Letters to the Editor
ETHICAL ISSUES - THE MEDICAL PROFESSION AND THE PHARMACEUTICAL
The medical profession and the pharmaceutical industry are important partners in the delivery of healthcare to patients and the public at large. The medical profession is expected to put the patients health and welfare above any financial or commercial gain. The pharmaceutical industry is expected to fund and develop new treatment for the benefit of the patients and market them ethically.
However, it is quite clear that a medical doctor or institution (as a drug purchaser, prescriber and dispenser) working in cahoots with a pharmaceutical company (developer and seller) can reap significant mutual financial gain at the disadvantage to the patient and society at large. On the other hand an antagonistic or disharmonious relationship between the profession and the industry would be detrimental to development and delivery of drugs for the benefit of patients and of society. Therein lies several ethical dilemmas. An such an ethical and professional behaviour must regulate the relationship so as to ensure that the patients and public interest are always upheld.
The medical profession at large and the individual physician must assure and be able to show to the patient and public that the medical treatment offered is the most appropriate for the patient (considering benefits, side-effects and cost) and not influenced by commercial or financial gains. Preservation of trust and confidence in the doctor-patient relationship is the single most important facet of developing a harmonious healthcare system. Public confidence and patients trust in the medical profession can only be preserved by responsible prescribing by the physician based on scientific and clinical integrity. The medical practitioner must be trained and be able to critically assess a new treatment modality and be aware of the subliminal-effects of drug promotional activity.
In an attempt to assess the impact on medical ethics of the principles and activities or the interaction between the medical profession and the pharmaceutical, a 5 way test is proposed, namely:
(2) Is it directly or indirectly beneficial to the patients health?
(3) Will it impede the patients autonomy to choose his treatment?
(4) Will it be beneficial to the society at large and all
(5) Will it build better professional integrity and character?
Using the 5 way test, one could classify each practice or activity as:
(II) Probably acceptable but needs professional self regulation.
(III) Possibly acceptable but with a potential to easily deteriorate into the
unacceptable - A Slippery Slope Situation best avoided.
(IV) Ethically unacceptable practice. Avoid at all cost.
(1) Discount and Bonus Schemes, Samples
Will it affect prescribing integrity?
Should the savings be passed on to patient?
Should list price be printed on medicine packages?
(2) Gifts - Lucky draw - Quiz Prizes
(4) Travel Grants
(5) Sponsorship of Drug Promotion Talks, Scientific Meeting
(CME) and Medical
(6) Sponsorship of Public Talks
(7) Pharmaceutical Promotional Methods and Materials
(8) Medical Research and Clinical Trials
Obviously, there are always more questions than answers which however,
should not preclude the development of guidelines and consensus. Only open
discussion, continuous soul (conscience) searching and realisation of human
follies can help us all move along the right direction in promoting an
ethical, harmonious relationship in the medical ecosystem.
DR T THIRUMOORTHY
CHAIRMAN, SMA ETHICS CONVENTION 1997
The SMA Ethics Convention will be held on 26 October 1997 from 9.00pm to 5.30pm at the College of Medicine Building, 16 College Road, Singapore 169854.