I refer to the letter Dubious sponsored healthcare meets .

I want to thank the many people, both from Malaysia and abroad, who forwarded their feedback pertaining to the subject above and at the same time urging for more discussions on the subject.

I must admit, I strongly advocate the argument put forward by Dr Stuart A Green, Clinical Professor of Orthopaedic Surgery at the University of California, who said quite bluntly that right now the medical profession is ‘on the ropes’.

And I cannot but agree that whether in America, Canada, Britain, Australia, Zimbabwe or Malaysia, where the healthcare debate rages, it is a fact that the media and policymakers are continuing to flail away at the unseemly relationship doctors have with big business, drug companies and medical device makers.

We have heard them all before and will continue to. There have been countless accusations of kickbacks for product selection, unearned ‘consulting’ fees, stock options tied to research results, ‘drug-rep’ supplied pizza for office staff, overseas trips and unlimited research funding which all imply that a certain cross-section of healthcare policymakers and the medical profession today put personal gain ahead of patient welfare.

This is not all. Even in the medico-legal arena, lawyers and judges realise that favourable testimony can be purchased in the marketplace replete with practitioners of questionable ethical standards.

Likewise, statisticians find that local and regional variation in treatment for common ailments - such as breast cancer and back pain - correlate with ownership of imaging equipment, testing devices, and ambulatory or in-patient treatment centres.

As an experienced consumer advocate, I am aware that rather than fighting the accusations of unethical conduct with self-righteous assertions, it is sad, even disgraceful, that the medical profession and the various bodies related to it continue to sidestep the issue.

This instead of training the next generation of doctors to incorporate a high-level of moral reasoning and ethics in their medical and professional decision-making.

I am quite aware that surveys of medical school and residency training programmes find that formal education in medical ethics and moral reasoning is sadly deficient, and no wonder as the subject is often discussed in an abstract and uninteresting manner.

Since doctors in training have turned increasingly towards review articles as sources of information, it occurred to me that such publications should explore and spearhead more discussion on ethical issues arising out of topics their authors cover.

Green cited, for instance, the submission reviews in the treatment of carpal tunnel syndrome and noted that most workers' who were compensated were treated with electro diagnostically negative CTS and did poorly after transverse carpal ligament release.

He rightly believes that the authors should discuss whether it's ethical to first perform surgery on a subset of patients prone to an unfavourable outcome. In this way, we can incorporate ethical judgment into all facets of medical education.

Like Green and other dedicated and ethically upright doctors abroad and in Malaysia, I am deeply concerned that the medical profession is not willing to endorse proactive changes.

We must take into cognisance the fact that newly-minted US Secretary of State Hillary Clinton's health plan was drafted without much input from physicians. Is it any wonder why?

Was it plain oversight or were these groups avoided because of their alleged ‘milking of the system’ for their own benefit?

As such, it is pertinent that we in Malaysia draw up a plan of action to address these issues and find ways to prevent the involvement of multinational ‘big business’ lobbyists in healthcare policymaking.

This to protect the long-term interests of consumers and those in the profession who serve with dignity, dedication and with high and undisputable ethical standards.

The writer is president, consumers association of Subang and Shah Alam, Selangor

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