Category: system

If you are a medical student, you know what I am talking about. The PG medical entrance test, called NEET PG, is a proprietary test conducted by National Board of Examinations. You have to sign a non-disclosure agreement to attempt this test. You cannot, according to the agreement, disclose the questions asked to anyone. Neither does NBE publish the question papers anywhere.

How is this fair at all?

For comparison, all the JEE advanced question papers from 2007 are put on the official website of JEE advanced. The USMLE website has content description booklet, plenty of sample questions, and practice tests. While the NBE’s website proudly writes everywhere that their exams (not just NEET, all of them) are “proprietary“.

This would not have been a problem if NBE was some private body which conducts test for the sake of individuals. But NBE is not that. NBE is an autonomous body under the Ministry of Health & Family Welfare. NBE is not a private entity.

How come they are doing this then? Well, turns out they have been doing this for years and nobody dared to ask. The DNB exams have been happening the same way from the beginning. Candidates take DNB exam with no knowledge of what they will be assessed on. Professor Suptendra has written about this in this IJME article titled “A farce called the National Board of Examinations“.

I have filed an RTI yesterday with the following content:

I, as a citizen of India, hereby exercise my right to information granted under sec (6) of RTI Act, 2015 by requesting the following.

1) Please provide me with the questions asked (including answer options) in the NEET PG Entrance exam held on Jan 6, 2019.

2) Please provide me the answer key of the above questions.

3) Please provide me with the questions asked (including answer options) in the NEET PG Entrance exam held on Jan 7, 2018.

4) Please provide me the answer key of the above questions.

5) Please provide me with the reason why there was a non-disclosure clause at the beginning of the NEET PG entrance test held on Jan 6, 2019.

The information may be emailed to my address: asdofindia@gmail.com

Thank you

This was addressed to National Board of Examinations. I’m sure the response will be “proprietary test”. Also remember that NBE makes 30 crores profit on NEET PG registration alone with no sanction from MoHFW.

What are students supposed to do to prepare for NBE’s proprietary examinations? Go to entrance coaching institutes? Read textbooks and continue working? The atmosphere around entrance tests is so tense that students are scared to prepare on their own. They are forced into joining medical entrance coaching centers.

But why? How can a test that decides who gets access to the very few postgraduate seats in India’s medical education system be made proprietary? Are you saying that only students who have the time and resources to go to entrance coaching centers should be able to prepare and score well? Should only people with time and money be becoming pediatricians and gynecologists?

What will that mean to India’s health system?

There is a lot of context needed here.

To begin with, Jacob Vadakkanchery is a self-proclaimed healer naturopathist from Kerala who goes around asking people to believe that modern medicine is harmful for health. His arguments are so basic and trying to respond to an argument he raised had me writing a 1200 word blog post in Malayalam explaining what science is and whether medicine is a science. He was arrested in the second week of September by Kerala police for asking people not to take Doxycycline prophylaxis (in the aftermath of the floods) under at least section 505 of IPC. Section 505 is one of those sections which exist owing to the “reasonable restrictions” over freedom of speech and expression in the interest of public order as per Article 19 of the Indian Constitution. It punishes people who spread rumors that are likely to disrupt the society unless they are based on reasonable grounds.

I, am an HIV physician and general practitioner of modern medicine. I have previously worked in a hospital where Ayurveda was regularly practiced alongside modern medicine.

Now, let us get to the matter. After Vadakkanchery’s arrest, there was a discussion in my circles about how it was wrong for the state to run Government naturopathic hospitals on one side and arrest people for taking stances against modern medicine rooted in naturopathy on the other side.

Isn’t it true? If you recognize natruopathy (or AYUSH) as a valid system of medicine by opening hospitals and offices for the same, are you not also paving way to firm believers in those systems to make everyday statements that insult families of cancer victims, make doctors and hospitals look like villains for providing standard care, and makes those who think question the role of scientific temper in our discourses?

Many times the prescriptions of modern medicine are directly contraindicated by the principles of alternative medicine. How is it that the government is allowing two such opposing systems to exist together? What is the government trying to tell people? Whom should a person go to when they get sick?

Here are my thoughts.

It is not the government’s responsibility to tell people what to do. Actually, the government does not have any power to tell people what to do. The government’s role, in a democracy, is to abide by the Constitution which is written by the people for themselves and “govern” the state. So let us leave the government out of the question.

How did we end up with such systems, though? I think the answer is simple if we try to understand what these systems are and what they represent.

