Healthcare is supposed to heal. Yet too often, it can be a source of harm. According to the WHO, one in 20 patients worldwide suffers medication-related harm. That statistic should alarm us all. Behind the numbers are real people – patients harmed not by their illnesses, but by the very system meant to care for them.
Why does this happen? Substandard or poor-quality medicines are one cause. But another is the prescribing of unnecessary or incorrect medications. Sometimes this occurs because doctors have gaps in their knowledge. Other times, it happens because financial incentives encourage doctors to prescribe medicines that benefit pharmaceutical companies more than patients. The consequences are serious: in low- and middle-income countries such as Pakistan, an estimated 83 per cent of preventable medication-related harm stems from errors in ordering or prescribing by healthcare providers.
Safe healthcare is not a luxury. It is a basic human right. To achieve it, doctors must be well-trained and must uphold ethical standards. Beyond that, medicines, medical devices, diagnostic tools and healthcare facilities must meet minimum safety requirements.
Unfortunately, this is far from the reality in Pakistan. Doctors’ prescribing habits are often influenced by pharmaceutical companies or diagnostic laboratories offering financial incentives. This practice distorts clinical judgment and places patients at risk, while also increasing the cost of healthcare for families who are already under economic strain.
The global opioid crisis illustrates how devastating unethical prescribing can be. In the US, aggressive promotion and incentivisation of opioid medications led to approximately 82,000 deaths from overdoses in 2022. Beyond the tragic loss of life, the US healthcare system now faces the immense challenge of addressing widespread addiction and its economic fallout.
The dangers are even greater in Pakistan, where patients rarely question their doctors’ prescriptions and regulatory oversight is weak. Out-of-pocket healthcare payments often force households to cut back on essentials such as food, education and housing.
At first glance, this may appear to be an issue of healthcare providers – including pharmaceutical companies, laboratories and doctors – choosing between profit-making and what is best for patients. In the short term, this is true. But in the long term, everyone loses if we do not move towards a safer, more effective and more ethical healthcare system. Doctors will lose because growing public awareness of hidden financial incentives is eroding trust in the profession. The pharmaceutical industry and diagnostic laboratories will lose as they become trapped in a cycle of escalating incentive payments to doctors.
The time for fair and strict implementation of regulations is now – to ensure ethical prescribing practices, minimum competence of doctors and essential safety standards for medications and diagnostic tests.
Dr Mishal Khan is a social epidemiologist.
Dr Naveed Noor has investigated pharmaceutical incentivisation to physicians.