Corporate capture of healthcare a challenge: Dr Matthew Varghese

Dr Matthew Varghese
Shobha Shukla and Bobby Ramakant, CNS
Corporate capture of healthcare in India has got much less attention than it should. Systematic weakening and dis-crediting of public health system, deepening roots of a bias towards private healthcare system, corporations chipping in with 'profit before people' principles, corruption and malpractices, shifting scales of public versus private medical education, strong influx of public healthcare experts in private sectors, sky-rocketing prices of medical care, drugs and diagnostics, and most importantly, less takers of evidence-based healthcare among doctors, policy makers and people at large, are just some of the reasons which are responsible for the state of healthcare in the country.

Dr Matthew Varghese, Head of Orthopaedic Surgery, St Stephen's Hospital, Delhi, spoke with Citizen News Service (CNS) at 22nd Cochrane Colloquium in Hyderabad, India.

Dr Varghese said: "Healthcare in India is getting corporatized. Government itself is abdicating its responsibility although National Rural Health Mission (NRHM) and other activities are going on but one can see a clear bias towards corporatization which needs to be evaluated on evidence-based platforms. How is corporatisation of healthcare affecting general health status of people in India, where majority are starving, majority have problems of payment, and one big panacea which is being brought about is private health insurance based services. We need evidence if private health insurance based services improve healthcare – there is not sufficient evidence. Even in government hospitals where patients have to pay based upon their income levels, there is no evidence that payment of service actually improves the quality of service in government hospitals. One may pay for it if it actually improves quality of service. These are challenging areas for research as these are multidimensional and not linear. So doing randomized controlled trials (RCTs) is challenging in such contexts."

Dr Varghese added: "There are influences by the industry which influences doctors to move from public to private hospitals for example. If we look at research over past 30-40 years there are several areas where science has been completely overturned. We are told at a point that 'A' is good for healthy heart and ten years down the line evidence comes up that it is not good for heart. We keep revising science as per the evidence."

"For example, a company had found that there is a long term side effect associated to Cox-2 inhibitor drugs, but company did not reveal it. When it was found, by then damage to several human beings was already done" said Dr Varghese raising questions of ethics and accountability plaguing medical 'industry'.

Dr Varghese gave another example: "Similarly Botulinum toxin is a drug which is very expensive which is used usually by the cosmetologists for making people look younger. There was a review in a peer-reviewed journal that looked at how were the studies showing benefits of this drug funded. More than 50% of the articles on Botulinum toxin benefits were industry-funded and corporate driven. Where there is a bias like that, one wonders when will we have total transparency of information? This is possible only when we have complete democratization of information."

Unless all the data and conflicts of interest are in public domain, easily accessible to everyone, such situation will persist. "Today not just economic imbalance is a problem, but knowledge imbalance is also a problem" said Dr Varghese.

Shobha Shukla and Bobby Ramakant
Citizen News Service - CNS
23 September 2014