NEW DELHI : Despite its best intentions to introduce sweeping reforms in medical education in India, the National Medical Commission (NMC) Act, 2019 seems to fail in addressing the larger issues plaguing the medical education and health sector.

The Act aims to improve access to quality and affordable medical education, and ensure availability of adequate and high quality medical professionals in all parts of the country. The Act in practice repeals the Indian Medical Council Act, 1956 and replaces the scam-tainted Medical Council of India (MCI), which was dissolved in 2010 following corruption charges against its president Ketan Desai by the Central Bureau of Investigation (CBI).

In place of the MCI, the government is now setting up an NMC that will have responsibilities ranging from approving and assessing medical colleges, conducting common MBBS entrance and exit examinations and regulating medical course fees.

While the NMC has merely organizational differences from its predecessor MCI, the provisions of the Act don’t show a way of bringing in any fundamental change in the way the medical education in India is imparted, though it certainly changes the process of admissions, awarding of degrees and licencing for practice.

“The NMC Act is unlikely to harbinger a fundamental change in the way medical education is provided in India or effectively address the rural–urban imbalance. The issue of variable duration of ‘bonds’ arbitrarily enforced by the states and medical institutes needs to be redressed on a priority and logically standardized. It is unfair on a young doctor to have grossly different policies in different states under the garb of federalism or institutional immunity. Emoluments to interns, residents, and fellows also vary severely and need to be made more uniform," said Santosh G. Honavar, former associate director at L.V. Prasad Eye Institute in Hyderabad.

Academicians and health experts claim that although the bill has taken into account undergraduate medical education (MBBS), it has completely ignored post graduate studies. “The Act does not address the ills of postgraduate education at all. Standard national curriculum and uniform teaching, surgical training and infrastructure standards for residency training, and a postgraduate board examination or a national exit examination to ensure uniform standards can be governed by the empowered subspecialty boards. The abolishment of 2-year postgraduate diploma and awarding of a uniform 3-year postgraduate degree is a crying need," Honavar said.

The paper said that if India really wants to provide high quality medical care service for every citizen, it urgently needs to have a clear idea about the health human resources required, decide how to set up the requisite number of training institutions, have clear policies for employment and remuneration of the graduates of these institutions, decide on the resources required to make this possible in a realistic time scale and take the states along in planning.

“There is a major urban and rural divide when it comes to availability of doctors. The doctor population is concentrated in the urban areas. While there are several private practitioners in urban areas, rural areas are devoid of basic health facilities. It is not clear as to how these issues will be addressed. NMC can also involve in corruption. Even when people are excellent, there can be serious corruption issues," said Arup Mitra, professor, Health Policy Research Unit (HPRU) at the Institute of Economic Growth in Delhi.

The Act doesn’t have any provision to equalize or improve the doctor-patient ratio. Instead, it proposes a controversial idea of bringing in community health providers to combat quackery. According to the Act, the Community Health Provider may prescribe specified medicine independently, only in primary and preventive healthcare. But in cases other than primary and preventive healthcare, the provider may prescribe medicine only under the supervision of medical practitioners registered under sub-section (1) of section 32. The provision has drawn flak from the medical fraternity and triggered nationwide strikes.

Source: https://www.livemint.com/

Global News reached out to medical schools across Canada and asked for their policies on industry donations and conflicts of interest disclosures. Below is what we received from university spokespeople.

University of British Columbia

• UBC is committed to upholding academic integrity and professionalism across the educational and research spectrum. As such, the university has a number of policies that govern fundraising and donation activities, including: Fundraising and Acceptance of Donations (Policy 114) and Conflict of Interest and Conflict of Commitment (Policy 97). It is also governed by its Research Policy (Policy 87). The Faculty of Medicine has additionally developed supplementary guidelines with respect to relationships with industry, as well as a required course for faculty members that covers key issues in the relationships between the medical community and industry, and to help faculty members discern what is relevant to include in their disclosure.

University of Toronto

• Relationships with Industry and the Educational Environment in Undergraduate and Postgraduate Medical Education, which addresses sponsorship of educational events to MD and post-MD learners, including provisions of educational materials; guest lectures from industry representatives; and faculty consultation to industry.
• Policy on Sponsorship from Commercial Sources of University of Toronto Accredited Continuing Education Activities, which addresses sponsorship of continuing professional development educational events.
• Research Administration Policy, Statement on Research Partnerships, and Statement on Conflict of Interest and Conflict of Commitment, which address sponsored research.
• Publication Policy, which addresses academic freedom and dissemination of knowledge, i.e. the right to publish.
• Policy on Conflict of Interest – Academic Staff, which addresses naming all sources of support for research in publications and prohibition on advertising.
• Guidelines on Fund Raising Strategy and Programs at the University of Toronto, which addresses philanthropic fundraising, including by industry.

