Let's consider ethics of medical practice first

British Medical Journal, Sept 30, 2000 by Samiran Nundy

EDITOR--During the past year I have attended three meetings on the ethics of research sponsored by the World Health Organization, the Harvard School of Public Health, and the Indian Council of Medical Research. They were all ignored by the media, although the Indian media report daily on the poor state of the health service and unethical medical practices. The recent alleged maltreatment of a central government minister who died in a private hospital in Delhi has caused particular public concern.[1]

That medical research in developing countries is meagre and of generally poor quality is well known,[2] and it has not improved in the past 20 years. Should one therefore discuss research ethics in developing countries when they barely exist?

In my view the ethics of medical practice is more important. To see how the public can be safeguarded from an inefficient and often corrupt medical system and receive comprehensive health care of a reasonable quality is paramount. Ordinary people have to choose between an underfunded and inefficient public sector with its long queues, dirty hospitals, and rude staff (not infrequently on strike for more pay) and the expensive private sector, perceived as being run by avaricious doctors fleecing patients through overinvestigation and overtreatment. Many patients, understandably, turn to the more accessible and cheaper practitioners of alternative systems of medicine or even to quacks, who regularly prescribe a cocktail of antibiotics, antimalarials, antipyretics, and steroids for fever. Despite this, 80% of the Indian gross domestic project spent on health care goes to the private sector.[3]

The medical councils, the main regulatory bodies, are generally ineffective, claiming that they do not have the necessary powers. Only one doctor (a well known actor who used his medical status in an advertisement) has been struck off since their inception. Even the Consumer Protection Act, which includes medical practitioners in its ambit, has not successfully curbed unethical medical practices because of the huge delays in its legal process.

In January 2000 the Ministry of Health recognised the growing concern about the absence of standards to measure the quality of health services and that the medical community in India is not accountable in any manner. It proposed setting up a system of monitoring hospitals and doctors in both the public and private sectors. Perhaps the sad and unfortunate death of a young minister will now result in some belated action.

Samiran Nundy gastrointestinal surgeon Sir Ganga Ram Hospital, New Delhi 110060, India snundy@hotmail.com

[1] Staff Reporter. Kumaramangalam passes away. Hindu 2000 Aug 24:1 (col 5).

[2] Reddy KS, Sahni P, Pande GK, Nundy S. Research in Indian medical institutes. Natl Med J India 1991;4:90-2.

[3] Naylor CD, Jha P, Woods J, Shariff A. India's public and private health care systems. In: A fine balance: some options for private and public health care in urban India. Washington, DC: World Bank, 1999:4.