QUACKERY & MOCKERY OF HEALTH CARE SYSTEM ?

Here is a large number of laws related to health care delivery systems in India. But if non-implementation of legal provisions is lawlessness, the health sector is the most lawless of them all.

The basic law to regulate and maintain the professional standards of the medical profession was the Indian Medical Council Act.
However, in the zeal to encourage 'Indian systems of medicines' and 'traditional systems of medicines', these essentially complementary systems have been projected and established as alternative systems of medicine. In the name of 'integrated medicine', a totally chaotic, unregulated and unregulatable system has come to exist.

Worse still, in the name of providing 'barefoot doctors' for the suffering 'rural poor', anybody, irrespective of their basic qualifications or capability, can be provided with a legal license, after the so-called 'basic training', to practice as a Registered Medical Practitioner (RMP). An RMP, legally, can do anything that a regularly trained physician is permitted to do. And, a trained doctor can do anything that he chooses. There is no question of any norms, standards or ethics.

Contradictions in the laws and their implementation
Placing jaggery inside a woman's uterine cavity to stop severe bleeding after she has given birth is a criminal act for a doctor registered under Medical Council Act. The same act would be termed 'life saving' for a registered practitioner of traditional medicine. To instill anything unsterile in an eye after a cataract operation would be gross criminal negligence on the part of a modern opthalmologist, but using cow's urine after a couching operation for cataract would be a fully justified procedure under the Indian system of medicine. An acupuncturist is permitted to attempt to cure a cleft palate case by assuring the parents that electric stimulation from a needle 'strategically' placed in the body will stimulate growth of issue across the cleft, though such a promise by others would attract penal provisions.

In the case of malignancies that are today identified as treatable or eminently controllable, not giving approved drug therapy would render a modern oncologist (cancer specialist) liable to legal action, but a practitioner of any other system of medicine claiming himself to be a 'cancer specialist' could give anything or deny anything to 'cure' patients, without any consequence of law.

Institutionalised quackery:

If acting beyond one's training, competence and skill is quackery, in India today we have virtually institutionalised quackery, where, irrespective of which system of medicine one is trained in, including self-training in the name of traditional medicine, one may do what appeals to whim and fancy.

It is no surprise that the Medical Council of India and other medical councils are ineffective and dead as far as their function of regulating the standards of different systems of medicine is concerned.

The Drugs and Cosmetics Act, with all its provisions to regulate the manufacture, distribution and safe use of the myriad products of one of the largest industries in the country - the pharmaceutical industry - is followed only for its money-spinning licensing provisions. Even this is in a distorted form. The state drug controllers, the implementing agencies of the Act, operate only as licensers. Under the loan licensing provisions, the State Drugs Controller can license anybody to prepare and market a medicine. As a result, one can see 'tonics', 'herbal medicines' and other such substances being prepared inkadhaiin the streets of Jaipur and Indore.

Spurious drugs :

According to a report of the drug control authorities, 20 per cent of such medicines were found to be spurious. It is anybody's guess what the actual extent of spurious drugs in the market is. Concoctions under the label of traditional and home remedies are now being marketed by organised national and international pharmaceutical companies. For herbal, ayurvedic, siddha and other such preparations, there is no method of quality control.

There is no evolved method of post- market surveillance, not even for newly licensed drugs. A licensed abortificent paste, the 'Fetex paste', killed hundreds of women, without the Drugs Controller being aware of it, let alone having to account for it, as the licensing authority.

Yet another Act is the “Drugs and Magic Remedies (Objectionable) Advertisement Act”. This Act makes advertising of sex tonics and sex stimulants, uterine tonics and menstrual disorder regulators a cognisable offence. It also prohibits advertisements about the diagnosis, cure, mitigation or prevention of 54 diseases and disorders listed in the Act such as cancer, diabetes, epilepsy, leucoderma, paralysis, sexual impotence. However, billboards in Delhi and even in small towns, the local train compartments in Mumbai, and other metros, advertisements in newspapers and glossy and not so glossy magazines, and now the electronic media, openly mock the law-making and law-enforcing agencies.