Memorial University

• From a donation perspective, in-kind donations can be accepted by Memorial University, as well as monetary donations which may be for the purpose of establishing a scholarship, bursary or award.
• The Faculty of Medicine at Memorial University has conflict of interest guidelines for faculty and below are details to help explain how someone should navigate interactions, partnerships and support with companies in the health industry.
• Industry funding for educational activities: Proposed industry support for undergraduate, graduate or postgraduate medical education activities, scholarships or fellowships should first be reviewed by the Faculty of Medicine development office. If deemed appropriate, such support can be given centrally to the Faculty of Medicine development office in the form of an unrestricted educational grant. Funds for educational activities may be provided to the Faculty of Medicine or to an individual department or division, but must not be given to an individual faculty member, staff or learner. It is to be understood that the allocation of funds will be done at the sole discretion of the Faculty of Medicine and there is no quid pro quo (a favour for a favour) expectation or commitment.
• Members of the Faculty of Medicine may become involved with industry when they participate in unaccredited CME/CPD (continuing medical education/continuing professional development). Interests of industry may not always be congruent with addressing the educational needs of the profession. Members of the Faculty of Medicine should be discouraged from speaking at industry‐sponsored non‐accredited events when they do not have editorial control of content. If members of the Faculty of Medicine do participate in such events, their participation should be disclosed and guided by provisions outlined in Article 21.04 of the MUNFA agreement.
• Industry-funded/sponsored research: Participation in industry-sponsored research activities must always be preceded by formal approval of the project by the Health Research Ethics Authority. The research must be conducted according to the appropriate current standards and procedures. Faculty of Medicine members shall not enter into research agreements with industry that indefinitely restrict the member’s right to publish or disclose results of the study or report adverse events that occur during the course of the study. Members of the Faculty of Medicine have an obligation to take all steps necessary to ensure research activities are ethically defensible, socially responsible and scientifically valid.

University of Calgary

• The University of Calgary’s Code of Conduct sets out rules regarding gifts and invitations to events and conferences from third parties, which would include the pharmaceutical industry. You can view the Code of Conduct policy and the recent update to UCalgary’s campus community posted in UToday.
• In addition to UCalgary’s Code of Conduct, the Cumming School of Medicine has policies addressing disclosure and management of potential conflicts of interest in relations with industry, which can be found here. Our policies align with national standards established by the Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, and College of Family Physicians of Canada.

University of Alberta

• The University of Alberta does not have any policies specific to the pharmaceutical industry. Instead, our relevant policies apply to all industry interactions. Please find below direct links to policies on the desired topics relating to the Faculty of Medicine and Dentistry. The faculty’s full policy suite can also be found here.
• University of Alberta Donation Acceptance Policy (university-wide, applies to monetary donations, as well as donated materials).
• Faculty of Medicine and Dentistry’s Interaction with Industry Policy (faculty-specific, addresses: gifts, industry samples, site access, continuing medical education, participation in industry-sponsored programs, industry-sponsored scholarships and other educational funds, food, professional travel and advisory boards, ghostwriting, purchasing, content violation of educational events, research compensation and acknowledgement of industry support).
• University of Alberta Sponsorship Procedure (applicable university-wide regarding organized sponsored events)
  University of Alberta Conflict of Interest and Commitment, and Institutional Conflict Policy (university-wide, includes addressing possible concurrent activities, gifts, invitations to events)

University of Manitoba

• Interactions between the Max Rady College of Medicine and Health-Related Industries policy

McMaster University

• Conflict of Interest Policy for Employees
• Statement on Conflict of Interest in Research
• Statement on Consulting Policy and Procedures
• Recommendations for Managing Conflict of Interest for Faculty and Students in Educational Programs in the Faculty of Health Sciences

Western University Schulich School of Medicine & Dentistry

• The school and the university have a number of policies that guide actions and interactions related to donations or sponsorship from pharmaceutical companies and donated material and lectures, as well as those related to advisory board membership of faculty and participation in industry-funded events.
• Western University’s Gift Acceptance Policy
• We follow the Canada Revenue Agency policies and guidelines on the definition of a philanthropic gift before issuing a charitable receipt. Our practice is to issue a business receipt to corporations. A gift: is a donation given voluntarily; is a transfer of property (not a gift of services); does not give any material advantage to the donor; is not directed to a specific person, family member or non-qualified donee; and there are no conditions attached to the gift. A majority of the time, we would ask questions related to whether the donor is at arm’s length from the project they are supporting. For example, a company cannot designate their gift to a specific project if there is a benefit to the company directly or a benefit to anyone with controlling interest at the company.
• Western also has a conflict of interest policy where faculty or staff who have (or are seen to have) the opportunity to use the authority, knowledge or influence derived from their position to benefit improperly in some way from that knowledge do need to declare this conflict of interest. This policy is unrelated to whether a gift is philanthropic, however it can often mean a change to the financial management of a project where philanthropic gifts are involved.
• Policies guiding conflict of interest and conflict of commitment requirements and procedures can be found in two different policies: One is for faculty who are part of the university’s faculty association (UWOFA). One is for faculty at the medical school who have clinical appointments and are part of the Clinical Teachers Association.
• Schulich Medicine & Dentistry also has a conflict of interest policy guiding interactions between the school and pharmaceutical, biotech, medical device, medical/dental supply and research equipment supplies industry.

