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Doctors oppose freebie exemption

- Plan to allow associations to use drug funds raises eyebrows

New Delhi, Feb. 25: A proposal by the Medical Council of India, the country’s apex medical regulatory agency, to exempt associations of doctors from a code of conduct binding on individual doctors has evoked sharp reactions of disapproval from within medical circles.

At least three members of the MCI’s own ethics subcommittee are among doctors who have decried its executive committee’s proposal last week to amend rules to effectively exempt doctors’ associations from the code of conduct binding on individual doctors since 2002.

The code of conduct pencilled in 2002 and revised in 2009 — amid long-standing concerns that drug companies may influence doctors’ prescriptions — prohibits doctors from accepting money, gifts or hospitality from the pharmaceutical industry, among its other rules.

But the MCI’s executive committee in its meeting on February 18 noted that the medical council can prescribe the code of conduct and ethics only on individual doctors and that it had “no jurisdiction whatsoever” on associations or societies formed by doctors.

“Associations or societies of medical professionals need funds to support their continuing medical education programmes which help raise professional standards,” said C. Varadapillai Bhirmanandham, a cardiologist and vice-chairman of the MCI’s executive committee.

“If funds accepted by associations from pharmaceutical companies are audited and declared to income tax authorities, the chances of misuse are nil,” he said.

But sections of medics warn that the MCI proposal will allow doctors to use associations as shields to gain from what the code of conduct rules prohibit individual doctors from doing and yet go unpunished.

“This is terrible — we’re looking at a regulatory agency that now wants to provide a loophole for doctors to cheat,” said Amar Jesani, a physician and consultant in bioethics and public health, and editor of the Indian Journal of Medical Ethics.

Under standard procedures, the 86-member general body of the MCI will need to take up the executive committee’s proposal to amend rules for discussion and — if it is accepted — recommend it to the central government for notification.

But three members of the MCI ethics subcommittee told this newspaper that they do not favour a decision that would effectively unfetter associations of medical professionals from engaging in activities prohibited for individual doctors.

“I’m unhappy to learn about this (proposal), the associations can’t be allowed to do anything they want,” said one of the three members of the ethics subcommittee, all of whom requested not to be named. “But, the MCI’s executive committee is a higher body than the ethics subcommittee.”

“I would argue we need regulatory oversight even on associations — they’re run by individual doctors who serve as office-bearers and take decisions,” said another member of the MCI ethics subcommittee.

Physicians campaigning on public health issues believe the proposal needs to be resisted through public pressure. Many believe the funds flow from drug companies even to professional medical associations could influence doctors’ prescriptions and work against the interests of patients.

“This is legitimising unethical things already happening in the medical profession,” said Gopal Dabade, convener of the All India Drug Action Network, a non-government organisation involved in drugs and health care issues. “It’s time for a public campaign against such practices,” he said.

A doctor in Kerala who had complained against the Indian Medical Association for accepting money to endorse consumer products suspects that the MCI proposal is also intended to avoid punishing the office-bearers of the association who had taken the decision to endorse products.

“This is a ridiculous proposal — it will allow seven or more doctors to form a society or association and do what is prohibited for individual medical practitioners,” said K.V. Babu, the ophthalmologist who had filed a complaint with the MCI against members of the IMA for endorsing consumer products.

But one member of the MCI ethics subcommittee said those opposing the proposal are “not in touch with reality”. Under medical licensing rules, doctors need to keep abreast of the latest advances in their fields through medical conferences and continuing medical education workshops.

“Who’s going to pay for such conferences?” said the member, Sudhir Taori, a radio-diagnosis specialist at the Government Medical College, Nagpur. “We can wish that the government should pay for all such conferences, but that is idealistic and unrealistic.”