Corruption in Medicine

Corruption in the field of medicine is real, rampant, pernicious and beyond redemption. Before I write any further, I must say that though I am writing about corruption in the field of medicine, almost every field of human life is corrupt. I can write about the field of medicine only because I am a part of this field, and I have seen things from close quarters. Even then, I have penned down my own perceptions- the perceptions of a small-town practitioner, and I strongly believe that whatever I have seen or heard of is probably only the tip of the actual proverbial iceberg. There is probably much more filth than I show here.

 For long, the medical fraternity has pretended to believe that no one in the outside world is aware of this little fact, but the truth is that the outside world assumes every piece of the medical machinery to be corrupt unless proved otherwise, and most of the time they don’t even bother to find out the truth. They simply submit to the medical industry in their hour of need, hoping for it to last for as short a time as possible.

Now, as I say this, I will emphasize that corruption as a way of life has become ingrained in humans all over the world, perhaps more so in India. There are two ways of conducting oneself. One is by being corrupt- easier, profitable, keeps you at par with your peers, and no one cares two hoots about it. Second, by being non-corrupt- difficult, loss-making, relegating and no one cares two hoots about it either. There was a time when most people chose the latter and were happy to keep their conscience clear. More recently, the conscience has become redundant, and most people choose the former way of life, and are happy to simply hoard wealth.

Medical education

Corruption in medicine begins from medical education. When we studied medicine, there were hardly any self-financed medical colleges, and I’m talking mid-eighties. As the country’s economy improved and people stared having enough money to buy careers for their children, the high-profile businessmen and politicians began this new lucrative business of medical education (Other fields of education as well but I’ll talk of medicine here). The first big corruption comes in at this point in the chain. It would have been alright, not just alright, it would have been a big favor for the country if these self-financed colleges offered quality education. But, alas, businessmen and politicians can only be themselves. The governing body responsible for overseeing medical education in the country, the Medical council of India, was dissolved in its former form in 2010, following serious graft charges on its president Dr. Ketan Desai. Therefore, I cannot accuse the present MCI in its changed format of any misdoings as yet, but this is what used to summarily happen in those days: Many such self-financed colleges were practically dummy colleges. There was no infrastructure worth its name, no required patient inflow for hands-on training, and no quality teachers. Some colleges were deft in arranging teaching staff overnight just for the inspection by the Medical council of India, which by no means was blind to such irregularities. In fact, for the corrupt people in the MCI, the worse the irregularities, the better- they would then manage to exhort maximum bribe for granting permission. These stop-gap teachers were made out of doctors from the surrounding cities, and they were paid heftily for their ‘act’ and then after the inspection was over, everything went back to the usual pathetic state. Some of such ‘once-in-a-year’ assistant professors and professors in medical colleges are personally known to me, so I don’t need any further proof to such a criminal act. Ambitious students and parents used to fall for such spurious colleges and ended up paying hefty amounts as fees and capitation only to finally spoil their lives, sometimes because these colleges never went on to get recognized by the MCI (perhaps by the way of the ‘deal’ falling apart), and sometimes by becoming worthless professionals owing to below-par training. Such professionals, when they come out into the society, armed with a qualification but not necessarily the skill, pounce upon the society to vent out their many frustrations, and more often than not, end up indulging in corrupt practices to recover their capital, if not their self-esteem.

One can only hope that the MCI in the new format will bring a curb to this blatantly felonious practice that has a potential of playing adversely with the lives of people.

Kickbacks from referrals

Now we come to the second type of corruption in medical practice- kickbacks from referrals. More colloquially, it is called ‘cut-practice’. This form of corruption is perhaps the most rampant of all kinds- affects the patients monetarily, is extremely easy to indulge into, for even the straightest of the doctors, and extremely difficult to say no to. There is no need for me to elaborate on this variety of corruption, and is easily understood that the referring doctor gets a cut from the fees received by the treating doctor. The referral could be from a GP to a specialist, a specialist to a super-specialist, and from any one of them to a diagnostic centre. Not that such ‘transactions between doctors is in any way respectable, but this practice came down to being downright filthy when referral fees were begun to be doled out to class-IV employees of government hospitals, and to the ambulance and auto-rickshaw drivers for diverting patients to target hospitals/diagnostic centers. Many doctors claim that such a practice is technically not corruption. They say that the kickback is paid out of their own fees, which the patient would have paid in any case. True, but it is still a blatantly corrupt practice, because it encourages unnecessary referrals, investigations, unnecessary procedures and even surgeries. Such is the audacity of the entities involved in this sort of corruption that these kickbacks are now blatantly paid through cheques, and duly reflected upon the balance sheets as ‘professional fees’ or ‘referral fees’. In other words, this practice has now come to be accepted among medical practitioners as almost legal- nothing to be ashamed of. Where cash is not involved, gifts of equivalent value are passed on, often of the choice of the recipient.  

