Business interests and corporations should not hold sway over physicians

Every medical student who has passed qualifying examinations and becomes a newly minted physician swears by the Oath of Hippocrates.

Since antiquity, physicians from all nationalities and all specialties have sworn to uphold some variant of it. A consensus among its many variations through the ages is its prime directive, whether it was explicitly stated or not.

Primum non nocere. First, do no harm.

This is the heart—if not the very soul of medicine.

It is the ideal by which all who have dedicated their work to the literal betterment of their fellow human beings are encouraged to strive at all times. For so simple a dictum, it carries most heavy a weight. That of integrity in safeguarding the well-being and the very lives of patients.

Health is an all-encompassing subject that includes physical, psychological, social, and even spiritual well-being. An insult to any or all of these is tantamount to illness.

All doctors must choose for the betterment of patient health, whether or not he or she likes it, for as long as human dignity is upheld.

The repercussions are dire when actions blatantly mar and damage this integrity. A physician may be caught in such a conundrum, especially when fellow physicians are responsible.

Thus, this question: Should a physician who has learned of the harmful actions of other physicians let the world know even if it means tarnishing or severing bonds with said colleagues?

There are those unaware that there are situations where some harm is unavoidable. Thus, to “first, do no harm” in such a position, a physician with integrity must choose the actions that are least harmful.

It is in a similar situation that the undersigned has been placed, caught between the proverbial rock and a hard place, for having spoken against what has been perceived as unethical business practice and one which borders on illegal.

Republic Act No. 6675, otherwise known as the Generics Act of 1988, was created to ensure that every Philippine citizen can access appropriate quality medication for the least possible price. It supposedly ensures that prescribed medications must be addressed by their generic name with physicians having the option of recommending certain brands.

While innocuous by nature, this perhaps presented a loophole for unscrupulous individuals to play on human desire for comfort and material wants and needs.

Though there is nothing inherently wrong for a physician to prefer one brand over another, this must be done by virtue of empiricism and impartial scientific evidence.

Someone who prescribes a certain brand of medication for the promise of material gain is thus complicit in an act of harm. Again, omission and ignorance of the bigger picture are small excuses.

Sure, these may not physically harm patients as long as the medication concerned is appropriate for their condition. But a patient’s means are another thing altogether, and not every patient can afford every brand on the market. There are even generic medications or those that belong to just one innovator who has prices so steep that the common Filipino could never hope to purchase them without appropriate help. What more, when two or more brands of the same generic drug are found to be equivalent in efficacy for a certain illness, but differ so steeply in price?

An honorable physician must be transparent and present the more practical and affordable among these choices, and explain the scientific proof behind their reasoning. Business interests and corporations should not hold sway over such decisions.

For those complicit in prescribing for their material gain, the consequences have been far-reaching. Public trust has been damaged and the transparency of physicians, especially those who have business interests, has been questioned. It is harm that reaches far and beyond—physicians, patients, and even the pharmaceutical industry so vital in producing the medications we need have been affected negatively.

If at least a Pyrrhic victory for what is right and what is lawful is to be achieved, a stand such as mine must be honored if not for integrity, then at the very least, for common decency.

Anthony C. Leachon, M.D., independent health reform advocate