quack causes death of one patient in one yeardue to wrong diagnosis an - PDF document

1 quack causes death of one patient in one
quack causes death of one patient in one yeardue to wrong diagnosis and treatment, nearly1.5 million silent killings take place across thecountry. Although a modern quack still mouthsthe same old promises, his manner and stylehave changed. He has become more sophisti-cated in his approach to fooling people. Hequotes or misquotes scientific references and hesprinkles his conversation with medical termsin dealing with prospective patients. Indeed,modern quackery has become so high-tech thatmany are deceived in the process. Nonetheless,the quacks hardly have any guilt about theirmedical practice. In fact, they tout it as one ofthe way of social serviceLot of patients visits quacks for anal canal ail-ment in the hope of low cost, operation less cure.Most of them face incomplete, irrational treat-ment and suffer from prolonged morbidity. Theyare shy to come forward to tell about these com-plications and to consult appropriate experts untilwhen they are in miserable situationIt is unfortunate that people approach quacksfor their low charges, but ultimately end up pay-ing more because of the wrong treatment theyundergo. The innocent patient is easily taken fora ride due to an easy access to such quacks andthe promise of early relief. There is a need to ed-ucate the masses about the dangers of beingtreated by the quacks. The Medical Associationsand law enforcing agencies are required to dealwith these pretentious charlatans, offering quackLack of awareness among the public, and apa-thy on the part of enforcement agencies, hasbrought about a situation where quacks are thriv-ing in the country.To distinguish quacks from registered doctors,doctors should display their certificates in theirclinics, abiding by the new ethical code of con-duct of MCI. A good deal of public education isnecessary to create awareness about anal canaldiseases and their scientific treat ment and mod-ern short stay, curative, patient friendly surgicalReferences. The quack doctor. J Lab ClinMed 2005; 146: 352-353.RAY. Ethical, scientific, and educational con-cerns with unproven medications. Am J PharmEduc 2006; 70: 141.Quackery–a feedback discussion. J In-dian Med Assoc 2007; 105: 656.Quackery–a burning threat of humanhealth. J Indian Med Assoc 2007; 105: 423.Price of visiting a quack–case re-ports. Indian J Med Sci 2000; 54: 290-292.. Proposal to ban quackery. J Indian MedAssoc 1987; 85: 60-61.P.J. Gupta retroperitoneal abscess necessitating emergencylaparotomy and defunctioning colostomy loomslarge. Excessive local reactions, necrosis fol-lowed by hemorrhage and allergic reactions, ex-ternal hemorrhoid thrombosis and delayed hem-orrhage are few other complications. However,the quacks hardly take any such precautions be-Quacks inject various corrosives in the fistulatract, which creates severe inflammation andnecrosis, which when heals by fibrosis leads toclosure of the fistula tract. Most of the patientshowever, are not lucky enough to reach to thishappy ending and land up with various complica-tions like necrotizing fascitis of the anorectum,perianal region, and scrotum, which necessitateemergency debridement and defunctioningcolostomy. Septicemia and renal failure can oc-cur due to absorption of the toxic material andwill require costly treatment and an extendedhospital stay. For treating anal fistula, the “KsharaSutratherapy” (medicated seton treatment) that has itsorigin in the age old Ayurveda appears to havegained popularity. In this technique, the physi-cian uses a medicated thread, the “KsharaSutra”to cut through the tract of anal fistula. A steril-ized thread is repeatedly soaked in a medicatedsolution and allowed to dry up. One of ends ofthis thread is inserted from the external openin

2 gto bring it out of the internal opening
gto bring it out of the internal opening in the analcanal using a probe with an eye. The two ends ofthis thread are tied and then tightened at the ex-ternal opening with three knots. This procedureis repeated every week, ranging between 15 to 50sittings till it cuts through the fistulous tract. Thissimultaneous process of cutting through the tracttowards periphery, and healing in the opposite di-rection, eventually ends up in slitting open thewhole tract while simultaneously healing thewound.This is an established and proven therapyprovided the treating doctor is well versed withthe anatomy and basics of anal fistula patholo-gy. The quacks unfortunately lack both these pri-mary essentials and they just put the thread eithercreating a false passage, or keep the thread tooloose to achieve slitting of the tract. The processof changing the thread is singularly painful. Of-ten the patient wound not allows the doctor to in-sert the thread in proper position and with re-quired tension due to the excruciating pain. A lotof patients are seen reporting to the proctologistswith the threads in place in their fistula tract withfoul smelling discharge, infected