and blindness)?

What is the solution?  Well, vigilance is good.  Some integrity is good. These however can’t be legislated or formalized in ways that are effective enough, especially considering how deep the malady could be.  A possible answer is a Medical Ombudsman. This would create a platform for people to bring to light possible criminal behaviour on the part of so-called professionals. 

We have to understand at some point that big pharmaceutical companies are robbing us, hoodwinking us and have spread their tentacles like a veritable cancer among the medical profession because we let them; we became dependent on their products.  But isn’t it true that there was a time when we didn’t really need them?  We did not borrow, we did not import food or drugs, but our ancestors still survived.  This is not to say no to all drugs, of course, but merely a cautionary note, i.e. we have to clean the process of prescription and procurement from ‘business interest’, ‘criminal negligence’ and ‘interest conflict’.  We need, however, to eliminate dependency on such drugs wherever there is a local alternative. 

Have we studied all low-cost local remedies/alternatives for curative value?  The nectar of the gammalu tree is a locally found equivalent of insulin.  Our spices are all cancer fighting agents.  Tea (import, yes), green or black, taken without sugar, is an anti-oxidant. The list is endless, I believe.  Where is the research?  What research there may be, I am willing to wager, must be channeled through drug companies with gene piracy and patenting rackets being part and parcel of the entire process.    

The bottom line is that knowledge has to be organized and disseminated.  While we wait for the Government to clean itself up, set up checks and balances, create posts that could help things along, such as a Medical Ombudsman, some crooked doctor (yes, yes, other professionals too, academics included) is turning some innocent Sri Lankan’s pockets inside out, keeping some bucks and sending some overseas to some multinational.  Who knows, maybe some officials in the particular ministry/department and some politicians might be getting a cut too.  While we wait, though, our children are running the risk of becoming victims of quacks, traitors and agents of big pharmaceutical companies. 

All professionals come neatly dressed.  They have name boards replete with all the qualifications they’ve acquired.  They don’t say ‘I am being paid by so and so’.  They are not hands-get-dirty pickpockets. They come wearing gloves.  The gloves are labeled ‘professional’.  We have no way of identifying crooks.  The professions don’t have self-regulatory mechanisms.  The Government has not imposed fool-proof mechanisms, not for these professional entities and not for itself.  It’s like we are being told ‘submit to the scalpel or die’; not knowing any better, we opt for surgery (metaphorically and literally).  We lose our whatnot in the process.  And we say ‘thank you’ and tell our friends who lovely it all was.

We deserve better.  Let’s take refuge in the knowledge that crooks are human, that they slip and that if we know what to look for, sooner or later, we will catch the crook before he steals our all. 

Yes, it’s the moment of the community of victims and potential victims.  Community activism.  With or without a Medical Ombudsman.  Mr. President, would you like to join us?

Malinda Seneviratne is a freelance writer. Email: malindawords@gmail.com.  Twitter: malindasene.