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The medical profession faces increasing challenges


The constitution of ethics committees (ECs) to approve research protocols in human experiments, was first written into international guidelines during the first revision of the Declaration of Helsinki (Helsinki II, 1975). The requirement for ECs to oversee clinical research was first articulated in an ethics policy statement of the Indian Council of Medical Research (ICMR), published in 1980.

CEs also later became a requirement in the International Ethical Guidelines for Biomedical Research Involving Human Subjects, produced by the Council for International Organizations of Medical Sciences (CIOMS), a body established by the World Health Organization.

ECs are made up of people from different backgrounds, such as doctors, social workers, lawyers, chartered accountants, and business people, who bring a variety of experience and knowledge to the table. Their responsibilities include protecting the rights, safety and well-being of human subjects involved in clinical trials.

They also review and approve protocols relating to the adequacy of investigators, facilities, methods, and adequacy of information to be used to obtain and document informed consent from study subjects. In addition, they guarantee the adequacy of confidentiality safeguards.

I served for some time as EC member of CARE Hospital in Banjara Hills, Hyderabad. Other members came from a variety of backgrounds. The president was a retired Telangana High Court judge, with six doctors, two professors, one of political science and the other of pharmacology, and a businessman being the other members.

An interesting experience, for all members at this stage of our lives, was to ask to study material on the role of ethics in health systems and to be tested by a team sent from the Central Organization of drug standards and control, to make sure that we had, in fact, studied and understood the material!

One of the most basic ethical principles of human experimentation is that the experimenter must first ensure that the experimental participants to any procedure are consenting. Informed consent is the principle that volunteers in the experiment must fully understand the procedure that is going to take place, be aware of all the risks involved and only then give their consent.

Although the EC in India has started to discharge adequately, much remains to be done. What is needed now is a mechanism and protocol to oversee all CEs, to enable improved operation, including on-site monitoring, etc.

An interesting development in recent times has been the renewed interest shown by central and state governments in alternative systems of medicine, such as Ayurveda, Siddha, Homeopathy and Unani.

The Ayurvedic system, which includes surgical procedures, is mentioned in Sushruta Samhita and is one of the oldest and most important ancient treatises of medicine. Sushruta, the author of the Samhita, was the world’s first surgeon and is called the “father of surgery”.

From ancient times, tribal settlements, such as the Red Indians in America, were served by traditional and spiritual healers, known as “healers”. They were believed to have supernatural powers and possess the ability to cure disease and control minds.

Similarly, traditional African medicine covers a range of disciplines involving indigenous herbalism as well as spirituality. A very notable feature in Africa is the fact that healers do not accept payment until the treatment has been completed and proven effective. Traditional healers and indigenous herbal remedies play a crucial role in the treatment of millions of Africans.

Unani medicine is a traditional Perso-Arabic system of medicine, as practiced in Muslim culture, in modern South Asia and Central Asia. Although pseudo-scientific, it has a substantial following that swears by its effectiveness.

The Unani National Institute of Medicine located in Bangalore is an autonomous organization under the Ministry of Ayush (Ayurved, Unani Siddha and Homeopathy), Government of India, and engages in teaching, training and research in the Unani system. The Unani Central Medical and Research Council, another autonomous organization under the same Ministry, is carrying out an experimental program under the National Program for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS ) managed by the General Directorate of Health Services. , Government of India.

The Siddha system of healing is a traditional discipline originating in South India and is considered to be one of the oldest systems of medicine in the country. Many of the principles of this ancient system continue to be relevant to modern practitioners as well. Breathing exercises, such as pranayama, which have gained great popularity in recent decades, are also part of the system, which places great importance on the joint use of herbs, plants and minerals.

Another system of alternative medicine is homeopathy, originally devised by German physician Samuel Hahnemann in the 18th century. It is internationally recognized as an effective system with around 300 million people in 70 countries following it, particularly in Northern Europe, where life expectancy is one of the highest in the world.

We often find practicing professionals, real or pseudo, such as doctors, lawyers, astrologers, accountants, very different from each other. Another unfortunate feature is the way these professionals scramble to impress clients, starting their sessions with a client by completely debunking the advice offered by a former colleague.

This is probably why the concept of a “second opinion” came into existence. Ultimately, whether or not a drug, regardless of the system that described it, works, or whether the advice given by the professionals just referred to is helpful or not, depends on whether the we have in the person.

My colleague and bandmate, BS Lamba, whose service included a stint at the World Health Organization (WHO), does not believe in medical treatment at all! A great believer, indeed, in the saying that time is a great healer! Also jokingly saying, that recovery will take a week with meds, and seven days without!

The truly sincere physician, for whom the welfare of the patient is the most important consideration, is like the physician who once said to a patient, in response to an anxious inquiry to know if the prescribed drug would work, “I studied medicine. For the symptoms you have, the books I’ve read say that’s the right prescription. Now whether the medicine works or not, I can’t honestly tell you. Let’s pray to God and hope for it. better.

Many problems, as observed in last week’s part, are also created by patients. Have you, for example, heard of a guy who went to a doctor and complained that he thought he had hypochondria? ! It is to such patents that sane doctors give placebos that work surprisingly well when the disease is imaginary.

Considering the importance of health and medical care, especially in a country like India, and the astronomical figures one encounters in the context of doctors’ earnings in India and abroad, one wishes fervently that doctors’ associations at the district, state, national and international levels would join with the state and central governments and build hospitals where the equipment, treatment and qualifications of the doctors would be comparable to the best in the world, with services strictly limited to people below the poverty line.

Morality, according to Oscar Wilde, is the standard by which we judge others. So it’s easy to get a ringside seat, away from the long hours, tense moments and frustrations involved in being a doctor, and to freely criticize the medical profession.

On the other hand, it must also be admitted that there is more than a modicum of truth in what has been said, earlier in this article, about deviations from the straight path on the part of doctors. In the end, it all comes down to the adage “doctor heals himself!”.

There is this story of a doctor and a dentist, who had in common a very pretty receptionist. The dentist was going on vacation for 10 days. Having heard that “an apple a day keeps the doctor away”, he presents ten apples to the receptionist, so that she keeps the doctor away during this period!

(The author is the former Chief Secretary to the Government of Andhra Pradesh) (The opinions expressed in this column are those of the author. The facts and opinions expressed here do not reflect the views of The Hans India)