The commercialisation of medicine is neither a new phenomenon nor a fresh concern. In 1989, outgoing SMA President Dr Yong Nen Khiong delivered the following speech on the industrialisation of medicine, which was first published in the May 1989 issue of SMA News, then known as the Singapore Medical Association Newsletter.
At the Singapore Medical Association's Annual Dinner on 16 April 1989, Dr Yong Nen Khiong, the outgoing President delivered his valedictory address the second time. His message provides food for thought to the medical profession. He perceives the loss of control of health care as "industrialisation" of medicine makes inroads into health care, as the grave challenge and dilemma facing the profession in Singapore. He said:
"The practice of medicine is no longer the sole prerogative of the traditional practitioner, honourable, dedicated, totally professional committed and greatly respected. Into the arena of medicine has moved governmental authorities, business entrepreneurs, pharmaceutical companies, accountants, hospital companies, and high tech. Small wonder that health care is now termed the Health Industry, with the word Industry in big bold capitals.
Medicine is big business and mega-bucks, to coin a trendy word. The solo doctor is fast becoming an anachronism, a museum relic of bygone days.
Numerous issues have been thrown up by this transformation, issues such as health screening businesses, health-maintenance organisations, hotel-hospital packages offering complete health screening at competitive rates, restructuring of the public hospitals, itinerant surgeons ("have scalpel, will travel"), and many more.
The first major challenge the profession has to face is to accept that control of health care has now slipped out of the hands of the profession. It would be wholly unrealistic to believe that we are still in charge. We would be kidding ourselves. The financiers, the entrepreneurs, the businessman, the bureaucrats and the politicians and other shadow-players have taken over.
Who is to blame? No one and everyone. It is a part of the times we live in, and this in itself is a reflection of the changing values of society and professions. I am reminded of a popular song "Money makes the world go round", a song I know will be familiar to most of you. That is what it is all about, the rank and almost obscene commercialisation of medicine.
The profession sadly has not gone untarnished in this radical shakeup of health care. At a recent Meeting at the Ministry of Health, when I raised my eyebrows over the statement that pharmacists needed to be business entrepreneurs as well as professionals, the retort I received from the pharmacist was "Aren't you also an entrepreneur?" That, distinguished guests, ladies and gentlemen, is indicative of how we are viewed.
When the reality is viewed in its starkness, the dilemma the profession is faced with is this: Do we go along with the so-called main stream, or do we stand firm and hold fast to our Hippocratic oath and our ancient code of ethics? The pressures on the profession are enormous, and come from all directions, not the least from the community itself. The Office of Fair Trade Practice in the United Kingdom is applying pressure on the legal, dental and medical professions to change their stand on advertising, pressure that is being strongly resisted by the British Medical Association. Similar pressure may well be brought to bear on us here.
What shall be our stand, what shall be our response? That I believe to be the most important issue at stake, the most fundamental of the principles on which we lay claim to be professionals. There are those who will argue cogently that times have changed and that our ancient ethical code must be adjusted to meet modern times. "The public has the right to be informed" is the argument advanced by both medical and lay public alike.
Or should not this be the time when it is most necessary that in the face of all and any pressures, the profession stands firm and defend its honour, independence and integrity. These are old-fashioned words, some would say for old-fashioned times. Each of us will have to search our own consciences, the profession will have to search its collective conscience. I know what my answer is, but it may not be the answer for everyone.
Whatever our answers, individually and collectively, I would be bold enough to say, that if we sell out, it we were to compromise and acquiesce, that day will the humanity go out of medicine, and the medical profession will lose its soul."
