Sex and corruption in medicine

 

The recent sex and corruption case at the Central Narcotics Bureau has certainly woken many people up. But there is really nothing new here other than the titillating stories of trysts  and late night sexting between two very gatal (itchy) people. Sex sells. And all through history women have used their wiles to charm their way into position, power and wealth. So was this corruption, or just two very gatal people acting out their fantasies? We won't know for some time, and Gigamole will not speculate.

Nonetheless, Gigamole is reminded that the medical and health industry is not immune to such sex and corruption issues. Just that many do not get flagged out.

The WHO has estimated that the about US$4.1 trillion is spent globally on health services and of this, US$750 billion was on pharmaceuticals. It is a massive industry. The pharma companies aggressively compete for this market, and many (if not all) resort to unsavoury methods to market their wares.

Recently GSK was fined US3 billion for illegal marketing of its products. Part of these charges relate to providing junkets for doctors and various other kickbacks. J&J also had to pay up US78 million to settle charges of bribery and kickbacks it had provided.

Does this happen in Singapore? For sure. But perhaps not so obvious, because of our CPIB. But bribery and kickbacks in some form definitely occurs. Our doctors (especially)  go on junkets all the time. Not to mention kickbacks of various sorts. These are supposed to be regulated and notified to senior management, but nobody really scrutinizes anything, and consultants regard these as the perks of their practices. Medicines Australia reported that the annual spending by Pharma companies in wining and dining doctors and healthcare workers amounted to about A$24 million. How much "hospitality" spending in Singapore? Gigamole doesn't know. In fact the authorities don't really want to know.The public should insist that this be reported and made known publicly.

Any sex involved? Gigamole cannot prove anything. But suffice to point out that the industry is much bigger than selling the odd IT systems. Anybody stopping to point out that the sales reps for pharma companies are invariably attractive young ladies in short skirts?

This is not a problem that affects just pharmaceuticals. Medical devices suffer the same corruptibility. The susceptibility also extends up all levels of the health care chain....all the way from the prescriber, procurer and possibly even the regulator. Can we trust that we have only the best medical information, drugs and devices? Possibly not.

We need to look at this more carefully. The trouble is that the medical industry is seems rather "protected" and few want to stir the pot to root out these problems within the industry.

The NParks wayang - Problems with GeBIZ that everyone knows about but the auditors turn a blind eye to.

When the NParks Brompton bicycle story first broke, I daresay many had already guessed at what lay behind the procurement/tender fiasco. I am not referring here to the allegations of corruption, or the buddy-buddy relationships between procurer-approver-supplier. Simply, the GeBIZ system is kinda screwed up and pretty much every procurement officer is well aware of these problems and knows exactly how to navigate (read 'cheat') the system to get what they want. It is not as if the auditors don't know. They generally pretend not to know and are pretty 'satisfied' so long as the documentations are in order. Minister Khaw's mistake was his over-eager endorsement of the purchase of the bikes on the assurance of procedural and documentary 'correctness'.

All tenders need to go through the GeBIZ system, yet many of the small suppliers are not registered on GeBIZ. Therefore if the product depends on small suppliers, how do you open a tender on GeBIZ, and expect a reasonable response from suppliers? In the NParks case, what is the likelihood that bicycle shops will be registered on GeBIZ, and will be aware of the tender? Ultimately this will depend on some non-GeBIZ way of disseminating the tender information and hoping the suppliers will go into GeBIZ and tender. This non-GeBIZ way of information dissemination is already subjective and selective to only a limited number of suppliers. And therefore open to abuse.

Secondly, very often procurement offices already have a specific product in mind. This is not necessarily dishonest, but operational centres often have a preference for a specific product. Sometimes this is logical, but often they are not.This is not necessarily the cheapest, but is often perceived to be the most 'desired' product. What makes this product most desirable depends on many factors, most of which are not codifiable. In the laboratory for example, many researchers have preferences for certain branded products, names which they associate with reproducibility or reliability. If they open the tender for the equipment, they run the likelihood of being swamped with cheaper but less desirable products. And endless needs to justify awarding the tender to the non-cheapest tenderer. So what do they do? They word the tender in such a specific way that only one brand name matches the tender specifications. In the NParks case, the wording of the tender was so obviously directed towards a very specific product.

The above are without doubt 'bad practices' but superficially may be viewed as being procedurally 'correct'. I challenge any auditor to say that he/she is unaware of these practices but has not looked the other way in performing the audits.

Another problem contributing to this fiasco is the familiar end-of-financial year monkeying with the accounts. How many of us are unfamiliar with the regular message that comes down from senior management that there is left over money that needs to be spent? Rather than to return the money and risking a reduction of next year's budget, the instruction that comes down from senior (or very senior) management is to spend the money. It is under these circumstances that the most wasteful expenditure of public funds occur. It is under these circumstances that you see the sudden purchase of weird, expensive and poorly justifiable items. Perhaps 26 expensive Brompton foldable bikes?

High salaries discourages corruption? A reality check.

Singaporeans woke up this morning to the alarming news that the Chiefs of both the Singapore Civil Defence Force (SCDF) and the Central Narcotics Bureau (CNB) have been relieved of their position pending investigations by the Corrupt Practices Investigation Bureau (CPIB).

This must have shaken the civil services to the core.

Without presuming guilt of these two guys, but if the suspicions are true that they have engaged in corrupt practices, it must surely raise serious concerns about the validity of the logic that corruption is prevented by paying high salaries. These guys have certainly not been paid peanuts.

To my reckoning, if we use money as the main lure into public service, surely that must attract only those for whom money and more money becomes the driving force for their ambitions. Corruption is fueled by greed, and there is never enough to assuage that thirst.

The most effective way to stem corruption is to have an independent, transparent and effective CPIB, and a vigilant public who is prepared to whistleblow. Our CPIB has done an excellent job so far, thankfully. But if we want our politicians to be free from corruption, then the CPIB must have the freedom to investigate all officials including the cabinet and even the Prime Minister. That the CPIB reports to the Prime Minister's Office does not give it a freehand in performing this critical function. Perhaps this line of reporting should be reviewed? Since we have an elected Presidency, should not the CPIB report to the President, rather than to the Prime Minister?