Reproductive 'rights' :
Another Act that has permitted mass butchery in the killing fields of medicare is the Medical Termination of Pregnancy Act. Intended to provide women the reproductive right of safe abortion (upto 12 weeks of pregnancy), the time span within which a legal pregnancy could be performed was increased to 20 weeks to accommodate population planners, though it was specifically stated that the Act was not meant for population control. The elaborate safety provisions of the Act and the Rules and the Regulations framed under it are overlooked with impunity.

As a result, induced abortions are one of the main killers of pregnant women in the country. Thousands of women become its victims every year. This has been going on for over the last 20 years. And of course it not only legalises 5 million foeticides every year but also makes it a laudable effort in nation building. The whole cultural ethos of the family and value for human life is shaken. Sects that used to abhor even killing an ant today think nothing when a foetus is dumped in the bucket to die.

Pesticides for household use ---
The Insecticides Act is intended to provide access to safe pesticides. Yet thousands of persons die every year, 20 per cent of them children, due to just one pesticide - aluminium phosphide, a product which is not to be sold in the market or be available as a household pesticide. Deaths by this pesticide have been reported in the medical literature, by forensic experts and in the lay press in the country. However, no authority has felt the need to act under the Act.

The Dangerous Machines (Regulation) Act is intended to prevent maiming of farm workers by agricultural machinery. Though thousands of labourers get their limbs chopped and mutilated by thrashers and chaff cutters and hundreds of women get descalped, the provisions of this central Act have not been implemented almost a decade since its passing by Parliament.

Amongst the silent killers are radiation-induced cancers, congenital defects and body damage caused by X- ray radiation. The thousands of improperly used X-ray units in the country, functioning without the mandatory safety provisions prescribed under the Atomic Energy Act, are collectively and continuously doing what the atomic bomb once did. But since the ill effects of X-ray radiation manifest after 10-15 years, or manifest in the progeny, they cannot be traced to the X-ray radiation that caused it. An X-ray exposure in woman's childhood may lead to cancer of the breast when she is a mother. Radiation of a man's gonads may cause acute childhood blood cancer in his son or daughter.

The Atomic Energy Act is a central Act but is to be implemented by the state governments. They just have not done it.

The rule of law :
The rule of law apparently does not include welfare law. Bypassing a law is not breaking a law. Indifference of statutes is not statutory indifference. Welfare of people is good for public posturing; otherwise, to fare well is the bureau-politician's overwhelming instinct.

There are several other laws that aid and abet activities in the killing fields, by default or design. Non- implementation of laws is no contempt of the parliament or the judiciary, and litigation leave little scope for the law enforcing authorities to effectively monitor and implement welfare laws.


The first conviction of a quack was in Honnali.
· Maharashtra has enacted a legislation to check quacks, while the Delhi government constituted a cell.
· Karnataka government's anti-quackery cell, started in 1983, is defunct.
Government circular dated November 28, 2001 to the district administration to take action against doctors practising any recognised system of medicine other than the one in which they are registered, is not being implemented.
· KARNATAKA HC order on March 1, 2002 that on any complaint filed against unqualified or fake practitioners, the government is competent to take action. ``It is hoped the government will take action in the letter and spirit of law,'' the court said to a PIL.
HC order on March 7, 2001 directing the DGP to take action against unregistered medical practitioners.


Quack. Charlatan. Cheat. A fake.
According to the Supreme Court of India, “someone who has no knowledge of a particular system of medicine but goes on to practise in that very system, pretending to be skilful and knowledgeable”.
Quackery is a business in India; an attractive business, at that, especially for people living in poor areas. For people who fail to complete their formal education and have grim career prospects otherwise, it is a preferred "career option."

Why is quackery such a threat to modern medicine?
Apart from irrational medical practice, quacks spread misinformation, helping to make an already strained relationship between doctors and patients even worse. Worse still, their actions can injure, disable, and sometimes kill unsuspecting patients. This doesn't serve the medical profession any more than it serves the patients.

