Take it or leave it? Health consumers have few choices

Take it or leave it? Health consumers have few choices

Ida Indawati Khouw, The Jakarta Post, Jakarta

Every time "Ani" is about to consult her well-known
gynecologist, she suddenly gets a "headache". The problem has
nothing to do with her pregnancy, but rather the amount of money
she will have to spend on the visit.

In fact, she will have to pay more than a million rupiah on a
single visit.

The 28-year-old woman, whose is carrying her first child,
realizes that medical care is expensive. But the thing is, she
feels reluctant to buy the expensive "prescribed" food
supplements at the doctor's clinic.

"The gynecologist says the food supplements are good for the
development of the baby's brain. I actually want to express my
hesitation but I'm afraid that if I do so, he won't give me the
best treatment available," Ani said.

Once she considered going to another gynecologist. However,
she is aware there is no guarantee other doctors will not do the
same thing.

The alleged involvement of doctors in boosting drug sales, in
this case food supplements, has been widely criticized.

There is as yet no data on the number of doctors involved in
the business, but Indonesian Health Consumers' Foundation
chairman Marius Widjajarta said that last year he had discovered
two doctors at a certain hospital here breaching professional
ethics by selling supplements.

"We reported the case to the hospital where they worked and
the doctors no longer continue the business," Marius said.

Such practices are considered as breaching the medical code of
ethics. One article in the code of ethics states that while
performing their professional duties, doctors should put personal
interests aside.

"The doctor, of course, is cheating the patients by telling
them to purchase things they don't need. Moreover, doctors can't
just recommend any kind of drugs in the prescription as there
should be certain categories. And the doctor should not prescribe
food supplements," said Firman Lubis, senior lecturer at the
University of Indonesia's School of Public Health, who teaches,
among other things, the medical code of ethics.

He even categorized doctors who commercialize their practices
as "prostituting" their own profession. He added that food
supplements should only be given to sick people and
overconsumption might lead to, among other things, heart
problems.

Firman said the main principle of the code of ethics is that
doctor should emphasize the patient's interests instead of the
former's personal interests or profit.

"Actually, there have been too many cases of breaching the
code of ethics but nothing has ever been done by the institutions
that should enforce ethics, such as the Indonesian Medical
Association (IDI)," said Firman.

Food supplements are a profitable business. Those sold through
multilevel marketing systems, for instance, can bring in tens of
millions of rupiah in monthly profits to each of the system's
members. And doctors who join such marketing systems can reap
even bigger profits, considering their major influence on their
patients.

Some of the food supplements, according to their labels, even
claim to have curative powers.

According to Professor Iwan Darmansjah from the University of
Indonesia's School of Medicine, there is no evidence so far of
food supplements having curative powers.

"But the food supplements' labels always claim they can cure
diseases. Such claims are violations since there is no proof of
this.

"Proving the claims would be quite difficult because the
products would need to go through clinical tests and the
producers, of course, would be reluctant to take the tests since
the results may not accord with the claims they have made," Iwan
said.

In some cases, the supplements can cause serious side effects.
Iwan pointed to 10 of his patients who came to him after
consuming the supplements and then suffering side effects. "Two
of them died," he said.

"The side effects included blindness, allergies, ulcers and
coughing. In another case, a diabetic patient's sugar level
increased after he took a so-called anti-diabetes drug," Iwan
added.

Ironically, there was no reaction when Iwan reported the case
to the Ministry of Health's then Directorate General for Drug and
Food Control, and even the World Health Organization. On the
contrary, the professor was threatened with a libel suit.

According to Marius Widjajarta, it is now the time for health
consumers to improve their awareness of their rights.

"Patients have the right to receive all information about the
drugs they use. It is also their right to refuse the medication.
However, patients usually 'surrender' their lives to their
doctors during the medication process. Thus, it is the doctor's
moral responsibility to educate the patients," Marius said.

"And medical doctors should totally avoid having commercial
interests that conflict with their professional ethics."