MP doctor arrest: flawed justice: reminiscent of Hammurabi’s era of medical regulation


A doctor has been arrested in Madhya Pradesh’s Chhindwara after a toxic batch of Coldrif cough syrup allegedly caused the deaths of 18 children across two states, exposing alarming lapses in drug quality control.

 Strangely enough, when the drug manufacturer and the drug controller are responsible for the quality of drug, the doctors are the one who is arrested.  Does that imply that doctors should now stop expecting justice from courts and Government?

 The whole process appeared flawed from the root. Blame for the poor quality of drugs manufactured is passed on the prescribing doctor.

  Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors due to application of average wisdom.

 This strange kind of justice delivery has unmasked the everyday struggle of the doctors in the present era.  The unjustified arrest just for prescribing a medicine has depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  This incident has unveiled the despondency, moral burden, and injustice that doctors work with.

 An effort to govern or regulate the medical profession is not new. Hammurabi had initiated to write the rules of the game. This single professional species was managed with cruel regulation around 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi 5000 years ago,  was  not even at the   doorstep of medical science, but he promulgated some rules. It is difficult to say whether he was naive or brilliant enough to make it more mathematical. He fixed heavy prize for saving lives and used to cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still remains somewhat  unfair to doctors.  In other words, it has not attained enough evolution and maturity. 

Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of a doctor to society is not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors due to application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished.

Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such harsh regulatory systems will dissuade other good people joining the profession, again resulting in further inhibition and flourishing of profession for the good.  Obviously, harsher penalties will discourage a physician surplus.

Today the global system of medical regulation, is becoming somewhat similar, to those ancient regulations in terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is even though now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

Fear factors of injustice to  doctors and impact of present legal complexities is already at par with that of Hammurabi’s era.

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Cough syrup tragedy. Responsible:  doctor-pharma-drug regulator?


A doctor has been arrested in Madhya Pradesh’s Chhindwara after a toxic batch of Coldrif cough syrup allegedly caused the deaths of 18 children across two states, exposing alarming lapses in drug quality control. Of the total deaths, 14 were reported from Chhindwara alone,    A special team from Kotwali police arrested Dr Soni from Rajpal Chowk in Chhindwara late Saturday night after the FIR was registered against him, the SP said.

      The doctor has been booked for negligence and prescribing the medicine even after its adverse effects on children for nearly a month. The manufacturer had been charged as it was supplying contaminated syrup, as per the test report, Pandey told PTI.

        Here doctor who prescribed was arrested, whereas who manufactured the cough syrup is primarily responsible.

 What is the role of ‘Drug regulator’ and ‘drug quality regulator’ in such cases?

Do they carry any accountability or responsibility?  

Strangely doctors are invariably the easy scape-goats.  It is time to treat pharmaceutical malaise. The rise in “falsified and substandard medicines” has become a “public health emergency.” A surge in counterfeit and poor-quality medicines means that thousands of patients a year are thought to die after receiving shoddy or outright fake drugs intended to treat ailments. Most of the deaths are in countries where a high demand for drugs combines with poor surveillance, quality control, and regulations to make it easy for criminal gangs and cartels to infiltrate the market.

   If deep investigations are not done in such cases, poor quality medicines will continue to be marketed and doctors would be held responsible for the adverse reactions and deaths. Strict regulations for quality of pharmaceutical agents are need of the hour.

    Usually, every problem related to health is called medical malaise, but that is a misnomer.  In fact, health care comprises tens of different industries.  Complex interplay of various industries like pharmaceutical, consumable industry and other businesses associated with health care remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain largely unregulated. Collective malaise of all these is conveniently projected as medical problems as blame is conveniently passed on to doctors, as they are only visible component of mammoth health business.  Rest all remain invisible, earn money and doctors are blamed for the poor outcome of the patient, as doctor is the only universal link that is visible with patient. By an average application of wisdom, it is easier to blame doctors for everything that goes wrong with patient.