Queen’s University

• Queen’s has a number of publicly available policies which govern the Faculty of Health Sciences and the university’s overall engagement with industry. Please consult the following:
• The Faculty of Health Sciences Policy on Conflict of Interest in Interactions with Industry establishes the framework for engagement between members of the faculty — which includes the Queen’s School of Medicine — and external industry partners. The policy addresses a range of interactions, including but not limited to, industry-sponsored research, consulting relationships, philanthropic gifts of all kinds, and industry funding for educational programming. The faculty’s Policy on Support of Continuing Professional Development builds on existing Queen’s policies on industry engagement and conflict-of-interest, as well as the National Standard for Support of Accredited CPD Activities and CMA guidelines.
• Further public guidelines are established in the collective agreement between Queen’s and the Queen’s University Faculty Association, and the conflict of interest and conflict of commitment policies (for faculty members outside of the QUFA bargaining units and non-faculty staff members).

University of Montreal

• We do not have a specific donation policy for the pharmaceutical industry. We ensure that our donations comply with the laws and regulations of the Canada Revenue Agency. We treat all donations received in the same way; they are evaluated according to our governance process, both financially and legally.
• To give you an idea of the amount of donations made by pharmaceutical companies to our university, in 2017-2018 a total of $474,463 was received from this industry.
• Code de la Faculté de médecine de l’Université de Montréal concernant les relations entre ses membres et l’industrie
• Any financial support from a company must comply with the code governing relations between members of the Faculty of Medicine and the industry. A written agreement may be required by the CQDPCM or strongly recommended by the faculty administration.
• Since 2017, we have offered online ethics training for members of the faculty who deal with the industry. More than 250 people followed the training last year.
• Professors may pursue professional activities in addition to their research and academic work. Whichever form they take, these activities are among those to be declared in the professors’ annual declaration of conflicts of interest. On the form, they must specify the value of the activities and the benefits they received, if any. These conflict-of-interest declaration forms are then given to the department heads and analyzed by them. More information on the declaration and the form here.
• Research grants are also reported and managed by our office of research and development. All professors’ research projects must be accepted by the ethics committee, which also requires a declaration of conflict of interest.

Laval University

• La politique d’acceptation des dons (Editor’s note: PDF attachment sent in email)
• Politique sur la conduite des relations avec les partenaires externes
• Politique en matière de conflits d’intérêts dans les activités de formation, d’évaluation et de recherche
• Directive sur l’organisation d’activités scientifiques et de formation continue )
• Information sur l’indépendance intellectuelle et conflit d’intérêts à la Faculté de médecine

McGill University

• Collaborations with industry are very important in order to bring our science and knowledge to society effectively, which is our mission. Equally important is the integrity and independence of our science from external influence, and so collaborations must include safeguards, i.e., policies and other mechanisms to ensure this. Members of the university are expected to act with integrity and adhere to the highest ethical standards. The university and faculty have policies, regulations and guidelines that dictate how individuals should interact with various external entities, as well as the importance of recognizing and mitigating situations of conflict of interest. Among these:
  • McGill Gift Acceptance Policy
  • McGill conflict of interest
  • McGill conduct of research
  • McGill Faculty of Medicine Guidelines for Avoiding Conflicts of Interest in Relations Between Faculty Members and Industry
• With respect to continuing professional development (CPD), the faculty adheres to accreditation standards established by working groups composed of representatives of the Committee on Accreditation of Continuing Medical Education, the College of Family Physicians of Canada, le Conseil québécois de développement professionnel continu des médecins and the Royal College of Physicians and Surgeons of Canada. All educational programming developed or co-developed by the faculty’s CPD office must meet these accreditation standards. As per these standards, pharmaceutical companies may contribute to the funding of accredited educational events only through non-restricted educational grants to recognized physician organizations. Pharmaceutical companies and their representatives are not permitted to be involved in the development of accredited educational content nor pay individual faculty members (moderator, lecturers, etc.) directly for their involvement in accredited activities.
• Regarding policies on donated materials (books, informational documents), McGill’s Gifts-In-kind Policy applies.
• With respect to guest lectures from members of the pharmaceutical industry, the Faculty of Medicine’s Guidelines for Avoiding Conflicts of Interest in Relations Between Faculty Members and Industry apply. Of note, the guidelines state that medical students and residents should not interact with representatives of industry, including but not limited to pharmaceutical companies, unless there is a clear pedagogic objective that cannot be met in another manner, such as learning how to use a novel device. In such cases, the interactions must always take place within the presence of a faculty member.
• Please see McGill’s Consulting and Similar Activities by Academic Staff.