Self-preservation is a fundamental drive of all living things. Humans must therefore have started thinking about the art of staying alive from the beginning. What humans also tend to do is form theories based on what they see and understand. We form theories for everything. In fact, what we call science is a continuous reforming and refining set of theories based on observations. But these theories are limited by what we can observe and imagine is happening.

Our imaginations become more accurate representation of reality when we can observe more closely and in more detail. That is how science keeps growing. The idea that there might be something that transmits diseases from one person to another was imagined by observing people living together getting the same disease one after the other even before the invention of microscope. Later, when we invented microscope, this imagination became observation. Then we moved forward imagining things which a microscope could not show us. That is how science happens.

In that spirit, Ayurveda is a science. Or to put it more correctly, Ayurveda was a science. From the set of observations that could have been made centuries ago, whatever could be imagined was indeed science at that time. AYUSH is a set of outdated imaginations based on observations that does not include all that can be observed with the state of affairs right now.

Now here is the most important sentence I am going to say. Outdated does not mean wrong altogether. If that is the case, the medicine I am practicing today in India is already out of date by a few years compared to Western world and I am completely wrong to practice that medicine. That does not make sense. It is okay to use the best of what is available. In HIV, there is a medicine called TDF which has a lot of side effects on the kidney and has been replaced by TA in the West. But it’s not yet widely available in India. So, should the 1 million people who use TDF not be using TDF? Absolutely not! Oral rehydration solution is an invention that is absolutely stunning. But for simple diarrhea, drinking plenty of fluids might just be enough. So, if I do not give someone ORS when they have diarrhea instead ask them to drink plenty of fluids, am I making a mistake? No.

Similarly, AYUSH makes sense for people who do not need modern medicine and for people who cannot access modern medicine no matter what. Take a close look at the clauses I used.

“People who do not need modern medicine”. A lot of conditions do not need modern medicine as a must. A simple cold with cough, a simple cut, obesity, psychosomatic illnesses.

“People who cannot access modern medicine”. When I was working with SVYM near Mysore, I became acutely aware of this. For populations of about 20,000 there simply is no surgeon available. The two obstetricians who are in different towns in the taluq have to coordinate with each other to ensure that when they take a Christmas vacation with family, the 20 ladies who are expecting do not suffer. Do not even ask me about how the on-call system of doctors could run. AYUSH practitioners are a luxury for rural Indians. MBBS doctors – an Utopia.

This is the context where AYUSH and modern medicine do not just exist together, but are forced to work together.

These are not the only reasons though. There is an element of human touch that goes missing in medical practice now. This leads to people seeking comfort from people who give that touch. Homeopathic medication might be placebo. But if placebo is the only medication that works for a particular condition, and if modern medicine practitioners are not able to give that placebo, then why not homeopathy? If in one 30 minute visit to an ayurvedic practitioner I can get relief from my headache, my grandmother’s knee pain, and my child’s cough, why will I visit someone else? Where is the modern medicine family doctor?

It is in this context that government opens its own naturopathic centers. This context, though tiny by definition, includes a large population of our country. Therefore, it is very important that we define this context well and nurture the continuum of care when there is a change of context. For example, a pre-diabetic who was being managed with lifestyle changes by an AYUSH practitioner will need a modern medicine consultation when they become a full-blown diabetic. At that point, it must be possible for the AYUSH practitioner to understand their limitations and refer them to the modern practitioner. At the same time the doctor at the modern medicine end must be sensitive about the context the patient is coming from and be willing to accommodate and include the system that the patient has easy access to in their prescription.

This is not happening now and cannot happen as long as practitioners of different systems do not understand their strengths and weaknesses and are not willing to collaborate on behalf of the patient. Where there is no trust and understanding, there cannot be collaboration.

When people like Jacob Vadakkanchery go about stating ill-based arguments against vaccine and doxycycline, they need to be stopped, arrested if need be. If they are not stopped, it would be ignoring all that human beings have achieved in the pursuit of science.

Only when the enmity ends can people begin to learn about each other and understand each other’s strengths. The enmity can end in only one way. AYUSH will have to accept that their role is in a limited context. They will have to learn their limitations and refer patients to modern practitioners before it is too late. And modern practitioners will have to understand the issues in their practice and make use of AYUSH practitioners.

This is not a natural collaboration. It needs to be forged into place. Some organizations like SVYM may have been able to do it successfully. But it is in the best interest of the state to enable this collaboration to emerge at a national level. Pitching one against the other is not going to work. And that is where Jacob Vadakkanchery’s arrest is the right thing to do.

What to do with BM Hegde though?