wound with ex-coriated skin, severe pain and induration in thatregion.In case of multiple fistulae, the proximal open-ing which is close to the anal verge and can bethreaded with relative ease is treated, while thedistally placed opening (which ideally should bedealt first) is left unattended. Thus, the tract per-sists in spite of long duration of therapy and suf-ferance for months together. In such situations, it is better to remove the of-fending thread and clean the wound thoroughly.If any necrotic or suppurative cavity is found, itshould be debrided. Antibiotics and anti inflam-matory medication would help in relieving thepain and discharge. Once the acute stage is over,appropriate surgical options could be adapted totreat such fistula.The way quacks treat large prolapsing or inter-no-external hemorrhoids is based on simple prin-ciple, throttle the mass to obscure the blood sup-ply, create necrosis and eventual sloughing of thepile mass from its place. Various threads, liga-tures and banding materials are used to carry outthis maneuver. But the patient has to passthrough a nightmare of severe pain, huge throm-botic lump at their bottom, bleeding and otherseptic symptoms. Few may get relieved once themass is sloughed off, but it leaves behind a largewound, which takes month to heal with eventualThe complications of such as mass hemor-rhoidal ligation include bacterial septicemia ortoxemia, bleeding and thrombosis, supralevatorabscess, delayed massive rectal bleeding, peri-anal abscess, perianal fistula, and painful pri-apism. Many patients have reported with pelvicAccording to a study, there are around 1.5million quacks in India, i.e. the number ofquacks in our country exceeds the number ofqualified doctors. If it is presumed that one The role of quacks in the practice of proctology The Piles and Fistula quacks set up shops andoffer “money back guarantee”. They brazenlydisplay billboards near big hospitals. Thesequacks claim to practice some traditionalherbal medicinal therapy. But in actual, theytreat the anal ailments of the patients using var-ious toxic chemicals and acids and then try tootics and analgesics used in veterinary practice.Majority of the victims end up with fibrosisand lifetime suffering. The anorectal diseasesare considered as some sort of a divine curseand a matter of shame. The victims of thequacks, therefore, suffer without complaining.People even from educated and effluent classclandestinely visit these quacks either becausethe mainstream treatment has failed to give re-lief/ cure to the patie

3 nts with hemorrhoids, fis-tula, and anal
nts with hemorrhoids, fis-tula, and anal fissure, or they are too shy to dis-cuss the ailment with their family physician orat time even on peer advice.The possible reasons for the patients visitingquacks could be the attractive publicity gim-micks claiming faster, cheaper and sure curecontrast, the general or family practitioners areless enthusiastic in treating these ail ments. Amisconception also prevails that surgery for analailments is fol lowed by too much of pain, incon-tinence, bleeding and so on. Low cost of treat-ment, promise of lifetime guarantee by thequacks (some of them even issue a life time guar-antee card!) and a false belief that, treatment byquack was just a “treatment”involving no surgi-cal intervention.Observations and experience in this field hasshown that quacks treating fissures and sentinelpiles often get away without many complica -tions. Problems indeed arise when they embarkon treating fis tulae, hemorrhoids or ano-rectalneoplasms. The complications are created dueto lack of scienti fic knowledge and lack ofscrupulous asepsis. Most of these quacks areprobably former employees or relatives of a se-nior quack proctologist. After observing theproctological surgery from their seniors, theymimic the technique, but for want of formal me -dical education, they remain tech nicians & cre-ate complications by mishandling the cases orhandling the wrong cases. In the following para-graphs, a brief treatise from the Author’s per-sonal experience is given about the variousmethods adapted by the quacks to deal withano-rectal diseases and the resultant complica-Injection sclerotherapy is popular in mostparts of the world to treat first and second degreehemorrhoids by creating fibrous reaction in thesubmucosa of thehemorrhoidal tissue. The useof injection sclerotherapy started over a centuryago and throughout its development differentsclerosants has been used. The most acceptablesclerosant used is 5% phenol solution in oil. Thelow cost of injection sclerotherapy and the easewith which it can be administered by a single op-erator in an outpatient setting have contributed toits popularity. The procedure is generally consid-However, the technique of injection needsknowledge of anatomy of the region and theskill to inject the medication in the dose, depthand direction of the affected anatomy. Ideally,the injection is given in the submucosa to createan aseptic inflammation which when heals,gives