MAM answers daphne - 25/9/2006

link to Daphne original article

link to MAM response

Giving doctors their due
by Martin Balzan

From Dr M. Balzan

I refer to Ms Caruana Galizia’s recent article, “Yes some doctors are corrupt” (TMIS, 17 September). The Medical Association of Malta (MAM) agrees that the cost of medicinals is escalating and we sincerely hope that the recent move by the government to reduce regulatory fees will increase the number of products available and increase competition. Hopefully this will be reflected in lower prices for


MAM categorically agrees with your correspondent that any form of “bribery” is wrong, however this allegation has not been substantiated. Any such misdemeanor should be immediately and unreservedly reported to the Medical Council.

Malta is such a small country and if one doctor charges more than his colleague or prescribes slightly more expensive drugs the word spreads around very quickly. GP fees have remained under Lm5 – usually more in the two or three lira range. Indeed doctors are very conscious of the price of their overall package and it would be contrary to their interest to lead their clients into unnecessary expense.

However, it is also in the doctors’ and patients’ interest to prescribe effective medication and unfortunately the newer drugs are expensive. Perhaps this is an area where the flow of information between doctor and patient becomes essential – in both directions.

While the local Medicines Authority has done sterling work in helping to remove low-quality generics from the market, it relies on data supplied by the importers themselves. It is the doctor working at the coalface who is in the best position to know which drugs are of high quality and which aren’t. That is why the suggestion that the doctor should only be allowed to prescribe the generic name of the drug is certainly not in the patients’ best interest. High quality generics are indeed doing quite well in Malta: proof that doctors will prescribe cheaper generics if they are convinced of their quality.

Pharmaceutical companies, be they “research-based”

or “generic”, feel the need to market their products. However, this is a highly regulated activity with

clear parameters of what is allowed and what is not allowed. The CPME (the European Medical association representing EU doctors) has signed an agreement with the pharmaceutical industry on how the relation between the

industry and the profession should be regulated. MAM has been part of this

agreement – and to my knowledge local representatives of all companies abide by this agreement.

As regards the use of antibiotics for viral infections in childhood, the local medical profession faces a difficult dilemma. While indiscrimate use of antibiotics does encourage the development of resistance, there are dangerous killer bacteria around in the local community in the form of Meningitis and the notorious MRSA. Such untreated infections can lead to death in matter of hours if untreated.

International studies have shown that withholding antibiotics can only be practised if regular frequent follow-up and often expensive tests, are possible.

Unfortunately, lone GP practice and heavily overloaded health centres are not always in a position to deliver this. And if a private GP is cautious enough to practise close follow up, a journalist might presume that he is doing so to earn more money!

But please let us stop blaming the medical profession. Who is so foolish to put his neck and reputation and career on the line for a few pounds when it is much simpler to raise one’s fee. Let us have logic and evidence before smearing the profession which has does this country so much good over the years! Let us have journalists who stick up for patients’ rights, but please give us our due.

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