Governance , or lack of it is often a major space filler in conversations across Pakistani drawing rooms. It was therefore interesting to hear a friend describe his recent achievement in organising a conference to discuss various aspects of this subject. Fascinated by his description, I wanted to know what all was involved in undertaking a typical seminar of this nature. Of course I was thinking of not just its intellectual inputs but also the usual mundane stuff like air tickets, hotel stays, transport, teas and lunches, mineral water, brochures and other expenses that go hand in hand with a traditional seminar. The recipe I was told was simple. Choose an impressive sounding contemporary topic. Make a proposal that briefly describes how discussion on this topic will change the world and more importantly the expenses needed to put half a dozen speakers and a few dozen listeners in a conference room for a few hours. Send the proposal to a foreign government or organization whose quota of yearly charity has not yet exhausted. Once the donor money arrives, the rest of the tasks are a mechanical routine. Book a conference hall, listen to (often boring) speeches and submit a glorious report. If someone questions the very need of foreign funding to discuss (between ourselves) a subject that is exclusively of our own concern, he/she should be dismissed as a naïve and ignorant person who has no understanding of how the donor-driven rackets operate.
The donor driven rackets are not exclusive to any one government department or an NGO. That is the only way known to this beggar-infested country for doing anything. The medical practitioners in Pakistan can rightfully claim to be some of the forerunners of this shameful contagious disease. They are prone to accepting gifts, free lunches, and hotel expenses from Pharma companies every time they hold a medical seminar. Why can the doctors who are a financially blessed community in Pakistan not pay for their own meals and their own expenses for the conferences that are meant for their own good. A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development. The CAM Group an international market research company in 2004, reported total promotion spending by the U.S. pharmaceutical industry as US$33.5 billion. A large part of these so called ‘marketing’ expenses go towards giving gifts, freebies, free meals and free samples to doctors. When the goodies that a doctor receives are made proportional to the extent of medicine that he prescribes, the results can be disastrous for the health as well as the wealth of the helpless patient. Social science research demonstrates that the impulse to reciprocate for even small gifts is a powerful influence on people’s behavior. Individuals receiving gifts are often unable to remain objective. The rate of drug prescriptions by physicians increases substantially after they meet sales representatives, attend company-supported symposia, or accept gifts and freebies.
Patients in Pakistan have continued to suffer from these unethical practices organized by the pharma companies and received with open arms by medical practitioners. Even the best, richest and the most famous of the medical tribe have often fallen prey to this petty greed. But surely and silently a change has started to happen. A small group of thoughtful, committed doctors did finally manage to demonstrate that professional seminars and discussions can be held without pharma charities. On 9th October 2011, the Pakistan Association for Mental Health (PAMH) an organization that runs on a shoe-string budget and offers free-of-cost psychiatric consultation organized a seminar on the subject of mental health. For the first time, there were no pharma sponsored lunches, teas, gifts or freebies. The seminar was held at a modest but professional venue (PMA House) instead of a 5 star hotel, which saved major expenses that would otherwise be happily picked up by a drug company. Just one day later on 10th October 2011, the Psychiatry Department of Jinnah Post Graduate Medical Centre (JPMC) Karachi organized a similar seminar without the traditional support for meals and other arrangements from Pharma companies. Here too, the major expenses of a 5 star venue were saved by holding this event within the professional surroundings of JPMC.
The two examples are a rare new phenomenon and speak of a new awakening amongst the health care providers. An awakening that we can be proud of. The principal beggars of Pakistan (its rich and educated elite) must learn to stop begging from foreign countries or be sponsored by the drug industry for the things they ought to do on their own. The key techniques could be holding all conferences and seminars in modest professional or academic locations rather than five star hotels. Do not invite people from other towns who could instead contribute by sending their views in writing or participate through skype and other video conferencing tools. Have a food stall serve simple meals and let every one who attends a seminar pay for his/her own consumption. Those who are keen to learn will still love to join. Those looking for a free lunch or a free junket would hopefully not be interested.
Express Tribune October 2011