Pakistan Cardiac Society successfully retains the No. 1 position as the most unethical professional specialty organization

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Professional ethics and professional specialty organizations

Pakistan Cardiac Society successfully retains the
No. 1 position as the most unethical professional
specialty organization

Diabetologists, Hepatologists and Orthopaedic Surgeons are not far
behind in extracting money from Pharma trade and Industry

Most conferences have no functioning Scientific Committee
and very little original research work is presented

By Shaukat Ali Jawaid

FAISALABAD: Pakistan Cardiac Society has successfully retained the No. 1 position of being one of the most unethical professional specialty organizations in Pakistan and it should ring an alarming bell with the conscious, God fearing, ethical members in the Pakistan Cardiac Society. At the last conference held at Karachi, the organizers allowed one of the overseas speakers to make a presentation on Statins wherein the speaker used company provided slides showing the brand name and company monograph on each and every slide he showed in his presentation. None of the PCS office bearers who were present on this occasion protested and stopped this highly unethical practice but when it was pointed out by me and the speaker was asked will he ever dare to make such a presentation in UK and what message he was conveying particularly to the juniors present, he realized the seriousness of the situation and immediately apologized.1

During the same meeting, Prof. Khawar Kazmi, Prof. Bilal Zakariya, Dr. Asad Pathan had also talked about the unethical practices by the Pakistan Cardiac Society and some of its members. But it appears all this had no effect at all as at the recently held CARDIO CON 2016, due to no central monitoring and incompetent and inefficient PCS leadership, products of one of the pharmaceutical company and its advertisements were shown repeatedly throughout all the scientific sessions, Almost over a dozen senior cardiologist came to me and pointed out this complaining that this was highly unethical and should not happen. I told them that it is better they gave up this hypocrisy and being members of the PCS, they  should have the courage to speak about such issues in the General Body meeting, protest and stop this screening of advertisements. Earlier in a meeting held at Multan, Prof. Salut Siddique from Lahore had strongly protested when one of the pharmaceutical companies managed to sponsor three speakers who all promoted their drug repeatedly mentioning their brand name during one of the scientific sessions.

In fact, in most of the conferences organized by various professional specialty organizations (there are a few exceptions) have no functioning scientific committees hence nobody bothers to look at the quality and contents of presentations. Infected with the materialistic virus, the main objectives with these conference organizers, it looks is to collect money from the Pharma Trade and Industry on different pretexts. The situation was worse in the Pakistan Hypertension League as well until a few years ago. There used to be drug banners, advertisements inside the conference hall, while the organizers had no time for discussion after presentation, they would waste lot of time in Lucky Draws and other company sponsored activities etc., during the sessions.  Then there was heated discussion and debate on this issue in the GB meeting.  Some conscious members took up this issue, after discussion, a committee headed by late Dr. Maqbool H. Jafary was formed which produced some guidelines for the conference organizers and ensured its implementation. Since, then, there has been tremendous improvement at PHL meetings though the practice of unreasonable demands from the Pharma Trade and Industry to collect funds still continues.

The conference organizer in most of the specialty organizations have come up with innovative ways to collect funds.  Stall in the pharmaceutical exhibition organized at the conference venue which used to cost Rupees ten to fifteen thousand in 80s and 90s now cost millions of rupees. The demand from the organizers starts from a minimum of one million and it goes upto to five million rupees and in some cases even more. Apart from that, they also order the Pharma companies to get delegates registered and the registration fee is quite high starting from five to twenty thousand rupees. Normally the accommodation, hotel rates at the conference venue are negotiated at subsidized rates to facilitate the delegates but in Pakistan the conference organizers book the hotel rooms themselves at subsidized rates but then sell it to the Pharma industry at double or triple the cost all aimed at making more money. At one of the meeting at PC Rawalpindi, the normal room rent of Rs. 12,000/- was provided to the industry sponsored delegates at a rate of Rs. 17,000/- An organizer of orthopaedic conference in Peshawar, through his brother booked the few hotels and most of the Guest Houses in Peshawar at subsidized rates and then sold these rooms at double or triple the cost.  Those who wanted to attend the conference had no option but to pay all this, which was of course again sponsored by pharmaceutical trade and industry. At one of the Neurosurgery conference, one neurosurgeon had got himself sponsored by two companies. In one room he was staying with his family while the other room was occupied by his brother in law with his family (not a doctor). At the CARDIO CON 2016, it is alleged each room at the conference venue was sold at the rate of Rs.25, 000/- per day. Not only that apart from handsome donations, the industry was also asked to pay for three nights for each of their registered delegates whether they had come for a day or two. One of the delegates from Karachi just spent about twelve hours but he too had to pay for three nights, of course paid for by the pharmaceutical firm which had sponsored him.  Registration of most of the delegates was also sponsored by the Pharma industry. The Pharma trade and industry eventually pass all this to the poor patients in shape of higher cost of drugs, medicines, equipment, instruments and procedures. One of the most important causes for failure with drug therapy in Pakistan hence remains high cost of drugs which remain unaffordable for a vast majority of the patients. During the conference some senior cardiologists fed up with the present state of affairs were heard saying that let us form a group in PCS which should be named as “Ethical Group of Cardiologists” who should not attend company sponsored Conference Banquet and also voice their concern about the ever increasing unethical practices evident at the cardiology conferences.

