The National Medical Commission (NMC) is a body of 33 members, regulating medical education and medical professionals in India. It replaced the Medical Council of India (MCI) on 25th September 2020; ostensibly because of the lack of transparency and accountability in the functioning of the MCI as per the report of the 92nd Parliamentary Standing Committee on Health.
It was therefore disbanded as recommended, and replaced by the NMC. Section 6(6) of the NMC Act, states “the Chairperson and every member of the Commission shall make declaration of his assets and liabilities at the time of entering upon his office and at the time of demitting his office and also declare his professional and commercial engagement or involvement in such form and manner as may be prescribed, and such declaration shall be published on the website of the Commission”.
An RTI application by an activist revealed that till date, none of the members who hold or have held positions on the Commission have done so, thus demonstrating the same opacity and lack of accountability as its predecessor in spite of functioning for three years. Neither the Union Health Minister nor the Minister of State for health have been able to provide satisfactory explanations.
A gazetted notification of the “NMC Registered Medical Practitioner (Professional Conduct) Regulations, 2023”, was released on 2nd August 2023. Guidelines-1, Guidance to RMPs, directed that drugs be prescribed with “generic”/ “non-proprietary”/ “pharmacological” names only. A generic drug is defined as a “drug product that is comparable to brand/reference listed product in dosage, form, strength, route of administration, quality and performance characteristics, and intended use”. Such directions were stipulated in the MCI regulations as well; but the NMC Guidelines raised the bogey of disciplinary action including the prospect of being struck off the register. As a result of strong protests led by the IMA, the NMC issued a gazetted notification on the 23rd August 2023, that the “NMC Registered Medical Practitioner (Professional Conduct) Regulations,2023, are hereby held in abeyance with immediate effect.” And “shall not be operative and effective till further Gazette Notification on the subject by the NMC”. Till then the MCI regulations of 2002 shall remain operative. These developments have a complex history.
It was alleged that doctors, in connivance with pharma companies contrived to prescribe specific products sometimes quite unnecessarily, in exchange for kick-backs of various kinds. This resulted in excessive expenditure for the patient, bearing in mind that branded products are 30 to 80% more expensive than generic ones. However, there were counter arguments. There were no authenticated reports of how far such rot had permeated. Was it confined to a few black sheep or was it across the board? More significantly, could the cheaper generic items be relied on for comparative therapeutic efficacy. After all, less than 0.1% of all manufactured drugs are quality tested; otherwise, we would never have had the children’s cough mixture scandal. The onus of deciding which drug to dispense now rested with the pharmacist; ignoring the fact that only 17% of all pharmacies had a qualified pharmacist on duty to make that decision. And who would guarantee that the profit-margin driven “scam” factor would not now be operated by the chemist/pharmacist. Isn’t it the duty of the authorities to ensure that drugs marketed by whatever name have the sanctity of quality control? And curious too, that the branded drugs are after all manufactured with all the required permissions only to be barred from being prescribed by practitioners. This will be a death blow to the billion-dollar pharmaceutical industry in India. It is a bit like permitting an auto manufacturer permission to manufacture a car and then imposing restrictions on the sale of the vehicle. Why do the authorities allow such a wide variation in the pricing of a branded drug? I had recent personal experience of purchasing branded drug “A” of one company and on repeat prescription purchased the same drug of a another equally reputed company. There was a 300% difference in the pricing! Multidrug combination medicines commonly used in diabetes, and hypertension will present further difficulties. Should the FDA not deal with such matters first before imposing rules which border on the illogical? In the event of a line of treatment failing, how does one distinguish between an NSQ drug (Not of Standard Quality) and an error of diagnosis and/or line of treatment? Personally, in the light of the introductory paragraph, it appears to be a case of the pot calling the kettle black.
Another bone of contention was organising CME programs; now referred to as Continuing Professional Development (CPD). The Ethics and Medical Registration Board (EMRB) made it illegal for the organisers of such educational seminars to accept any assistance from pharmaceutical companies on the grounds that the company will push its own products. Such conferences often host internationally recognised speakers from foreign countries with airfare and accommodation included. Bearing in mind that attendance at such seminars is compulsory for renewal of registration, one bright suggestion made is that the NMC meet the expenses for such conferences from the hefty fees they collect from the doctors for registration.
Space constraints do not permit all issues to be discussed. However, the attempt to introduce a “national” registration number (UID) needs mention. The guidelines released on May 12, 2023 by the NMC state that the UID will be suffixed with the code of the state or the union territory that the doctor registers with. For example, a doctor in Goa would have a NMC registration number like “G123” somewhat like car registrations. Around Delhi and Mumbai in particular, there are doctors who shuttle between two, even three or more States. How will their numbers be issued?
We eagerly await the revised edition of the EMRB regulations of the NMC; hoping that the cure will not be worse than the disease.
(The writer is a founder member of VHAG)