It is easy to see why patients sometimes fall prey to fake doctors. They seem more accessible, charge less, take more time to talk to them, seem to understand patients better, and apparently examine them well. Well groomed doctors, on the other hand, are "mechanical," scarcely allowing more than five minutes for a patient, examining patients as if there was something wrong somewhere in their bodies and that was all there was to it, and that the problem needs to be sorted out right away. More often than not trained doctors seem to fail to recognise that reassurance is the first step in the management of any disease.

Poverty, ignorance, illiteracy, lack of health education, and an increasing aversion towards modern doctors all serve the quacks well. This is particularly true in rural communities in India, where doctors rarely attend their clinical postings on a regular basis. One look at the dilapidated hospital buildings might make you wonder how deserted they are; they lack basic facilities, such as injections and wound dressings. This leaves little choice for the villagers.
· The govt.has to increase the health budget
· increase the basic infrastructural facilities & medicines in all primary and sub centers.
· recruit more doctors,nursing & paramedical staff by offering good reasonable salaries.
· health education must be spread to the masses in rural areas.
· Compulsory vaccination and good sanitation measures.

Take a walk through any Indian street and ask anyone who they think is the best "doctor" in the locality-it's likely to be a quack. Most of the quacks earn their bread and butter thanks to a "placebo" effect. Although Indian laws include punishment to quacks, this is usually implemented to an unsatisfactory degree.

Quacks never reveal the secrets of their trade. After all, they are fraudsters. Loose and unlabelled packaging of medicines gives them a means to escape scrutiny. They criticise modern medicine in front of their patients but mix drugs such as corticosteroids in their own formulations. A substantial portion of quackery also involves faith healing, but this often goes unnoticed.

"A land of diversity" is how India itself, and the world, sees the subcontinent. That is the case even when it comes to medical practice-from pyramid therapy and magnetotherapy to aerotherapy and electro-homoeopathy, there is no shortage of therapies in India. Since such practitioners are often less educated, they identify with most of the population. Therefore they gather a lot of public support, which makes it difficult to remove them.

Quacks account for untold economic losses and affect every known aspect of healthcare. India is one of the largest producers of counterfeit drugs, which are used mainly by quacks. Counterfeit drugs are cheaper than real drugs, widely available, and they resemble the real drugs. Unfortunately, they often increase antibiotic resistance and can cause severe adverse drug reactions. Often the herbal drugs used by quacks have their own adverse effects.
When used with allopathic medication, the risk of an interaction between drugs often increases.
Classes of quacks

Although there is no officially agreed classification of quackery in India, we divide quacks into classes.2 All of them distribute medicines and claim to know cures for all ailments.
Class 1 - Sophisticated, educated, and otherwise qualified people who are health conscious and once wanted to be doctors. These are among the biggest critics of medicine . They often maintain their clandestine clinics and make a lot of money.
Class 2 - Chemists, pharmacists, and doctors' assistants. They are employed by allopathic physicians and thus learn drug details. Chemists here serve as part time doctors and run their "clinics" behind their drug stores. These often learn medicine from their experience and from "local" medical books.
Class 3 - Qualified practitioners of alternative medicine, using allopathic medicines. These often learn by reading medical books or by getting trained by doctors, as informal trainees or unpaid observers.
Class 4 - These are the least qualified of the bunch; they may even be illiterate. They may be "holy" men or women and often proclaim to be "super-specialists" in many fields such as cancer, diabetes, hypertension, etc. Their advertisements and banners can be found even in front of premier medical institutions of India. They are also labelled jholla chap ("gypsies") doctors by the lay press. The have a panacea for every problem and claim cures for anything that is untreatable by conventional medicine. They ridicule medicine and spread misinformation. Unfortunately, they often have many supporters, and therefore politicians too support them. Therefore it can become difficult to stop them from practising.

What could be done ?
All it takes is political will, reinforcement of the existing laws, and awareness among medical practitioners of the problem. But this cannot be accomplished without educating the public.

Here are a few steps towards a possible solution.