University of Ottawa

• Interactions Between the Faculty of Medicine and the Pharmaceutical, Biotechnology, Medical Device, and Hospital and Research Equipment and Supply Industries

Northern Ontario School of Medicine

• Conflict of Interest with Commercial Entities
• Conflict of Interest Policy with Commercial Entities

Dalhousie University

A spokesperson for Dalhousie University said she was unaware of any links that provide the university’s positions or policies on donations from pharmaceutical companies. Contacted Friday, she said the university was unable to answer questions by our publishing deadline.

University of Sherbrooke

• The Faculty of Medicine and Health Sciences (FMSS) at Université de Sherbrooke (UdeS) collates its research revenue data yearly for the purposes of annual reporting to the Association of Faculties of Medicine of Canada (AFMC). However, the revenue breakdown does not isolate the research funding from pharmas per se, but rather from all private sector research partners as a whole. This is why we do not have precise data on the funding provided specifically by pharmas. We are, however, happy to share this data with you: at the FMSS, private sector funding fluctuated between $4.8 and $5.9 million per year since 2012. Also important to note is that the research agreements the UdeS enters into with partners from the private sector are usually subject to confidentiality restrictions regarding not only the agreement terms, but also the identity of the partner or even the existence of the agreement itself. Indeed, most contain critical commercial information that is of crucial value to this category of partners who are typically looking to protect any competitive advantage for economic considerations.
• Many university professors regularly act as scientific consultants in their particular area of expertise. This not only provides a desirable contribution to society, but is also an expected part of the career path of researchers who come to develop highly specialized scientific expertise and know-how that are often difficult or impossible to find outside of academia. Our researches are thus regularly invited to give talks as guest speakers or to be part of scientific advisory boards, not only by public sector partners but also by the private sector. At the FMSS, all professors must return all consulting honoraria to SMUS(in the case of profs who are MDs) or to CRMUS (in the case of profs who are not MDs). Also, at the suggestion of the AFMC, the FMSS developed a guide on the activities (training, continuing education) and professional conduct to adopt with pharmas. FYI, should a researcher receive a cheque in his or her name from a pharma, that person is required to immediately hand it over the cheque to UdeS financial officers.
• All UdeS professors must declare their situations of conflict of interest (financial or other), in compliance to UdeS Policy 2500-21. Also, in the case of research with human participants, all conflicts of interests must additionally be declared to the Institutional Ethics Review Board, who is charged with examining and approving research protocols. UdeS policies are available on its website. The duty to declare conflicts of interest is also enshrined in a series of normative instruments including the Tri-Council Policy Statement, as well as the FRQS Policies on research ethics, integrity and responsible conduct, the Code des professions, and other health professional codes of ethics (MDs, nurses, physiotherapists, occupational therapists, etc.). At UdeS, although we do not collate the amounts disclosed in declarations of conflicts of interests, the management measures of individual situations of conflict of interest may pertain to financial verifications. Also, research contracts that are entered into by UdeS with private sector partners generally comprise misted budgets, i.e. part of the funding goes to salaries (including any consulting honoraria) whereas the other goes to consumables and small equipment. We never collate the individual details of contractual budgets. In some instances, the contract amount is not determined, but rather determinable, meaning the contract duration or amount of services rendered (etc.) may vary. University financial services are accountable to strict controls with respect to management of all research funds and awards.

University of Saskatchewan

Media contacts for the University of Saskatchewan did not reply to Global News’ multiple requests for policy comment.

Source: https://globalnews.ca/news/5743215/medical-schools-policies-on-pharma-interaction/

NEW DELHI: The Union cabinet on Wednesday cleared a bill to set up a National Medical Commission (NMC), which will have responsibilities such as approving and assessing medical colleges, conducting common MBBS entrance and exit examinations and regulating course fees.

The National Medical Commission Bill 2019 proposes to repeal the Indian Medical Council Act, 1956. NMC will replace the Medical Council of India (MCI), which was dissolved in 2010 following corruption charges.

The common final year MBBS exam will now be known as National Exit Test (NEXT) to start medical practice, seek admissions to post-graduate medical courses and as a screening test for foreign medical graduates.