Guidelines meant to stop cross pathy by doctors stir a hornet’s nest 

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A proposal by the India’s apex regulator of medical education and medical professionals to ban cross pathy, or doctors prescribing medicines from branches of medicines which they are not trained in, has stirred a hornet’s nest.

The proposal has triggered demands to cease the practice by many state governments of allowing AYUSH doctors to run primary and community health centres where they are made to prescribe and dispense allopathic drugs.

AYUSH is short for Ayurveda, Unani, Siddha and Homeopathy.

The Ethics and Medical Registration Board of the National Medical Association this week has released a draft of the Registered Medical Practitioner (Professional Conduct) Regulation, 2022 for public consultations.

The regulation proposed that every Registered Medical Practitioner (RMP) would only be allowed to practice the system of medicine in which they have been trained and certified.

“Every RMP shall practice the system of medicine in which he/she has trained and certified (for this purpose referred to as modern medicine or allopathic medicine) and shall not associate professionally with any unqualified person to perform any treatment, procedure, or operation,” the draft said.

It also proposed that a person qualified in more than one system of medicine should decide which system he or she wants to practice.

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“Once licensed to practice Modern medicine under the NMC Act, they shall not practice another system of medicine simultaneously,” said the draft regulation, adding that short courses in other systems of medicine do not qualify a practitioner to practice and prescribe medicines used in that system.

This proposed clause in the draft regulation is in sharp contrast with the line endorsed by the government and its policy think tank Niti Aayog who have been batting for an integrated system of medicine.

Existing systems

The National Rural Health Mission, 2005, first suggested giving rural people across states that have a weak health infrastructure the option of choosing ayurvedic, homeopathic and other traditional medicines apart from allopathic drugs.

A shortage of MBBS doctors willing to serve in rural areas has prompted some states to permit AYUSH doctors in rural primary health clinics to prescribe allopathic drugs; some like Uttar Pradesh, Bihar and Maharashtra among a few others have even issued official notifications to that effect.

The rural health statistics report 2020 released by the Union health ministry recently showed that 8,709 AYUSH doctors were posted in 25,140 rural primary health centres across states in 2020-21. Some 541 AYUSH specialists had been posted at 5,481 rural community health centres.

Officials in the health ministry say that although no central data exists on how many PHCs have only AYUSH doctors and no MBBS doctors, it is implied that centres without MBBS doctors are run only by AYUSH doctors.

Public health specialist Dr Antony K R, who is also an independent monitor of the National Health Mission, said that in many states AYUSH doctors had been permitted to oversee childbirths, conduct minor surgeries and prescribe allopathic medicine.

During the COVID-19 pandemic, there have been instances when AYUSH doctors have even managed Intensive Care Units in some public hospitals.

A dangerous trend?

Dr R V Asokan, a senior member of the Indian Medical Association, the largest network of doctors in the country, likened the legitimizing the prescription of modern medicines by AYUSH doctors to legalizing political corruption.

“Anyone with a basic understanding of the various systems will know why cross pathy is dangerous. The systems are different from one another in principles, conceptions and practice,” he said.

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“Successive governments have been hand-in-glove in this crime. Lack of adequate investment in health and lack of insights in healthcare has led to the mixing of systems. In a way it is a camouflage for the failure of all governments since independence to provide decent healthcare to the people,” Asokan said.

He also pointed out that medical systems that do not approve the use of microbes, for instance, are allowed to prescribe antibiotics and forms of medicine that do not approve of vaccination are entrusted with the national vaccination programme.

“What is the human cost of such a decision? People are short-changed with such inept decisions,” said Asokan.

Antony said that just because the appointment of AYUSH doctors in place of MBBS doctors is a common practice in many north Indian states, it doesn't make it any less a crime.

“Ordinary people believe that they are trained doctors and that is where impersonation comes up as an ethical question,” he said.

Deputing AYUSH doctors to school health programmes and Anganwadis for screening people suspected of congenital heart disease, tumours, hearing and visual defects under the Rashtriya Bal Swasthya Karyakram is also a crime and waste of resources, Antony said.

A wise course? 

Asokan said the NMC has done well to have adopted the right line.

“No one disputes the right of AYUSH doctors to prescribe AYUSH drugs; in a similar vein, modern medicine doctors prescribing AYUSH drugs should be punished,” he said.

Sources in the IMA said many MBBS doctors prescribed AYUSH medications such as cough syrups and drugs like Liv52, which claims to correction liver damage, routinely.

“It’s not only unethical but it’s an offence because someone who’s not trained in a particular field cannot practice that but unfortunately it’s going on totally unchecked,” said Dr. Gurinder Grewal of the Association of Doctors for Ethics in Healthcare.

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Some experts said encouraging cross pathy may lead to the erosion of traditional medical systems.

“The near total disappearance of Chinese traditional medicine has happened in our times. A similar fate may be awaiting ayurveda due to mixopathy and cross pathy,” warned Asokan.