Dr NC Asthana, IPS, MSc, PhD The Doctor is Cheating You
- A Devastating Expose of Unethical Malpractices in the Medical Field,
Delhi: Authors Press, 2011Hard Back. pp.405. Price Rs.995/-

We live in disastrous times: things fall apart, the centre cannot hold them, as the great poet declared quite a long time ago. We are reading almost everyday about mothers killing their little infants and kith and kin are committing heinous crimes molesting even little kids. Our national ethos and faith is that there could be no bad mother. We still live believing the dictum Vaidyo narayano harihi: a physic, a doctor, a healer and the giver of a feeling of wellbeing is Lord Narayana Himself.

But like many of our beliefs, much of our so called faith has been thrown overboard by many. Those associated with the medical profession and, most importantly, doctors are committing grievous sins along with those non-practicing thugs associated with the manufacture and distribution of medicines. It is a horrifying fact that they are going scot-free. The higher a person goes up the ladder, the more is his propensity to buy anything he wants and perpetrate any crime he wants to be committed with no fear either of our law, which anyway is not very operative, or of God Himself.

Dr Asthana’s book with a thunderous declaration as a title, deals in detail with stinging frankness the mean and inhuman activities of doctors and the medical field in general, which he boldly and blaringly calls Unethical Malpractices. It was Gandhi ji who said that the most heinous of things should be called as such without caring for politeness in turns of expression.

We, the citizens of this hoary, tradition-rich Motherland are broadly of two categories: the helpless and the permissive A right-minded, rational, thinking person that the author is, there is no wonder that he takes a blood getting sizzling hot look at, and sees through, the external veneer of respectability in the money-making devils. And then, there is his training both as a scientist and as an officer protecting the welfare of people committed to his charge.

This painstakingly researched, professionally planned and well-produced book contains twenty-three sections in nine parts. A brief summing up of each of the sections would be in order for two reasons: first, the readers should get a clear idea as to why the work is true reporting and next, not many can afford buying he book for it is priced heftily at nearly 1 K.

The Preface is quite exhaustive, presenting the rationalistic attitude of the writer who expects others also to have the heart in the right place. If the language appears to rise in an angry crescendo, it only reflects the author’s anguished, righteous indignation.

Part I has an intro and an overview of the unethical practices of the doctors and the pharmaceutical industry. The second section has the title: What practice? Only Malpractice. The third section deals with the misdeeds of pharmaceutical companies with which the doctors happen to be hand in glove. For this reason the companies are called pimps straight. The author doesn’t hesitate to call a bloody shovel so boldly with undisguised disgust. The fourth section deals with looting of the patients by an unconscionable ordering of a battery of unnecessary diagnostic tests that drain the impecunious patient’s already lean purse.

Part II explains how the unscrupulous doctors (most of them are so in the patients’ experience too) cheat. The writer has a flair for being humorous too even in the subtitle: How they frighten and cheat you in matters of your heart. The pun is intended too. The sections are about useless but abundant angioplasties. The subsequent sections show how they successfully build and frightfully maintain a culture of costly invasive cardiology; how angioplasties compare with harmless and comparatively less expensive non-invasive treatment. It shows how the costs of angioplasty have an impact on our socio-economic system. There are graphic portrayals of the unholy business of stent-implants of dubious value. (In the case of patients who are eligible for reimbursement the tests prescribed go up to high levels.) There is a whole section on the shocking truth about bypass surgery and scientific facts about cholesterol. This section explains how doctors fool, frighten and cheat you even to begin with. Then there is a section about hypertension, the medical term for high readings of blood pressure. Even the lay reader with a fairly good understanding of English, can understand the complexity of treating the disorder and how innocent patients are taken for a merciless ride. The next section deals with some facts as to how and why doubts were raised by scientists over conventional treatments for this condition. Here the author deals with the unholy practices of some practitioners in cheating by frightening. One section in this deals with the blossoming business of Angioplasty in India thanks to the untiring efforts of some close-knit coteries in the metropolises Another section describes the looting of patients by ordering a battery of unnecessary diagnostic tests These are attempts to earn extra pounds, not pence, to feather their own already feathered nests. MRIs, CT scans, prostrate cancer tests nuclear Heart Scans and packages of multiple tests at enticingly attractive rates are cases in point.

