Medical Council of India on deathbed

The parliamentary Standing Committee on Health has delved deep into the working of the Medical Council of India (MCI) and has discovered some alarming facts. That a lot was wrong with the MCI was known to all ever since its president, Ketan Desai, was arrested on graft charges in 2010. Its ineffectualness was also there for all to see. Despite its stern warnings, the practice of doctors taking “bribes” from pharmaceutical companies has not stopped. But what the committee has found does not augur well for the medical profession as well as for the health of the general public in India.

The committee found that despite the mushrooming private medical colleges, the number of doctors in India is nowhere near the WHO recommended the doctor-population ratio of 1:1000. If we go deeper, we will find that the ratio is even more skewed in rural areas. High concentration of doctors in urban and semi-urban areas means that our rural population, largely comprising of the poorest of the poor and other marginalised people, remain without even the most basic medical attention. The committee also found that not only the number but the quality of doctors also leaves a lot to be desired. The MCI was found to have issued licenses to colleges that did not have the required physical and teaching infrastructure. The committee was of the opinion that the quality of medical education was “at its lowest ebb,” with the system now in force not producing the “right type of medical professionals.”

Another alarming fact was that there was a huge imbalance in the number of medical seats in states according to their population. 58 percent of MBBS seats are now with just 6 states with only 31 percent of the population. Meanwhile, 8 states with 46 percent of the population have just 21 percent of the seats. Widespread corruption – the current president of MCI, Dr. Jayshree Mehta, herself admitted as much before the committee – has meant that the MCI has played favorites. Instead of working to improve standards, it overlooks irregularity by imposing penalties. Colleges are known to hire ghost faculty and patients during inspections and this can only happen because there is no system of continuous feedback. In fact, there is no system at all. The MCI is just running a license-permit show, with an eye to maximising the earnings of those who are mandated to enforce standards.

The parliamentary committee was of the view that unless a complete overhaul of the body was undertaken, the medical system in the country will collapse. It also said that action to be taken is “so urgent that it cannot be deferred any longer.” As in all things that need a total makeover, the committee has suggested that the government should start from the beginning. This means that the Medical Council of India Act, 1956 should be replaced with a new Act that incorporates best practices from around the world. The Act has been tinkered with in many amendments over the years but it is no longer time for piecemeal reforms. A new Act with proper accountability and safeguards against corruption is urgently required.

The MCI has two main functions. It grants licenses to set up medical colleges and also has the power to increase or decrease the number of seats in each college. The MCI is also mandated to maintain ethical and professional standards of medical practice in the country. While the failure of MCI in carrying out the first task is clear in the paucity of doctors, lopsided state-wise colleges and the arrest of its former president, it has completely failed in the second task too. Suffice to say, it has failed to rein in errant doctors who have been found to promote drugs of particular companies by taking “bribes” in cash and kind. These errant doctors also prescribe unnecessary antibiotics.

Acting on a complaint, the MCI had summoned 300 doctors from across the country in 2014 to answer charges of having been “bribed” by a pharmaceutical company. Less than half appeared although the charge was very serious. It was found that an Ahmedabad-based company had bribed the doctors by offering them cash rewards, cars, flats, and foreign trips for prescribing its brand of drug formulations. This was apparent from the fact that the sales of the company zoomed from zero to Rs 500 crore in just five years. Moreover, such practices went on despite the fact that the same drug formulations were available in the market at cheaper rates from well-known companies as Cipla, Ranbaxy, Sun, Aristo, Alkem, Zydus, and Cadila. It is very difficult to prove that the doctors accepted “bribes” as no doctor is stupid enough to put the cash in his bank. Hence, it is better for doctors to prescribe drugs by their generic names and let the patient buy the cheapest, or the most popular, as per his choice. This is the practice in most countries where drugs are not prescribed by brand names. But the pharma lobby in India has prevented this from happening. The MCI, on the other hand, just raps the knuckles of errant doctors without ever actually suspending their licenses. Suffice to say, the offense continues with gay abundance.

Anyone aware of the medical profession will know that doctors almost always used to insist that you get your medical investigations done from the centers they suggest. Although with advances in technology the practice is now working in reverse. With most labs having computers, doctors get their “cut” on the strength of their prescriptions regardless of whether they have suggested that center or not. Doctors attached to private hospitals, where their promotions and raises depend on how much revenue they generate for the company, are known to prescribe unnecessary tests. Medical representatives visit pharmacies. Their first question to the owner is whether so-and-so doctor is prescribing their companies’ drugs. Representatives of new companies tell pharmacies to stock their drugs as they have told so-and-so doctor to prescribe them.

It is a sad reflection on the state of affairs in the medical profession that the only knowledge general doctors (as opposed to specialists) acquire after passing their MBBS is through medical representatives and that too on how to maximise their incomes by juggling drugs by brand. There are no periodic examinations to see if doctors keep themselves abreast of advances in medical science or pharmacology. The various seminars organised for the purpose of knowledge advancement are often sponsored by big pharmaceutical companies and are more like paid holidays. In any case, how many general doctors actually go to such seminars? How then are they expected to treat patients in the best possible way? A cursory examination of prescriptions of many general medical practitioners in the country will show that they prescribe unnecessary medicines and often in wrong doses. Sometimes, they do not even prescribe the full course. The MCI has no system to monitor all this and has left the patients at the mercy of these hacks.

Further, the MCI at present is composed entirely of doctors. That makes it a one dimensional body. Since its job involves many functions, its membership should be broad based. It should at least have experts in hospital management and human resources, representatives of NGO’s working in the health sector and medical colleges, among others. 

The parliamentary committee has recommended as much. The committee has also recommended that the two main functions of MCI be separated from each other in two bodies created under a new act. This is a sensible recommendation that needs to be looked into, for the two functions require two different sets of enforcers. There should be a debate on the recommendations of the committee and the government should work on having a new act.

It will be disastrous if the present report also goes the way of a report on the drug regulator that was submitted by the same committee four years ago. The committee had then recommended total overhaul of the drug regulation system in the country. Nothing came out of it. Now with this report, the time has come for the government to act on both of them. As the recent order banning 350 FDC drugs showed, despite the presence of the drug regulator, unapproved drugs of little or no therapeutic value continue to be sold in India. 

From the education of those who will treat us to the way they will treat us, and from what drugs they will prescribe to how those drugs will be manufactured and distributed, everything has to be monitored in a new and better way. Otherwise, the health delivery system in India will face total collapse.