medical treatments

[ANALYSIS] Hippocrates and hypocrites

Dean de la Paz

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[ANALYSIS] Hippocrates and hypocrites

Marian Hukom/Rappler

If conflicts of interest introduce extraneous variables into the prescribing processes for medicines, thereby reducing options, then that dilutes the highest standards of medical ethos and ethics

At one time or another, certain professions fall into such ill-repute that anyone who has made a career in these is adjudged accordingly, by mere association tainted, and perhaps even unfairly cast as a representative of the whole lot. More than just a question of a few rotten apples affecting the rest in the basket, in some cases, the whole basket itself turns rotten from the start. 

The negative reputation may have been justifiably earned, or it may be a product of external forces, perhaps a demonization campaign, bad publicity, fraternal differences, disputes, diversity or simply different values, principles, and practices. What should have been confined to a homogenous few set to stereotyping can eventually coagulate, keloid and petrify into intolerant prejudice, bias and bigotry.

While the cliché halo effect works in the opposite direction and bestows both deserved and undeserved positive reputations, to understand the darker side, cognizant of the Lucifer Effect and the “Breaking Bad” transition from good to evil, allow us a few familiar examples of classic rotten apples and rotten baskets.

The most obvious and perhaps the most relevant is the politician and the political milieu. Greed, ambition, manipulation, thievery, and dishonesty are among the most attributed common negative adjectives. 

Another profession suffering similar negative bias are traffic enforcers, policemen and their various iterations. The accompanying adjectives run the gamut of negativity from fearsome, to crooked, to abusive. 

A third would be prostitutes, pornographers and those involved in the sex trade whether as clientele, proprietors, practitioners, or human traffickers. 

In direct contrast is the public’s generally positive perspective on the ethos, nobility and honor of teachers, prelates, and physicians. 

Among these let us focus on the medical profession since no other takes a Hippocratic Oath to “primum, non nocere” (first, do no harm). 

The term “primum” is important. It is the first commandment. Primary and fundamental, it sets as a theme everything that follows lest subsequent acts distract, negate or worse, harm.

While controversies in the medical milieu that include but are not limited to a vaccine whose budget was released on the eve of a political campaign period; the mismanagement and eventual depletion of a pre-need healthcare fund; and the subjugation of critical medical priorities and the iron-hand application of police powers in pandemic management; plus the notoriously condemned Pharmally scandal and the constant peddling of snake oil in social media – all involving physicians cum politicians cum hucksters and peddlers – we are again confronted with another that effectively chips away at the medical profession’s credibility before the public. 

Where an unempowered public surrenders to expert medical competence and professionalism, credibility and trustworthiness are not simply fundamental but existential to the medical profession and its individual constituencies. Beyond competence, ethos and an ethical sense are likewise integral.  These become even more critical when we expand our perspective from the single rotten apple paradigm to the rotten basket bias.

A case in point is an issue culled from legitimate media however one likewise fought quite viciously in other fora from unregulated social media to battlegrounds where justice may not necessarily be as fundamental as we might think. At least not today when institutions are no longer sacrosanct and even statutes fall prey to being used in ways they were not meant for.

The issue at hand revolves around important discourses and debate on the ethos and ethics of the prescribing practices by medical practitioners. Here we take the perspective of the general public and among us, patients, as we focus directly on conflicts of interest that should not even exist had “primum, non nocere” been the primary consideration trumping all others.

Unless statutorily prohibited as they are in a number of jurisdictions, conflicts of interest are not automatically illegal especially where the Hippocratic Oath is taken seriously, and no other considerations enter the prescribing processes. That they do not in reality, and may in fact be a widespread aberration, still qualifies it among the ethical issues that should be factored in when we surrender our trust and fate to medical professionals. 

[ANALYSIS] Hippocrates and hypocrites

Extraneous and undisclosed incentives that refocus gain elsewhere outside the Hippocratic ideal create conflicts of interest. It is for that reason that we fear that the necessary discourses and debates on medical ethics boldly initiated by Anthony C. Leachon, M.D, a well-respected professional, may fall by the wayside should the basic freedom of speech and discourse be threatened, or worse, silenced where legal systems and its institutions are used to delegitimize a perceived opponent and create chilling effects to muzzle issues critical to the general public. 

Given the serial challenges inflicted on the medical profession and those who trust it implicitly – from the Dengvaxia issue all the way to Pharmally and the constant peddling of snake oil and miracle potions to the vulnerable – allow us to declare that free and open discourses on conflicts of interest must continue if only to restore trust on a profession that is gradually losing it.  

To the credit of significant regulators and associations within the medical community and among enlightened policymakers, the initial discourses have already borne fruit and must continue. Our gratitude goes to the whistleblowers who prioritize patient welfare over personal gain, convenience or creature comforts. Ethical standards are now being given the attention long denied and procedures are being discussed, reviewed and disclosure requisites are being proposed.

The late Senate minority leader Aquilino Q. Pimentel Jr., in authoring the Generics Act, said that it “is important that the people be given the freedom of choice.” Referring to prescribed medication, such freedom is a function of disclosures on alternatives and options both offered or virtually denied patients. 

If conflicts of interest introduce extraneous variables into the prescribing processes, thereby reducing options, then that dilutes the highest standards of medical ethos and ethics by distracting from, or worse, by negating “primum, non nocere” altogether.

It is at that point that we suddenly realize the difference between Hippocrates and hypocrites. –

Not a pyramid scheme, but pharma company admits giving doctors incentives

Not a pyramid scheme, but pharma company admits giving doctors incentives

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