Healthcare Regulation in India; from Medical Council of India 1933 to National Medical Commission 2017, problems, pitfalls and progress - a critical analysis of past and present along with recommendations to Parliamentary Standing Committee for a future with better checks and balances. By Dr Jagadish J Hiremut

Regulatory oversight in Healthcare:

Regulation of healthcare sector and its professionals has become increasingly important over past few decades. Regulation in healthcare, ensures compliance to set standards of healthcare for patients benefit and regulatory oversight is especially more important to healthcare administration as it carries the responsibility of safety in public health.

Conforming to set standards in training and practice of medicine ensures that, correct procedures and requisite level of care to patients are met in a transparent process  ². This is essential from patient care point of view and also from cost saving perspective for public healthcare bodies and authorities concerned (Due to our federal structure, states carry burden of implementation and execution in healthcare while central government is more involved in planning, policy making and regulation). 

Recommendations for regulation in Medical education and Healthcare to be made more pervasive and improved than it is today, stems from fundamental concerns due to failure of Medical Council of India in adapting to changing times and nature of healthcare delivery, consequently rendering itself inadequate and failing in its job ^{6, 7}. This has been discussed regularly in meetings of Parliamentary standing committees on healthcare almost on a permanent basis ^{6. 7}. Key stake holders (Government, Doctors, Administrators, Assorted Health workers, Medical colleges, Patients, and now Corporate hospital business owners etc..) and public in general; acknowledge that regulatory oversight is needed when factors as essential as life, health and medical education are involved; including myself, albeit suspicious of heavy-handed government bureaucracy see public interest in some form of external supervision in Healthcare. Policy debates, for most part, swirl not around whether oversight should exist or not but, instead, around the way it should be structured. Public Healthcare apparatus and it’s regulatory oversight today has evolved from an amalgamation of professional, social, economical, organizational and political factors ¹

Aim of regulatory oversight is not just standardization of performance and uniform end points, but also provision of assurance to stakeholders that Healthcare services meet certain standards and also to establish a reasonably competent mechanism for holding organisations and individuals involved in healthcare to account ⁴. Work of regulators includes that of setting standards, detection of wrongs/wrongdoings, measuring/ monitoring performance and enforcement of the rule. There are two basic models of regulation used by regulators, that of deterrence and compliance, however a move towards an intermediate area of responsive or smart regulation has been emerging in recent years in Healthcare for better results ³. In practical terms, model of deterrence can be viewed as a hard law approach prevalent in United States ^{2, 3}.  A divergent “model of compliance” more akin to a soft law approach has been followed by Europe, England and India. Recent regulatory reforms of healthcare systems in both United States and the United Kingdom, show an interesting move by regulatory bodies towards a middle ground or hybrid model of regulation which combines the best of both the deterrence and compliance models  ^{2. 3}.

Contemporary evolution of healthcare regulation developing across globe (not only US,UK, EU or India) in last two decades has brought  some very positive results with better defined end points or goals to regulatory oversight in Healthcare. India’s regnant approach (precipitated by abject failure of MCI in its mandate) to regulatory reform in its healthcare sector is not only following  the path taken by England (and to some extent US)closely but it is also points to the fact that, we are moving towards a more responsive regulatory regime, despite differences in our respective healthcare systems (UK provides UHC to its citizens; whereas US spends almost $ 10000/- per capita on its healthcare ¹¹). What we are witnessing now as changes in healthcare regulation in the form of National Medical Commission, is an evolving  global phenomenon in almost all countries where mature governments understand importance of regulation of medical education and practice to public health and it is not  unique to India. Consequently, it is pertinent for the stakeholders to play their rightful part to establish an efficient regulatory system which is goal oriented, evolves according to changing needs of our citizens and brings the nation’s healthcare from deep depths of 3^rd world status to a pioneering 1^st world status.

History and Evolution of Medical regulation in India:

Formation of British government in India after failed first war of independence in 1847 led to initiation of several services including Indian Medical Service. Central and Provincial Medical Services, and Subordinate Medical Services were initiated to provide medical services and improve public health. A public health commissioner and a statistical officer were also appointed to Government of India ¹³. In 1869, medical departments in the three presidencies were amalgamated into a (Pan) Indian Medical Service. A competitive examination was conducted in London to recruit people into Indian Medical Service. European officers of Indian Medical Service headed military and civil medical operations in the three presidencies. However, they needed trained assistants and supporting staff such as apothecaries, compounders, and dressers in their work. European doctors came with a large financial cost, this prompted the British government to look towards establishing a system of medical education in India to recruit local staff ^{14, 15, 21}.

