Letters to the Editor
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I share your concerns about the ethical issues raised by the connection between the medical profession and the pharmaceutical industry (SMA NEWS, Sept 1997).
Every exercise in continuing medical education (CME) seems to be sponsored by the industry. It is true that I cannot fault the content of these CME sessions but they are always financed by a firm which has an axe to grind. A seminar on headache is funded by a company that sells a drug for migraine, one on mood swings by a firm which is interested in promoting antidepressants. The list is unending.
The private hospitals have joined in the game and are offering doctors the opportunity for learning the hi-tech advances in medicine which these hospitals, of course, are capable of providing.
The pill of knowledge is difficult to swallow unless sweetened by lunches, teas and cocktails before dinner. A more insidious form of advertising is difficult to imagine. This was not always so.
In the early fifties, a group of doctors decided to share experience and knowledge. The backbone of the group was Dr Gwee Ah Leng, Mr Yahya Cohen, the professor of pathology, S Shanmugaratnam and my father, Dr B R Sreenivasan, who, if memory serves me correctly, was the founder president of the SMA. They met on Wednesday evenings at the old Alumni Association building which has since been replaced by the starting point of the AYE. Later, when I was a young doctor, these sessions were held at the path theatre of the Singapore General Hospital to cope with the numbers who attended.
Medical education was, in those days, considered an unending process. There were no incentives, no CME points and after the meeting we went to a roadside hawker for beers and dinner, for which we paid ourselves or treated each other. There was an informality about these occasions which as an oldie I find charming and honest. Alas, I cannot say the same about the few CME sessions that I have attended.
With this as a background I turn to the 5-way test you propose.
2. Is it directly or indirectly beneficial to the patients health?
3. Will it impede the patients automy to choose his treatment?
4. Will it be beneficial to the society at large and all parties concerned?
5. Will it build better professional integrity and character?
When I went into private practice I called the man who had trained me as a neurosurgeon. He is a man of suicidal dedication and relentless honesty. I asked him what it was that would protect me from operating just for profit.
His answer was simple. He said, In the dead of night, when you are by yourself,
ask one question. Are you doing it for anything other than your patient? For money, for
fame, to gain expertise, to prove a point. If you can look at yourself and say
no then go ahead.
DR GOPAL BARATHAM