To be or not to be…

Though against the law, prescribing allopathic products by Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy (AYUSH) doctors is a regular phenomenon. Even today, a large chunk of population relies heavily on AYUSH doctors to fulfill their healthcare needs. However, recently Maharashtra Food and Drug Administration (FDA) decided to come down strongly on chemists who entertain allopathic prescriptions from homeopathy doctors. This diktat evinced severe protests from AYUSH doctors. Chemists across Maharashtra chose another way to show their displeasure for this diktat. They decided to work only from 10 am – 6 pm sharp and refuse to honour prescriptions for allopathic medicines from AYUSH doctors, which in turn had caused lot of distress to the local populace. This move put the Maharashtra Government in a quandary since the agitation would have seriously compromised the healthcare services in the state. Today, Maharashtra Government, in principle, has agreed to allow AYUSH doctors to prescribe allopathic medicines. However, on the other hand, Indian Medical Association (IMA) has raised strong objections against any such move by the Maharashtra Government.

Legally right…

Legal provisions justify IMA’s stand but it is also a known fact that the healthcare system in Maharashtra, or for that matter any state in India, would collapse if AYUSH doctors are not allowed to prescribe allopathic medicines. Thus, it is nothing short of a tricky balancing act for the Maharashtra Government to safeguard the interests of all the said parties.

“AYUSH doctors are not trained in allopathic medicines. There is a Supreme Court judgement which prohibits therapeutic pluralism. This was sometime in 1990 and due to which cross practice is prohibited.” Shashank Sandu Managing Director, Sandu Pharmaceuticals

Shashank Sandu, Managing Director, Sandu Pharmaceuticals says, “AYUSH doctors are not trained in allopathic medicines. So, they are not expected to be experts in this form of medicine. Further there is a Supreme Court judgement which prohibits therapeutic pluralism, this was sometime in 1990 and due to which cross practice is prohibited. On the reverse side, under the Maharashtra Medical Practitioners Act 1961, in parts A, A-1, B & D, Maharashtra Government passed a GR allowing AYUSH doctors to cross practice and prescribe allopathic medicines. Due to these reasons they cannot protest but the AYUSH doctors are a confused lot.”

“I don’t think that the pharma industry has any role in this matter as it is upto the government to take a decision by keeping in view the need of the people and factual position of health services in the State,” opines Dr Bahubali Shah, President, Maharashtra Council of Homeopathy (MCH).

“We have no correct and proper law to curb the menace of misuse of medicines and the same is being exploited by all. In India anybody and everybody can give medicines.” Dr Jayesh Lele State Secretary, Indian Medical Association (IMA), Maharashtra

Dr Jayesh Lele, State Secretary, IMA, Maharashtra, takes a strong dig at the Government. He says, “There are not enough laws to tackle quackery. Government has an inadequate approach to health and medical education matters, at the State as well as at the Centre. There are not sufficient plans and fund allocation for looking into the future of healthcare. And moreover, there is a lot of political interference.”

According to Lele, at least today Government of Maharashtra and other associations have admitted that as on date they have no permission or know-how or legal provisions to use allopathic medicines. So they should accept the fact and stop prescribing allopathic medicines on the pretext of a scarcity of doctors in rural areas. There are many such doctors practicing in city areas, who keep their consultancy fees low, to make up for their inadequate knowledge and treat needy patients.

“We have no correct and proper law to curb the menace of misuse of medicines which is being exploited. In India, it seems anybody and everybody can prescribe medicines,” says Lele.

Pharma industry, the loser?

“It is upto the government to take a decision by keeping in view the need of the people and factual position of health services in the State.” Dr Bahubali Shah President, Maharashtra Council of Homeopathy (MCH)

Though it would seem the pharma industry would be one of the biggest losers (in terms of sales) if the AYUSH doctors are not allowed to prescribe allopathic medicines, there seems to be no reaction/ protest from the pharma industry to this controversy.