Part III is exclusively about Diabetes, now inerasably raised to the level of a national scare. In this part all the sections are about the diabetes, called sugar disease. The reader is given succinct explanations of what the disorder is, how the treatments, when become aggressive, may lead even to harm according to the observations of the ACCORD Studies in the area. ACCORD is an acronym for Action to Control Cardiovascular Risk in Diabetes. This study has shown how intensive lowering of blood sugar increased the risk of heart attacks. Aggressive treatments (to lower sugar levels in the blood considerably with drugs like Glitazones) do have deleterious effects. Since the doctors’ prescriptions mostly indicate just the brand names (invariably for their own possible unfair gain), the author invariably cites the generic names of drugs not giving any prominence to the brand names.

Part IV is about some drug scams and other dangerous scams. Drugs discovered to be positively dangerous are banned in advanced countries. They are promoted here in our country where the level of medial awareness is low. In this part there are five sections where Dr Asthana deals with certain drugs giving their generic names. Avandia (Rosiglitazone) prescribed for treatment of Type II diabetes was withdrawn from the market by the intervention of the US Govt. It was found to be causing heart problems. The readers are given a piece of sincere advice: It is important for you (read, all of us) to know how pharmaceutical giants play with your lives in their quest of endless profits, possibly with the minimum of expense from their pockets. The ghastly details are worth reading. We can draw lots of benefit by reading about this scandal as also the scandal of Vioxx, used as an analgesic, pain-reducing medicine. This killed some people instead of relieving pain, which might have gone away any way. Poison Pills: The Untold Story of Vioxx Drug Scandal by Tom Nesi was quoted to prove that the much bragged about medicine actually caused heart attacks, kidney problems, many of which proved literally deadly. In a section, the author explains how the fraud was exposed by some honest scientists and then goes on to another section showing that scientists revealed how dangerous that drug was. In another section it was noted how a famous company concealed facts for its own profit. The point worth noting is that the big names ought to be approached with additional care for obvious reasons. Then there are cases of anti-cancer drugs used wrongly for curing infertility. The author comes up with accounts of how individual drugs like Letrozole and Prozac are dangerously used for treating depression. There are sections on banned drugs, irrational combinations and the unholy nexus between the pharmaceutical industry and the dreadful doctors.

Part V deals with the misuse and abuse of antibiotics and vitamins. We are constantly reminded by many that antibiotics need to be taken very selectively. Unfortunately doctors prescribe antibiotics even when they are unwarranted and unnecessary. The practice, again, is another racket. The unscrupulous want their cuts, their profits, no matter at what cost to the patient. The danger is that indiscriminate use of these powerful drugs causes the development of resistance by the bacteria. The unnecessary vitamin supplements also may lead to toxic effects. This reviewer read somewhere that the Americans pass the most expensive urine since the vitamin supplements they ingest are just washed away in the urine. In their over anxiety to preserve health, people buy vitamins sold across the counter. There are five sections, all making very instructive reading: Are supplements really necessary? Unnecessary use of vitamins for children and women, toxic effects of some unnecessary vitamins, deaths caused by overdose of Vitamin A given to children and how patients are monetarily cheated by unnecessary prescriptions of vitamins.