Whilst, evolution of medical education and regulatory oversight in healthcare in India, can be discussed at great length, it is not the scope of this article - it suffices here to say that, formation of Indian medical service and  starting of medical college in Calcutta, then Bombay followed by Madras gave rise to a cadre of doctors called “Native Doctors” ^{15, 21} or the colloquial sobriquet ‘Brown Sahibs’, which led to formation of a Register of practitioners was probably the first baby step in development of regulatory apparatus for medical practice in India. Even so, the medical register of 1877 had a list of 8000 doctors, among them only 450 were trained in modern medicine or allopathy ¹⁶ and rest were practitioners of Indic systems of medicine. This intermingling cauldron of several systems of medicine (Modern medicine, Ayurveda, Unani, Siddhar etc) in British India, did not continue for long, the very discriminatory Madras Medical Registration act of 1914 stopped registration of doctors practicing all forms of indigenous or Indic medicine ¹⁷. Practitioners of Indic systems of medicine, who served about ninety percent of people of the land of that time, were reduced to untouchables of the profession by allopathic practitioners who considered themselves as ‘Seraph-im Illuminati’ of the day in Healthcare ¹⁸. This Colonial yoke of state sponsored discrimination against Indic systems of medicine and native system doctors continues even today after 70 years of independence as allopathy continues to be accorded the status of official state sponsored healthcare system by government of India.

The bright spots for modern medicine during colonial times were the initiation of public health measures, vaccination, and elevation of tropical diseases to a special subject/department of studies. The state took responsibility for sanitation and hygiene. Collection of vital statistics was initiated and a number of epidemiological and research studies were conducted on cholera, plague, malaria, tuberculosis, and leprosy leading to better outcomes in management ¹⁹.

The act no XXVII of 1933 passed by British parliament ²⁰, led to constitution of Medical Council of India, through this act section 2(d) modern medicine was accorded the status of ‘official medicine’, section 2(g) recognized only those educated in modern medicine as practitioners of medicine in India and section 2(f) allowed licencing and entry of names in the provincial  medical practitioners register only to those trained in modern medicine. By this Indian Medical council Act of 1933 of British parliament; regulation of Medical education and it’s practice became monopoly of Medical Council of India and thus even today, the archetype ‘Brown Sahibs’ or allopathic practitioners continue to be inheritors of this usurped legacy.

I invite the readers of this article to indulge in reading the original Indian Medical Council Act of 1933 pages 161 to 171 to understand two issues ²⁰: (no 20 in reference section below)

i)                How Indic systems of medicine was kept out of Indian Healthcare by a British act  and understand, to analyse why Indian state continues to sponsor the same to this day.

ii)             How nothing has changed in Medical Council of India since its formation in 1933, the thought process behind it, it’s modus operandi, its constitution, it’s composition, it’s discrimination of Indic systems of medicine etc... Not surprisingly even the medical education methodology and medical practice regulation  have not changed to suit the changing needs of independent India, even after 70 years of independence.

The questions which the stakeholders and especially the government, should answer is “Why Government of India continues to practice rules and regulations which were deemed suitable to India as a British province, even after 70 years of independence?”. Are will still a British province?

Subsequent Indian Medical Council Act of 1956 which came into being after repeal of IMC Act 1933 did not change much with regards to basic structure and function of regulatory apparatus of medical education and practice. If anything, it further strengthened the hold of practitioners of allopathy (the Brown Sahibs) on our Public healthcare apparatus converting it into a even stronger monopoly. Successive governments brought in amendments several times in 1958, 1964,1993, 2001, 2005, 2010, 2012 and 2013, nevertheless, the basic monopolistic structure of MCI remains unchallenged. Pluralistic Indic systems of medicine continue to be neglected by the state completely, as if they are a pseudoscience.