Speaking at the PHL GB meeting at Rawalpindi-Islamabad sometime ago Prof. Abdus Samad had advised his professional colleagues that they should refrain from making unreasonable demands for donations from the Pharma trade and industry.  There should be a willing participation and accept whatever they can offer and refrain from using unfair means to extract funds from the Pharma industry because  in that case it  comes under the category of “Bhatta Collection” and not donation. However, it appears his advice has fallen on deaf ears. Pharmaceutical industry all over the world sponsors medical conferences and other academic activities but they follow some ethical guidelines but in Pakistan unfortunately the organizes do not bother about professional ethics and most of these conferences have been turned into  “Social Get Togethers with Families” at these Five Star Hotels all at the cost of the poor patients. Attendance in the scientific sessions is most of the time highly disappointing but there is unusually great rush at the time of Lunch and Dinners.

In all fairness one must admit that organizing a conference is a very stressful and frustrating job for the organizers.  For them it is difficult to please everyone. One of their most important worries is how to feed the invited guests, participants and the army of uninvited guests.  Most of the delegates come with families something which needs to be checked. Registration of delegates by the Pharma industry should be discouraged. Let the delegates pay the registration fee themselves, and then only those who are interested will come to the meetings. There should be a complete ban on sponsorship of medical conferences; any other academic activities by Pharma Trade and Industry at Bhurban because it is always social get togethers of doctors with families with very little or no scientific contents. The organizers collect huge funds from the industry and also misbehave with them and refuse to provide them hotel rooms for the delegates they have sponsored because they provide these rooms to their family friends to come and have enjoyment.  If they wish to relax and enjoy, they can afford it themselves, why the poor patients should pay for all this?

Prof. Naeem Aslam was the chief organizer of the CAARDIO CON 2016. He did manage to invite a large number of Pakistani cardiologists from USA members of Association of Pakistan Descent Cardiologists of North America (APCNA) who made rich contributions to the scientific programme. A joint meeting of ACC and PCS with two distinguished speakers from USA who made presentations using the latest information technology was also arranged. In collaboration with Health RAB he also organized Cardiology Research Award which was a unique initiative which will go a long way in promoting research culture and encourage young researchers who were presented handsome prizes. Three best oral presentations were also offered prizes and their names were announced by Dr. Ehsanul Haque. One of the sessions was organized in collaboration with Preventive Council of PCS and Cholesterol Awareness Society of Pakistan besides a special session on Cardiac Surgery.  Audiovisual arrangements were excellent throughout the conference. The organizers also did not arrange tea for the delegates who were asked to enjoy it at hospitality suites set up by the Pharma companies. No drug banners were on display inside the scientific sessions. Lunch at subsidized cost was made available by the hotel management for representatives of the Pharma industry attending the conference and the organizers also helped establish, equip an auditorium with a seating capacity for about seventy five people at the Faisalabad Institute of Cardiology from the funds they had generated. These are some of the positive steps which need to be commended and appreciated. However, professional immaturity on the part of organizers was very much evident.  It looked as if he could not form a Team and it not possible for one man howsoever efficient and competent he or she may be to organize such events. One has to make a team, give the team members responsibility as well as authority only then they can perform their duties efficiently.