Pharmaceutical company-Doctor nexus  

The third type of corruption involves the Pharmaceutical companies. Of late, pharmaceutical companies have started cropping up in India like mushrooms in a rainforest. Anyone can start a pharmaceutical company without much ado. The modus operandi is quite simple- think of a good sounding name for your company, purchase drugs of your choice from the bulk drug manufacturers, have them packed with your label and presto, you have a drug company of your own! All you may need to do is put a small disclaimer on your label saying manufactured by xyz and marketed by you!  Thus, we have the multinational companies that have invested millions of dollars into their state-of-the-art manufacturing units, their R&D, and marketing, AND we also have companies like the ones mentioned above, that run at best from dingy, two-room apartments in small towns. And both of them sell the same drugs, obviously with a huge difference in quality, and therefore, the price. Now, both have to sell their products in the market. The lesser company sells at a lower price because its investment is less, and quality is suspect. The MNC sells at a higher price for the opposite of the above reasons. But BOTH go on to offer freebies to the doctors and clinicians in order to make sure they prescribe their products. These freebies can be anything according to the clinician’s ability to sell the products- from a simple two-rupee pen to foreign tours; from candies to LED TVs. Anything; the choice is sometimes the doctor’s. The lesser companies do it because they have to survive the competition. The MNCs do it because they have surplus money, and they have to survive the competition as well. Corruption of this kind encourages over-prescription, and spurious/low quality drugs. The sufferer, here too, is the patient. And by the way, kickbacks are not limited only to drugs. Transactions of all medical consumables, including orthopedic implants, angioplasty stents, etc. are conducted in a similar fashion.

Insurance company-Doctor-Patient nexus

Then there are the insurance companies for everyone to loot. These companies have, of late, started enforcing strict rules to prevent pilferage, but connivance of an errant employee is sometimes all that is required, at a nominal cost, to make all the rules fall flat on their faces. I must say that this variety of corruption involves the ‘patient’ as well. For e.g., someone who is resentful about the fact that despite paying premium for a health policy for three years in a row, he has not had a chance to get a reimbursement (like why am I not meeting an accident?), would simply approach a doctor to prepare a fake case, complete with all required formalities, and the amount thus claimed from the insurance company would be gleefully divided between the doctor, ‘patient’, and the insurance officer, leaving everyone happy, except of course the insurance company, which would not get to know about it in any case! 

I have listed above the major areas of corruption in medical practice. There are, of course, many other errant practices that I have not listed here like the Chemist-doctor liaison, the local drug inspector-chemist liaison etc. If I go on to elaborate all of them, this piece would become endless.

You must be wondering as to why, being into the profession, I must expose all this? Why expose, you all are perhaps aware of all this already. So, why I must write about all this?  I have simply enlisted the areas of corruption in my field to ask you as to how will a Lokpal, a Janalokpla, or a lokayukta bring a curb to such malpractices? Except, perhaps, the issue of spurious and below par medical colleges, all other varieties of corruption mentioned above could well continue to stay beyond the reach of any law. A punitive action, if any, can be taken only in the event of a complaint. In all types of corruption, all parties involved are happy in the end, so who’ll be the complainant?  The point I want to stress here is that unless there is a lokpal in every man’s heart, corruption has no chance of losing it out to any law.

Disclaimer: Despite the sorry state of affairs as stated by me, there are still a handful of medical personnel who continue to be honest and dedicated to their field of work. My sincere apologies to such personnel. Secondly, though I have tried to remain untouched by corruption of any kind in my medical career, I cannot, in any way, claim to have remained completely unaffected by it.