Vansh Singh and Niyati Trivedi
Introduction
In his keynote speech at the first session of the National Academy of Medical Sciences, the Chief Justice of India (CJI) emphasised the important connection between ‘Law and Medicine,’ particularly highlighting the widespread problem of quackery as a significant issue impacting the country. The Chief Justice of India (CJI) raised concern about the dominance of a profit-oriented culture in hospitals, which is overshadowing their dedication to serving society. They emphasised the connection between the scarcity of healthcare services and the increasing prevalence of quackery. They underlined that quackery flourishes in settings where there is a lack of information and the persistence of misunderstandings.
The term “quack” is used to describe individuals who make false claims about their medical knowledge, which might endanger the well-being of unwary patients. In the 1996 case of Poonam Verma v. Ashwin Patel, the Supreme Court provided a legal definition of a “quack” as an individual who practices modern medicine without the required qualifications or training.
Quackery, which refers to the utilisation of deceitful or ill-informed medical methods, poses a significant barrier to the advancement and preservation of public health. An example that demonstrates this is the case of “Collodaurum,” which is a colloidal solution of gold that was marketed as a cancer therapy by the Kehlenberg Laboratory in Sarasota, Florida. In 1963, the American Medical Association (AMA) Council of Pharmacy and Chemistry definitively stated that Collodaurum has no therapeutic benefits for the treatment of cancer. As a result, the United States Food and Drug Administration (FDA) took legal action against Collodaurum and won by default in 1965.
The prevalent problem of quackery has escalated to a concerning level, evidenced by recent occurrences, such as the apprehension of three Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) doctors for practicing quackery. India is home to a wide range of alternative therapeutic methods, including various forms of pseudoscience such as colour therapy, aromatherapy, electro homoeopathy, acupuncture, Reiki, and witch-culture, among others. The influx of unqualified individuals into the profession has raised concerns among qualified practitioners. The subject was a central topic of discussion at the 21st National Conference on Dermatology, hosted by the Association of Cutaneous Surgeons of India in Nagpur. The symposium, which took place on 6th October, 2023, focused on the subject of “Quackery in Dermatology: Unravelling the Crisis,” highlighting the increasing worry and necessity to tackle this problem within the medical community.
Case Law Developments
Bhanwar Kanwar v. R.K.Gupta case concerns many matters including medical malpractice, fraud, unauthorised medical interventions or misleading tactics, and the administration of allopathic medicine by a practitioner who is only qualified in Ayurvedic medicine. The present circumstances encompass various controversial areas of unlawfulness, such as unjust commercial practices, negligence, and deceptive advertising, resulting in the imposition of punitive or exemplary damages.
The Defendant, who has a little knowledge of Ayurvedic medicine, advertised their services through several advertisements, claiming to offer a reliable treatment for epilepsy. The plaintiff, who entrusted the care of her four-year-old kid to the defendant, endured this therapeutic regimen for a period exceeding two years. Unfortunately, the child’s health worsened, characterised by an increase in epileptic seizures instead of the expected improvement. Throughout the extended period, the respondent continually provided reassurance to the appellant regarding the favourable progress of the treatment.
After seeking advice from a specialist in allopathic neurology, it was conclusively established that the child’s chances of attaining typical development were quite poor. Further inquiries uncovered that the person in question dispensed allopathic pharmaceuticals while deceitfully portraying them as Ayurvedic treatments. The child and the mother suffered both physical and psychological distress as a result of this misinformation.
Considering the situation, the initial compensation of Rs 5 lakhs was increased to Rs 15 lakhs. The aforementioned ruling emphasises the grave repercussions resulting from the respondent’s deceitful behaviour, inflicting substantial damage on both the kid and the mother.
In the Kerala Ayurveda Paramparya Vaidya Forum v. State of Kerala case, the court upheld the government’s unwavering dedication to addressing the issue of fraudulent medical practices. The court acknowledged the potential harm to society caused by unprepared and poorly trained practitioners who lack proper accreditation. Legislative measures were implemented to support this position, such as the enactment of the Travancore-Cochin Medical Practitioners Act, 1953, and the Indian Medicine Central Council Act, 1970. The aforementioned statute specifies that practitioners who are registered under the Indian Medicine Central Council Act, 1970, are considered to be registered under this Act. Nevertheless, the present situation where a number of people are engaged in the practice of traditional medical systems such as Sidha/Unani/Ayurveda does not comply with this requirement, as the appellants have not provided sufficient evidence to prove that they possess the necessary and legally recognised qualifications for registration in the Indian system of medicine.
