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If your Ukrainian doctor prescribes medication for an ailment, at least two questions are in order: “How will this help my health?” And, sadly, the other all-too-logical question for patients is: “How much are pharmaceutical companies paying you doctors to prescribe this pill?”
Ukraine is proving to be a wonderland for the aggressive pill-peddling common around the world, a compromised circumstance in which doctors prescribe certain medications in return for financial favors from drug firms.
Ukraine’s health-care industry is considered to be a mess wherever one looks. The fast-growing pharmaceutical trade, until recently one of the healthiest sectors in the sick industry, has lately been under stress as well.
Importers were shaken up after the government last year restricted mark-ups to no more than 20 percent. Meanwhile, a declining domestic currency has nearly doubled the cost for imports. The result may mean lower profits.
Stepping into the void to rescue profits, health-care watchdogs say, are increasingly aggressive and desperate pharmaceutical sales representatives racing after doctors. “They are like locusts in hospitals,” said Victor Yatsyk, deputy head of the Romodanov Institute of Neurosurgery in Kyiv.
“They arrange personal meetings with medical staff and shove them their products one-on-one instead of a civilized promotion like a conference.”
The consequence is that patients often walk out of the doctor’s office with more pills than are clinically warranted.
“In the West, doctors don’t prescribe two or three antibiotics like they do here,” Yatsyk said. “[In Ukraine,] they recommend a few [extra] drugs just in case, and no one cares that it’s like using a sledgehammer to crack nuts.”
Ukraine’s pharmaceutical market was worth $2.6 billion in 2008. Domestically made drugs took up only a quarter of these sales. A non-governmental professional union, the Association of Pharmaceutical and Microbiological Industry’s Employers, estimates that 95 percent of foreign drugs have Ukrainian clones. Valery Pechayev, head of the association, thinks that Ukrainians overpay Hr 9 billion – more than $1 billion – to buy more expensive foreign medication.
In Yatsyk’s workplace, the Romodanov Institute of Neurosurgery, it is easy to see why doctors and the hospitals where they work need money.
Nurses draped in not-so-white robes over woolen sweaters rushed through chapped and cold corridors. Some medical equipment looked fit for museums. Yatsyk’s office resembled a set from a post-war Soviet film, with a single chair and desk, against toxic blue walls.
“Some companies buy furniture for the clinics in exchange for promotion. Others help with equipment,” Yatsyuk said. Some doctors, however, take payments and gifts which grow proportionally to the amount of medicine they sell. “They don’t approach me personally as I showed them the door from the start,” he added.
But if wolves are fed, the sheep don’t come out as well. “In best case scenarios, people lose financially,” Yatsyk said, referring to the alarming trend.
But financial consequences are not always the most troubling ones.
Pensioner Lidia Bilyk from Kryvy Rih lost her husband in January after a doctor’s alleged malpractice. “He had a knee injury. They injected him the type of medication which was forbidden and taken out of production,” Bilyk said angrily. “There was a strong side effect. They killed his bone marrow with an overdose of these shots.”
It all happened within six months after a workplace accident. Before that, the late Petro Bilyk turned 70 last summer in great health, his widow said. But she contends that after being prescribed with the wrong medication, Bilyk – struggling to draw breathe – fatally shot himself in January with his hunting rifle.
“I am afraid to take it to court,” Bilyk said. “My husband was a stubborn man. He wrote to health authorities seeking justice. But they replied saying that he could have [prescribed] this medicine himself. I don’t want to pursue it. What if anything happens to my son?”
Before taking his own life, Bilyk approached the All-Ukrainian Council for Patients’ Security and Rights, a non-governmental organization in Kyiv. It has no resources to work outside the capital.
But Victor Serduk, the lawyer and doctor who heads the NGO, said of the abuses going on with prescribed medicine and conflicts of interest with health-care personnel: “It’s genocide against the nation and a medical experiment.”
In Ukraine, a person's ethical code is often the only check on unethical behavior. “Personal greed makes doctors get royalties from pharmacies,” Serduk said. “In Ukraine, we are governed by situational ethics. If no one is watching over your shoulder, do whatever you want.”
Timur Bondaryev, a senior partner from Arzinger law firm, said that there is little chance of winning cases on patients’ right in Ukraine.
“To prove doctors’ lack of professionalism, there is a need for an expert assessment which is also carried out by their colleagues in white robes,” Bondaryev said. “Because of solidarity and the so-called ‘union’ factor of their profession, these experts refuse to testify against their co-workers and soften their conclusions considerably, which makes it impossible to hold a quack responsible.”
The Association of Ukraine's Pharmaceutical Manufacturers, which represents 80 percent of domestic producers, admits the industry lacks regulation. Such lax oversight opens the way for unfair methods of competition, said association president Petro Bagriy.
One psychiatrist quit the profession mainly because of the intrusive pill marketing. But she didn’t want to be identified because she was thinking of returning to the fold and didn’t want to face the wrath of colleagues. Of the seamy prescription practice, she said: “Doctors in charge of the asylum would advise persistently what brand of medicine to prescribe. I felt restricted in treating my patients and it was repulsive.”
She said that pharmaceutical representatives were frequent guests in the clinic and even had keys to the asylum, which is off-limits to the public.
A Kyiv representative of a leading multinational pharmaceutical company also refused to be quoted by name. But the representative refuted accusations of unfair dealings.
With more than 500 pharmaceutical firms working in Ukraine, each follows its own rules. “I don’t give bribes to my doctors,” this representative said. “I convince them with my knowledge." The sales representative said pharmacies and sales representatives print their own prescription forms to track doctors’ performances.
In America, two members of the U.S. Senate have been pushing a bill requiring drug manufacturers to disclose all payments and gifts made since 2007.
In Ukraine, however, the only policing of “the medics on the pill” appears to come from private insurance companies, not government.
“Practically every day we have to restrain doctors in their prescriptions,” said Oksana Artamonova, deputy head of the medical services department of the European Insurance Alliance. “Very often, either because of lack of knowledge, little experience or some other reasons, some doctors advise medication of the same type to strengthen the effect. That’s when we step in and argue.”
Once again, business trumps ethics, Yatsyk said, and may continue to do so until physicians start earning decent salaries and working in adequately equipped hospitals.
Source: Yuliya Popova, Kyiv Post Staff Writer