Nurfika Osman – A medical expert has warned that many Indonesian doctors may be putting major pharmaceutical companies ahead of their patients' well-being when it comes to prescribing drugs.
Iwan Dwiprahasto, head of the Association of Indonesian Pharmacologists (IKAFI), said on Tuesday that his concern stemmed from recent reports that the domestic pharmaceutical market was worth an estimated $3.9 billion annually, with about 100 manufacturers operating in the country.
"Doctors should be accountable, meaning they should prescribe only high-quality medicine based on the patients' needs," he said. He added that part of the problem was that the country lacked clear regulations governing how doctors prescribed drugs.
"We're not at the stage yet where we can screen doctors who are being influenced by drug companies, because they work independently of regulators," Iwan said. "We don't have the people to do this important job."
He said that while organizations such as the Indonesian Doctors Association (IDI) and the Medical Ethical Code Council (MKEK) provided guidelines on ethical behavior for health professionals, they tended to act after the fact.
"These organizations can't carry out preventive actions, they don't have the regulations for this Iwan said. "So they'll only act once a dispute has already arisen."
He said there needed to be a new institution dedicated to the task of monitoring doctors' prescriptions. "A professional union is needed that will ensure that the doctors act responsibly toward their patients and maintain a high standard of ethics," he said.
He said some of their current behavior that could be considered unethical in terms of their ties to pharmaceutical companies included receiving commissions for prescriptions or accepting gifts, travel packages or scholarship offers for family members.
These practices, Iwan pointed out, went against the 2009 Law on Medical Practice. Article 62 of the law, which includes the doctor's oath, says: "I hereby promise to conduct my duties within ethical means and will not accept directly or indirectly from anyone a pledge or a gift."
Agus Purwadianto, chairman of the MKEK, said doctors should always strive to maintain a high standard of ethics in carrying out their duties.
"Doctors should prioritize society and always try their best to serve the community and further academic knowledge at the same time," he said.
"They should have control over what they do because their work should be based on integrity and a code of ethics and aimed at serving the best interests of patients."
He conceded that there might be doctors who "abused their power" through questionable practices such as burdening their patients with prescriptions for unnecessarily expensive medicine.
"In such a case, the doctor should see it from the patient's point of view: How would he feel about being deceived like that?" Agus said. "The essence of being a doctor is that one works based on the principle of upholding human rights, trying to eliminate people's suffering."
Luthfi Mardiansyah, head of the International Pharmaceutical Manufacturer Group (IPMG) in Indonesia, said his organization's members were committed to efforts that benefitted patients and to collaboration with health professionals to enhance the practice of medicine.
He said the IPMG sought to preserve the independence of the decisions taken by health professionals in prescribing medicine for patients.
"Industry relationships with health care professionals must support, and be consistent with, the professional responsibilities that health care professionals have toward their patients," he said. "Ultimately, it is the physician's decision what drug to prescribe."