In the case of Electro Homoeopathic Practitioners Association of India v. A.P. Verma, the appellants requested to be included in the proceedings and to have their members authorised to register as Electro-Homoeopathy doctors. In addition, they supported the licence to provide courses in Electro Homoeopathy and objected to disciplinary actions taken against their members.
The Delhi High Court noted that the petitioners did not possess the required qualifications or registrations as stipulated by the Indian Medical Council Act, 1956, Indian Medicine Central Council Act, 1970, and Homoeopathy Central Council Act, 1973. As a result, the High Court ordered the Central Government to thoroughly review the laws that outline the process for licensing Electro-Homoeopathy practitioners and practitioners of other medical systems. Additionally, the court instructed the government to establish a regulatory structure to supervise these practitioners.
The court, recognising its limited knowledge in the field of medicine, abstained from explicitly endorsing Electro Homoeopathy as a valid medical practice. The credibility of this viewpoint hinges on the recognition of Electro Homoeopathy by reputable regulatory bodies consisting of medical experts. The court highlighted the widespread existence of many medical systems in the country, and stated that recognition would only be granted if these systems were officially approved as genuine by state medical authority with knowledge.
In the case of D.K. Joshi v. State of UP, a Public Interest Litigation (PIL) was commenced, and the Supreme Court rendered a verdict aimed at overseeing those involved in healthcare activities without the necessary qualifications. The Health and Family Welfare Department of the State of UP and the Secretary to implement targeted actions to put an end to the practice of medicine by those who are not qualified or registered. The recommended procedures consisted of:
(i) Directing all District Magistrates and Chief Medical Officers of the State to swiftly identify unqualified or unregistered medical practitioners within a certain timeframe and begin legal proceedings against them.
(ii) Instructing all District Magistrates and Chief Medical Officers to supervise any legal actions taken against these persons.
(iii) Mandating the Secretary of the Health and Family Welfare Department to disclose the identities of these medical practitioners in order to discourage individuals from getting medical care from them.
(iv) The Secretary of the Health and Family Welfare Department was assigned the responsibility of overseeing the actions of the Magistrates and Chief Medical Officers. They were also responsible for issuing instructions to prevent unauthorised individuals from practicing medicine in the State.
Furthermore, in the instances of Dr. Mukhtiar Chand v. State of Punjab, Medical Council of India v. State of Rajasthan, and Subhashis Bakshi v. West Bengal Medical Council, the Supreme Court upheld the privilege of practicing medicine solely for individuals who possess the necessary qualifications and are duly registered on either the Indian Medical Register or a State Medical Register. In the case of Dr Mehboob Alan v. State of U.P, the Supreme Court established that an individual who is qualified and registered in a certain field of medicine is not permitted to practise in any other field.
Critically Analysing Quackery: Indian Context
The high occurrence of deceptive activities, often known as quackery and camouflaged as pseudoscience, presents substantial obstacles to health policy. The external appeal, marked by assurances of extraordinary remedies and innovative treatments, exploits susceptible and desperate persons, fostering unjustified hope and yielding financial gains. Executed by dishonest individuals, this immoral behaviour skilfully manoeuvres around gaps in regulatory scrutiny and takes advantage of loopholes in healthcare legislation.
Quackery takes advantage of the lack of knowledge amongst healthcare practitioners and patients by spreading misinformation and fraudulent claims. It uses scientific language to create a false sense of respectability. This intentional deceit maintains a misleading belief in effectiveness while subverting evidence-based medical procedures. The adaptable character of quackery is a challenge for regulatory systems aimed at protecting public health, since it enables quackery to take advantage of unclear legal boundaries and evade existing prohibitions. The widespread accessibility of the internet intensifies this problem, allowing unqualified individuals to take advantage of jurisdictional loopholes to promote deceptive products and services.
The economic consequences of quackery are significant, as fraudulent methods not only fail to deliver effective therapy but also waste financial and emotional resources. Fraudulent medical practices can lead patients to delay getting genuine medical treatment, putting their well-being and recovery at risk. This scenario imposes excessive strain on healthcare systems and violates the goals of health legislation regarding patient autonomy and well-informed decision-making.
According to Section 11 of the Indian Medical Council Act, 1956, it is clearly stated that a legitimate medical qualification must be acquired from a university or medical school in India that is included in the First Schedule. Qualifications that are not listed in the First Schedule do not have official recognition according to the Indian Medical Council Act. This means that individuals who are linked with unrecognised medical systems may be involved in illegal actions.
The Indian Medical Central Council Act of 1970 demands the recognition of medical qualifications from institutions mentioned in the Second Schedule, with a specific concentration on Indian medicine including Ayurveda, Siddha, and Unani systems. According to Section 17(2), it is required for practitioners in Indian medicine to have legally recognised qualifications and be registered in the State or Central Register of Indian Medicine. Section 17(4) specifies the consequences for any infractions of this requirement. The Provision states that Individuals who breach the provisions outlined in sub-section (2) may be subject to a maximum imprisonment of one year, a fine of up to one thousand rupees, or both penalties.