Once after the pre-conference workshop during the psychiatric conference at Lahore, Prof. Riaz Bhatti the chief organizer who was very strict did not allow family members with children of some delegates to come for dinner. He invited only registered delegates which annoyed many. He told them that they had come to attend the workshop and he was responsible to entertain them only not their families as it was not the Valima of his son.

As a member of the organizing committee of international ENT conferences in the late 80s and early 90s, once it was the term of Sindh province to host this conference at Karachi. During discussions for sponsorship of lunch and dinners, I asked Chairman of the organizing committee Prof. M. Jalisi that God almighty had given him enough and he can very well afford to host dinner for international delegates and outstation participants while the one conference dinner should not be a much of a problem. Let him set a healthy tradition to which he agreed. He hosted the dinner for conference delegates at their residence. Next time it was Prof. S.H.Zaidi and Prof. Kamaluddin who hosted dinners at their residence on first and second day. This tradition further flourished and at Lahore Dr. Ali Muqaddus Syed hosted dinner at his residence for overseas, outstation delegates. Prof. Ishtiaq was keen to host dinner at his residence in Karachi but he had to wait. That was the spirit in those days. However, now we have progressed so much that recently a physician hosted a dinner for about ninety delegates  which included foreign delegates and important members of the local organizing committee at his residence but did not had the moral courage to announce or disclose that it was all sponsored by funds collected  from  the Pharma industry. Not only that he also charged for cleaning of his house and security guards which were arranged on that occasion.

During the inaugural session of CARDIO CON 2016, moderation of the session was entrusted to two young doctors who did not know what is the difference between welcome address, inaugural address and vote of thanks. Why the organizing secretary of the conference was not entrusted the responsibility to moderate the session is now known. There was no Secretary’s report which is usually presented in the inaugural session, Prof. Khawar Kazmi was not present on the dais and the Guest of Honour Prof. Iqrar Vice Chancellor of University of Agriculture Faisalabad was not invited to speak. He must have felt embarrassment and humiliation.  In the past Prof. Feroze Memon and Prof. Hafeez Chaudhry have organized PCS conference at Hyderabad and Faisalabad respectively   much better because they were able to make a team. Even before the establishment of Punjab Medical College and Allied Hospital, Faisalabad Institute of Cardiology, Dr. Ehsanul Haque used to organize cardiac conferences at Faisalabad which had much better attendance in scientific sessions.  Attendance in some of the sessions was very much disappointing which prompted three speakers from USA to say that they had prepared their talks for young doctors and trainees but they do not seem to be there. We feel embarrassed to make these presentations in front of our seniors and teachers but requested those present to bear with them.  It is not fair to blame the organizers alone for all these mishaps but the credit for all this goes to the leadership of Pakistan Cardiac Society. If they did not take some measures and have some central monitoring of scientific programme, inauguration and other issues related to the conference, one should expect a still greater mess in the days to come.

 Now even the GPs and Family Physicians the common man’s doctors have also started following the example set by their seniors, specialty organizations and they too now insist on holding their meetings at Five Star Hotels and there are too many groups of the GPs, Family Physicians and they all compete as to how many Stalls in the Pharma exhibition they can attract at the conference venue as it all brings more money. Unfortunately again all sponsored by the Pharma Trade and Industry eventually which is again passed on to the poor patients by the industry.

If the objective of these conferences is to promote academic activity, research culture, show case the research work being done in the country and not to make money, then the organizers must take the following measures:

