Un-Controlled Quackery all over the Country.

An Update By, Dr.Abdul.Ghafoor Shoro

PMA Anti Quackery Sub. Committee Karachi.

Quackery.• How Should It Be Defined?

• Quackery can be broadly defined as "anything involving over promotion in the field of health.“

• A quack is an untrained person who pretends to be a physician and who dispenses medical advice and they claim to be properly qualified doctors.

• The FDA defines health fraud as “The promotion, for profit, of a medical remedy known to be false or unproven”.

STATISTICS

According to PMDC REGISTERED doctors UP TO 27th September, 2012

TOTAL NUMBER OF DOCTORS / DENTAL SURGEONS (G.P's with basic degree only)

M.B.B.S. B.D.S. L.S.M.F. (Licentiate of State Medical Faculty)Province Male Female Total Male Female Total Male Female Total

Punjab/ 28456 24030 52486 1970 2632 4602 511 54 565

Federal Area

Sindh 28260 25208 53468 1473 2642 4115 284 22 306

K.P.K 10110 4712 14822 850 869 1719 52 2 54

Balochistan. 2351 1485 3836 172 118 290 44 11 55

A.J.K. 1394 954 2348 127 95 222 3 1 4

Foreign 2460 800 3260 317 107 424 98 8 106

Nationals

Total 73031 57189 130220 4909 6463 11372 992 98 1090 RMP RDP LSMF/LDS

TOTAL=130220+11372+1090= 142682• TOTAL LSMF =1090• TOTAL RMPs (Basic & Specialists) =(130220+27855) =158075• TOTAL RDPs (Basic & Specialists) =(11372+913) =12285• GRAND TOTAL= 158075 +12285 +1090 =171450• GRAND TOTAL= RMP +RDP +LSMF

Current Situation.

• According PMDC anti quackery committee:• 600000 Quacks in Pakistan .• 1/3rd in Sindh.• 70000 -80000 in Karachi.

• TOTAL NUMBER OF DOCTORS/DENTAL SURGEONS REGISTERED Up to 27th September, 2012 .

• Doctors = 158075 +12285 +1090 =171450• GRAND TOTAL= RMP +RDP +LSMF Total

(L.S.M.F stands for Licentiate of State Medical Faculty)

Complaints Against quacks

Types of quacks1.Dispensers.• These are the commonest and most dangerous type

of quacks in our country. • They may or may not have a technician's diploma.

They usually have served for a while with a doctor to assist him in his clinic usually for 3 tasks.

1. Giving injections and I/V fluids to patients.2. Giving medicines to the patients on doctor's prescriptions3. Carrying out minor dressings and stitching.

2.LHV’S /LHW’s .• There are so many Maternity homes and Clinics run by LHV’S and

LHW’s in rural areas and Peripheral areas of cities. • They claim as a qualified lady doctors. • Lady Health Visitors(LHV’s):• Job Description. They are responsible for preventive and curative care

with a focus on Family Planning (FP). • Assist the clients to make their decisions based on their family planning

needs after providing thorough counseling.• Lady Health Workers. (LHW’s) are working under the National Program

for Family Planning and Primary Health Care. It was launched in Pakistan in 1994.

• Education . Mostly 8th Class education -• Job Description. Visiting the homes of her community - registering

pregnant women for antenatal care, health education and basic preventive services for family planning, maternal and child health, improving nutrition, basic hygiene ,sanitation and immunization.

3.Street Doctors Or Hakeems.• This is another category of quacks in our community ,Street Doctors Or Hakeems.(Gali

Mohalay ka Doctor)• These are usually found in every house and if not then at least in every street. • They have never received any formal health

education but they seem to know every thing about every illness including Cancer, HIV ,AIDS, Hepatitis, and Diabetes etc.

4.Aamils and Jinnati babas.

• This is a totally unique category of practitioners in our culture. These derive their roots from the ancient evil arts of magic and related categories. Some of them put a veil of Islamic face on their malpractices.

• They usually exploit the psychiatric illnesses of the category usually encountered in young girls from lower or middle class of our society.

• These People also treat infertile couples with a promise of giving them off springs at certain high costs.

5.Sex Experts.