Lele points out that the pharma industry can never be the loser even if a ban is imposed on crosspathy practice and their prescriptions are not honoured by chemists, since a patient would take help and treatment from doctor. He explains, “Pharma industry cannot support crosspathy but they follow notifications from the FDA. Also, FDA can put pressure on them to follow the guidelines. Sale of medicines will not be affected. In fact, chemists and druggist associations are going to be the key partner if we really want to do something to curb the quackery.”

Though the Government of Maharashtra has showed a flexible approach towards allowing AYUSH doctors to practice allopathic medicines, IMA seems to be in no mood to end the fight. Not just the organisations representing AYUSH doctors but also the Maharashtra Government will have to fight the legal battle against IMA. However, Sandu doesn’t find anything unusual in IMA’s approach as this is an association of MBBS doctors and hence he feels that they will obviously protect their constituents’ rights and practice territories. Sandu explains his stand, “We, as an ayurvedic medicines manufacturer, meet ayurvedic, homeopathic, unani and allopathic doctors. We cannot comment on IMA’s stand as it is a body of professionals.”

Shah refused to comment on IMA’s stand but he asserted that the Maharashtra State Government has taken this policy decision to render best of health services to the people of the state after a series of legal consultations and in the capacity of rights availed as per constitution of India.

No crosspathy

IMA has always been against crosspathy. “We have many times approached various authorities without luck. This is again because many States have not implemented the Supreme Court judgements on this matter. These need to be taken into account by all States. But they are not doing so again on the premise that there is lack of doctors in rural areas. It is a failure on part of the Government to provide infrastructure of Primary Health Care (PHC) as well as small hospital in villages,” says Lele. In fact IMA has now 191 branches with over 30000 members, across all districts of Maharashtra. According to IMA authorities, they are ready to help Government to tackle the issue. Also now there are nearly 1,00,000 doctors registered with Maharashtra Medical Council. “IMA cannot support this prescription practice, as there is lot of difference in learning, diagnosing and treating. It is not a question of just obtaining a certificate of one year of pharmacology; we need to have a complete learning of the MBBS process. The validity of such certificate is again questionable,” stresses Lele.

Though AYUSH doctors have been blamed for crosspathy, according to experts, MBBS doctors do sometimes prescribe ayurvedic medicines. So should they also be blamed for quackery? “It is possible that some MBBS doctors may be prescribing medicines like liniments or some herbal tonic preparation but it is very minimal. But this cannot be the basis to allow allopathic practice to all others by teaching a one year certificate course,” opines Lele. Pharma industry has to follow the FDA rules as these rules are based on the Government rules and notifications. The issue of allowing prescriptions of allopathy medicines by other than MBBS doctors is started by Government of Maharashtra in spite of the Supreme Court and MCI guidelines in this matter. According to Lele, pharma industry shall follow the FDA and surely support the cause as well as oppose the anti-quackery mission.

A ‘Play safe’ approach

There are no two opinions on the fact that the pharma industry has to stick to the rules and laws formulated by the Government. However, though the pharma industry is expected to make its stand clear on this issue, they seem to have no option left but to wait and watch. As mentioned earlier, pharma players will have to follow the rules. Moreover, not all doctors prescribe allopathic medicines may necessarily be quacks. Every effort made to get the views from the pharma industry proved futile as none of the pharma companies (allopathic medicine manufacturers) who were been approached seemed interested in explaining their stand on this issue. This is perhaps the most awkward situation that the pharma players have ever come across in India. Any move by them would end up in harming their own interests in this most productive market of India. Though Maharashtra Government has made up its mind to allow AYUSH doctors to prescribe allopathic medicines, an official notification hasn’t yet been released. This stand by the Government is in fact good news for the pharma companies. However, this outcome would perhaps be celebrated back stage. Today, on this issue, pharma industry is like a helpless audience. They may like the drama but can’t appreciate the scene. It will be interesting to see when the curtains fall. Meanwhile, taking a leaf out of the Maharashtra episode, AYUSH doctors in Karnataka have also decided to press their Government to allow them to prescribe allopathic medicines.

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