Medical Council of India after 1956 Indian Medical Council Act ²²:

This act, to be fair provided a solid foundation for development of post graduate medical sciences in first two decades of its enactment. Notwithstanding the same, by early 1990s regulation in medical education and practice by a group of elected representatives in MCI, had given way to lobbying and quid pro quo for permissions given and inadequacies spared (by the MCI as a regulator)in private medical colleges and sometimes even in sate run government medical colleges too. MCI by year 2000 had grown completely monopolistic and all powerful in its control over the most sought after medical education and practice regulation in India. Entry of unscrupulous Ketan Desai in 2001 as President of MCI through electoral process destroyed its sanctity as regulatory powers of MCI were used as a bait and bargaining tool to collect bribes converting MCI into a rent seeking body. Analysis of healthcare regulators globally during the same period demonstrates that; elections as a means to appoint regulators to medical education and practice had fallen out of favor and abandoned in all countries ⁶. Ketan Desai a manipulator par excellence oversaw a 10 year bull run of corruption as president of MCI. He was finally arrested by CBI after multiple complaints in April 2010, caught red handed accepting bribe, actually exposes that, the permissible level of corruption index was breached by him in an era of corruption and scams in India. If Lalit Modi and Indian Premier League scandal ever needed a competitor in sheer audacity of its main player, India’s medical establishment had one to offer in the form of Ketan Desai. While IPL was about game and entertainment, Desai and his coterie of elected members of MCI oversaw destruction of this institution involved in regulation of medical education and practice beyond repair. A dedicated chapter on corruption in MCI (chapter XII) in the 92^nd parliamentary standing committee report tabled in RS has recorded the unqualified admission by MCI president that there was “corruption in sanctioning of medical colleges or increasing or decreasing medical seats” ^{6, 7}, should be enough for government of India to repeal MCI and supersede it with an ad hoc committee until a fresh better start with checks and balances takes over.

Above facts have been in public domain for some time now and have been reported, analysed, reviewed, commented upon, Op-eds written, also extensively debated and discussed by: the parliamentary standing committees on health and family welfare, Ranjit Roy Chaudhary committee, Niti Ayog Vice President Arvind Panagaria led committee on IMC act 1956 and finally the oversight committee set up by the Supreme Court of India. Those who want to know more can go through the above committee reports from reference section below. I will relegate myself to expose the stark failure of MCI to fulfill its mandate as corruption discussed above  and incompetence discussed below are two separate issues and MCI was plagued by both.

MCI as regulator of medical education in India has repeatedly failed on all its mandates over the decades. Deteriorating quality of medical education can be assessed by the fact that a fresh medical graduate today is not competent enough to manage something as simple, as a straight forward, uncomplicated normal labour and other similar common issues he might face as an independent practitioner. Less said about the quality of post graduates the better; as I do not want people to lose faith completely in the system. Selection of most students in private institutions is seldom on merit thereby reducing overall quality of people entering medical field to become doctors. Standards of education in both undergraduate and postgraduate categories leave a lot to be desired. Under MCI, medical education in India became pro affluent, class conscious, condescending, deficient, sub-standard and yet an aristocratic elitist hubris. In addition to this, required number of graduates to reach stated goal of doctor population ratio of 1:1000 was unmet; the current ratio is 1:1800 ²³. Criminal activities within the MCI ⁵ and others in medical colleges like ghost faculty ^{24, 25} which ended up in CBI arresting few doctors and deans of medical college’s shows how disgraced and immoral medical education and its regulator MCI have become.

MCI as regulator of medical practice and ethics is an outright failure is an understatement. Even under watchful eyes of the oversight committee set up by Supreme Court you can notice that most of the members of MCI come from corporate hospital practice without any representation for public healthcare intellectuals and patient rights groups. Medical practice regulations and policy are being ghost written by council members and elected members of MCI who come from cheesy corporate practice background, destroying the “social calling” which formed the very core for many of us to take up medical practice as a vocation. Corporate hospitals today are nothing but profiteering businesses run by MBAs and business leaders masquerading as doctors with zero social responsibility, thriving on business of scale and/or referral fees and cut practice (with marketing department budgets bigger than the overall salaries they pay to doctors and nurses put together). Doctors in Corporate hospitals have been reduced to treasury gatekeepers and the bigger income they create for hospital, the better their remuneration arrangement has killed the very spirit of medical practice as a vocation and its code of ethics. Imagine regulations to practice under direct control of these unscrupulous corporate business leaders (not doctors anymore), MCI today has the dubious distinction of having precipitated and brought to pass that dreaded circumstance in our everyday life and practice of medicine.

