The Indian Medical Association (IMA) has been much in the news recently. Weeks ago, the association called for a national day of protest on June 14 to protest the incident of assault on a doctor in West Bengal. This rather prompt and aggressive reaction to incidents in Bengal raised questions on the IMA stances on issues related to assaults on doctors in other states rather than Bengal, and also on it’s questionable silence when some amongst it’s own have been persecuted.
Flashback to these series of attacks on doctors by elected representatives of the ruling regime where the association maintained a stoic silence. This Calendar os assaults tells its own story. Switch to the brute abuse of Dr Payal Tadvi in a Mumbai hospital leading to her tragically taking her own life. Again not a whimper of protest from the IMA.
The IMA, established in 1928 calls itself “the only representative voluntary organization of Doctors of Modern Scientific System of Medicine, which looks after the interest of doctors as well as the well being of the community at large.” It has branches in 23 different state and 9 union territories and has over 78,000 doctors as its members.
Health in India has remained an issue which is marred by disinterest, a lack of political will and ill-thought policies. Apart from scientific determinants, the health indicators in India are also impacted by social and political factors.
Caste bias
In the aftermath of the suicide of the 26 year old gynaecologist Dr. Payal Tadvi, who belonged to the Bhil-Adivasi community, the IMA asserted that there was no caste based discrimination in the field.
In their letter, signed by IMA President, Dr. Santanu Sen and General Secretary, Dr. R. V. Ashokan commented on the prevalance of general casteism saying, “As a fraternity the medical profession is miles ahead in overcoming the barriers of caste, religion and politics. There is no discrimination on any ground within the fraternity or with the patients. However individual bias and behaviour can be at variance to this unwritten code of conduct. IMA does not condone any discriminatory behaviour.”
IMA did not recognise the caste based discrimination that many professions in India suffer from. A profession like medicine and health, which is meant to heal, ends up ending the lives and livelihoods of many health professionals because their caste is not acceptable to the dominant castes. Infact IMA consistently termed the issue of suicide of Dr. Payal Tadvi to be arising from workload.
In their letter to doctors, the IMA repeats this multiple times. They say that doctors “especially in government hospitals”, have an “inhuman work load and suffer burn out and depression”. They also say that doctors in government hospitals particularly, have “poor working conditions” and an “abnormal overload of work” and face an “ever present ridicule for deficiency of clinical sills.”
The medical profession in general has been accused of a bias against the policy of reservation. Doctors and medical professionals on occasions more than one, have said that if reservations are allowed in the education, it will compromise with quality.
In 2006, when the HRD Minister Arjun Singh announced a policy to introduce reservations for Other Backward Castes (OBCs) for 27% seats in central universities which included the Indian Institute of Technology (IIT), Indian Institute of Management (IIM), AIIMS, Delhi University and others, a platform called Youth for Equality with the stated objective of “determination to do something against the reservation policy” came into prominence. The IMA units in Delhi and Mumbai gave call for strikes during this time. This had exposed the inherent casteist bias of the IMA as an institution.
The Pepsi controversy
In 2015, for the first time in the history of medical associations, the IMA, a medical association agreed to endorse PepsiCos Tropicana fruit juices and its breakfast cereal Quaker Oats. It went ahead and called it a “partnership for healths. The then Secretary general SN Misra had said that although the company hadn’t paid money for the endorsement, PepsiCo may sponsor the associations conferences and meetings for three years, the agreement period. Media reports said the company paid the association Rs 50,00,000 for the deal.
The Medical Council of India suspended the licenses of the then president, Ketan Desai and secretary of the Association. The IMA took an adversarial stand here and got Delhi High court to stay the order making a mockery of code of ethics.
An editorial published in a medical journal, Indian Journal of Medical Ethics said, “it is an open secret that financial transgressions are common in medical practice. The classic case is the receipt of kickbacks for referring patients for investigations like magnetic resonance imaging scans”
Congratulating government on charging students with sedition
In February 2016, IMA wrote a letter to the then Home Minister of India congratulating him for the action they had taken against JNU students and warning medical students not to participate in such protests. The JNU students were charged with sedition then. Not only did their letter congratulate, but also they urged the government to take “strict actions against any persons or organizations or group carrying out any anti national protests, speeches, debates or writings in the country”.
The letter was signed by then national president of the association, SS Agarwal and its honorary general secretary KK Aggarwal. Agarwal was then the co-convenor of the ruling Bharatiya Janata Party (BJP)’s training cell and till 2013 was the national convener of the party’s medical cell.
A practicing surgeon, who wrote to the IMA asking about their stand, notes, “Whilst you showed instant concern over the events in JNU, the IMA has been silent over several issues related to public health problems in the country. Whereas you include the demand for a fair conduction of the NEET exam, the association has never openly attacked the very idea of private capitation medical colleges and deemed universities controlled by powerful politicians that have played havoc with India’s medical education system. In my view, your letter to the Home Minister was nothing but an attempt to curry favour with the new power centre”
Also now, the Govt.’s attempts to replace MCI with NMC
The Medical Council of India is a representative body of the medical profession in India. Roughly 2/3rd of its members are elected through various electoral processes. Any registered medical practitioner in the country can contest the elections and every qualified doctor can vote. The government now proposes to bring another body, which will be an all nominated body.
In June 2019, the IMA filed a petition in the Supreme Court alleging that the purpose of Indian Medical Council (Amendment) Ordinance 2018 was to give permission to “incompetent” medical colleges so that that they could give financial and other support for Lok Sabha elections.
The National Medical Commission is proposed to have non-elected members nominated by the government.
While protesting the new bill the doctors had said “Anywhere in the world, medical profession is bestowed with reasonable autonomy. Patient care and safety are the main benefits of such autonomy. Regulators need to have autonomy and be independent of administrators. The proposed NMC will be a regulator appointed by administrators under their direct control.”
The members had then alleged that the constitution of NMC takes away the voting right of every doctors in India to elect their medical council.
As per the IMA National President, Santanu Sen, the proposed bill, which was passed in Lok Sabha early 2019, aimed at three different aspects. He had said, “First, by reserving 50 per cent of the seats at medical college for management, the opportunity to the poor is being denied. Second, the bill seems to increase the compensation amounts payable to the patients to impossible levels and third, the bill may lead to increased healthcare expenses incurred by common people.”
The editorial published in a medical journal, Indian Journal of Medical Ethics saidunlike “medical associations in countries such as the USA, the UK, and Canada, the IMA has not been prominent in shaping medical policy in India. It has no history of providing leadership in identifying the health problems of India and providing input into how they should be tackled. The pitiful state of health affairs in India, with some of the worst health indicators, has not prompted this large group of health professionals to introspect on the situation and come forward with constructive suggestions. Instead it has stood by as a mute spectator to the chaos in medical care in India.”