• Last but not the least this is another commonly encountered category of quacks. We can witness a very strong advertising campaign by these experts throughout our country by various methods.

• Unfortunately our print media is also used at times by these quacks to get their advertisements across to the public.

• Usually they resort to wall chalking, banners, sign boards, brochures and wall posts in addition to hired agents who are utilized to spread the success stories of their miraculous cures.

Why does quackery 'work' for some people?

• Quackery thrives on susceptibility. We are all susceptible at certain times in our lives. Anxiety and fear can be so strong that reason gives way to false hope or an unsuspecting person may simply be enticed by catchy advertising and convincing personal testimonials.

• The two main reasons why a quack product might seem to "work" are:

• A placebo effect — Placebos have no active ingredients. They may work on the power of suggestion. Scientists speculate that a person's confidence in a certain treatment may activate chemical impulses in the brain that diminish symptoms. It is estimated that 10% to 20% of persons are very responsive to placebo treatments.

• A self-limiting illness — Diseases vary in their duration and intensity. Arthritis, for instance, can be a life-long problem whose symptoms may improve for periods of time. If you happen to be using a quack treatment when pain subsides, it's natural to think that the "wonder cure" really helps. Colds are another example of a self limiting illness that gets better whether or not a person seeks treatment.

• So there are two arguments in favor of letting quacks run their businesses:

1. They earn their bread and butter through this profession.

2. It is all about freedom. Every one is entitled to adopt whatever profession he wants.

• Can we really afford to let them play havoc with the health and lives of our ignorant people?

• Is there any comparison between a doctor who enters the profession after a tough competition then learns his skill under close supervision of experts of field for many years and at immense expenses?

• And a quack who has highly dubious knowledge about therapeutics and does not possess any valid qualification?

The Hazards of their Practice.

• They are an important source of spread of needle borne diseases especially viral hepatitis and HIV.

• The frequently use latest antibiotics injudiciously and are responsible for development of resistance against such life saving medicines.

• They frequently endanger the lives of patients because of inappropriate use of medicines about whose pharmacological properties they know the least.

• Due to their vested interests and poor knowledge they frequently spread misinformation regarding health, disease and health systems.

Who is responsible?Quacks. Who deals with treatment practices in spite of the awareness of their ignorance of proper knowledge.

Government and its Institutions . Due to its apathy towards the social problems of our nation and its lack of will to set the health care system right.

General public. Due to its ignorance of modern medical knowledge and lack of effort to seek the right professionals.

Doctors and their organizations. Due to their passive role in the current jumble. It is their responsibility as well to shout it loud and clear to government and masses that there must be no place for quackery in our country.

Who is responsible? Pharmaceutical Companies. Pharma: co’s. Representatives visit the Quacks and offer different packages for prescription of their Medicine. Media. Print Media as well as Electronic media(not All) are promoting the quackery through different documentaries and ads. There are lots of ads for fake doctors and quacks and even programs about them. Pakistan's press and electronic media should stop illegal health related ads, which led the people towards quacks. National and International NGO’S. Due to their vested interest they recruit Quacks for their different Health related Projects to save money.

NEW LAW AGAINST QUACKERY

ISLAMABAD, MONDAY, AUGUST 13, 2012PART I Law amend mended

Acts, Ordinances, President's Orders and Regulations

NATIONAL ASSEMBLY SECRETARIATIslamabad, the 13th August, 20/2THE GAZETTE OF PAKISTAN"EXTRA. AUGUST 13, 2012

31. Amendment of section 28, Ordinance XXXII of 1962.-In the Said Ordinance, for section 28 the following shall be substituted, namely:-'

"28. Penalty for fraudulent representation or registration.- Whoever falsely pretends to be registered under this Ordinance as a medical Practitioner or dentist and uses with his name or title any words or letters representing that he is so registered with the Councilor uses the word "doctor" without legal basis, irrespective of whether any person is actually deceived by such pretence or representation or not, shall, On conviction before a Magistrate of the first class, be punishable with fine which may extend to one hundred thousand rupees or with imprisonment for a term which may extend to six months or with both.Any person found aiding and abetting him shall also be prosecuted and punished.".

