A few days back the National Medical Commission (NMC) issued its new regulations, and one of the main regulatory points is that Medical conferences in star hotels with cocktail dinners and cultural programs might become a thing of the past. This new regulation bars doctors’ involvement in any seminar, workshop, or conference which involves direct or indirect sponsorships of pharma companies. Actually, NMC is the apex regulatory body for medical education and practice in India.
What are the NMC’s new guidelines?
1 Social Media Usage Guidelines
- Doctors can provide information online, ensuring it is verifiable and not misleading.
- Prohibition on discussing patient treatment specifics or sharing patient scans.
- Restriction on sharing patient testimonials, images, and videos.
- Prohibition on soliciting patients directly or indirectly through social media.
2 Right to refuse treatment
- Doctors may refuse treatment to abusive, unruly, or violent patients or their relatives.
- Doctors may deny treatment if the patient can not afford it but not in medical emergencies.
- Prohibition on discrimination based on gender, race, religion caste, and socio-economic factors.
3 Prescription and Medication guidelines
- Prescription to be written in legible, capital letters.
- Generic medicines should be prescribed, except for specific cases.
- Judicious use of fixed-dose combinations, prescribing approved combinations only.
- Encouraging education about the equivalence of generics and branded medicines.
4 Continuous Professional Development (CPD)
- Mandatory for doctors to continue learning throughout their active careers.
- Doctors should undertake 30 credit points in their relevant field every five years.
- Annual CPD sessions are recommended, with max 50% online training.
- Recognised degrees and courses added to the national medical register
5 Conference Participation Guidelines
- CPD sessions or conferences can not be sponsored by Pharma Cos.
- Doctors should not participate in third-party educational activities with Pharma sponsorships.
- Doctors or their family members should not receive gifts, hospitality, cash, or grants from Pharma Cos.
- Prohibition on accepting commissions from diagnostic centres, medical equipment suppliers, etc., for referrals or endorsements.
These guidelines have sparked a protest from the Indian Medical Association (IMA), the largest body of doctors in the country, which has called the guidelines “unscientific and impractical”
Now what are the IMA’s issues with these guidelines
1 Generic Medicine Prescription
- The doctors are raising concerns about the quality and efficacy of generic drugs available in the country. They claim that there is a lack of standardization and regulation of generic drugs and that many of them are substandard, spurious, or counterfeit.
- According to IMA, less than 0.1% of the drugs manufactured in India are tested for quality. This way ensuring the quality of drugs and safety could be compromised.
- The new guidelines do not allow doctors to write a specific brand, which means that you will get whichever medicine with relevant active ingredients is in pharmacist stock. This way doctor’s choice in prescribing the most suitable drug for the patient may be restricted, potentially affecting treatment efficacy.
- They demand that the government should ensure strict quality control and testing of generic drugs before making them mandatory for prescription.
2 Other Issues
- Imposing an additional burden on doctors to accumulate credit points through CPD sessions.
- Limited availability of recognized continuous training courses for doctors to meet CPD requirements.
- Reduced educational sessions due to the prohibition of Pharma industry sponsorships. This will impact doctors’ exposure to medical advancements and research.
- Legal and ethical concerns arise from doctors refusing treatment based on a patient’s ability to pay.
Some of the concerns shown by doctors and IMA look genuine. There should be a way forward to implement such guidelines, and unless the following steps are not taken by Government/NMC/ IMA these types of guidelines will not be practical:
- Enhance the quality and safety of generic drugs by setting up testing labs, conducting regular inspections, imposing strict penalties, and creating a database for drug quality.
- Educate doctors and patients about the pros and cons of generic drugs, using scientific evidence, dispelling myths, etc.
- Encourage medical institutions and professional bodies to organize CPD sessions that cover a wide range of medical advancements.
- Facilitate open discussions and consultations between NMC, medical practitioners, Pharma industry representatives, and patient advocacy groups.
- Create platforms for regular feedback and suggestions to refine and adapt the guidelines to address emerging challenges and ensure ethical patient care.
- There should be certain separate guidelines for the Pharma companies for sponsoring/conducting certain types of training programs by which doctors’ knowledge can be enhanced and updated.
Waiting for your views on this blog.
Anil Malik
Mumbai, India
21st August 2023