In modern medicine, there may be two axes that regulate ethical behavior in everyday practice: a) evidence-based medicine and b) precision medicine or previously called personalized medicine, but this term is actually confusing, since medicine has always been personalized. In the first concept, practically all over the world, for several decades, clinical medicine is guided by trying to implement the best therapeutic behaviors based on the results of clinical studies, which strictly followed the steps of research protocols, in accordance with good clinical practice and where they provided benefits in the examined patients .
The results of these clinical studies are published in indexed journals that anyone can theoretically consult, but this is where the problems begin, since not everyone has access to these journals, since their costs are usually high, for this reason most institutions try to have a certain subscription to the journals they consider the most recognized in their area and who can help their staff to update them.
Recently, the concept of precision medicine has been introduced, which basically consists of individualizing each patient with his disease, since we have always known that each person can have different clinical reactions and drug effects. The problem of individualizing each patient is that one part is based on the determination of molecular tests that specify the genetic information of each patient, increasing costs, even in many cases many of these tests can be more expensive than the same treatments. they try to choose.
With that in mind, our country is no stranger to these demands of current medical practice. However, the differences between public and private medicine are very contrasting. Each administration tries to put its stamp on the health care system it inherits and modify it according to the idea each has and wants to adopt for Mexico. This administration, despite its good intentions of wanting to provide drugs for the entire population, did not plan well for the procurement, distribution, preparation and administration of drugs, causing shortages and bureaucratic delays in scheduling patients, forcing many rights holders and patients into hospitals run by INSABI, in order to have their imaging and laboratory studies done in a special way so that they can continue their treatment as planned and so that they do not suffer delays in them, since these delays can last for weeks or months, as well as for the purchase of drugs that do not exist at that time in their care units.
This situation is not new, as it has been present since past administrations; so much so that some colleagues even said “that their institutional practice is not evidence-based medicine, but stock-based medicine”, that is, prescribing only available drugs; This, along with the falsification of data by pointing out that there is no shortage, because only the drug that is in stock is issued, confuses the health personnel themselves. However, in this government it is emphasized more emphatically. It should be pointed out as something positive, that having expensive drugs in pathologies such as cancer, where the prices of many of them are too high and which almost no patient can afford, in this administration there are more opportunities to treat some more patients, although occasionally, due to periods of shortages that occur also due to limited budgets of institutions, still have to discriminate against patients with the intention of trying to optimize resources for those who are considered to have greater opportunities for better results. Some directors of state and health institutions are trying to force doctors to adapt to such circumstances and treat their patients as much or less than the hospital can offer them, that is, they treat the population with what they have… Unfortunately, reality overrides the story.
This is where the doctor’s mentality falls into a duality that is sometimes not easy to reconcile. In a public institution, the doctor gets used to prescribing “nothing” or “there is only this or that”, even though he understands that this is not the best option for the patient, and gets used to “something is better than nothing”. Doctors who, in addition to working in a public institution, also work privately, will hardly postpone procedures or the start of treatment.
Obviously, institutions try to ensure that their doctors adhere to international management guidelines, but often, due to the special characteristics of each, they internally allow the “tropicalization” of therapeutic management according to the circumstances prevailing at the time. your institution.
When you live reality or “the real world” as the Americans say, the therapeutic results will be very varied; each patient will experience the good or bad luck that has befallen him and only he will know about his luck or misfortune. The doctors will be satisfied with what they considered to be the best alternative according to the conditions of their hospital at the time, or if they at least offered something, and in the end the Government will say that it complied, because no one protested and will assume that its policy was successful.
*The author is a medical oncologist at the National Cancer Institute (InCan), with a master’s degree in the direction and management of health institutions, a full professor of the Biological Therapy course and is the representative for Mexico of the cooperative group SWOG (South West Oncology Group). Currently in the dissemination project: Science, politics, economics and medicine.