Really, health is but just a business
Dato' Dzulkifli Abd Razak
Article
New Sunday Times - 04/20/2008
AT the slightest hint to separate prescribing from the dispensing of medicines, the healthcare fraternity is at each other's throat once again.
Perhaps it is an "epic battle", considering this issue has dragged on unresolved for three decades. The same tired arguments are being rehearsed again. What seems clear is that the issue
is beyond just professional considerations. Rather, it is a complicated mixture of economics as well as politics; health is just an incidental part of the argument.
It explains why the debates are often very intense and uncompromising, framed on winner-takes-all logic. Just like a battle, there will be losers and winners — an ironic situation for healthcare where there should be no "losers".
Contextualised in this way, it is interesting to read the revelation during a US Senate Ageing Committee meeting last month, especially the testimony provided by one Shahram Ahari, who is with the School of Pharmacy, University of California, San Francisco.
Based on his two years' experience selling a number of branded drug products for a leading pharmaceutical company, he told the committee that his job involved rewarding health professionals "with gifts and attention for their allegiance to your product and company despite what may be ethically inappropriate" (ABC News, March 12).
He was quoted as saying: "The nature of this business is gift-giving."
Substantiating his experience in a journal article written with an associate professor at the Georgetown University Medical Centre (published online, PLoS Medicine, April 2007), Ahari confessed that his job was to figure out what a health professional's price was.
"For some, it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship... but at the most basic level, everything is for sale and everything is an exchange."
One just has to look around to realise how true this is even in Malaysia where articles such as pens, notepads, coffee mugs, clocks, calendars and all sorts of glossy posters are visible in healthcare outlets. At times, it is like some sort of a battle game with companies trying to outshine one another.
Another former drug salesperson and anthropologist in the same journal reaffirmed the importance of developing loyalty through gifts, comparing it to "bribes that aren't considered bribes", involving what was termed as a "carefully calibrated generosity".
It is, therefore, not surprising to note that in the US alone, tens of billions of dollars are allocated for such activities. Ahari allegedly received "four quarterly bonuses, an annual bonus, stock options, a car, 401K, great health benefits, and a US$60,000 expense account", on top of a fat basic salary.
In other words, there is more to the so-called "epic battle" for the drug dispensing market than meets the eye. It certainly is not about providing "healthcare" in the true sense of the word. More aptly, it is about the "business" cleverly disguised in the language of healthcare.
When buying a consumer product, the purchaser is able to freely exercise his choice and pay for what he decides for himself. But this is not the case for medicines, made worse when the level of awareness is appallingly low.
In Malaysia, chances are that the public would literally swallow whatever is "dished out" (in contrast to "dispensing") to them, even by poorly trained personnel.
The real "epic battle" is about changing public apathy. We must take ownership of our own health. We should begin by knowing our rights about healthcare. To allow business as usual may not be in the best interests of the common man — lest we become the ultimate losers in a winners-take-all culture.
Article
New Sunday Times - 04/20/2008
AT the slightest hint to separate prescribing from the dispensing of medicines, the healthcare fraternity is at each other's throat once again.
Perhaps it is an "epic battle", considering this issue has dragged on unresolved for three decades. The same tired arguments are being rehearsed again. What seems clear is that the issue
is beyond just professional considerations. Rather, it is a complicated mixture of economics as well as politics; health is just an incidental part of the argument.
It explains why the debates are often very intense and uncompromising, framed on winner-takes-all logic. Just like a battle, there will be losers and winners — an ironic situation for healthcare where there should be no "losers".
Contextualised in this way, it is interesting to read the revelation during a US Senate Ageing Committee meeting last month, especially the testimony provided by one Shahram Ahari, who is with the School of Pharmacy, University of California, San Francisco.
Based on his two years' experience selling a number of branded drug products for a leading pharmaceutical company, he told the committee that his job involved rewarding health professionals "with gifts and attention for their allegiance to your product and company despite what may be ethically inappropriate" (ABC News, March 12).
He was quoted as saying: "The nature of this business is gift-giving."
Substantiating his experience in a journal article written with an associate professor at the Georgetown University Medical Centre (published online, PLoS Medicine, April 2007), Ahari confessed that his job was to figure out what a health professional's price was.
"For some, it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship... but at the most basic level, everything is for sale and everything is an exchange."
One just has to look around to realise how true this is even in Malaysia where articles such as pens, notepads, coffee mugs, clocks, calendars and all sorts of glossy posters are visible in healthcare outlets. At times, it is like some sort of a battle game with companies trying to outshine one another.
Another former drug salesperson and anthropologist in the same journal reaffirmed the importance of developing loyalty through gifts, comparing it to "bribes that aren't considered bribes", involving what was termed as a "carefully calibrated generosity".
It is, therefore, not surprising to note that in the US alone, tens of billions of dollars are allocated for such activities. Ahari allegedly received "four quarterly bonuses, an annual bonus, stock options, a car, 401K, great health benefits, and a US$60,000 expense account", on top of a fat basic salary.
In other words, there is more to the so-called "epic battle" for the drug dispensing market than meets the eye. It certainly is not about providing "healthcare" in the true sense of the word. More aptly, it is about the "business" cleverly disguised in the language of healthcare.
When buying a consumer product, the purchaser is able to freely exercise his choice and pay for what he decides for himself. But this is not the case for medicines, made worse when the level of awareness is appallingly low.
In Malaysia, chances are that the public would literally swallow whatever is "dished out" (in contrast to "dispensing") to them, even by poorly trained personnel.
The real "epic battle" is about changing public apathy. We must take ownership of our own health. We should begin by knowing our rights about healthcare. To allow business as usual may not be in the best interests of the common man — lest we become the ultimate losers in a winners-take-all culture.