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Our Morals: Their Morals

The National Medical Commission (NMC) recently barred doctors from attending events or seminars or meets which involve direct or indirect sponsorships from pharmaceutical companies or the allied health sector. The regulations even impose a suspension of licence for three months in case of violation. Section-35 of the new professional conduct regulations prevents doctors and their families from seeking consultancy fee or honorariums from pharmaceutical companies or representatives. While the intent of the regulation is good, how much of it is practicable?

Pharma companies generally indulge in Direct-to-Consumer advertising (DTC), use promotional material, sponsor medical education, give away free samples, engage doctors in speaker programs and consulting agreements, give away gifts, provide hospitality, fund research, lobby, advocate, offer patient assistance programs, provide patient support services, and collaborate with healthcare professionals. The question however is, how many of these practices are legitimate and contribute to the advancement of medical science?  How many create conflicts of interest and undermine the objectivity of healthcare professionals, and compromise patient welfare? That said, should the regulations have been more open ended?

Actually, the practice of pharmaceutical companies throwing parties or providing freebies to doctors falls within a grey area that is ethically questionable and potentially corrupt, depending on the context and the intentions behind such actions. Should the contexts not be evaluated then?

Corruption in the society has risen to systemic proportions. However, can something of it be ethical? Look at the case of transporting fresh vegetables. If the payment of an insignificant amount of money at the check post, can speed up a border check, on the perishable cargo in the truck or ship, is it unethical? The assumption is that without such ‘facilitating payment’, that truck or that ship may be detained for many more hours or even days, causing the cargo to turn bad, which will result in large financial losses. While graft, cronyism, favouritism in procurement, shell companies, ghost employees, influence peddling, blackmail, extortion rackets, offshore accounts, phantom projects, and front companies can hit the roots of governments and societies, the question of whether “a little corruption is good if it gets things done faster” is a complex ethical dilemma.

Systemic corruption is due to process weaknesses of an organization. While systemic corruption includes conflicting incentives, discretionary and monopolistic powers, lack of transparency, low pay and a culture of impunity, what is of equal importance is moral corruption such as lying, deception, cheating, plagiarism, exploitation, betrayal, discrimination, prejudice, cruelty, abuse, selfishness, indifference to suffering, and unethical business practices.

If corruption is judged on the basis of business economics, macro-economically, it costs money to society which should be treated as loss. From a micro-economic point of view, for the bribing entrepreneur, it is profitable. Everything that is illegal is corrupt, but not everything that is corrupt is illegal. Why might this be so? Most of us fail to imagine that corruption can also grease the wheels of prosperity. Yet in places where bureaucracies and organizations are inefficient or where entrepreneurs and big firms struggle to import or export or comply with regulation, corruption could improve efficiency and growth. Opportunity cost of waiting may be saved.

The ‘mordida’ or ‘bribe’ in Spanish, is an informal corruption practice that was prevalent in Mexico for many decades. It involved citizens paying bribes to police officers and government officials to avoid fines, legal trouble, or inconveniences. While this practice was illegal, some argue that it provided certain perceived benefits in the context of a complex bureaucracy and economic challenges. While it allowed quicker access to essential services such as medical care, education, and public utilities, it also aided their economic survival and helped maintain social harmony. Bribes avoided legal conflicts and helped prevent confrontations with authorities that could escalate into social unrest or conflicts. While all that may be true, it also entrenched corruption, and promoted inequitable access.

We live in an imperfect world, and a bit of controlled corruption can function as a lubricant to overcome some of our worst problems. Maxim Mironov of the Graduate School of Business University of Chicago, infers in a study on corruption that uncorrelated corruption with other governance characteristics is positively related to GDP growth in countries with poor institutions. Interestingly, the global coalition against corruption calls corruption ‘bad business practices.’ Is it not a moral judgment, rather than economics based? Probably changing times?

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