Bring prescription audit for AYUSH vaidyas in private practice

The intention of the Government of Karnataka in introducing fair price norms for medical treatments in private hospitals and the much-needed prescription audit on all prescriptions of the medical practitioners in private practice in the state to understand the drugs prescribed by them and its rationale deserves full appreciation and support.

When the union Government proposed to ban the FDC’s based on the possible irrationality and introduce DPCO norms for the sale of drugs in open market every one felt it was not sufficient and more stringent norms are must for doctors in private practice.

Once the prescription audit is introduced and followed by letter and spirit, the Government can easily establish how the doctors in private practice prescribe various drugs including antibiotics, the rationale behind such prescriptions etc. Similarly how the diagnosis is done, how frequently the patients are shuttled for costly diagnostic procedures, the commercial interest and nexus between doctor and lab also can be established.

The point is not about the medical reforms that are initiated by the Government but whether are we really serious in implementing all such reforms and are we truly concerned about the health and well-being of poor people in villages?

The existence of organized looting and leeching the poor patient by our present health care system in private sector is ominous and obvious and that is why many patients die financially even after successful medical treatment. By the time the patients complete the treatment they become street beggars and might wonder had they survived just to begin the street for rest of their life. Most of the so-called doctors from the allopathic system are rotten than the rotten egg and are heartless in sucking out the entire savings of the patients.

Once the law is implemented stringently and the offenders are punished severely the system would automatically improve. But we should not limit the reforms to the scientifically proven allopathic system of medicine alone.

Exploitation of the gullibility and faith of poor patients by the so-called 5000 years old traditional systems of medicine is causing incalculable harms to our health care delivery system. The poor patients seldom can differentiate whether they suffer from curable or incurable diseases. When such patients visit the qualified healers from different schools of Indian traditional systems of medicine, naturally they are likely to get treatment with products from the traditional healing system with no proven effect and science and all likelihood such treatment would distract the poor patents from getting the best treatment from allopathic medicine where the cure is certain for curable and infectious diseases. Many curable diseases reaching an epidemic and pandemic proportion and resulting in the debilitating stage are mostly due to patients seeking treatment for all such diseases from unproven traditional healing system.

Incurable diseases anyway do not have a cure in the allopathic system and hence the vaidyas from traditional healing system often ride on the waves of relief responses expressed by the patients that are often psychological, psychosomatic and spiritual in nature. The science of placebo is well exploited by such system whereas the science does not believe is offering placebo as treatment and hence the allopathic system admits its limitation and concedes its defeat.

The faith healing does not have any strict and scientific regulatory norms. The vaidyas in private practice speak a lot about own system but when comes to treatment, secretly and or openly use allopathic drugs (cross pathy). For example a diabetic patient is when prescribed with 500 gm of different churnams along with potent anti-diabetic drugs of the allopathic system, naturally the patient would get relief from the proven allopathic drug but in all likelihood most patients may think that the products of AYUSH are effective mainly because of the quantity they have been consuming vis-à-vis 250 or 500 mg of the scientifically proven allopathic drugs.

The gullibility of the patients comes as an advantage for the healers of the traditional systems of medicine. The Dengue tragedy that the state of Tamil Nadu had witnessed recently after the aggressive promotion of Nilavembu kudineer a Siddha preparation without any scientific credence, proof and efficacy should be noted as evidence to the above narratives.

Much before regulating and reforming the allopathic medical system, AYUSH needs to be reformed. The best and the most scientific reform in AYUSH will be redefining the faith-healing practices as paramedical and not as medical science. Similarly, all those who have graduated from such system and enjoy the title doctor also must be tagged diligently so that the poor people will not have any confusion in differentiating the doctor from the scientifically proven system from a traditional belief system.

AYUSH does not have a single product that worth to be called drugs like Acetaminophen or Cetrizine. What medical relief the so-called AYUSH drugs would offer to patients, God alone knows but our Government since independence is promoting such system as holy truth and attempting to gift such system to poor people in rural India.

Instead of wasting money on reforming AYUSH by way of promoting research activities or raw material standardization or finished product standardization although all such efforts are needed, converting AYUSH purely for paramedical benefits will be the best reform ever the Government of India can do to AYUSH. Once the graduates are re-designated as health and wellness experts of traditional healing methods and regulate them to provide paramedical services, our health care delivery system will improve several folds.

Irrespective of the quantum of funds/grants are allocated for research in AYUSH, we are never going to get any drug from the system and at best, we may get ‘drug-like substances to support the treatment like how paramedical services do. Today all substances’ that may have some medicinal values are defined as drugs by AYUSH. In that sense, even water has several medicinal values, especially for renal calculi patients.

Time has come we must differentiate the paramedical benefits of AYUSH from medical benefits of the scientifically proven allopathic system.

By promoting different branches of AYUSH to thrive as medical science and its graduates as a doctor, we are causing more confusion and not the solution to our health problems. Why should we give products from different schools of traditional healings like Siddha, Ayurveda, Unani as drugs and more doctors without any science? Such an attempt has reduced our health care delivery system to health care bazaar where each system competes to prove their greatness and authenticity.

Real reform in our health care delivery system will be not just containing the malpractice by some allopathic doctors for making money but redefining AYUSH as paramedical practice is the real reform India wants. No country on earth has given medical science status to their native healing practices like India has given to AYUSH. Tradition, religion and faith must be separated from medical science and health care delivery system otherwise we will be subjecting poor people as guinea pigs to various faith-based healing practices.

Considering all the above confusions, prescription audit for all AYUSH vaidyas in private practice to know how they diagnose the diseases as per own system and the products prescribed including their engagement in cross pathy. The audit trail in all chemists shops also must be done to know at what proportion the chemists' shops are dispensing drugs without prescriptions or prescriptions from vaidyas.

Dr S Ranganathan