rise to fibrosis, which obscures the patho-logical vascular enlargement of the hemorrhoid,that is responsible for most hemorrhoidal symp-But the quacks know little about these anatom-ical facts and thus instill the solution in placesother than where it is needed. Misapplication ofthis injection results in its being either too super-ficial, i.e. in the mucosa causing ulceration andbleeding, or too deep in the muscles or underly-ing tissue to create various septic complications.Such complications include severe pain, injectionUrological complications also are likely to re-sult from an anteriorly misdirected injection in-to the substance of the prostate, urethra or theperiprostatic venous plexus. The complicationsincludehematuria, oliguria, urinary retention,scess and impotence. As the most commonlyfound hemorrhoidal place is in right anteriorposition (11’O clock positions), the chances ofoccurrence of this complication are relativelySimilarly, the phenol in oil solution is to beprepared under strict aseptic conditions andshould be injected with all aseptic precautions.The patient is to be tested for HIV and Australiaantigen before being so treated. Immunologicallycompromised patients pose an additional risk insuch situations. The quantity of phenol to be in-jected

4 has to be scrupulously measured, as ther
has to be scrupulously measured, as thereis a potential for phenol to be absorbed systemi-cally with severe consequences. P.J. Gupta Most human beings will doalmost anything to prolong their existence orto relieve themselves from the suffering of adisease. Others will do anything to exploitthese desires by selling what they claim to bemagical remedies or panacea for all diseases-even for the incurable ones. Quack is one ofthe several names used for practitioners orpeddlers using supposedly ineffective medi-cines while it also relates to advertising bydoctors.This article describes the practice of quack-ery in ano-rectal diseases, their presentationsand the complications arising out of such pro-Quack, Proctology, Medical association, Alternative IntroductionBy definition, a quack is one who practices aform of medicinal system without qualification,training and registration from the appropriatecouncil or authority. Some of these practitionerssuccessfully promoted their medical and surgicalabilities and their remedies to a gullible public.Although many may have been harmless, a num-ber of them may be considered to be rather dubi-ous and dangerous. Alternative medicine has al-ways had an attraction for some members of thecommunity, and this allurement has even extend-ed into the twenty-first century.Quacks are practicing in every field of medi-cine, field of surgery being no exemption.Quackery in sur gical field mainly revolves roundthe treat ment of anal canal diseases i.e. piles, fis-tula-in-ano, fissure-in-ano etc. Quacks in thisfield are often more popular than the regu larpractitioners. One can find their advertisements,signboards and offices in every township. TheyReview for The role of quacks in the practice of proctology P.J. GUPTAGupta Nursing Home, Laxminagar, Nagpur (India) Pravin J. Gupta, MD; e-mail: drpjg_ngp@sancharnet.in drpjg@yahoo.co.in have neither a recognized degree nor a license torunning their “dispensaries” with impunity inevery part of the country. Most of them have one-room chambers. They even put up signboards inized doctors and even handout prescriptions ontheir letterheads. They even dare to drive away aqualified one from the area of their operations.A large number of patients from all walks oflife and different cross sections of society, visitSome of them are happy, too, for visiting themand declaring that their ailments were cured. Butmany of them have to repent for life, mainly be-cause their origi nal problem gets complicatedand have to pay a heavy cost for getting out ofsuch complications. Incidentally, most quacksclaim to be super-specialists in their fields of ex-pertise. These quacks use the abbreviation RMPas qualification. The letters stand for Rural Med-ical Practitioner, a camouflaged version of theofficial title Registered Medical Practitioner.There are also cases in which fraudulent medicalpractices are passed on from father to son, thefather’s MBBS degree being used as an heir-Many of these piles specialists claim to treatpiles within an hour with a “magic wand” andpeople, especially from the lower strata of soci-ety, becomes an easy prey to such baits. In thename of providing relief within an hour, thesequacks inject various corrosives directly into thepiles thereby causing severe inflammation andcausing excruciating pain to the patients. Attimes a single needle is used for injecting medi-cine in many patients. This can result in higherincidence of blood borne infections like hepatitisand AIDS in patients visiting them. Whilequacks claiming to treat piles dote every nookand corner of the country, in many cases theAyurvedic and Homoeopathic practitioners tooact as surgeons and treat every kind of anorectal 2010; 14: 795-