Satyamev Jayate got through three episodes of what is best described as riveting public service programming, without launching a controversy. Female foeticide, child sexual abuse and harassment for dowry are social evils where the villains of the piece as portrayed by Aamir Khan are hardly likely to surface yelling that they have been maligned and misunderstood. With the fourth episode on medical malpractice however he triggered protests from the medical profession for misrepresentation. Even as the subject achieved far greater resonance than the earlier ones, it had doctors on the defensive and offensive.
The programme did not, they alleged, allow them to give their side of the story, specially where individuals were named. It made sweeping generalisations and tarred all doctors with the same brush, even as Aamir mouthed the occasional disclaimer that there are a lot of good doctors around. Through email campaigns and a programme on Saturday night on NDTV they have come back with their side of the story alleging that there was no right of reply.
Despite the serious nature of the allegations (medical negligence; non-essential procedure etc.) made against the hospital, Khan did not cross-check the facts with transplant surgeon, Ramcharan Thiagarajan, the nephrologist, Dr. R. Sreedhara or anyone from the hospital to get their side of the story.
The Hoot has a copy of the rebuttal that the nephrologist, Dr. R. Sreedhara e-mailed to Amir Khan on 28.5.2012, as well as copies of Major Rai’s consent forms (three separate consents for high-risk procedure, blood transfusion and admission profile consent); a copy of the FIR that Major Rai lodged; the affidavit that Dr. Bhagya the Resident doctor who was on duty on the night of 1-5-2010; medical notes of the nurse present at the hospital on the night of 1-5-2010; a copy of the Karnataka Medical Council’s (KMC) judgement dated 2-6-2011 that had ruled in favour of the hospital; besides four independent medical opinions of well-known surgeons from AIIMS, Delhi; St John’s Medical College, Bangalore; the Madras Medical Mission and University Hospital Brooklyn – considerable evidence that somewhat dilutes Major Rai’s charge against the doctor. This evidence was not presented on the show, as journalistic norms might have required.
Worse, the verdict of the Karnataka Medical College pronounced on 1-5-2010 that forms an important piece of evidence was not mentioned on the show. The KMC judgement clearly states that the kidney-pancreatic cadaver donation on Seema Rai was done in the interest of the patient and not for any personal gain, and that no procedural norms appear to have been flouted before or during the surgery and finally that the risk and procedure was clearly explained to the Rai family. Khan also did not mention during his show that the Commissioner in Karnataka Health and family Welfare Department that is the Appropriate Authority for Human Organ Transplant Act also reached the same conclusion in an order dated 7/10/11.
Not just that. Major Rai also ‘forgot’ (or perhaps it was edited out) the fact that he has filed a complaint with the Consumer Forum seeking compensation of Rs. 84,55,933/ from the ‘erring’ hospital. This case is yet to be settled. Meanwhile, Major Rai has also appealed against the KMC verdict at MCI. The point that he made on NDTV on June 2 night, among others, was that the Fortis hospital in Bangalore did not have a licence for pancreatic surgery.
On other issues dealt with in this episode of Satyamev Jayate, another doctor, Nishith Chandra sent an email to Amir Khan (The Hoot has a copy of this email) on 5/28/12that points out other crucial ‘missing’ elements of investigation. For instance, while Khan allows a guest on his show to make a sweeping statement againstprivate colleges that demand capitation fee of Rs 40 – 50 lakhs, he does not identify even one such college by name nor gives them a chance to respond to the charges.
Steep prices of essential, life-saving drugs and the practice of asking for hefty commissions from pharmaceutical companies were other controversial issues taken up on this show in good populist fashion, without going into the depth of the malaise and examining relevant issues such as the price de-control policies of 1990s that causes spurt in all drug prices; the demand for standard treatment protocol; the need to have an independent regulatory body to monitor price movement of essential, decontrolled drugs; a formal listing of all generic (non-branded) drugs with a published directory of their authorized dealers; and the need to create a general awareness about what formulations can or cannot be sold as generic drugs etc. Sunday morning programming on entertainment channels cannot get into such dreary details, can it?
Doctors whom the Hoot spoke to allow say that the ills of the profession that the show focussed on exist but were highly exaggerated. To say that “all is not well anywhere, may not be appropriate, without going into the depth of these issues,” points out Dr Anil Vasudevan, a senior research associate at St. John's Medical College Hospital, Bangalore.
“In India, any show without movie masala would fail. That is very unfortunate,” concurs Dr. B G K Sudhakar, a consultant cardiologist at Kamineni Hospital in Hyderabad. That said, “it cannot be denied that pharmaceutical (vaccine, chemotherapy, surgical implant) companies push their products to the patients through doctors and quid pro reward the doctors by sponsoring them and their families to exotic locations for conferences, gifts, etc.,” says Dr Vasudevan.
However “The doctor-pharma nexus in the show is highly exaggerated. I don’t think medicines get prescribed merely because of the commission offered to the doctor,” says Dr C B Patil, Prof and HOD of Cardiology at St John’s Medical College, Bangalore.
An important fact pointed out by the show however is that “most drugs do have a generic version. Only recently discovered new drugs that are still under patent protection (usually about for the initial 10 years or so) may not have generic versions. You may have heard recently about a cancer drug sold by Novartis which was sold for more than Rs 2 lakhs whereas the generic drug is less than Rs 10,000 or so,” says Dr. Sreedhara.
“On the other hand, not all generics may be as good as the original. Especially biologic agents may vary great deal from company to company. For example, erythropoietin produced by different companies may have different effects,” he hastens to add. “All said and done, medical practice is not an IPL show, it is serious affair,” says Prof Upendra Kaul, executive director and Dean Cardiology at Fortis Escorts Heart Institute, New Delhi.
“If doctors were to spend enough time with each patient explaining the issues at hand, much of the misconceptions and misunderstanding would get nipped in the bud,” says Dr A B Chandorkar, a Consultant Interventional Cardiologist at Ruby Hall Clinic, Pune.
“I am a cardiologist who has seen the transformation of cardiology practice in India from pure clinical to the present intervention era and I bloody well know everything that is happening in the name of cardiology. I only request my colleagues not to react to allegations levelled by somebody but do some introspection and keep their critics near them, giving them shelter in their courtyards,” says Dr Pramod Kumar, Head of Cardiology at Fortis Hospital, Shalimar Bagh, New Delhi.