Crosspathy

• 30 Jan 2025

For Prelims: Homeopathy, Indian Medical Association, Medical Council of India, Supreme Court of India, World Health Organization, eSanjeevani 

For Mains: Crosspathy, Regulation of Healthcare Professions, Healthcare Access in Rural Areas, Medical Negligence and Liability 

Source: TH 

Why in News? 

In December 2024, the Maharashtra Food and Drugs Administration (FDA) issued a directive allowing homeopathic practitioners with a pharmacology certificate to prescribe allopathic medicines. 

• The decision has faced criticism from the Indian Medical Association (IMA), which warns it could lead to "crosspathy" and harm patients. 

What is Crosspathy? 

• About: Crosspathy refers to the practice of healthcare professionals prescribing or practicing medicine outside their recognized scope of expertise.  
  • Specifically, it involves practitioners of alternative medicine systems (like Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homoeopathy (Ayush)) prescribing or performing treatments typically reserved for allopathic (modern) medicine. 
• Concerns: This practice is often criticized because it can lead to misdiagnosis, inappropriate treatments, and risks to patient safety, as these practitioners are not fully trained in the methods and practices of modern medicine. 
• Regulations and Legal Precedents: 
  • MCI Code of Ethics 2002: The Medical Council of India (MCI) established the Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002, under the Indian Medical Council Act, 1956, which restricts unqualified individuals from conducting medical procedures such as abortions or issuing medical competence certificates. 
    • It also mandates that qualified doctors cannot assign non-qualified personnel for medical tasks. 
  • Supreme Court Judgments:  In a landmark 1996 case, Poonam Verma Vs. Ashwin Patel, the Supreme Court of India held a homeopath liable for negligence after prescribing allopathic medicines, which led to the patient’s death. 
    • The Court ruled that cross-system practice constitutes medical negligence.  
    • This has been upheld in subsequent rulings, stating that crosspathy is only permissible if explicitly authorized by the concerned State Government. 

What are Reasons for Promoting Crosspathy? 

• Shortage of Specialists: A report on Health Dynamics of India 2022-23 highlights an 80% shortage of specialist doctors in Community Health Centres (CHCs) in rural areas, with only 4,413 specialist doctors available, while 21,964 are needed. 
  • The government has been promoting AYUSH doctors to help alleviate the shortage of medical professionals, particularly in rural areas.  
• Expanding Healthcare Access: As of June 2022, there were over 13 lakh allopathic doctors and over 5.5 lakh AYUSH practitioners in India. 
  • India's doctor-population ratio is 1:836, surpassing the World Health Organization (WHO) standard of 1:1000, but most doctors are concentrated in urban areas, limiting rural healthcare access. 
  • Crosspathy improves healthcare access in remote areas with fewer allopathic doctors, offering an affordable alternative for rural patients who cannot access specialists or urban facilities. 
  • Poor working conditions and low remuneration deter MBBS doctors from taking up rural posts. 

What are the Concerns Regarding Crosspathy in India? 

• IMA's Concerns: The IMA criticizes the Maharashtra FDA’s  latest directive, arguing that the National Medical Commission (NMC) Act, 2019 does not authorize AYUSH doctors to practice allopathy. 
  • Maharashtra's decision contradicts national policies, as even the Central Council for Homeopathy does not permit homeopaths to practice allopathy.  
  • The IMA insists that such practices would be detrimental to patient safety and could potentially lead to negligence or malpractice. 
  • IMA argues that it promotes "crosspathy," undermining the integrity of medical qualifications and specializations. 
• Quality of Care: Compromises the standard of healthcare, as AYUSH practitioners lack formal training in modern medicine. 
• Hospital Practices: The directive encourages appointment of AYUSH doctors in allopathic roles, violating medical ethics and contributing to reduced employment opportunities for Bachelor of Medicine and Bachelor of Surgery (MBBS) or Modern medicine doctors. 

Indian Medical Association (IMA) 

• Founded in 1928, the IMA is India's largest voluntary organization for doctors, focused on improving public health, medical education, and safeguarding the dignity of the medical profession. 
• IMA headquartered in New Delhi, plays a pivotal role in shaping health policies and organizing national health programs.  

Way Forward 

• Strengthen GP System: Instead of integrating alternative medicine practitioners, efforts should focus on attracting MBBS doctors to underserved areas by improving incentives and working conditions in rural areas. 
  • Strengthen India's general practice (GP) system by mandating specialist training for mid-level healthcare providers. 
• Regulation of AYUSH and Allopathy: The government should create a regulated framework for AYUSH practitioners to work with allopathic doctors, with clear role definitions.  
  • They must undergo additional training in modern medicine, especially pharmacology, to safely prescribe allopathic drugs, under the supervision of medical regulatory bodies. 
• Promoting Telemedicine: The Telemedicine (eSanjeevani) can bridge the gap between rural patients and urban specialists, providing quality healthcare through technology without compromising safety. 

Drishti Mains Question: 

Define crossopathy and explain its impact on patient safety. Discuss the legal precedents and regulations governing cross-system medicine in India.

UPSC Civil Services Examination, Previous Year Question (PYQ) 

Mains 

Q. How is the Government of India protecting traditional knowledge of medicine from patenting by pharmaceutical companies? (2019)