Healthcare workers, regardless of their association with modern or past medicine, must comply with the criteria specified in laws or similar rules. In order to engage in medical practice, it is necessary for them to uphold registration as mandated by the legislation.
Similarly, the Homoeopathy Central Council Act of 1973 limits the practice of homoeopathy to those who have legally recognised medical qualifications and are duly registered in the State or Central Register of Homoeopathy. Section 15(4) stipulates the penalties for contraventions of Section 15(2).
Section 15(3) of the Indian Medical Council Act, 1956, stipulates that infractions would result in either a one-year imprisonment or a fine of Rs 1,000. Bail is permissible for anyone sentenced to one year in jail. Nevertheless, this tax may be ineffective in deterring behaviour due to the influence of inflation.
Quackery is also dealt with in the Indian Penal Code (IPC) alongside the Medical Council Act. The IPC specifically handles this issue under Sections 120B (criminal conspiracy), 304 (culpable homicide not amounting to murder), 420 (deception), and 419 (impersonation). An illustrative example pertains to the Delhi High Court convicting an unlicensed physician under Section 304 of the Indian Penal Code for the fatality of a 9-month-old infant due to the administration of wrong medications.
Compensation is an often used solution to settle the complaints of individuals who have been harmed by fraudulent practices. In the legal matter of M.D. Suleman Ansari (D.M.S.) v. Shankar Bhandari, the person being sued experienced a hand fracture as a result of the activities of the person bringing the lawsuit, who did not possess the necessary qualifications to practise medicine. The appellant’s improper administration of medical care, which involved bandaging the hand and administering specific medications, resulted in damage. The Supreme Court, recognising the defendant’s failure to exercise proper care, ordered the appellant to provide a monetary compensation of 80,000 rupees to the respondent as restitution for the injuries caused.
In the case of Surendra Chauhan v. State of MP, the appellant engaged in the practice of electro homoeopathy, asserting association with the Board of Electro Homoeopathy Systems of Medicine, Jabalpur, and made an effort to terminate a pregnancy that had reached a duration of three months. Due to the appellant’s absence of a recognised medical qualification as stipulated in the Indian Medical Council Act, 1956, the woman’s untimely demise occurred as a consequence of shock waves and absence of anaesthesia. The appellant was convicted by the Supreme Court to one and a half years of hard imprisonment under section 314 of the Indian Penal Code (IPC) and was also fined 25,000 rupees, which is to be paid to the mother of the victim. The Supreme Court acknowledged the seriousness of the offence. This legal case highlights the importance of holding individuals accountable and providing compensation to address the negative outcomes of fraudulent practices.
During a media briefing on the National Medical Commission Bill in 2019, Union Health Minister Harsh Vardhan promised stricter penalties for fraudulent medical practices, including a one-year imprisonment and a fine of up to ₹5 lakhs. Under Section 34 of the 2019 National Medical Commission Act, unlicensed doctors can be sentenced to one year of imprisonment, a fine of Rs. 5 lakh, or both. However, the absence of a clear prohibition of fraudulent medical practices in the statute could result in a misreading of its intended message.
Conclusion
To effectively address this issue, a comprehensive strategy that incorporates all aspects is necessary. Improving health regulation is crucial to successfully tackle the intricacies of contemporary fraudulent medical practices. Legislation should have the quality of being agile, allowing it to quickly and effectively respond and prevent the increasing prevalence of deceptive practices. Creating a unified framework that can effectively detect, track, and punish those involved in fraudulent medical activities requires cooperation between regulatory bodies, healthcare professionals, and legal specialists. Moreover, enhancing public health literacy can equip individuals to discern between authentic and deceptive information, so safeguarding them against fraudulent medical practices.
To summarise, the intricate connection between deceptive medical practices and laws regarding public health remains a puzzling obstacle. The widespread spread of false scientific claims, effectively taking advantage of legal gaps, requires a coordinated effort to strengthen legislation, enforce it strictly, and raise public awareness. One significant step towards curbing quackery would be implementing the guidelines as set down in the DK Joshi case on a state level as discussed above. Only by collectively pursuing the efforts described above we can eliminate fraudulent medical practices and ensure the unhindered prominence of genuine medical knowledge. Consequently, our action helps safeguard the credibility of public health and maintain the undeniable rights of those seeking medical care.
The authors are third-year students at Symbiosis Law School, Pune.
NUALS Law Journal 