LETTER FROM BANGALORE
Doctors and the
press
Sanjay A Pai
The relationship between the press and doctors is
difficult to define. Whereas doctors are not allowed, according to their
code of ethics, to advertise or talk to the press, one routinely finds
gross violation of these rules. One newspaper in this city carries, at
least twice a week, a health- or disease- related story, usually written
in 'human interest' style. I find this a significant difference between
this newspaper and its parent newspaper in Bombay (unless things have
changed recently). Indeed, more and more newspapers have started aping
this, clearly an indication of what people like to read.
Thus we have articles with titles like 'first.-
done in city' or '- will save lives'. Photographs of the patient are, of
course, included so that it adds to the authenticity - while patient
privacy takes a backseat. Physicians, otherwise rather busy professionals,
somehow manage to find time to talk to the press. That many of the
statements are unscientific and even ridiculous at times seems to be irrelevant.
This and other related topics were the
subject of a dissertation by a colleague of mine at The Institute of Law
and Ethics in Medicine course at the National Law School of India University.
Her findings and discussion were interesting, but I cannot divulge them as
I hope to see a paper from her in the pages of this journal in the near
future.
However, what is clear is this: doctors can now
safely write for the lay press, according to a judgement passed by the
Karnataka high court recently. The Karnataka Medical Council saw red in
1997 when they noticed an article in the lay press by a noted vascular
surgeon in Bangalore. They immediately hauled him up, stating that the
article in the newspaper amounted to an advertisement. The surgeon then
approached the High Court where Mr Justice RV Raveendran decided that the
article was clearly meant to educate the public and could not be
misconstrued as an advertisement. No payment was made for an advertisement; nor
was there any solicitation of patients, noted the judge. The matter
written on would fall into the purview of 'matters of public health', he
added. As someone who has written in the newspaper on matters of health in
the past, I am relieved.
Some months ago I had written, "Nothing ever happens in Bangalore." Well,
it appears I was wrong. Chittaranjan Andrade and BS Srihari of the NIMHANS
have been awarded the 2001 IgNobel award for their research that school
children in Bangalore pick their noses. For those unaware of the awards,
they are awarded by the journal Annals of Improbable Research (www.improbable.com) for research that
'cannot and should not' be repeated. 'A Preliminary Survey of
Rhinotillexomania in an Adolescent Sample.' (J Clin Psychiatr 2001; 62:
426-431) was the paper - and rhinotillexomania refers to digging
one's nose! Two hundred school-going children were interviewed to learn
the exciting fact that it is a common habit.
While I accept that research findings can be useful
on unexpected occasions and while I am certainly not the best of referees
in psychiatry, surely there is something wrong with such research. This is
similar to a news report in October last year that the ICMR had given a grant to
a group of scientists to measure the average length of the Indian penis. I
look forward to comments from readers, especially those who disagree with
me.
This is not to say that NIMHANS does only such
research. A report in The Times of India states that not only is Bangalore
the country's IT capital and garden city, it is also its suicide capital. From
426 suicides in 1990, the number increased to 1,938 in 1999, clearly a
serious matter. It appears alcoholism is an important fcator. The WHO,
taking notice of the increase, has initiated workshops to educate and
sensitise the public about this epidemic and ultimately devise strategies
for suicide prevention.
Many medical professionals have felt offended at being equated with businessmen
and shopkeepers while their patients are likened to consumers, according to the
Consumer Protection Act. Where will this lead us? You might get an idea from a
patient of ours who recently demanded her money back because she believed that
the investigations ordered ('ordered', to use the American term; I personally
prefer the term 'requested', which is more polite if less used, but with
essentially the same meaning) by her physician were not indicated clinically.
What next? Money-back guarantee if the surgical biopsy is inadequate for
opinion? 100% success to be promised after surgery? We need to get rid of this
department-store mentality. I have already seen: "Do one test (investigation)
and get the other done free." Rather like a pizza joint.
A physics post-gradauate (my teacher's son) writes to me about my Letter on the
ethics of publishing, that this phenomenon occurs in his field too. The "publish
or perish" aspect has resulted in many useless papers being published. With
reference to my statement about not wanting to be a co-author because I
disagreed with the conclusions, he states that most of the papers that he
collected during his literature search had no proper conclusion! Truly, in
medicine, we are rather more lucky, it would seem.
Sanjay A Pai, MD,
Consultant Pathologist, Manipal Hospital, Airport Road, Bangalore 560 017.
E-mail :s_pai@vsnl.com
