Now, AYUSH doctors barred from accepting gifts, freebies from pharma companies

New Delhi: The new Code of Ethics and the practitioners of the Indian System of Medicine bars them from accepting gifts or other favours from pharma companies.

While dealing with pharmaceutical, allied health sector industry, diagnostic center, testing lab, marketing or sales company or person, the doctors have been advised to ensure that they do not receive any gifts, travel facility inside or outside the country, paid vacations, hotel accommodations, cash or monetary grants etc.

Although medical research, study and allied works can be received through approved institutes, they have to be done in accordance with the law. However, the doctors may work for the pharma companies in advisory capacities as consultant, researcher, treating doctor or in any other professional capacity.

These new set of rules specifying the Code of Ethics for the practitioners of the Indian System of Medicine have been specified in the recently notified National Commission for Indian System of Medicine (Ethics and Registration) Regulations, 2023. These regulations have come into force after their publication in the official gazette i.e. 28.12.2023.

Apart from prescribing the doctor-pharma relationship standard, these regulations also advised the AYUSH doctors to prescribe drugs with generic names and to ensure that there is a rationale behind the prescription and the use of drugs. They have also been asked to write the prescription in legible or typed format.

Further, the regulations have also specified that it is not unethical for a medical practitioner to dispense drugs, remedies, or medical appliances unless there is no exploitation of the patient and the drugs. Solicitation of patients in any direct or indirect manner has also been termed unethical. 

Section 22 of the regulations dealt with the standard Code of Ethics for doctors of Indian System of Medicine in the following manner:

Code of Ethics:

(1) A practitioner shall expose, without fear or favour, incompetent, corrupt, dishonest or unethical conduct on the part of members of the profession.

(2) The practitioner shall ensure that he shall not employ or take services of unregistered practitioners, that is, those who are not registered in the State Register or the National Register of any system of medicine and shall ensure that reasonable due diligence is maintained to prevent the same.

(3) A practitioner, engaged in the practice of medicine shall give priority to the interests of patients and the personal or financial interests of a practitioner shall not be in conflict with the medical interests of the patient and he shall disclose his fees before rendering service and not after and shall charge reasonable fees.

(4) Every practitioner shall, as far as possible, prescribe drugs with generic names and he shall ensure that there is a rationale behind the prescription and use of drugs and the prescription written by him shall be legible to read or shall be typed.

(5) It is not unethical for a practitioner to dispense drugs, remedies, or medical appliances unless there is no exploitation of the patient and drugs.

(6) The drugs, remedies or medical appliances prescribed by a practitioner or which are to be bought from the market for a patient shall explicitly state the proprietary formulae as well as generic name of the contents and the expiry date.

(7) The practitioner may dispense the drugs prepared by himself as per the traditional practices of preparation of such drugs.

(8) Soliciting of patients directly or indirectly, by a practitioner, by a group of practitioners or by institutions or organisations is unethical.

(9) A practitioner may apply patent trademark, Copyright, design for his product or process subject to the provisions of the Patent Act, 1970 (39 of 1970), the Trade Marks Act, 1999 (47 of 1999), the Copyright Act (14 of 1999) and the Designs Act, (16 of 2000).

(10) It shall be unethical if the benefits of such patents or copyrights are not made available in situations where the interest of large population is involved.

(11) (a) a Practitioner shall not give, solicit or receive nor shall he offer to give, solicit or receive any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment;

(b) a Practitioner shall not directly or indirectly participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment;

(c) the provisions contained in clauses (a) and (b) shall be made equally applicable to the referring, recommending, or procuring by a Practitioner or any person, specimen or material for diagnostic purposes or other study or work: Provided that nothing shall prohibit payment of salaries by a qualified practitioner to other duly qualified person rendering medical care under his supervision.

(12) The Practitioner while dealing with pharmaceutical and allied health sector industry or diagnostic center or testing lab or marketing or sale company or person, shall follow and strictly adhere to the following stipulations, namely: -

(a) a practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales persons or representatives;

(b) a practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship, cruise tickets, paid vacations and such others, from any pharmaceutical or allied healthcare industry or their representatives for self or family members for vacation or for attending conferences, seminars, workshops and continuous medical education programs as a delegate;

(c) a practitioner shall not accept individually any hospitality like hotel accommodation for self or family members under any pretext;

(d) a practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pre-text.

(e) Funding for medical research, study and allied works can only be received through approved institutions in accordance with the law or regulations or guidelines adopted by such approved institutions in a transparent manner and the same shall always be fully disclosed;

(f) a Practitioner while dealing with pharmaceutical and allied healthcare industry, shall always ensure that there shall never be any compromise either with his own professional autonomy or with the autonomy and freedom of the medical institution;

(13) A practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities as consultant, researcher, treating doctor or in any other professional capacity in compliance to these regulations and the Act.

(14) For the purpose of Sub-regulation (13) a practitioner shall always. –

(a) ensure that his professional integrity and freedom are maintained;

(b) ensure that patient’s interest is not compromised in any way;

(c) ensure that such affiliations are within the law; and

(d) ensure that such affiliations or employments are fully transparent and disclosed.

