Weeding out unhealthy practices

Professor Tan Sri Dato' Dzulkifli Abdul Razak
My View - The Sun Daily
December 27, 2016

MY awakening as to how “mean” and “unjust” the world is, ironically, came about during my early university days. I was proud to be enrolled in the country’s first school of pharmaceutical sciences, only to realise that the pharmaceutical world is perhaps one of the most devious. Exposure to incidents involving one Stanley Adams, a top executive of a Swiss multinational pharmaceutical company, who turned corporate whistleblower when he discovered some unethical practices in 1973 “educated” me as to what healthcare businesses are basically in for: maximise profit not health.

This case involved the dubious practice of “price-fixing” to artificially inflate the price of vitamins that Adams was determined to expose. But it backfired when the European agency to which he passed on the detailed documentation “failed” to protect his anonymity leading to his arrest for “industrial espionage and theft”.

He was made to serve six months in a Swiss prison after being held in solitary confinement for three months. Upon his release in 1985, the European Union agreed to pay Adams £200,000, said to be short of 60% of his total costs, notwithstanding he lost his wife (she committed suicide). For the next three years, he was elected rector of St Andrews University in Scotland. The saga is now captured in a must-read, Roche versus Adams (1984)

Like in many corrupt practices, change seems insurmountable. In fact, the UK Guardian reported in its Nov 25, 2001 issue that 13 drug companies colluded illegally to raise the price of vitamin pills and vitamins added to foodstuff through a cartel dubbed “Vitamin Inc”.

According to Mario Monti, the European Commission’s competition director-general, this was the most damaging case the commission had ever investigated, as it continued throughout the entire 1990s and involved substances that are purported as vital for healthy living. Such cases are merely the tip of the iceberg.

Fortunately, another person caught my attention in the early 1970s. He was Dr Hafdan Mahler, a Danish physician, who impressively led the World Health Organisation from 1973 to 1988 as its third director-general.

He was largely recognised for shifting its focus to primary care and “to search for a balance between the vertical (single disease) programmes and the horizontal (health systems) approach.” The shift is crafted in the famous Declaration of Alma Ata, named after the host city (now called Almaty) for the International Conference on Primary Healthcare, Sept 6-12, 1978 located in the former USSR, now Kazakhstan. Indeed, a year before that he boldly announced that smallpox had been largely eradicated.

The declaration affirms that “health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right”. It became a major milestone of the 20th century in the field of public health, and it identified primary health care as the key to the attainment of the goal of Health for All by 2000.

In addition Mahler used to warn about many health-related issues affecting public interest ranging from the casual to the critical including lax hygiene in airline food, fad diets, misleading drug labelling and also excessive reliance “on unproven, unsophisticated and overcostly health technology”. Many of them are still relevant which would have been left to the mercy of the unscrupulous industry otherwise. He even pressured infant-formula manufacturers not to discourage mothers from breast-feeding, and banned smoking at the organisation’s headquarters – allegedly smashing an ashtray to make his point.

The likes of Mahler and Adams are the conscience of the people who know no better given the level of complexity involved in delivering health to the community. As students too they would be equally vulnerable because the universities by and large take little interest in such issues. Universities, more so today, are more preoccupied in the welfare of the industry rather than the well-being of the people or citizens. It goes without saying the tendency is to gloss over inherent unethical and corrupt practices putting constraints on the “ethos of (health) education”.

Thus the announcement of the demise of Mahler (1923-2016) last week at the age of 93 in Geneva when he slipped into a coma comes as a big loss to many health activists in particular. No doubt, however, his courageous legacies will continue to shine on the lives of many more generations to come though it will remain a challenge to weed out the pharmaceutical world of unhealthy practices unless the Declaration of Alma Ata is reaffirmed as part of growing interest in sustainable health in the context of the United Nations Sustainable Development Goals 2016-2030. We owe much to him, may he rest in peace.