Part VI details the malpractices of resorting to unnecessary surgeries and estimates the burden they place on the poor patients. This part has three sections, one dealing with what these unwarranted surgeries entail, explaining what an unnecessary surgery is and what exactly a surgical malpractice is. These practices are termed felonies by a responsible medical body in the US. The most notable point about this book is that a lot of study and research have gone into its writing. The author is conversant with the modern academic perspectives on medical treatments. He comes to rational and definite conclusion that what drives the scalpel is sheer thirst for lucre. In one section he details some common unnecessary surgeries that are totally avoidable. In 1985, we are told, the US Senate’s Special Committee on Aging found twelve unnecessary operations, far from helping patients, actual shortened their lives. As lay men we cannot fight this dreadful evil all by ourselves, but surely those of us who are fortunate to have read this work cannot say that we have not been amply warned. Fighting this evil needs substantial consumer awareness. Way back in the 1970s, the CERC (Consumer Education and Research Centre) of Ahmedabad sent us (a consumer organization in Vizianagaram, AP) a large brochure listing irrelevant and hazardous drug combinations. (Though I lost touch with them, I am delighted to see on the Internet that the organization is still forging ahead full steam.) As individuals, we should consult some doctors among our friends, relatives and acquaintances before signing on the dotted line in the forms before surgeries. In this part there is a section on the outrageous business of Gastric Bypass Surgery for weight loss. In a later section we are told that expensive laparoscopic surgeries were thrust on patients while cheaper conventional surgeries would do. A lot of misinformation is spread about these keyhole surgeries. It is shocking to read this: In practice in India, one who can afford to purchase the equipments, acquires them first and then proceeds to acquire some training (p.278). For those who are interested in details, the author asks them as to whether their doctors ever told them the essential six points he lists. (Constraints of space here make the reviewer helpless to list them here). The sections on OrthopedicSurgeries and ICUs are eminent must reads for all.

Part VII deals with the subject of exploitation of women patients by thrusting Caesarean sections and hysterectomies. There are very delicate issues which women cannot discuss openly. In this part there is one section on Caesarian sections and the Mammon driven heinousness on the part of surgeons. The writer says that the scene in our country is particularly alarming. This is termed a surgical epidemic. While an estimate goes that in the US in 2010 there were 3.49 lakhs of Caesarians, in our country, what with illiteracy, poverty and scarcity of health facilities, the %age of Caesarians crossed the limit of 15% in Asiatic countries. This practice is against the advice of doctors to keep these surgeries to the absolute minimum. These surgeries are unfair and amount to crimes against the fair sex. The medical reasons against hysterectomies are many. Then there are IUDs: intra uterine devices for birth control. Mirena is such. It is a proprietary Levonorgestrel-releasing intrauterine device which delivers small amounts directly to the uterus. For one thing the device is not effective many a time. But it is unfortunate that it is used in the treatment of dysfunctional uterine bleeding. The unholy nexus between practitioners and manufacturers lays emphasis on pleasing patients only and not on efficacy.

Part VIII explains in detail how patients are treated like guinea pigs in unethical medical trials. Multinational companies use people from India and other Third World countries. The author quotes dependable sources. According to a study by Connecticut-based Business Communications Co (BCC), American companies are set to spend about US $ 36.3 billion on clinical research and it is growing at about 12% per year. India offers immense savings in that respect. Indian doctors conspire with foreign companies to cheat the patients. They flout rules, international norms and standards for clinical trials. The author has collected invaluable evidence to drive home his points at several places. It is shocking to read that six died after cervical cancer vaccines are tried on young girls. Then the modus operandi of various frauds like stem cell therapy in India are listed.

Part IX is an elaborate explanation of the hype surrounding yoga. Self-styled yoga gurus make millions fools. We must note that the medical claims made by yoga camps are unverified and unsubstantiated. Instances have been quoted of TV channels going gaga over a man who, a yoga practitioner claimed, lived for seventy years without food or water. There is a section on randomized control trial tests giving a lucid account of the great efficacy of yoga. Besides that, we are given the history of the various schools yoga in the west and the inside accounts of their immoral activities. We are told that randomized control trials bust all tall claims about yoga as a cure for anxiety, asthma, cardio-vascular fitness and multiple sclerosis.

The book is an excellent handbook on frauds and unconscionable crimes in the field of medicine. It makes immensely interesting and widely beneficial reading. You cannot put down the book without heartily feeling that the author has rendered a great service to the enlightened reading public.