Why in the News?

The Maharashtra Food & Drugs Administration has, in a recent directive, allowed homeopathic practitioners, who have completed a certificate course in modern pharmacology, to prescribe allopathic medications.

What’s in Today’s Article?

• Crosspathy (Meaning, Legal & Regulatory Framework, Reasons, Challenges, etc.)
• News Summary (Context, Controversy, Implications, etc.)

Crosspathy in India:

• Crosspathy refers to the practice where medical practitioners trained in one system of medicine (e.g., Ayurveda, Homeopathy, or Unani) prescribe medicines or perform treatments from another system (primarily Allopathy, or modern medicine).
• This practice is a significant issue in India's healthcare sector due to its implications for patient safety, legal frameworks, and medical ethics.

Legal and Regulatory Framework:

• Permissibility:
  • Crosspathy is generally deemed illegal unless explicitly authorized by state laws or special government orders.
• Judicial Rulings:
  • The Supreme Court of India has ruled that practicing medicine outside one’s expertise without explicit authorization amounts to medical negligence.
  • Crosspathy practitioners have faced legal actions under the Indian Medical Council Act and other state-specific medical laws.

Reasons Behind Crosspathy in India:

• Doctor Shortages:
  • India faces a critical shortage of allopathic doctors, especially in rural areas, with an 80% shortfall of specialists in Community Health Centres (CHCs) as of 2022-23.
  • AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) practitioners are often utilized to fill this gap.
• Policy Gaps:
  • Some states have allowed limited crosspathy to address accessibility challenges, such as in Maharashtra and Goa.
• Economic Factors:
  • Patients in rural areas often cannot afford specialist doctors or urban healthcare facilities, making AYUSH practitioners a more accessible option.

Challenges & Criticism:

• Patient Safety:
  • Crosspathy practitioners may lack comprehensive training in modern medicine, increasing risks of incorrect diagnoses, improper prescriptions, and complications.
• Legal Ambiguity:
  • Conflicting laws and court rulings create confusion about what constitutes permissible crosspathy.
  • Regulatory oversight is often weak, particularly in rural areas.
• Professional Conflicts:
  • The Indian Medical Association (IMA) strongly opposes crosspathy, citing it as a dilution of healthcare standards.

News Summary:

• The Maharashtra Food & Drugs Administration (FDA) has permitted homeopathic practitioners with a certificate in modern pharmacology to prescribe allopathic medicines.
• This move aims to address challenges in healthcare delivery but has invited strong opposition from the Indian Medical Association (IMA) and others.

Background of the Directive:

• In 2014, the Maharashtra government redefined “registered medical practitioner” under the Maharashtra Medical Council Act to include certified homeopathic practitioners.
• A directive in late 2024 clarified that chemists must honour prescriptions by these practitioners, resolving confusion regarding their authority.

Controversies Surrounding Prescriptions:

• IMA’s Opposition:
  • The IMA labelled the move as "crosspathy," stating it undermines patient safety.
  • Critics argue that a short pharmacology course cannot substitute for the rigorous MBBS training required for modern medicine.
• Judicial Challenges:
  • A 2017 notification permitting homeopaths to practice allopathy was stayed by the Bombay High Court. The new directive contradicts this ruling.
  • Past Supreme Court rulings have labelled cross-system practice as medical negligence unless explicitly authorized.

Government’s Rationale:

• The directive aims to address India’s acute shortage of doctors, particularly in rural areas. According to a 2022-23 report, there is an 80% shortfall of specialist doctors in rural health centres.
• With over 13 lakh registered allopathic doctors and 5.65 lakh AYUSH practitioners, the government seeks to utilize alternative practitioners to bridge healthcare gaps.

Implications for the Move:

• For Patients:
  • Concerns about the safety and efficacy of treatments prescribed by non-MBBS practitioners.
  • Potential risks of medical negligence in rural and underserved areas.
• For the Healthcare System:
  • Challenges in regulating prescribing practices, particularly in rural settings.
  • Dilution of general practice standards, potentially weakening India’s already strained healthcare infrastructure.
• For Policy and Governance:
  • Highlights the urgent need for structural reforms, better rural incentives, and improved working conditions for MBBS graduates.

Conclusion:

Maharashtra’s directive represents a critical juncture in healthcare policy. While the intention to bridge healthcare gaps is commendable, the implementation raises ethical, legal, and practical questions.

Resolving these challenges requires a balanced approach that prioritizes patient safety, respects medical standards, and addresses workforce shortages sustainably.