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."