Our misdiagnosed healthcare system

Doctors are supposed to be saviours. And they are also supposed to be up to date about the practice methodologies, medicine and research in their field. These are requirements expected of a professional and honest doctor. After all, all of us depend upon their diagnosis to learn what kind of medical problems afflict us.
In Pakistan, however, this seems to be largely lost upon the practitioners of this practice. In contrast to the developments being made in this field that ultimately lead to enhancement of quality of life, the medical profession in Pakistan suffers from the same trend of overall decline that has become a common feature in almost every field here.
You may wonder: why the fuss? Don’t we all know that? It is true that, in general, most of us are aware of this. But what is lost in this generality is the magnitude of suffering that mediocrity may inflict upon us. The complete repercussions only dawn upon us once our near ones become a victim. This is exactly what happened to this writer recently when my parents had been wrongly diagnosed with various ailments.
Their ordeal brought to reality not only their suffering, but also forced me to think about millions who may have gone through the same crisis. I want to share their story and a few general thoughts related to regulation of healthcare and healthcare products.
About a decade ago, my mother was diagnosed with blood clotting after she fell unconscious one day. In order to take care of this ailment, blood thinning medicines were prescribed to her and a filter was inserted in her body to regulate the flow of blood. For more than a decade, she took the blood thinning medicines. But she encountered some severe side effects. Her joints became itchy and bothersome, blood used to flow into her eyes, and one of her legs developed a severe wound that just would not heal.
We took her to the best and renowned doctors available within this country (both civilian and military). The prescription would always be the same: increase or decrease the consumption of medicine. Last year, she went abroad and managed to have a medical check-up done there. It was discovered that her real problem was an oversized liver, which had given rise to so many other problems. Moreover, the doctors told her that the filter inserted in her body is never prescribed for more than a year and it’s standard practice to remove it. But now, after a decade, removing the filter was impossible because it could damage a major nerve. Suffice to say, my mother is now doing fine and in much better physical shape than before.
Similarly, my father was told back in 2011 that he had sugar. Since then, he had been taking medicine to control it. Recently, his medical record was checked by my brother-in-law, who is a practising doctor in England. We all were astonished to learn that he never had sugar in the first place and was wrongly diagnosed. My brother-in-law revealed that the medicine my father had been taking contained a chemical that had been known to cause bladder cancer. It had been banned or severely restricted in many developed countries. Lo and behold, my father was diagnosed with a minor case of bladder cancer a few years ago. He had to go through minor surgeries to curtail its spread.
The story of my parents is a reflection of the bitter truth that there is no regulation regarding wrong and damaging prescriptions. Federal and provincial governments will dispute this claim by pointing to the presence of consumer courts. In fact, as I was writing this article, the instance of a consumer court penalising a doctor with financial penalty came to the fore. But the fact is that these courts are either overburdened or mostly inactive.
And even if financial penalties do become the norm, they cannot undo the damage that a patient has already suffered due to a wrong diagnosis. You cannot bring back the life of a person who has been imperilled or has died due to a wrong diagnosis. And what about the millions of poor who are not as lucky as my parents? What kind of medical advice are they being subjected to? God knows how many of them have lost their lives or have contracted diseases that were the outcome of wrong medical prescription. To whom should they appeal?
Whatever regulation exists in this country, it is of a completely counterproductive variety. The main crux of this regulation has for years been the regulation of drug prices. Government, at all tiers, is infatuated with the idea of keeping the price of medicines low (the ‘prize-freeze’ phenomenon). On the surface, this looks like a people friendly, pro-poor policy. That is what those in charge of policymaking in this field love to crow about, citing ‘welfare’ of the masses. But the repercussions of this policy have been disastrous. To understand how, consider the following.
The logic that lower drug prices help poor people is completely irrational. One implication of artificially suppressed prices of medicines is that quality medicine becomes scarce or disappears of the shelves (a producer whose cost comes out to Rs100 will be highly unlikely to continue if he is forced to sell his product at half that price). Their place is usually taken by substandard medicine. So yes people may be getting medicine at lower rates, but they are not necessarily the most effective.
The end result of consuming these medicines is prolonged medical problems, more side effects and even death in extreme cases (as in the case of a substandard cough syrup that led to the loss of many lives in Lahore). As a result of these enforced price reductions, quality medicine finds its way to the black market (where they are sold for a much higher price), and there is always a shortage of critical drugs in the market.
Another implication of this kind of counterintuitive regulations is that many multinational drug manufacturing companies have wrapped up their business in Pakistan. Those who remain are now increasingly concentrating on more profitable areas like consumer products. Their place is taken up by local manufacturers whose medicines usually lack the same quality as that of multinationals.
So not only is the regulation negatively affecting people’s health, it is also causing businesses to leave the country. And it’s all absurd because if you ask anybody (poor or not) whether they would prefer an expensive drug that takes care of their ailment or a cheap drug which not only prolongs their ailment but causes them the same amount of financial loss in the long run, people will definitely prefer the former over the latter.
Somehow, this commonsense seems to be lost on our regulators.
Tailpiece: For those who are interested in knowing in detail the harm (financial and otherwise) caused by the government’s price regulations in the pharmaceutical sector, PRIME institute in Islamabad came out with an extensive report on this issue. It is an interesting read on this subject.
The writer is a freelance contributor.
Email: shahid.mohmand@gmail.com
Twitter: ShahidMohmand79