32. Insertion of new sections 28A and 28B, Ordinance XXXII of 1962.- In the said Ordinance, after section 28, substituted as aforesaid, the following new sections shall be inserted, namely:-

"28A. Penalty of practicing without registration.- (I) No person, other than a registered medical or dental practitioner, shall practice medicine. or dentistry.(2) Any person who acts in contravention of the provisions of sub-section(I) shall be punishable with imprisonment for a term which may extend to two years but shall not be less than six months or with fine which may extend to two hundred thousand rupees but shall not be less than one hundred thousand rupees or with both.

28B. Cognizance of offences.-(I) No court shall take cognizance of any offence or matter under this Ordinance except upon complaint in, writing made by the authorized officer of the Council.(2) Notwithstanding anything contained in the Code of Criminal Procedure, 1898 (Act of 1898), it shall be lawful for any Magistrate of the first

class to pass any sentence authorized by this Ordinance even if such sentence exceeds his powers under Section 32 of the said Code.".

Law amendment 2012

PMDC registers bogus doctors.

After getting the bogus registration certificates, now these half-baked doctors are doing government service and running their own clinics. Some of them are said to have left Pakistan to get jobs abroad in the light of these bogus registration

certificates issued to them with the help of PMDC.

These candidates after failing to pass the PMDC test are said to have paid millions of rupees to the top guns of PMDC .

  Pakistan ambassador to Bishkek Tanveer A Khaskheli had written to the then president of PMDC Prof Dr Hasnain that Kyrgyz State Medical college Academy and Osh university had informed him that documents submitted by the Pakistanis students to get PMDC registration were bogus and fake.

Role of PM&DC.

A report By Rauf Klasra. Published in Pak Tribune on 06-04-2010

The Senate Standing Committee on Health was informed on Wednesday that the Pakistan Medical and Dental Council (PMDC) registered more than 40 doctors last

year without any formal testing.

• “The council registered these doctors without fulfilling the basic criteria of clearing a registration examination,” Senator Zahid Khan.

• Majority of the 48 medical practitioners whose degrees have been declared fake are serving in government-run health facilities and the council has recommended strict action against them, said an official of PMDC.

• The chairperson also constituted a sub-committee to look into the matters of PMDC and suggest recommendations to streamline the council.

Published in The Express Tribune, April 14th, 2011.

Pakistan: Fake doctors have PMDC registration certificates

• President PMDC Dr Asim .Hussain confirmed that he knew that at least 30 such students were given fake registration certificates by PMDC.

• FIA unearthed the following doctors whose files were missing from the official record.

• The names of the doctors are Dr Shafif Ahmed, Dr Jehangir Khan, Dr Said Wali, Dr Syed Salauddin, Dr Syed Naseemudin, Dr Ikram ullah,

Dr Sakhi Jan, Dr Rehmanullah, Dr Abrar ullah and Dr Malik Asad.The News dated 04/06/2010

What is Needed ? Quackery is a society-wide public health problem it should be clearly defined .

Laws should be implemented against unauthorized health care.

Through our actions, we need to convey that the exploitation of sufferers should not be tolerated by our society.

To cope with it adequately, a more scientific approach is required.

As with any other public health problem, an epidemiologic strategy is needed to develop information on causal agents (which people become quacks and why) and environmental aspects that favor or discourage the proliferation of quackery.

Vital statistics are needed on the morbidity, mortality, incidence and prevalence of quackery. Presently, we have only isolated case reports. These are enough to indicate that great harm is being done, but don't tell us how many people are being harmed.

There is need of a system be developed for reporting quackery cases, this would enable us to keep track of what is being promoted, where the "hot spots" are, and what legal and educational efforts are needed for an effective response.

Cont: What is Needed ?

Health professionals have a duty to take action when the public is being abused in an area in which they have special knowledge. The failure to take concerted action against quackery sends an unprofessional message. Quackery and unauthorized health care giving should be penalized under law.

A doubting attitude like “this may work” at official level must now be stopped forthwith.

Only scientifically proven methods must be allowed to practice.

We should not condone the "victim-blaming" ideology which says that if people are too dumb to spot quackery on their own, they are probably too dumb to be worth saving.

Nor should we condone the attitude of law enforcement officials who feel that quackery is "merely" a form of white collar crime" that takes money from its victims.

Thank You For your

Patience