Educate the general public; doctors should be health educators too. India's professional medical bodies need to publicise information on the extent of problem, trends, favourable factors, and how to make doctors aware of it it.
Policy makers need to be persuaded that quackery is a nuisance to the public; millions of rupees are spent, and lives are lost in treating problems caused by bad advice, treatments, and procedures.
Doctors in some seminars or other gatherings should counsel those who implement the law. People in such positions need to be made aware of the problems created as a result of not stopping illegal practices.
Medical students should be taught about this problem and ways of dealing with it. Introducing periodic village tours for medical students to introduce them to information, attitudes, beliefs, and practices of villagers might be useful. This will help them examine some of the factors that lead to quackery. In many medical texts there are references to alternative medicine, and students need to be aware of the "local" remedies and practices prevalent in a particular area.
Doctors need to realise that patients are becoming increasingly assertive and aware; especially in urban areas. They have to be more empathetic and compassionate, spend more time with patients, listen and examine them properly, and, wherever appropriate and required, educate them about health and disease.




Why quackery?
IT IS DUE TO some misconceptions in the public as like --

Allopathic doctors are "expensive"

Many illnesses are poorly understood

Doctors take too little time to examine patients

They do not talk to patients "properly"

They do not believe in prevention but "quick fix" solutions

Lax rules, poverty, illiteracy, lack of health awareness, and unemployment

Any acts/ bills to curb this quackery ?
New Delhi, May 16: The health department of the Delhi government is all set to revive its three-year-old dormant anti-quackery cell. The cell will have hold its first monthly strategy meeting ``as soon as possible'', the government's Health Minister, A.K. Walia told a delegation of doctors from the Delhi Medical Association (DMA). The anti-quackery cells comprises representatives of the councils of allopathy, homoeopathy and Indian medicine, drug controller's office, the police and the Delhi Medical Association.

The health minister told Express Newsline that the “cell” has not been in a position to do much because measures like registration of doctors to councils for the various branches of medicine available in India (allopathy, homoeopathy and ayurveda/unani) had not been done.

Dr Walia said that his government would make the registration of doctors mandatory by the end of this year. A council for auyurveda-/unani sciences has been approved and would be set up soon, he told the press.

The councils would then need to have a common apex body. The registration of doctors would facilitate the police to crackdown on quacks operating in the Capital, the Health Minister said.

The Delhi Medical Association's anti-quackery cell chief G.R. Manghani said that the current set of anti-quackery measures were too mild. A quack can be arrested and his premises raided only on the basis of a complaint. So even if a quack splashes his posters all over the place, the anti-quackery cell does not have the powers to raid his workplace.

Even if a quack does get arrested, after paying a fine of Rs 500 he/she can walk free. The anti-quackery Bill, which is still pending in the Assembly, states has a stringent penalty for practising without a licence with fines ranging from Rs 50,000 to Rs 1 lakh with six months' imprisonment.

The DMA is also lobbying for laws against chemists who sell medicines without prescription. According to the association, 90 per cent of the chemists in Delhi were acting as quacks by prescribing and giving medicines to patients.

How & why common public mischieved by quacks ?

Patients suffering from chronic diseases like epilepsy often use complementary and alternative medicine (CAM) as first-line treatment because of myths, superstitions, and stigma attached to the disease.
The present study reports on 108 patients with epilepsy presenting to an allopathic hospital with uncontrolled seizures, status epilepticus, or drug toxicity. Blood samples of these patients taking unlabeled pills from a CAM provider specializing in the treatment of epilepsy contained prescription antiepileptic drugs (AEDs) such as carbamazepine, phenytoin, valproic acid, and phenobarbitone. Serum samples in all but 5 patients demonstrated presence of one or more AEDs. Most of the patients had serum levels of these AEDs either in the subtherapeutic or in the supratherapeutic range. The authors alert clinicians that the patients resorting to "safe" or "natural" CAM may end up receiving modern prescription medicines from unauthorized CAM providers in toxic or subtherapeutic doses.

Any petitions/ court directions against quacks ?