Out of 40 disciplines in modern medicine, cardiologists, cardiac surgeons, general surgeons and general medicine practitioners from corporate hospitals get maximum representation. It is as if other disciplines and academicians are non-existent or are considered incapable of contribution towards regulation of medical profession by MCI. Cut-practice or referral fee based practice has reached such alarming criminal proportions under MCI that, there are actual books written on it. Criminalisation of medical practice in India has been reported in many medical journals including international journals of repute like BMJ and Lancet. Government should address this menace separately by enacting a law criminalizing the same with severe punitive measures like fine and jail term. In addition to above issues, dispute resolution by MCI, with regards to complaints of medical negligence lacks credibility, as we rarely see negligent doctors punished by MCI; apparently shielding bad or incompetent brother doctors from accountability appears to be the norm. As in so many spheres, concentrated monopoly of power is the underlying problem, and safest remedy is to abolish the MCI, form ad hoc committee to take over functioning and allow bodies like National board of Examination to assist while a better system is put in place, notwithstanding current status of NMC bill in PSC. According to me and many doctors amenable to reason, there is no reason for a corrupt and incompetent MCI to stay in any capacity.

Indian Medical Association (IMA) and the guild mentality:

As an active member of IMA, I write this with a lot of pain, IMA lost a great opportunity to be the bellwether and watch dog to MCI and save it from the clutches of corrupt and inefficient people. The last few years of functioning of MCI has taken its toll on the IMA. Acceptance that self-regulation has failed leading to newer legislation taking away the monopoly enjoyed by medical establishment constituting MCI and IMA had over medical education and practice is a sobering reality. Notwithstanding this, the fact is IMA unlike MCI is here to stay and it should be a guiding force to the newer regulatory body formed by NMC bill rather than behave like a guild. The NMC bill has been referred to a parliamentary standing committee currently; there will a tug of war between champions of self-regulation and proponents of state controlled regulation in healthcare. Circumstances demand that, IMA as a professional body should adhere to the social code of ethics and become an independent body capable of standing in judgement to guide the future of our profession in India. The authority of medical profession rests partly on science and partly on public respect for tradition of medicine as a vocation. Today, the challenge of IMA is to discover how best to rebuild this spirit and to ensure doctors are not treasury gatekeepers in corporate hospitals but are actually custodians of patient’s well-being. History will stand in judgement of office bearers of IMA during this period, to distinguish whether IMA stuck by the code of ethics in favour of the patients or behaved like a guild trying to safeguard the monopoly of medical establishment.

The National Medical Commission Bill ²⁶:

A lot has already been said and written in articles, blogs, Op-eds and prime time shows on “Newstainment” channels about the NMC bill which is set to replace the corrupt, archaic, incompetent, feudalistic and British raj residuum MCI.

For starters, the best thing about NMC bill is that, it is disbanding the MCI, personally as a practicing doctor inside the system; I was even okay with Hammurabi’s code, as long as MCI was disbanded and a fresh start to proper regulation of nation’s medical education and healthcare was made. Here below, I relegate myself to critically analyzing NMC with suggestions for improvement to parliamentary standing committee (PSC) to which it has been referred to now, I hope PSC considers my suggestions made as a public health intellectual and policy expert. For those interested in contents of the bill I refer them to reference number 26 in reference section ²⁶.

Monopolistic and discretionary powers in hands of few has always led to corruption, even a professional body of highly educated practitioners of medicine have fallen prey to corruption as in the case of MCI. NMC should not fall into the same trap which, apparently it is falling into now in current format. Let us begin with the composition of NMC;

In Current form, NMC Bill proposes a 25-member all powerful “Commission” appointed by Central Government, a Chairperson, a Member Secretary, 12 ex-officio members and 11 part time members ²⁶. Of these members, 20 will be appointed by a search committee chaired by Cabinet Secretary. Nomination will be done for 12 ex-officio and 6 part-time members. Three of these will be from disciplines such as management, law, medical ethics, health research, consumer or patient rights advocacy, science and technology, and economics. Only five will be elected by registered medical practitioners from among themselves from regional constituencies ²⁶.

Search and selection committee for the above appointments will be headed by cabinet secretary. Commission apart from overseeing board functions shall also be the appellate authority with respect decisions of the boards ²⁶.

Above composition of the commission and the brute power, central government controlled bureaucracy wields in it, is unacceptable. According to above structure of NMC; the health and family welfare ministry of central government has absolute control over NMC and consequently on medical education and practice, converting it from earlier self-regulated monopoly of MCI to a State controlled monopoly of NMC now. NMC in current form looks like a subservient department of this ministry. Politicians with influence on this ministry and those who own private medical colleges can change policy to suit their needs. We may have just moved from frying pan to fire unless change in the structure and composition of NMC made to bring in checks and balances in the organisation.

