Code of ethics for medical professionals omits accountability provisions

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Only a few years ago, doctors openly said, “Go to this pharmacy to get this medicine. You can buy it by simply saying my name.” Some used to write the phone number and address of the pharmacy on a piece of paper, and say, “Take it and get medicine from this pharmacy only.”

In fact, although this situation has disappeared, their “tricks” have narrowed. When visiting a private hospital for a consultation, they put informational materials in front of customers to “promote” newly introduced drugs and medicines. They humbly advertise, “The price of this drug is a bit high, but this is more effective. Only this organization imports it.” People believe that doctors are good and tell the truth, so they only think about taking the medicine or injection recommended by doctors. Therefore, it is no secret that the business of medicine is flourishing and eventually became a pyramid scheme.

Mongolia, with a small population, is still among the “leaders” in the world in terms of disease. Our country leads the world in terms of death due to cardiovascular diseases, and ranks in the top five for cancer, accidents and diseases of the digestive tract. In particular, cardiovascular diseases are increasing year by year, and the number of deaths remains high. In 2011, more than 6,200 people died due to heart attacks and strokes, while the average for the next four years was about 5,600.

So, in our country, more than 10 people die of heart and vascular diseases every day. Due to the high number of diseases, people’s use of medicine is disordered. For instance, there are many antihypertensive drugs. Drug supply organizations seem to be importing at least one new drug per month, and the number of drugs is increasing rapidly. This is not the case only with this type of disease. It’s one thing to covertly advertise drugs.

However, they even created social media accounts to promote medicines and services. More specifically, there are five doctors who actively give advice on diabetes and have many followers on social media. Their recommendations differ somewhat. One teaches to eat only beef, while the other advises to eat anything. Another one tells people not to abstain from food, but only to eat little by little and often. One of them says that it is good to use only one food and product, and points to goods and products imported from abroad. It seems to be no different from drug promotion.

Dr. B.Dugarkhuu, in particular, advertises many medicines on social media. Lately, however, he seems to be cutting back on posting a lot of information. This may be related to the fact that President U.Khurelsukh appointed him as a part-time advisor in charge of public health education.

He hosts the “Ai Yo” program on public national television. It’s seen that he uses this advantage for his personal business. If not medicine, he started promoting kitchen utensils, such as pots and pans. He explains that these are made of materials that are not harmful to health. But it is safe to say that this is business.

Of course, individuals can do businesses. However, the question arises as to whether it is ethical for a medical worker to use his or public position, such as the status of the president’s advisor and host of national television programs.

Therefore, violations that need to be checked by the supervisory authorities have plagued our country no different than toxic emissions.

In connection with the appointment of the new minister of health, there is a need to check and monitor whether public and private hospital doctors work in accordance with the Code of Ethics of Medical Professionals approved by Order No. A/406 dated September 4, 2019 of the minister of health.

The code regulates the relationship, attitude and moral norms of medical professionals in their professional activities. Hospitals, health care organizations, ethics committees and teams must promote and monitor the implementation of this code and hold them accountable within their powers. Medical specialists and health workers of public and private health institutions providing health care and services in the territory of Mongolia are obliged to follow this code of ethics. A medical professional has the basic principles of being humane, compassionate, respectful, honest and fair, treating everyone equally, not discriminating, being responsible, and maturing.

In the chapter “General Ethical Standards for Medical Professionals”, there are many regulations. For example, they are prohibited to charge for benefits, force or recommend the use of medicines, influence the choice of clients, instruct and provide unnecessary care and services.

It also clearly mentions not to participate in any advertisement that clearly misleads the customer and does not carry false information. It is also prohibited to use, recommend, support, promote, or sell drugs, medical devices and biologically active products for treatment and diagnosis that are not registered in the Mongolian drug registry.

Medical professionals also must not receive financial support such as gifts, trips, foreign training, donations, incentives offered by drug and medical equipment supply organizations in order to increase sales of their products. They should not accept bribes, donations, informal payments from clients for providing medical care and services, and should not provide paid care and services other than those prescribed by law.

They are obliged to immediately inform the director and the Independent Authority Against Corruption of any information about corruption or conflict of interest discovered during the performance of official duties. If the violation is related to an official at the management and decision-making level, they have to report it to the Independent Authority Against Corruption.

In general, the Code of Ethics clearly states what kind of person a medical professional should be and what he or she can and cannot do. In fact, there is no entity that determines where and who commits a violation, warns or holds them accountable. Even if there is such an organization to check, it will be kept silent unless someone complains.

 In this regard, the Mongolian woman who is a permanent resident of Germany was asked whether doctors abroad promote other people’s businesses when providing health care and services to citizens. She said, “They don’t promote other people’s businesses. I pay for health insurance, so if my children get sick, I don’t pay for hospital visits or medicine. When a child gets sick in Mongolia, I feel sad when I see that the entire household budget is spent on medicine. German doctors almost never give antibiotics. After analyzing whether it is a viral or bacterial cold, if necessary, antibiotics are given to the patients.”

“I am saddened to see the haphazard use of drugs and antibiotics in Mongolia. When my oldest daughter was a baby, she had a fever for three nights in a row. Then we went to the emergency hospital. My child’s throat seemed to be strangled, and we panicked when we went to the hospital. The doctor said my daughter was fine and sent her back without giving us any medicine. Compared to other countries, it seems to me that Germany has created a truly human-friendly society.” 

Medical professionals adhere to the following Code of Ethics for Medical Professionals approved by Order No. A/406 dated September 4, 2019 of the minister of health:

• Article 1.1 states that the relationship, attitude and moral norms of medical specialists in their professional activities shall be regulated by this Code of Ethics for Medical Professionals.

• Article 1.2 stipulates that the Code of Ethics shall be determined by the laws and the provisions of international legal documents, namely, the Constitution of Mongolia, Law on Health, Law on Medical Care Services, Law on Medicines and Medical Devices, Law on Regulation of Public and Private Interests in Public Service and Prevention of Conflict of Interest, and Law on Anti-Corruption.

• Article 1.3 reflects that hospitals, health care organizations, ethics committees and teams shall promote and monitor the implementation of this code and be accountable within their powers.

• Article 4.11 states that Medical professionals are prohibited to use, recommend, support, promote, or sell drugs, medical devices and biologically active products for treatment and diagnosis that are not registered in the Mongolian drug registry.

• Article 4.12 provides that medical professionals must refuse to receive financial support such as gifts, trips, foreign training, donations or incentives offered by drug and medical equipment supply organizations in order to increase the sales of their products while performing official duties other than in the direction of associations.

Misheel Lkhasuren