Can healthcare take the wrong turn?

TWO interactions that I have had recently convince me that we need a major re-think about the influence of the market on healthcare. My reading of Dzulkifli Abdul Razak’s column in this paper, titled, “Weeding out unhealthy practices”, clearly indicates that the market can unfairly exert its power over access to healthcare.

Dzulkifli, a pharmacist by training, has taught and researched on the subject to know enough about the abuses in the industry.

In his article, he points out that pharmaceutical companies can and do fix prices and collude in order to raise the price of drugs, even of vitamin pills and vitamins added to foodstuff.

Those who attempt to expose these instances of wrongdoing can suffer the consequences of fighting for justice as, for instance, in the Roche versus Adams (1984) case.

Another problem that he raises relates to the improper influence that the healthcare industry can have on public health.

In the interests of profits, the healthcare industry misdirects people into using unproven and over-costly health technology, engaging in misleading drug labelling, and persuading people to choose options that are unnecessary and expensive.

All this to further the commercial interests of companies.

In effect, this means that the objective of companies can be completely at odds with that of people.

Companies will want to maintain profit maximisation as their objective function; people want to maximise their health and well-being.

Both objectives can be in conflict with each other; and this has terrible consequences on public health. It also has serious economic implications.

My second interaction was in the form of personal communication with Lim Kah Poh. Lim, a member of the Malaysian Pharmaceutical Society, chairs the task force against inducement of health professionals.

Lim, in sharing his personal views, drew attention to questionable practices such as pharmaceutical companies rewarding health professionals for things such as achieving sales targets; and retail chains being given inducements for favouring and selling the products of particular pharmaceutical companies.

Lim offered an insightful observation on the occurrence of corruption in the healthcare industry. He noted that power had a deleterious role to play in healthcare. Power, in his analysis, arises for a number of reasons.

First, professionals have the power to make decisions. Because of the asymmetry of knowledge and information the reasons why certain decisions are taken is not open for analysis and discussion.

Second, the ownership of patents gives companies monopoly power. In turn this gives them high profit margins, which encourages them to exercise the ability to corrupt those who can further their interests.

Third, it is often difficult to trace or detect evidence of corruption. Finally, the victim or the patient, as Lim correctly suggests, is helpless.

The issues that Dzulkifli and Lim raise demand serious re-thinking of how healthcare should be treated. There is a long list of recommendations that one could consider in light of the insights that they offer.

In the first instance, the definition of healthcare has to be re-examined. It might make more sense to consider preventive healthcare than to emphasise curative treatment.

Primary care and health systems should be given more weight than the treatment of diseases.

The prevention of unethical practices in the healthcare industry should be given more attention in Malaysia.

There are innumerable reports of companies providing inducement to nurses so that they will discourage mothers from breast-feeding.

Similarly, there are claims that doctors are given incentives to prescribe some drugs over others, and these preferences do not arise from medical reasons.

Some doctors have been accused of overprescribing and recommending hospitalisation too soon and for too long, much to the disadvantage of patients and insurance companies.

As was suggested by Lim in discussion with me, the issue of ethical practice has to be taken very seriously.

Unethical practices by all parties in the healthcare industry (doctors, pharmacists, pharmaceutical companies, hospitals and the like) have to be dealt with firmly.

So too the question of anti-competitive practices.

Also, policy measures affecting healthcare have to be carefully considered. Many countries have policies on the cost of drugs; there are ceilings that are set on the price of pharmaceutical products, particularly on prescription drugs. This is not the case with Malaysia.

The division of function between doctors and pharmacists is recognised in many countries, but not in Malaysia. Last, but by no means least, is the issue of healthcare financing.

In many European countries access to healthcare is a very important concern and the government bears the burden of providing it.

The US, on the other hand, treats access to healthcare very much as one would treat access to any other commodity. We have to seriously debate the principles that will govern access to healthcare.

While Dzulkifli stressed the importance of justice in healthcare, Lim was more concerned with the play of power and corruption in the medical and pharmaceutical industries.

Both men take a strong stand against unethical practices in the industry.

They have blown the call to consider these issues and promote just and ethical practices in the medical and pharmaceutical industries.

Shankaran Nambiar is author of Malaysia in Troubled Times. Comments: letters@ thesundaily.com