  1. All specialty organizations should hold their conferences after two years. Instead of holding annual conferences, the provincial chapters should organize small group discussions, CME programmes, Workshops in the small cities and districts of their province during that year which will be much more cost effective way of CME programmes.  They have been talking about prevention of diseases sitting at Five Star Hotels for too long, now let them do some work and also provide service to the poor people in the small towns and cities who can ill afford to consult them in big cities. 
  2. They must ensure that there is a functioning Scientific Committee which wets the scientific programme, contents of presentations.
  3. Time management must be ensured. Each speaker should be restricted to the allotted time, the organizers at CARDIO CON did try to ensure that but even then some of the speakers did not adhere to it. There should be adequate time for discussion after the presentations. Most often the most important issues are highlighted during the discussion rather than the presentations.
  4. Presentation for Updates on different topics and the speakers should be carefully selected so that the delegates are interested to attend and listen. It is the quality of contents and speakers which will attract audience.
  5. The organizers should sponsor the participation of young researchers, junior faculty members, postgraduates who cannot afford to attend these meetings instead of looking after the seniors who can afford to pay.
  6. It should not be the responsibility of the organizers to arrange for tea, lunch or dinner for the conference delegates and participants. They can offer the industry to organize Corporate Satellite Symposia’s at the lunch or dinner time and let them invite their guests themselves. These corporate symposia should not be part of scientific programme and it should be clearly mentioned.
  7. Conference Banquet or Gala Dinner should not be sponsored by any drug company. Let the delegates buy their ticket for this and those who wish to opt out, let them do so. That is the only way to ensure sanity, dignity and decorum at such occasions.  I remember while attending Conference Banquet at British Academic Conference at Birmingham, UK, I paid Fifty Pound sterling’s in 90s which was a hefty amount in those days. At present one sees mad rush at Lunch and Dinner. Contributory Banquet Gala Dinner will also take care of army of uninvited guests from five to sixty or above yeas of age. That is practiced all over the civilized world.
  8. It should be mandatory for all the presenters at the conferences to declare their sponsorship/ disclosure of interest before making their presentation.
  9. The organizers should refrain from hiring accommodation except for their own invited speakers and let the Pharma industry who sponsor other speakers negotiate the room rates at hotels themselves.
  10. Conference expenditures should reduced as much as possible and once they do not have to sponsor lunches and dinner, teas etc., it will be reduced drastically.
  11. Organizers should refrain from making unreasonable demands for donations from the industry. Let them contribute willingly what they can afford. Too many specialty organizations, groups have emerged within each specialty and the Pharma industry is fed up with their unfair, unreasonable demands for donations running into Millions of rupees.
  12. The organizers should publish conference proceedings at the end of the conference for the benefit of those who could not attend these conferences. This involves lot of hard work but unfortunately most of the conference organizers are least interested in such academic activities, that is why we never see such conference proceedings.
  13. Handsome Prizes, Awards should be offered to those who present original research work.
  14. The practice of handing over Shields, Mementoes to everyone and provision of expensive conference bags should be done away with. Remember all this is eventually paid for by the poor patients.
  15. The organizers can always request the Pharma Trade and Industry to sponsor such  Research Awards, Prizes and let them also take the credit. Similarly if there is a need to renovate some Wards, lecture halls, Operation Theaters, establishing Seminar Rooms or sending some young specialties, postgraduates on scholarships within the country or overseas, negotiate it with the industry and they will be more than willing to participate in such activities but then give them due credit for all this. At present funds for some of these activities are provided by the Pharma industry but it is the organizers or specialty organizations which takes the credit which is highly unethical and unfair.
  16. National Bioethics Committee has produced Guidelines on Physicians interaction with Pharma Trade and Industry which is a very useful document. It has been approved by Federal Government, PM&DC and just awaits its implementation. It has covered all these issues. Till such time that some government agency starts implementing it, the specialty organizations and conference organizers can benefit from it. 2
  17. The organizers should refrain from asking for direct cash or cheques from the Pharma industry but instead let them provide the required services including sponsorship of the invited speakers. All this will ensure transparency and the medical profession will regain their lost image and prestige.
  18. CME certificates should be issued carefully to only those who attendance scientific sessions which should be confirmed through attendance.

As regards the affairs of Pakistan Cardiac Society in particular, it is the duty and responsibility of its senior members like Prof. Azhar Farooqui, Prof. Abdus Samad, Prof. Shehryar Sheikh, Prof. Hafeezullah, Prof. Ashur Khan, Prof. Khawar Kazmi, Prof.  Nadeem Hayat Malik, Prof. Bilal Zikariya, Prof. Saulat Siddique, Prof. Ejaz Ahmad Vohra, Prof. Azhar Keyani, Dr. Bashir Haneef, Prof. M. Ishaq and Dr.Asad Pathan, Dr. Ehsanul Haque and Prof. Hafeez Chaudhry and other conscious members to take a note of the situation and play their role to arrest the rot which has set in before it is too late, otherwise what is going to happen is not at all difficult to imagine.

REFERENCES

  1. Professional Ethics and Pakistan Cardiac Society. (Off the Record) Pulse International January 15, 2015.
  2. http://www.pulsepakistan.com/images/Pulse/NBC_Guidelines.pdf (Accessed on December 5, 2016).
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