FROM THE PRESS
Medicine merchants
Few US doctors know that their prescribing practices are available to pharmaceutical manufacturers for a fee. Drug makers buy information from pharmacies, the government and the American Medical Association to compile “prescriber profiles”, to sway doctors’ prescribing habits. The AMA generates $20 million annually by selling biographies of every American doctor.
Of the $13.9 billion that drug companies spent promoting their products last year, 87 percent was aimed at the one million doctors, nurse practitioners and physicians’ assistants who can prescribe some medications.
Marketers say they use the reports to help determine which doctors should be offered certain perks.
Sheryl Gay Stolberg and Jeff Gerth: Medicine merchants / tracking the doctors high-tech stealth being used to sway doctor prescriptions, New York Times, November 16, 2000
Cross-border trade
Patients undergoing dialysis in Germany received a circular from an organisation based in the Czech Republic offering kidney transplants without waiting lists from live donors. In Germany, 12,000 of the 50,000 patients receiving dialysis are waiting for a transplant. The Czech Republic does not yet have a law forbidding organ trade. Since 1997, German law bans any trade in human organs or attempts to solicit trade.
Annette Tuffs: German doctors condemn kidney offer BMJ November 18, 2000.
Just an error in paperwork
A 25-year-old woman admitted to the Sawai Man Singh Hospital, Jaipur, for the removal of kidney stones ended up losing her uterus when her records were confused with those of another patient with the same first name. When surgical staff were asked why their preparations were so elaborate for relatively minor surgery, they told the patient to shut up, and administered her anaesthesia. The mix-up was noticed when the woman’s husband read the patient slip after she was brought out of the operating theatre.
P Kaushal: Rajasthan docs goof up, remove woman’s uterus, Indian Express, November 20 2000
Pay up or else
A worker suffers a stroke in the office and is rushed to a private charitable hospital but dies shortly after. His relatives cannot claim his body till they paid up Rs 30,000, borrowing from friends and neighbours.
Consumer activists say managements resort to this tactic, harassing grief-stricken relatives to claim their dues. Hospital authorities say this is a misunderstanding. “There are emergency tests, despite which the patient dies. Relatives blame the hospital for the death and refuse to pay.” The judge of Mumbai’s consumer court says a consumer court has already ruled that there is nothing legally wrong with the practice.
Rekha Dixit: Withholding bodies to extract pound of flesh, The Times of India , January 20, 2001.
Radiation overdoses
A study by the Bhabha Atomic Research Centre measured radiological doses for 12 different examinations in 40 hospitals in the country, and found wide variations. Children received the same doses as adults, which sometimes meant they got more than five times the necessary dose.
Correspondent: Unjustified exposure to radiation: study, Asian Age, February 23, 2001.
Test new drugs on the poor
The US-based Discovery Laboratories had planned a placebo-controlled study in Latin America of sinapultide, a new drug for treating idiopathic respiratory distress syndrome in premature newborn infants. A control group of 325 babies would have received a placebo instead of available surfactants, as a result of which many would have died unnecessarily.
The trial would have the Helsinki Declaration, which requires that new treatments be tested against the best current method.
The company’s Dr R Capetola said the study planned three arms: sinapultide, an already-approved surfactant drug (beractant), and a placebo. Alternative trial designs were rejected as likely to increase the length of the study, resulting in thousands of additional deaths and debilitating lung conditions among infants. Following public protest, the trial was modified to include an active control.
Fred Charatan: Surfactant trial in Latin American infants criticised BMJ March 10, 2001.
How did she get that idea?
A 50-year-old woman in Puri, Orissa, wrote to the prime minister and the National Human Rights Commission saying she is ready to sell one of her kidneys to save her husband who is suffering from cancer. Mustari Biwi begs every day to provide a meal for her family. Affected by the cyclone last year, she received no relief. “I wrote to the chief minister and district commissioner seeking financial help but got no responses, so I decided to sell my kidney and arrange the money,” she said.
Bibhuti Mishra: Woman offers kidney to save husband, Mid-day, March 12, 2001.
A rap on the knuckles
The Maharashtra Medical Council Act of 1965 gives the council powers to deregister doctors found guilty of negligence or malpractice. Of the 162 cases registered against doctors till date, no doctors have been deregistered. A few have been suspended, and a number are being heard at present.
John Manjali: No doctor deregistered for negligence, Asian Age, March 22, 2001.
Innovative solutions
One year ago, municipal hospitals in Mumbai raised fees for registration and for minor tests, and imposed new charges for various surgical procedures – as well as for delivery of a third child. The result: a discernible drop in the number of patients attending the out-patient department as well as for in-patient treatment. Some patients slip away before they get discharged. Instead of seeing this as a symptom of people’s desperation, some hospitals plan to deal with the problem by advancing the time of check-out so it doesn’t coincide with visiting hours.
Rajiv Sharma: Case of the vanishing patients leaves civic hospitals baffled: over 100 patients who have refused to pay new medical fees are ‘missing’, Indian Express , March 22, 2001.
Slow and steady
On February 13, six people who underwent cataract surgery at the KJ Somaiya Hospital in Mumbai lost their eyesight after contracting an infection. A state government inquiry found infection prevention practices, and records, inadequate. A senior opthalmologist states that quick action could have saved some people’s sight, but the hospital did not have the facilities, nor did it refer the patients elsewhere. At a press conference on March 21, the hospital’s dean insisted that the infection must have come “from some extraneous source”, but that the management was considering giving compensation to those who lost their vision.