Author’s recommendation: Addition of members who are independent of influence of central government is a must and there should be an acceptable balance of government nominated members and independent members of NMC. In current form, all are directly or indirectly serving the central government.

In matters as important as regulation of medical education and practice which affects nation’s well-being directly, states have no say in current form of NMC. It is state councils which do all the hard work on the ground and it is states which run most number of medical colleges and universities. Giving adequate representation to states is a federal obligation. NMC in present form is failure of federal structure at the very least. Leaving NMC under total control of central government and its bureaucrats and politicians is a recipe made for disaster.

Author’s recommendation: Every state must be represented in the commission at least once in 2 years, in current form it happens only once in 20 years. This will increase the number of members in the council from current 5 to 15; it also brings in the federal nature of our governance to the fore as the individual states inputs will contribute for nation’s well-being.

MCI in its presentation before the NITI ayog Vice President Arvind Panagariya led committee, had asked for expanding representation of doctors in MCI by 1 person for every 20,000 practicing doctors ⁶. In current composition of the commission, practicing doctors are represented by only 5 members in the commission. This is brazen injustice to the nearly 8 lakh practitioners of the country. It appears as if committees which wrote the structure of the commission starting from Ranjit Roy Chaudhary led committee to the NITI ayog VP Aravind Panagaria led committee and experts who contributed to the same have a prejudice against IMA and practicing doctors of the country.

Author’s recommendation: Every 50,000 (fifty thousand) practicing doctors must have a member representing them on the commission. They can be selected by lottery from the medical registers of the state. That will be an addition of 11 members to the commission from the current 5, taking the total of independent practicing doctor members of the commission to 16. This will bring the acclaimed “checks and balances” system into the organisation of the commission. I strongly recommend a fool proof method of selection by lottery to be done using a computer algorithm to select the practicing doctor member here. Involving the biggest voluntary membership organisation of doctors the IMA is the key to make the doctors feel their contribution is valued, in this change, from monopolistic MCI to a pluralistic NMC. This will remove the elitist nature of the commission and also strengthen the element of self-driven regulation most needed in practice.

Although central government wields more power in the commission which it should, increasing state representation and representation of practicing doctors who are not nominated by central or state governments, will bring more stability to the organisation and structure of the commission.

The Medical advisory council is a joke with only advisory role and no powers to enforce anything at all. The PSC should work a mechanism to make it more productive than what it is proposed now.

The 4 autonomous boards: (a) the Under-Graduate Medical Education Board, (b) the Post-Graduate Medical Education Board, (c) the Medical Assessment and Rating Board, and (d) the Ethics and Medical Registration Board are by their very structure, made elitist, with ample room for owners of private medical colleges and corporate hospitals to manipulate as insiders. Again, the checks and balances approach, needed for fool proof functioning of these boards are missing. Selection criteria are such that; the chairmen of the boards and its members can be filled with cronies of political masters from corporate hospitals and private medical colleges and justified too.

Author’s recommendation: Addition of two independent members into each of the boards (as an additional responsibility) from among the independent 16 practicing doctors in the commission will change the elitist nature of these boards. The decision making has be on unanimous basis and not majority. This will most certainly address the need for checks and balances in decision making of these boards.

The equating of post graduate degrees from medical institutions and universities with DNB from NBE is unacceptable clause 36(2) ²⁶. Norms laid by MCI for conventional post-graduation with regular full time teachers and professors is definitely superior to the DNB degree got from corporate hospital training or training in nursing homes from full time practitioners and part time teachers. If an independent body inspects this arrangement, it will conclude that DNB students are abused and exploited by corporate hospitals and nursing homes (which are approved for the course) as cheap labour. These students join DNB because they did not get post graduate seat in conventional teaching institutions and it is seldom their first choice. Ideally, NMC must take steps to increase number of PG seats available for post-graduation or bring in stringent teaching and training norms to elevate DNB training to that of conventional PG training. Equating DNB postgraduate presently with conventionally trained postgraduate is gross injustice to medical colleges, post graduate institutions and universities. Such a step will eventually lead to demise of conventional training and thereby research too, as there is no added incentive for full time professors teaching students their trade and post graduate training will become a casualty of corporate greed. Will NMC and Government of India equate the training of postgraduate from AIIMS/PGI to DNB training? If yes, why spend so much money on training institutions? GOI can as well build corporate hospitals and nursing homes instead.