(15) A Practitioner may carry out, participate, work in research projects funded by pharmaceutical and allied healthcare industries and fulfillment of the following clauses shall be complied with undertaking any research assignment or project funded by industry, hence in accepting such a position a practitioner shall ensure that, -

(a) the research proposal has the due permission of the concerned competent authorities;

(b) such a research project has the clearance of National Ethics Committees or State Ethics Committees;

(c) it fulfils all the legal requirements laid down for medical research;

(d) the source and amount of funding is publicly disclosed at the beginning itself;

(e) proper care and facilities are provided to human volunteers if they are necessary for the research project;

(f) undue animal experimentations are not done and when these are necessary, they are done under the relevant guidelines of the Indian Council of Medical Research;

(g) while accepting such an assignment he shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a regulation in the memorandum of understanding or any other document or agreement for any such assignment.

(16) A Practitioner shall not endorse any drug or product of the industry publicly and any study conducted on the efficacy or otherwise of such products shall be presented to or through appropriate scientific bodies or published in appropriate scientific journals in a proper way.

(17) (a) every practitioner shall maintain the medical records pertaining to his indoor and outdoor patients for a period of three years from the date of commencement of the treatment or handover all records to the patient after outpatient department consultation; 

(b) a Practitioner shall maintain a register of all the medical certificates, issued by him, giving full details of certificates issued and when issuing a medical certificate, he shall always enter the identification marks of the patient and keep a copy of the certificate.

(c) a Practitioner shall record the signature or thumb mark, address and at least one identification mark and any identification proof of the patient that include the patients address on such medical certificates or reports;

(d) efforts shall be made to computerise medical records as mentioned above, in such manner as notified by the Commission or Board, from time to time;

(e) the Practitioner shall take maximum care to ensure that the patient’s medical records are kept in the private custody of the practitioner and that the same are not leaked or shared with a third person subject to such conditions as mentioned in this regulation.

(18) (a) every Practitioner shall display the registration certificate granted to him by the State Medical Council or Board as the case may be, in his clinic and his registration number in all his prescriptions, certificates, and money receipts given to his patients by him;

(b) in exercise of the powers granted under clause (b) of sub-section (1) of section 34 of the Act, the practitioners shall display as suffix to their names only recognised medical degrees or such certificates or diplomas and memberships or honours which confer professional knowledge or recognises any exemplary qualification or achievements.

(19) (a) a Practitioner is not bound to treat every person asking his services, however, he shall be ever ready to respond to the calls of the sick and the injured and shall also be mindful of the high character of his duties and the responsibility;

(b) a Practitioner shall endeavor to add to the comfort of the sick by making his visits at the hour indicated to the patient in the hospital and clinic;

(c) a Practitioner advising a patient to seek service of another practitioner is acceptable, however, in case of emergency a practitioner shall treat the patient to the best of his abilities and the available infrastructure or facilities at the time thereof on humanitarian grounds;

(d) no Practitioner shall arbitrarily refuse treatment to a patient, however, for good reason, when a patient is suffering from an ailment which is not within the range of training or experience of the treating Practitioner or in the case of unavailability of the requisite facilities or infrastructure, the Practitioner may refuse treatment and refer the patient to another practitioner;

(e) the Practitioner shall provide a complete holistic treatment for a particular disease and illness and ensure that the patient is duly counselled about his body-mind constitution and informed about the ideal lifestyle that is required to be followed for such a constitution;

(f) the Practitioner having any incapacity which is detrimental to the patient or which can affect his performance relating to the patient, shall not practice his profession;

(g) confidences concerning individual or domestic life entrusted by patients to a practitioner or defects in the disposition or character of patients observed during medical attendance shall never be revealed unless their revelation is required by the law;

(h) a Practitioner shall when fighting against communicable disease and epidemic disease act as he wish another to act toward one of his own family in similar circumstances;

(i) the Practitioner shall neither exaggerate nor minimise the gravity of a patient's condition and he shall ensure himself that the patient, patient’s relatives, or patient’s responsible friends have such knowledge of the patient's condition as shall serve the best interests of the patient and the family;

(j) the practitioner shall determine the underlying cause of the illness and not merely identify the symptoms and provide a holistic treatment plan for the patient that treat both the symptoms and the underlying cause and he shall also identify the reasons that led to the disease and illness and counsel the patient to avoid such things that caused the disease;

(k) a practitioner is free to choose, whom he shall serve, however, he shall respond to any reasonable request for his assistance in an emergency on humanitarian grounds and once having undertaken a case, the Practitioner shall not neglect the patient, nor shall he withdraw from the case without giving adequate notice to the patient and his family;

(l) provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care;

(m) when a practitioner who has been engaged to attend an obstetric case is absent and another is sent for and delivery accomplished, the acting practitioner is entitled to his professional fees, but shall secure the informed consent to resign on the arrival of the practitioner engaged.

(20) Notwithstanding anything contained in these regulations the practitioner shall reserve the right to refuse treatment to a patient in case the patient or his representative resort to unruly, violent or abusive behaviour.

Apart from the Code of Ethics, other details such as guidelines for registration of AYUSH doctors in the State and National Register, rights and privileges of the practitioners, standards of professional conduct and etiquette, the issue of misconduct, the process of inquiry by the State Medical Council into the acts of professional misconduct, the appeal procedures, and the meetings of the Board have also been included in the new regulations.

To view the regulations, click on the link below:

https://medicaldialogues.in/pdf_upload/national-commission-for-indian-system-of-medicine-ethics-and-registration-regulations-2023-229746.pdf

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