These are some judgments against quacks.
· A.P. HIGH COURT judgement dated. 7-2-2000, delieverd by hon. Justice I.Venkatnarayana, IN THE CASE OF writ petition no. 3003 of 1990.
· Supreme court judgment( citation sol no:279/ 2000 ) D.K.JOSHI Vs U.P.STATE GOVT.
Our constitution clearly told, that the quackery is a cognizable offence.
And so many acts clearly stating, “that only qualified doctors should do allopathic practice”.
Some acts:
· M.C.I. act with regard to quackery.
· Indian medical council act 1956-section 15.
· Indian medical degrees act of 1916
· Drugs and cosmetic act 1940
· Drugs and magic remedies act 1954.
· United provinces act 1917 –section 30.
· Indian medicine central council act 1970-section 17.

DELHI Govt told to hurry up on Bill against quacks !
EXPRESS NEWS SERVICE
NEW DELHI, January 9: Expressing dissatisfaction over the non-enactment of the Delhi Quackery Prohibition Bill in the Capital, the Delhi High Court today said the city government should take necessary measures to pass the Bill.

Hearing a petition against quacks, a division bench comprising Justices Y.K. Sabharwal and Dr M.K. Sharma observed: "We hope the Bill will be made an Act before April 14, the next date of hearing."

The city government had introduced the Bill on August 28, 1997, in the Assembly after reports that as many as 30,000 quacks were practicing in the Delhi.

On March 11 last year, the bench, in an interim order on a petition filed by the Indian Medical Association (IMA) had said that those persons who were practicing without a recognised degree should be prosecuted.

Earlier, arguing for the city government, counsel Arvind Nigam said the Bill was pending before the Assembly, which was currently not in session.

However, counsel for the petitioner Devinder Singh had pointed out that even as the government was introducing an anti-quackery Bill in the Assembly, the Chief Minister, while addressing a demonstration organised by quacks, had promised that no action would be taken against them.
Nigam agreed with the court on the importance of enacting “the anti-quackery law” as the present legislation providing for a meagre fine of Rs 500 "is hardly a deterrent against quackery."

The government, he said, was not against the practice of a person in that sphere of medicine in which he has obtained a degree but it was of the firm view that there should be no cross-practicing: A person qualified in Ayurveda should not practice modern medicine.

A question was raised during the last hearing that a similar petition was pending before the Supreme Court, and whether in that event the high court should proceed with the matter.

Appearing for the national integrated medical association, advocate Pramod Gupta gave details of the issues pending before the apex court in connection with practice by quacks.

Petitioner's counsel submitted that though specific information regarding alleged practice by over 500 quacks was given to the Delhi Police, the latter had taken action against only six.
How Quackery Harms Patients ?
Economic Harm
The amount of money wasted on cancer quackery is mindblowing , probably exceeds one billion dollars per year -- the amount spent for cancer research. The financial impact upon individuals and families can be catastrophic if they fall into the trap of heroically "leaving no stone unturned" in their quest for a remedy in hopeless cases. Some quacks are quite willing to bleed them dry financially. I know of cases in which survivors were deprived of the family's savings, were left with a large mortgage on a previously paid-for home, or even lost their home.
Direct Harm
Dubious therapies can cause death, serious injury, unnecessary suffering, and disfigurement. Cyanide poisoning from ingesting apricot pits or laetrile, Salmonella dublin infection from drinking raw milk, electrolyte imbalance caused by coffee enemas, internal bleeding from deep body massage, and brain damage from whole-body hyperthermia have all caused needless death of cancer patients. At clinics providing substandard care, intravenous infusions of various concoctions have caused septicemia and malnutrition. And the application of escharotics (corrosive chemicals) to the skin of cancer patients has resulted in needless disfigurement..

Some of the worst quackery-related tragedies result from delay or failure to act.
Overreliance upon dietary treatment is a common means by which indirect harm kills cancer sufferers.
Stealing time. By offering false hope, quackery steals the most precious thing terminal cancer patients have -- the best use of what little time that they have left. The notion that terminal patients have nothing to lose by turning to quackery is dead wrong..

PREVENT THEM TO MISUSE THE WORD-- DOCTOR .
CURB THE QUACKS- FROM DOING TREATMENT.

It’s a clariyan call of every responsible citizen to impose strict measures to control quackery and improve the health care system.