Alexander Mathew has practised paediatrics for close to 40 years in India and abroad, and helmed many a hospital in the city. After years of working in Kerala, however, the doctor decided to leave mainstream medical practice disgusted with the lure for lucre among hospital managements. Dr. Mathew, who has worked as a doctor and a medical administrator, decided he had enough of a system in which pharmaceutical companies and hospital balance sheets dictated doctors’ diagnoses.

Dr. Mathew, who practised paediatrics in the U.S. for 10 years and a Fellow of the American Association of Pediatrics, says the story published in The Hindu “When ICU turns into a business opportunity” on June 8 prompted him to open up about his experience about the medical practice in Kerala.

“Many tests and procedures done in hospitals here are unnecessary,” he says.

Dr. Mathew says pharmaceutical companies influence all levels of medical practice, right from sponsoring medical research to offering doctors benefits to prescribe certain drugs. “There are not enough data and studies regarding the incidence of infectious diseases in India for which new expensive vaccines are being introduced,” he says. Of the studies published here, many are sponsored by pharmaceutical companies looking to sell their drugs. Companies then sponsor news items based on these studies, further promoting their drug.

Sixty-six-year-old Dr. Mathew gives the example of the MMR (measles, mumps and rubella) vaccine. “Lots of children in India die of measles every year. However, MMR vaccine was introduced into the national schedule much, much later than Hepatitis B vaccine, because of commercial interests,” he says.

Pharmaceutical and medical equipment manufacturing companies have also infiltrated doctors’ associations, hospital managements, and doctors’ practice. Hospital managements pressurise doctors to direct patients to procedures that bring in more money for the hospitals. Doctors’ merit is decided on who brings more money and not based on their skill. “I can manage five x-rays if you bring a child with fever and cough to me. But a doctor should not go for these tests unless it is absolutely necessary. What a doctor needs is a good physical examination, good history, and good follow-up,” says Dr. Mathew. Besides drawing money off patients, unnecessary medical tests could also throw up false positives that confuse doctors regarding the diagnosis, making patients more ill.

Pharmaceutical companies ultimately influence medical care by offering benefits to doctors. “Company executives offer benefits to doctors if they can make 100 prescriptions for their drug each month. Benefits include cars, air-conditioners, office furniture, tours to Singapore, the U.S. or Europe. For medical conferences held abroad, companies sponsor air tickets and stay at five-star hotels,” says Dr. Mathew.

Executives approach doctors as soon as they begin practice. A young doctor in the city said he was offered a trip to Munnar when he was a house surgeon at a city hospital. All he had to do was prescribe an amount of the company’s drug. As the doctor’s fame in the city goes up, so does the value of benefits offered.