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        • UHC, increasing public healthcare spending should be the larger aims of ADEH: Dr Arun MitraThe Alliance of Doctors for Ethical Healthcare (ADEH), Pune, met this month for an informal conversation with Ludhiana-based Dr Arun Mitra, Former Chairman of Ethical Committee Punjab Medical Council and Senior Vice President IDPD (Indian Doctors for Peace and Development). The ENT surgeon, who has been deeply involved in public health issues - from the fight against stent pricing to exposing the practice of ‘ghost doctors’ in Punjab Medical Colleges to campaigning against nuclear weapons – put forth important observations on how to counter the growing menace of corporatisation of healthcare and commercialisation of medical practice. “If we don’t correct ourselves, people will,” he said, while also condemning the violence against doctors in today’s volatile society. Underlining his belief that “most doctors are ethical,” he called for medical practitioners to align themselves with the interests of patients and rally against profit-oriented, corrupt practices in healthcare, with the larger aim of working towards Universal Healthcare in India and greater govt expenditure in the public health sector. “This will help minimise the mistrust between doctors and patients. Doctors have the expertise and technical knowledge of the industry. Joint committees of doctors and citizens should be formed to spread awareness about this fight and to carry it forward,” he said. A good example of doctors working for people’s interests is the recent success in bringing down stent prices. “The issue of steep stent pricing has been raised and followed up by ethical doctors for long. Birender Sangwan, a Delhi –based lawyer, citing his own experience with his father’s surgery, filed PILs in Delhi high court after which there was a ruling to cap the prices. While the govt has been quick to take credit for bringing down stent prices, the truth is that it was the initiative of doctors,” Dr Mitra said, adding, “What the govt is in fact doing in public health sector is dangerous. It has cut the health budget further by 20% and has decided to shut down public sector pharma firms, which have been feted for their work by even the WHO. These issues need to be brought into the public discourse.” Drug Pricing and irrational drug combinations, which have been banned in most countries but continue in India after pharma companies have received a stay from the court, are other issues that ethical doctors must take up, Dr Mitra believes. “There’s a report by the NPPA (National Pharmaceutical Pricing Authority) on the Ministry of Chemicals and Fertilizers website which says that the profit margin on drugs is 1800%. The report also gives detailed suggestions on permissible profit percentage but recently, there has been news of the govt deciding to reduce the power of NPPA,” he said, highlighting the dim picture of today’s public health scenario. Doctors, with their insiders’ knowledge of health issues, can provide some much-needed hope to patients, especially the poor population that bears the brunt of India’s privatisation-driven, unregulated healthcare sector, Dr Mitra reiterated. “The govt spending on public health right now is only 1.04%. That is nearly equal to countries like Sierra Leone and Haiti. In countries like UK and US, healthcare spending is a make or break issue for governments. But in India, this issue doesn’t matter. If public health spending improves, if more money goes towards sanitation and nutrition, public health improves. The Alliance of Ethical Doctors should look at this issue as their ultimate goal,” Dr Mitra concluded.
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        • Challenges and way ahead for ethical healthcare discussed at ADEH meetingThe meeting of ADEH, Pune Chapter, held in August, was a step towards expanding the community of ethical doctors in the run-up to the National Convention for Ethical Healthcare that’s being planned for December, Dr Arun Gadre of SATHI, said. Efforts will now be made to reach out to more and more doctors who wish to do ethical practice even as the takeover of healthcare sector by profit-oriented corporate hospitals poses real challenges for well-intentioned medical practitioners. The need for an independent ethical voice from within the medical community, distinct from the IMA, was recognised at the meeting. Not only will this alliance for ethical practice, with Universal Healthcare as its larger goal, work in favour of the patients, it will also help ameliorate the negativity surrounding doctors and improve the doctor-patient relationship that’s currently at its lowest. “We need to have a voice representing ethical doctors that is against medical practice following commercial logic. We will only listen to our professional logic. We stand for taking medicine away from market forces, in protecting honest doctors and at the same time penalising unethical ones. We know there are ethical doctors as well as unethical practices. What the society wants to know is – why are the ethical doctors not speaking up?” said Dr Abhay Shukla of SATHI, stressing the significance of ADEH reaching out to more doctors as well as citizens. Dr Anant Phadke, agreeing that an expansion of the community of ethical doctors is needed, also said that in pursuance of the greater aims of UHC and public health accountability, one needs to take small steps in the right direction. “Preparing standard treatment guidelines, which are absent in India, and working on the issue of drug pricing can be two baby steps in this journey,” he said. While tracing the way ahead to strengthen the cause of ethical healthcare, there are challenges that need to be faced. “Laws in our country are still inadequate to deal with unethical practice. For example, the MMC (Maharashtra Medical Council) Act works only against individual doctors under some circumstances. It doesn’t cover diagnostic centres and corporate hospitals,” Dr Sanjay Gupte, well-know gynaecologist, said. He also expressed concern about young doctors not coming forward to join the cause of ethical healthcare. “Young doctors are scared of us when we talk of ethics. They find themselves in a situation where ethical practice, even when one is willing, becomes very difficult. We need to listen to their issues and helping these young doctors should be our concern.” Radiologist Dr Sameerkumar Shah also underlined the need to bring all healthcare service providers under one govt notification. “Right now, they are not bound by ethics,” he observed. The concerns of ethical doctors, who are for the interests and rights of patients, need to be reflected in the media on a regular basis, Dr Shukla noted. “We can all speak out against unethical practices in our own branch of medicine. For example, in gynaecology right now, Stem cell banking is a huge racket,” said Dr Gupte. “If we don’t speak up against corruption and unethical practice, we will be counted as being one of them. We need to tell the society that we are concerned,” Dr Shukla concluded.
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        • Perspectives on Gorakhpur deaths…Here are three editorials on what really led to the Gorakhpur tragedy. Dr Abhijit More talks about the lack of political will and adequate funds to run government hospitals: http://www.esakal.com/sampadakiya/marathi-news-health-sector-needs-oxygen-boost-67519 Dr Devi Shetty dismisses the lack of money as an important reason for weaknesses in India's public health system and says accountability, career progression for nurses and more medical specialists can solve the present crisis in government hospitals. http://www.esakal.com/sampadakiya/marathi-news-health-sector-needs-oxygen-boost-67519 A long read in today's HT claims that though India's health spending is rising, it's not keeping up with the burgeoning population. http://www.hindustantimes.com/india-news/gorakhpur-deaths-why-india-s-poor-public-health-delivery-system-is-a-killer/story-ts9FxktlcUCXHgHrM3FS0I.html Thoughts and comments welcome...  
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