The National Medical Commission (NMC), an autonomous body responsible for maintaining quality medical education as well as practice in India, recently deferred two of its important decisions abruptly without explanation. The recall note simply said, "...as per the advice of the ministry."
The NMC decisions — (1) The introduction of the National Exit Test or NExT exam for final year MBBS students from this year, and (2) the release of updated guidelines for medical practitioners to stop prescribing brand names of medicines and eliminate their nexus with drugmakers — were withdrawn despite their vitality in ensuring standardised healthcare practice.
The Commission has been working on the two proposals for some time and held various consultations. This implies the decisions were much sought-after.
NMC, though functions under the Union Health Ministry, is constituted under the National Medical Commission Act, 2019, and it has four autonomous boards vested with powers to make final decisions pertaining to positive changes in India's medical education and professional ethics.
The introduction of NExT, which was supposed to take place this year (the 2019 MBBS batch onwards), was recalled barely a week after the circular was issued by the NMC in July.
Soon after issuing the circular, the NMC conducted a nationwide virtual workshop for the final year MBBS students and the faculties to facilitate the implementation, an important shift (upgrade) from the current medical graduate examination and entrance test for post-graduation.
Why NExT
NExT, which is meant for the successful completion and exit of students from graduate courses, was also to be the entrance test for postgraduate or MD courses. It would also become the mandatory benchmarking for medical graduates to register for healthcare practice in India, while it was to be the licensing criterion for medical graduates who studied in foreign universities to practice in India.
But the NMC Secretary Dr Pukesh Kumar wrote to all the medical colleges in July that “all the stakeholders are hereby informed that the National Exit Test examination is deferred on the advice of the ministry dated 11.07.2023 till further direction from the Ministry of Health and Family Welfare.”
The recall surprised many as NMC had prepared finer details of the implementation and written to all medical colleges. It circulated all the details regarding the examination, including two steps —Step 1 and Step 2 — of the test, the number of papers, subjects covered, the level of knowledge for acquiring the required competencies, and even the timing.
NExT is equivalent to the world's best competitive medical licensing exams like USMLE in the US or UKCAT/ BMAT in the UK. In these exams, the theory part of all the key subjects is focused in-depth, while more weightage is given to the students’ clinical aptitude — the most important requirement for quality medical practice.
The problem is — many medical colleges, mostly in the private sector, are not competitive enough to train the students this way due to infrastructural issues, shortage of skilled and competitive faculties, lack of competitive departments and labs, and more importantly, limited hospital facilities and patient pool.
Indian healthcare has been witnessing the implications of low-quality medical education ever since it has been thrown open to the private sector, where several medical colleges have come up with limited infrastructure, faculties and hospital facilities. It is evident from a series of actions by the NMC cancelling permission for many medical colleges due to these inadequacies in the recent past.
The non-merit quota for medical seats has also led to the poor quality of students, who can’t often match the requirements of an upgraded benchmarking system.
Naturally, poor results will affect the reputation and the business of education for many institutions. So, as expected, the representatives from certain quarters of the medical education industry, including students, met the health ministry seeking deferment of NExT.
Why Generic Prescription
The NMC also withdrew its updated guideline which directed all registered medical practitioners in India to prescribe generic names of medicines instead of brands following a protest by the Indian Medical Association.
The doctors' body along with the Indian Pharmaceutical Alliance, another influential lobby representing the top branded-generic drugmakers of India, told the government that the generic medicines are inferior in quality and thus generic prescription by doctors may affect the patients.
But, here lies the contradiction. In India, the office of Drug Controller General of India (DCGI) — the Central Drug Standards Control Organisation (CDSCO), which is also under the Union Health Ministry, regulates the quality of all medicines sold in the market (generic-generics as well as branded generics). It is difficult to understand the logic of listening to the argument of ‘low quality’ generic medicines and ‘superior quality’ branded generics, approved and allowed in the market by the same regulator. Curiously, the Health Ministry itself promotes generic-generics through its Jan Aushadhi stores.
So the government's action to allow medical practitioners to continue prescribing branded generic medicines, sold at much higher prices as compared to the generic-generics, is like allowing both unfair and unsafe marketing practices instead of strengthening its own quality regulation department.
It also encourages the nexus between the drug industry and the medical practitioners (through gifting and sponsorships by the pharma industry to generate more prescriptions). While one argument that the industry and the medical profession make in support of the collaboration between the two is medical research, which is fair and needs to be encouraged, this is often limited to a selected few, and it can't be used as a cover to hide a bigger nexus aimed at industry profiteering.
Also Read: The Untold: Generics vs Branded Generics—here’s how India’s drug price ‘control’ kills the patient
(Edited by : Amrita Das)
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