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Good morning all.. Recently I read an article (BMJ) about quackery in Indian medical practices. The facts were shocking. Here I am sharing a part of that article. * Are India’s quacks the answer to its shortage of doctors? Unqualified practitioners who pose as qualified doctors and administer potentially dangerous treatments to patients so called quacks are numerous throughout India. But state governments and police aren’t taking action, say officials from state medical councils, who are grappling with complaints against these practitioners. “There is no political will” to deal with quacks, because they are popular among the electorate, Anil Bansal, former chairman of the antiquackery cell of Delhi Medical Council, told The BMJ. An Indian Supreme Court ruling in 1996 defines anyone practising modern medicine without training in the discipline, even if they are trained in alternative systems of medicine such as ayurveda, as quacks or charlatans. The Indian Medical Council Act of 1956 punishes this with up to a year in prison and a fine of Rs1000, a weak penalty, argues Bansal. State medical councils, meanwhile, have their own penal provisions; the Delhi Medical Council Act, for example, punishes quackery with imprisonment of up to three years and a fine of Rs 20 000. Quacks can also be tried under provisions of the Indian Penal Code, which punishes impersonation and cheating with up to seven years in prison. Several studies of unqualified practitioners have found that drug companies supply drug samples to quacks, leading to indiscriminate prescriptions. * How many unqualified doctors? Although there have been no India wide surveys to estimate the number of such unqualified doctors, regional surveys indicate that more than 70% of healthcare providers in rural India have no formal medical training. “Suppose one qualified doctor has a private practice. He has someone called a compounder or a helper. When the helper masters a few medicines, he starts working in an area where there is no other doctor,” GS Grewal, president of the Punjab Medical Council, told The BMJ. He estimates that there are close to 100 000 quacks in Punjab alone, a state with only 30 000 registered doctors. Quacks proliferate for two main reasons. Firstly, India simply does not have enough physicians, at 0.7 doctors for every 1000 people. The World Health Organization recommends at least one doctor for every 1000 people. And India’s doctors do not wish to practise in rural areas because of the lack of critical infrastructure, Bansal says. Secondly, the police do not take action against quacks even when medical councils lodge complaints, says Bansal, because the government lacks the will. In a working paper on such practitioners in the former state of Andhra Pradesh, KV Narayana, a health economics researcher at the Centre for Economics and Social Studies in Hyderabad, noted that they enjoy the patronage of local political leaders in rural areas because they are the only medical workers available, and they cultivate strong relationships with their clients. Such popularity and political support make it difficult to take action against them. * Government inaction and public support Bansal, who estimates that there are two quacks for each of the 40 000 registered doctors in Delhi, says that efforts by the Delhi Medical Council to bring these offenders to book have been thwarted by inaction from the local police and the state government’s own antiquackery cell. In May 2014, reacting to this inaction, the High Court of Delhi approved an order requiring local police officers to conduct monthly raids in each of Delhi’s 13 districts to bring unqualified doctors to the notice of the Delhi Medical Council. The council, in turn, was asked to verify the credentials of the doctors within 72 hours. “Until today, more than one year and two months later, hardly any raids have been conducted. Police are not cooperating at all,” Bansal told The BMJ in July 2015. Of about 250 doctors that the council flagged to the police in response to public complaints last year, very few have had cases lodged against them, Bansal said. Kishor Taori, president of the Maharashtra Medical Council also blames the government for lack of action. “The antiquackery cell has been given teeth by the government; they can seek, raid, and file criminal cases. Unfortunately, their meetings do not take place regularly.” The damage caused by quacks is serious, say the members of state medical councils. For one, Bansal says, quacks overuse intravenous drugs because these fetch them higher fees from patients. Grewal attributes the high incidence of hepatitis C infections in Punjab to the unhygienic overuse of syringes by quacks. AK Jamrani, the chief district medical officer of the central Delhi region, whose office is required to conduct inspections and report quacks to the Delhi Medical Council, told The BMJ that taking action against these practitioners was a big problem because they were so numerous. “When we visit a quack in an area, all others run away,” he said. In late November 2015, an unqualified practitioner of Unani medicine in Hyderabad allegedly tried to burn the body of one of his patients after an intravenous drug administered by the practitioner killed the patient. The local police subsequently raided several city clinical establishments and arrested about 100 unqualified practitioners. But Rao says that the number of complaints from patients about quacks continues to remain low, despite such extreme cases of malpractice. “We get complaints about corporate [private] hospitals, but there are very few complaints against rural medical practitioners [quacks]. Nobody complains against them. [The public] excuse unqualified people very liberally, but don’t do so for qualified doctors.” Rao adds that when his office shut down the hospitals run by quacks, the practitioners merely moved to another locality and began practising again. Kindly share your views regarding this. Thank you.

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