If you go into the bylanes of any city or town in India, you will be greeted by sign boards offering quick-fixes for any medical problem under the sky. Be it haemorrhoids, psoriasis, heart ailments, asthma, cancer or even erectile dysfunction — there is a cure for everything.
A visit to any of these ‘clinics’ can be an experience in itself, with walls covered with messages of ‘endorsements’ from celebrities and stories of patients whose lives were ‘saved’ by the ‘treatment’. The most obvious inference from these advertisements is that there is a good clientele for these ‘cures’. Another inference, and a more disturbing one, is that a section of the population either does not have easy access or does not trust the formal healthcare system.
Much of this failure has to do with how the healthcare system communicates with the patients and public.
Heartburn and embarrassment
The recent controversy regarding Coronil, an Ayurveda preparation for COVID-19, from Ramdev’s Patanjali, has ignited a broader debate on communicating about healthcare products. Coronil had received a Certificate of a Pharmaceutical Product (CPP) from the AYUSH section of Central Drug Standards Control Organization (CDSCO), as per a system designed by World Health Organization (WHO) for quality assurance. The WHO’s Good Manufacturing Practices (GMP) system assures that “medicinal products are consistently produced and controlled to the quality standards appropriate to their intended use”.
The CPP is issued by country-level regulatory agencies, and it can open the export markets for the product. A section of the media and some people associated with Patanjali started claiming that it’s the first evidence-based medicine for COVID-19 and has been approved by the WHO.
This forced the WHO’s South East Asia Regional Office to come out with a statement saying that the organization has not reviewed or certified any traditional medicine for COVID-19. This caused significant heartburn and embarrassment for the government internationally, especially at a time when India’s role as a global vaccine supplier is being hailed across the world, and our health minister is the chair of the WHO’s Executive Board.
Democratise health and Google
Even if the Coronil controversy was due to a lack of understanding about the WHO-GMP certification system, we should be using it for improving the way in which health or science is communicated to the general public.
The medical fraternity, be it modern medicine or AYUSH, has always lorded over an information divide. In countries such as India, many medical practitioners adopt a paternalistic attitude towards patients and chooses for them, with an assumption that patients do not have the ability to make the right choice. I have come across doctors and nurses who get offended when patients ask questions about their medical conditions; and most of this is because of a large information divide which creates ivory towers.
There is a need to democratise health and it can happen only with a greater understanding of human body among general public. The human physiology has to be taught to school students and communication has to be a part of the medical curriculum.
Though the medical fraternity may abhor the argument, Google has played a significant role in democratising healthcare than any other intervention in the history of mankind. The accountability aspect of the healthcare system becomes stronger, when a patient with a reasonable knowledge of the healthcare condition is being serviced.
Information and intellectual honesty
The healthcare profession should also introspect about the integrity of the communication process with patients and public.
There are several diagnostic challenges with cancer, haematological diseases, autoimmune conditions and chronic infections. Similarly, there is a high probability of treatment failure in these conditions and it may result even in death. But in many instances, the conventional strategy followed by medical professionals is to pass on information selectively. There has been several reports about expensive therapies being pushed, even in the absence of significant survival benefit to patients. The commission or cut system prevalent among some sections of the healthcare sector, even puts real estate agents to shame. This further complicates the communication process between healthcare providers and patients, by reducing the overall integrity.
The intellectual honesty in health communication is another aspect which needs evaluation. During the early stages of the pandemic, the way in which Remdesivir was suggested as a treatment for COVID-19, without any solid evidence regarding the same, is suggestive of commercial considerations. An expensive medication such as Remdesivir escalated the cost of COVID-19 treatment, and the overall burden on the healthcare system was huge.
The Solidarity Trial of WHO later said that Remdesivir had little or no effect on COVID-19 mortality or length of hospital stay. Another example is the way in which Non-Invasive Prenatal Testing (NIPT) and stem cell banking is being advertised in maternity hospitals. These are expensive interventions and the evidence regarding benefits for a normal patient is very obscure.
Bridge the gap
Most sections of society do not understand the reasons for doing clinical trials or the importance of generating statistical inferences. Besides, there is a large gap between the knowledge accessible to patients and healthcare providers. More than an effective legal machinery to stop misleading advertisements on treatment options, what we need now is a deep introspection on how the healthcare sector views communication with the public.
Increasing transparency and educating patients can be more effective in maintaining the trust of the public in our formal healthcare system. Without any significant efforts in that line, we will continue to see hoardings, which tell us about magical remedies for impotence, barking at us from electric poles and facades.
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