Responsibility and accountability

Abstract

Excerpts from the second Past President Oration of the Research Society of Anaesthesia and Clinical Pharmacology ‘Medicine is not merely a science but art: The character of a physician may act more powerfully upon the patient than the drugs employed.’ —Paracelsus When we are young we are romantic, filled with dreams and aspirations of taking the world by storm, dreaming of finding answers to all the worlds woes and definitely standing by the Hippocratic oath.[1] Our duties are clearly demarcated into self-regulation, where we need to maintain an ethical code of conduct, avoiding negligence and malpractice and accepting external regulation by the law (The law does not cure all ills but does facilitate our “good behavior”). In the ambit of self-regulation it is also our duty to keep up with change and upgrade our knowledge. In addition, we have duties to our patients: Kindness, patience and confidentiality. However as time goes on, reality sets in and it gets more difficult to hold on to our ideals.[2] Commercialization of Health Care Over the years health care has become more commercialized as Benjamin Franklin put it “God heals and the doctor takes the fees.” Sandeep Jauhar, an Indian origin American cardiologist, in his book “Doctored: The Disillusionment of the American Physician”[3] talks about the rush to “it over and done with”, the short time we spend with patients, the referrals to umpteen specialists, the number of investigations that have no relevance to the treatment we plan to give and so on, all billed and accounted for. Are we forgetting the human element, the patient, in our busy, money generating, commercialized lives? Is it because we are in competition with surgeons who demand huge fees, or the corporates who demand we do more investigations to draw in a minimum income per patient, or pharmaceutical companies whose drugs we order so that they will fund our next trip abroad? Do we expect commissions from laboratories, radiologists, touts and others for providing basic good care to patients? How often do we forget that among the fundamental rights enunciated by our founding fathers is the (patients) right against exploitation. We seem to be more involved in cutting edge technology, anesthesia workstations, and robotics and often forget the plight of the uneducated poor, forget humaneness and uncomfortable ethical issues. Take the case of the 13 women who died after tubectomies in Chhattisgarh. Ramesh Mahwar and his son Sunil provided the antibiotics to the government-aided tubectomy camp, drugs that were spurious and adulterated with insecticides. Their operation was suspect, but did anybody take action before these women died? Now there are 13 homes where the children have no mothers, 13 husbands with no wives. Who is to be held accountable, just the makers of bad drugs or the authorities who set unreasonable targets and fail to take action against charlatans or the surgeon who agreed to operate under abysmal conditions?[4] Research Ethics Requirements for clinical research are universal though they must be adapted to the health, economic, cultural and technological conditions in which the clinical research is conducted.[5] Often human frailty does prove to be the stumbling block of researchers who want to prove to the world that they are the best. In reality today's “evidence-based medicine” may be tomorrow's malpractice. The case of Joachim Boldt and his ‘research’ on intravenous starches comes to mind. Joachim Boldt, a German anesthesiologist, was considered a world leading researcher on intravenous colloids. Though the fraud was revealed, over ninety of his research publications withdrawn and his Professorship stripped the damage he has done to thousands of patients the world over is unimaginable.[6] Hopefully, his exposure as a fraud will have far reaching effects on clinical and research practices as well as on editorial policies. Another example of research fraud is the case of the antiseptic solution Ch