Before we rejoice over another stem cell transplantation programme

BY JOSHUA OPANIKE

Advertising and marketing are aged strategies deployed to encourage potential consumers to purchase a product or service. Although some business leaders believe that a quality product is more important than marketing to build a sustainable brand, corporations continue to invest billions in making products attractive to consumers. In their defence, a good product deserves to be well-advertised. This is not the case for orthodox medicine. The founding fathers of medicine believed that the foundation of the noble profession of this world cannot be contaminated with the emotional manipulation and deception of advertisement.

One of the most crucial elements of medical practice is the sacred trust between the patient and physician. It influences the outcome of the condition. It makes the patient comply with the treatment plan, it makes the physician confident in his craft and keeps him committed to the task of cure. Even when the outcome becomes grim, like between comrades, trust between the physician and patients alleviates the suffering. Once that trust is broken, regardless of the intentions and manner, it is usually irretrievable. The nature of advertising -in that it amplifies the good of a service and never mentions its ills- is incompatible with the transparency the trust in medicine that is built.

Furthermore, advertising in medicine risks the commercialisation of medical services. Medical decisions become easily influenced by money, and the focus shifts from providing the best care to providing the most lucrative option. Sometimes, physicians may become overzealous, offering services that are not needed or worse, healthcare becomes an elitist privilege beyond the reach of the common man. It would be naïve to insinuate that the current practice of medicine is not influenced by money at all.

Medical practice is not immune to the mechanics of industrialisation, commerce and trade that propel the human society. Yet, if we think that the world will become better and that all strivings shall cease, then we may consider the current state of medical practice to be an evolution towards a future where the practice of medicine is fulfilled, only by its mission of alleviating the suffering of men.

Because advertising blurs the line between truthfulness and creative persuasion, it risks leading to misinformation.

There was a recent media campaign on the availability of stem cell transplantation services at the Lagos University Teaching Hospital. Stem cell transplantation is a life-changing, disease-altering procedure that can potentially cure several disease conditions, including sickle cell disease. For Nigeria, the world epicentre of sickle cell disease, access to such a level of care is definitely a welcome development. Optimism on the potential benefits of the service is growing, and it is beginning to influence attitudinal change and management protocols for sickle cell disease in Nigeria.

For decades, the response to sickle cell disease was premarital counselling. People who do not have compatible genotypes were asked not to marry. Although progress was slow, eventually many people became advocates. Several churches mandate intending couples to do their genotyping. In fact, several couples have broken off their engagements because of this. Indeed, such extreme measures are noble and a ‘necessary evil’ especially when our healthcare system is unable to appropriately deal with public health issues. It was better to avoid birthing a child with SS than having them and dealing with the toll of the condition.

The erstwhile focus of health education on sickle cell disease was the socioeconomic fallouts from the management of sickle cell disease in our environment. ‘If you birth a child with haemoglobin SS, your finances will be ruined’ is true because most payments for healthcare in Nigeria are out-of-pocket. The average Nigerian is one major health crisis away from poverty. If payment for healthcare weren’t burdensome, or if an effective treatment option for sickle cell disease were erstwhile available, would the arguments against AS marrying AS have stood? We have found ways to cope with the limitations of our systems, which is normal. It is interesting to hear what a marriage counsellor will now say to intending couples who are both AS. We will be quick to realise that our limitations are not apparent; they have simply been imposed on us by the failings of our system.

It will be mischievous and untruthful to accuse the team pioneering this of collusions. However, this must be more than media shenanigans. Interestingly, physicians in Benin city had announced the availability of stem cell transplantation services since 2019, although this author cannot comment on the present state of the program. It is therefore not enough to say the service is available. We should be intentional about improving access to the service.

At a rumoured price of 70 million naira, how many people will afford it? How can geographical barriers to accessing stem cell transplantation services be eliminated? What are the plans to identify potential patients and establish a referral? What are the plans to make the treatment affordable? Are there plans to increase indigenous technical and human resource capacity in stem cell transplantation?

When someone lives in Nigeria long enough, their tendency to become cynical increases. This is because our society exploits the lure of ‘progress’ to serve selfish interests. Yet again, hope is being reignited. May the hope for an improved healthcare system in Nigeria not be cut short, again.

Joshua Opanike, a medical doctor, can be contacted via [email protected]