Author’s recommendation: Confirming with MCI standards, DNB postgraduate must complete 2 years of post DNB status to be considered equal to postgraduate degree from conventional medical college/university. Commission has to appreciate the difference in training of both these post graduate courses and not be influenced by corporate hospitals lobbying for DNB, looking for cheap labour.

Clause 49 sub clause (3): regarding development of specific educational modules to be introduced in UG or PG courses of different systems of medicine to allow a pluralistic approach: needs to be studied further, research and pilot studies must prove beyond any doubt, that such an interface between different systems will benefit the patient, until such time the commission must not indulge in bringing it to public domain.

Clause 49 sub clause (4): Training of AYUSH doctors with a bridge course and allowing them to practice allopathy is a foolish decision on many counts and must be abandoned. The Commission has a prejudiced notion (owing to UN prescribed standards and also lobbying by corporate hospitals looking for cheap labour) that there is shortage of doctors in India. The shortage of doctors is mostly in rural areas while in metros and major cities, there is an oversupply. Government has to work to improve redistribution of doctors to rural areas ²⁷.

Author’s recommendation: Abandon the bridge courses, the various state governments must study and replicate Tamil Nadu model ²⁷ where today there is a wait list of doctors wanting to join rural health force, instead of experimenting on patients’ lives with bridge doctors or mini doctors as is being done now in Jharkhand. Job of the commission is to regulate medical education and practice and ensure better doctors, not to dance to the tunes of government or corporate hospital lobby looking for cheap labour.

The accreditation and rating function of the Medical Assessment and Rating Board (MARB) should be out of the ambit of NMC. This was the recommendation of the Parliamentary Committee report in March 2016. The author recommends that it should be kept out of ambit of NMC as earlier experience with MCI shows that, this is an area prone for corruption, lobbying and rent seeking.

Finally, the chairperson of the commission must not come from corporate hospital or private medical college background at any cost. Criteria for selection of chairperson of NMC are easily met by many millionaire and billionaire doctor business leaders owning or running single or multiple hospitals and/or colleges. It is not in the interest of medical education or practice to hand over the reins of such an important regulatory body to them.

Author’s Recommendation:  Selection criteria for chairman of commission and presidents of 4 autonomous boards must include exclusion criteria to exclude doctors from corporate for profit hospitals and those closely associated with running of private medical colleges.

The author appreciates NEET and NEXT concepts brought to fruition by NMC.

Regulatory oversight in medical education and practice is evolving to suit changing needs of the stakeholders and public, globally. It is our duty as stakeholders to work together to create a responsive regulator which suits to the changing needs and meets goals set. I hope the changes made in NMC by the PSC it is referred to now, can bring about all these and be a model regulatory organisation.

[Special note by the author: Along the way, we have completely ignored Indic and non-western concepts of disease and discarded alternative ways of providing succor to humanity. Even today in my observation, traditional Indic medical systems prevail in the primary levels of health care in rural areas and among urban poor, while Western medicine is more popular as people  move up the social and economic ladder. Focus of Indic systems of medicine has always been on health promotion and prevention of disease (prime among them is Yoga), rather than the curative bias seen in Western medical systems. Had a dialogue been successfully initiated under proper regulatory oversight and on specific outcome based research, between these two systems, the resulting  symbiotic growth and outcome might have probably got us our Nobel in medicine ²⁸ (Traditional Chinese Medicine expert “To Youyou” won Nobel for her contribution in 2015 ²⁸) and would have contributed to better health of people. The abject lack of communication and learning between the Western systems of medicine on one hand and indigenous Indic systems of medicine on other hand has not worked well for the country. Indic systems of Medicine will greatly benefit from induction of scientific temper, standardization and quality control, improving and providing uniform educational standards along with clinical research, better curricula and peer review from doctors across the aisle from western system of Medicine. It is the government’s job to bring in necessary changes in the regulatory apparatus of Indic systems of medicine to inculcate the above and grow as a proper science based on the concept of evidenced based medicine. This will ensure development of a symbiotic relationship between modern medicine and Indic systems of medicine leading to mutual respect among the practitioners and the nation too will be better served. Trying shortcuts like bridge courses is reckless and unwise].

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