We read with a heavy heart the letter by the New Zealand Medical Students’ Association (NZMSA) in the 14 October 2011 edition of the NZMJ titled “A policy of no pharmaceutical sponsorship: a case for health equity.” Before responding to the points made in the letter though, I must declare my conflict of interest in that I am an employee of a multinational pharmaceutical company. However, it is not in my professional capacity that I wish to respond, but as a Kiwi and father.
NZMSA set out an argument for disengagement from what they describe as the pernicious influence of the pharmaceutical industry. The segregation policy which they espouse has the connotation of ethical apartheid where you are prejudged based not on one’s actions but on who employs you. The pharmaceutical industry has room to improve in terms of ethical engagement based on the common good of patients, but this ought not to be a beauty pageant where we endeavour to separate the self righteous team from those of supposed moral turpitude.
Lest we forget the skeletons in the medical profession’s ethical wardrobe: the cases of sexual impropriety with vulnerable patients;2 fraud (28 prosecutions between 1994 and 2002);3 tax avoidance;4and misrepresentation of clinical results,5 to name but a few.
My own son, Zachary, a fourth-year medical student, died of meningococcal septicaemia in 2009. After more than 2 years of fighting for truth and justice, the Auckland District Health Board finally offered a public apology for Zachary’s substandard care and for failing to investigate and openly disclose. This is sadly one of many cases of medical misadventure annually.
We are all stakeholders in the health system with something valuable to offer. We all make ethical (and other) errors of judgement from time to time. Together we can be stronger but ethical apartheid will only weaken us all. As the good book says: before you take the splint out of your neighbour’s eye first take the log out of your own.
The NZMSA appears to also imply that the existence of a state monopsony purchaser such as PHARMAC is an important tool in achieving national health equity. Unfortunately this hypothesis is unreferenced. PHARMAC’s statutory obligation to provide the most benefit for the greatest number within a fixed resource is the epitomy of utilitarianism. It has long been recognised that not only is utilitarianism not dependent upon equity but indeed is inconsistent with it.6
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