In 2005 the Royal College of Physicians in the UK published a booklet ‘Doctors in Society: Medical professionalism in a changing world’.1 In this they stated that ‘Medicine is a vocation in which a doctor’s knowledge, clinical skills and judgment are put in the service of protecting and restoring human well-being’. Six professional values were then listed that ‘underpin the science and practice of medicine and form the basis for a moral contract between the medical profession and society’. These values were: integrity, compassion, altruism, continuous improvement, excellence and working in partnership (or teamwork).
Sadly, despite integrity being top of this list, two recent articles in the British Medical Journal (BMJ) focused on the extent of corruption within the global healthcare system, ranging from individuals taking “informal payments” to major corporate fraud and falsification of drug company trials.
For the article ‘Corruption: medicine’s dirty open secret’ published 25 June 2 the journal used the Transparency International definition of corruption as: the abuse of entrusted power for private gain, which in healthcare encompasses bribery of regulators and medical professionals, manipulation of information on drug trials, diversion of medicines and supplies, corruption in procurement, and over-billing of insurance companies.3 The authors write that ‘this complex challenge is one that medical professionals have failed to deal with, either by choosing to enrich themselves, turning a blind eye, or considering it too difficult. This is no dirty little secret. It is one of the biggest open sores in medicine.’
As a measure of the extent of corruption the article highlights that an estimated10-25% of the global $7 trillion health spend each year is lost to corruption – a staggering $700 billion to $1.7 trillion. According to The Economist, in 2011 the US alone lost between $82 – $272 billion to medical embezzlement.4 Much of this was caused by falsification of sickness certificates.
Corruption is not victimless crime and results in the deaths of many people who are deprived of the treatments they need. Whilst much of the problem arises in the richer countries, the burden falls hardest on those in the poorest situations. It is in poorer areas that patients are most likely to have payment demanded from them to obtain treatment. Transparency International reports that in India the payment of bribes for services is twice the global average.
A later article in the BMJ 5 ‘Who is paying your doctor?’ highlights the increasing lack of trust in healthcare professionals as various scandals come to light – pointing to such cases as the fining of GlaxoSmithKline $3 billion for false marketing. With a degree of greater transparency occurring, at least in some countries, the scale of payments to doctors and other healthcare professionals is coming to light – with increasing uneasiness and distrust. In 2012 the top 12 drug companies in the US paid doctors $1 billion while payments of £40 million were made to over 2000 UK clinicians.
So what should we do as individuals? Firstly, rather obviously, ensure one’s own integrity. In some situations this is hard to do. In some parts of the world where PRIME has taught, doctors and nurses are poorly paid. I have even heard officials shrug off the problem saying they don’t need more as they all take “informal payments” from their patients. Some of PRIME’s partners in these situations suffer real financial hardship by avoiding these – and sometimes because the practice is so ingrained, patients don’t believe they will get proper treatment unless they pay more for it. A major dilemma! Or what about when someone finds themselves working in a situation where the whole unit engages in corrupt practices and someone who refuses is accused of “letting everyone down”? We will revisit some of these issues in a future newsletter.
But is individual integrity enough? Or do we have a wider responsibility – say for the child deprived of malaria treatment because their parent can’t afford the bribe they know will be demanded? Edmund Burke, an 18th century Irish philosopher and politician said, “The only thing necessary for the triumph of evil is for good men to do nothing.” It is hard to escape the spider’s web that corruption spins. Jesus told a story of a man who planted a field with wheat to produce a crop of good food, but in the night an enemy came and sowed seeds of a poisonous weed (Matthew 13:24-40). That is like corruption – a poison that spoils the many good and wonderful things God has provided, and can so often involve us, even in ways we are unaware of. This is shown very effectively in a short video clip by the Exposed campaign, at:
It is time we, the healthcare professionals of today and tomorrow take a stand against corruption in any form in our own lives, workplace, country or the world.
1. Doctors in Society: Medical professionalism in a changing world. Report of a Working Party of the Royal College of Physicians, London, 2005. ISBN 1 86016 255 x
2. BMJ 2014; 348: g4184 (Published 25 June 2014)
3. Transparency International. Global corruption barometer. http://www.wingia.com/web/files/news/61.pdf
4. Health-care fraud. The $272 billion swindle. Economist 2014. http://www.economist.com.news/united-states/21603078-why-theives-love-americas-health-care-system272-bollion-swindle.
5. BMJ 2014; 349: g4601 (Published 15 July 2014)