     In routine, if patient gets fake or low-quality medicines and does not get well, gets side effects, doctor will face harassment. Whereas people involved and industry will be sitting pretty and make money.

The government on Sunday also suspended Dr Soni from service. He has been attached to the health department regional officer in Jabalpur, as per an order.

MP Chief Minister Mohan Yadav on Saturday said strict action will be taken against those responsible.

The Tamil Nadu drug control authorities, in their report dated October 2, declared the Coldrif syrup sample (Batch No SR-13; Mfg: May 2025; Exp: April 2027) manufactured by Sresan Pharmaceuticals, Kancheepuram, as adulterated because it contained diethylene glycol (48.6% w/v), a poisonous substance “which may render the contents injurious to health”.

Following the report, the Madhya Pradesh Food and Drug Administration issued instructions to stop further sale and distribution of Coldrif statewide and immediately seize any available stock for investigation under the Drugs and Cosmetics Act, 1940. It also ordered that other products manufactured by Sresan Pharmaceuticals be removed from sale pending testing.

The Tamil Nadu government on Friday banned Coldrif following reports of deaths in Madhya Pradesh and at least three similar fatalities in Rajasthan due to suspected kidney infections.

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How MDROs (Multi-drug resistance bacteria) have entered our community, body and homes


It is a common belief that MDRO’s (multi-drug resistance organisms) are found and generated in hospitals, but in recent times this may not be entirely correct. Resistance bacteria are present in community and present in our home environment.  This trend is dangerous as millions of people are losing battle to antimicrobial resistance (AMR) and MDROs every year.  AMR alone is killing more people than cancer and road traffic accidents combined besides economic loss. To combat AMR, it is important to find causes of generation of MDROs and how they enter human body and community environment.   Therefore, it is important to realize the contribution by all the following four important factors: humans, animals, food and environment.

Prevention of MDROs and   AMR in India is a challenge. India has been referred to as ‘the AMR capital of the world’. While on one hand, emergence of newer multi-drug resistant (MDR) organisms pose newer diagnostic and therapeutic challenges, on the other hand India is still striving to combat old enemies such as tuberculosis, malaria and cholera pathogens, which are becoming more and more drug resistant.  Factors such as poverty, illiteracy, overcrowding and malnutrition further compound the situation.  Lack of awareness about infectious diseases in the general masses and inaccessibility to healthcare often preclude them from seeking medical advice.

        Easy availability of over- the- counter (OTC) drugs, leads to self-prescription of antimicrobial agents or administered without any professional knowledge regarding the dose and duration of treatment.

         Pharmaceutical industry has caused tremendous rise in the amount of chemical waste.  With the lack of strict supervisory and legal actions, this waste reaches the water bodies and serves as a continuous source of AMR in the environment.

 Another important challenge could be the use of antimicrobial agents as pesticides and insecticides in the agriculture industry. Farmers use antimicrobial agents to protect their hard-earned field and animals from pests and rodents. They are unaware about future consequences and impact on environment.

AMR in milk and food animals has been another big challenge.   Gram-negative bacilli with extended-spectrum β-lactamases (ESBL) have been isolated from milk samples and poultry.    Enterobacteriaceae isolated from fish and Salmonella species from broiler were isolated. 

AMR in environment; Antimicrobial-resistant bacteria have been reported from different water sources of India. The major sources are the pharmaceutical waste waters and hospital effluents that are released into the nearby water bodies without adequate treatment.

    In large rivers of India, multiple inlets with varying concentration of drug-resistant bacteria have been found.  ESBL producers among Gram-negative bacteria isolated and E. coli isolates found from north as well as south Indian rivers. 

To combat AMR, there are many steps possible at communityand Government level. Antibiotic stewardship plans for healthcare settings, promoting further research on the drivers of AMR, judicious use of antibiotics, strict vigilance of over the counter(OTC) antibiotics, control  of  hospital effluent plants, monitoring waste water discharges from pharmaceutical companies, regulation of use of antimicrobial in food and milk animals, improving agricultural practices and educating masses at community level  about AMR.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

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 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

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