22.09.2013 Qualified quacks!
Physicians educated in approved medical colleges, trained in recognised Unani Tibb institutions and homeopaths trained in homeopathic colleges are accepted as ‘regular practitioners’
By Syed Mansoor Hussain
The Punjab Healthcare Commission (PHC) recently announced that there were around two hundred thousand (200,000) quacks practicing medicine in the Punjab. By ‘quacks’ we mean ‘medical practitioners’ that have not gone through a proper educational and training process that qualifies them to provide medical care.
Physicians that graduate from ‘accredited’ medical college and receive post graduate medical training as house physicians and advanced training in medical specialties firmly believe that all forms of medical care ‘other’ than what they themselves provide is quackery. This in spite of the fact that officially, Homeopathy and Unani Tibb (Greek-Arab Medicine) are accepted as established alternate forms of medical treatment. So it would seem appropriate to try and define what exactly a medical quack is. A little bit of history is then worth looking at.
Modern medicine is indeed a modern reality. However, there are some systems of medicine that have been around for thousands of years. Of these, the best known is the Greek system of medicine that is often associated with Hippocrates (Buqrat) circa 400 BCE and Galen (Jalinoos) circa 200 CE and was refined and improved on by generations of Arab physicians during the previous millennia including the likes of Ibn Sina (Avicenna). Well into the sixteenth century, this was the primary medical system in Europe. However, this started to evolve in the seventeenth century or so into a more modern ‘scientific’ system while it continued relatively unchanged in the Indian subcontinent especially under the Muslim rule. Hakeem Ajmal Khan was perhaps its most famous practitioner in India during the twentieth century.
Besides the Hippocratic system, we also have Chinese medicine that includes herbal medicine, acupuncture and other modalities like massage therapy. All these three have survived into modern times with some change. Then we have the Ayurvedic system that originated in India in antiquity and survives even today. Most of these ‘ancient’ systems are relatively ‘benign’ in terms of treatment with the emphasis being on diet, exercise and ‘behaviour modification’. Herbs and other indigenous substances were also used for treatment and still are.
What we call the modern system of medicine started to develop during the seventeenth and eighteenth centuries as scientific discoveries helped to advance medical science. These included the discovery of ‘germs’ and then identification of germs as cause of disease. Also herbal medications were chemically broken down to identify the ‘active’ ingredients in them and these were then synthesised in the laboratory.
Most importantly there developed the idea to use a particular type of treatment and record its results; this was followed by the concept of medical trials that further refined treatment. This gave rise to what is now called ‘evidence based medicine’. General anaesthesia, discovery of blood groups and development of blood banking as well as the concept of sterilisation revolutionised surgery. Until the discovery of antibiotics and many modern medicines, even the so called modern medicine was still relatively primitive and its results were often not satisfactory.
During the nineteenth century as medicine was evolving, many other schools of treatment based often on what are now proven to be errant scientific ideas also developed. Of these, Chiropractic, Osteopathy and Homeopathy survive albeit with modifications. So, patients disappointed by regular medical treatment often resorted to these forms of therapy looking for relief. The important thing about these systems especially Homeopathy is that treatment is unlikely to produce any serious adverse effects. To sum it up, in Pakistan physicians educated in approved medical colleges, trained in recognised Unani Tibb institutions and homeopaths trained in homeopathic colleges are accepted as ‘regular practitioners’. All others that practice medicine then are by definition quacks.
But let us look a bit deeper into this situation. Should all those that provide some form of basic healthcare without belonging to one of the three categories mentioned above be called quacks? As it is even in a country like the US that has strict laws about who can practice medicine, we are seeing some liberalisation when it comes to primary healthcare. Nurses and pharmacists are being allowed to take care of some basic medical problems and midwives are allowed to oversee uncomplicated home deliveries. The understanding, of course, is that any problem above and beyond the capability of such ancillary medical personnel to manage will be referred to a qualified physician. This allows physicians to take care of those that really need their services.
Besides freeing up physician time, when ancillary personnel participate in primary and basic medical care, the cost of treatment is also considerably decreased. Things like a fever with flu, a sore throat, and an upset stomach can all be treated quite adequately by a nurse, a lady health visitor or a pharmacist. And that is often what does happen in many of our rural areas as well as in more than a few urban areas; people that have had some medical training provide basic medical care. As long as such ‘practitioners’ stay within the ambit of their abilities and appropriately triage patients to hospitals and qualified physicians as needed, their services should be allowed.
More importantly, since these practitioners are community based, therefore, they have a better idea of local problems and also have the need to provide ‘good’ results if they want to continue to offer their services in that particular area. In my opinion then, such practitioners should not be penalised but should rather be mobilised and provided educational resources so they can provide better care including immunisation and pre and post-natal care.
That then leaves two categories of people that should be called quacks. The first are those that have little or no medical training but pose as qualified physicians. The major problem with such practitioners is that they often misdiagnose patients, treat them with incorrect medicines and make things much worse. There are those among them that to make money often give unnecessary ‘injections’ with inappropriately sterilised needles and syringes. This can produce massive infections and worse transmit deadly diseases like Hepatitis C from one patient to another. In this category, we should also include ‘road side’ dentists that use unsterilized instruments and are also responsible for spreading Hepatitis C.
The second category that I consider quacks are also sometimes referred to within the medical profession as ‘hacks’ are ‘qualified’ physicians that out of greed give every patient an injection or worse an intravenous infusion (the bottle) whether the patients needs it or not. And they often reuse needles exposing their patients to the risks mentioned above. Such physicians frequently over treat patients even when the patient is not getting better and will only refer the patient onwards to a major hospital when the patient’s condition has deteriorated and is often beyond salvage. Little can be done about them since they possess a ‘genuine’ MBBS degree.
As long as there is a need for inexpensive and locally available healthcare, especially in areas where qualified physicians are not available, quacks will fulfil that need. And as things stand, there is little the PHC can do to control this problem.
The writer is former professor and Chairman Department of Cardiac Surgery, KEMU/Mayo Hospital, Lahore: smhmbbs70@yahoo.com