Physicians Academy
Established in December 2006 by the Kashmir Academy Of Private Physicians
Table Of Contents
Editorial :
 Illegal Practice in Kashmir
Article 1 :
 The prevalence of Community Acquired Multi-resistance organisms, Urinary Tract Infection in Kashmir, India: a Pilot Study
Article 2 :
 Fecal Microbiota Transplantation
Picture of The Month :
 Picture of The Month February 2018
Drug Update :
 XTANDI® (enzalutamide)
Abstracts from Other Journals :
 Abstracts from Other Journals-February 2018

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Feb 2018 ( Volume -12 Number -2)

Illegal Practice in Kashmir
Sarosh Ahmed Khan, MD; FACP
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Illegal Practice in Kashmir

Sarosh Ahmed Khan, MBBS; MD; FACP

Due to the three decades of turmoil in Kashmir, most departments have suffered. But the brunt of the damage done is to the medical profession. There have been various factors responsible for the decline in healthcare, including patient care, the morals and the ethics associated with this profession. Lack of accountability is perhaps the main reason. Illegal practitioners of medicine were present before too, but got invigorated in the present dismal scenario.

The practising Chemists, Barbers, and Quacks: These people have been ‘treating’ the gullible and the ignorant. The barbers used to drain the boils and abscesses though now this practice is seen less in the cities but continues in the rural areas. The risk of infecting the patients by contaminated needles and instruments is high. In one such case recently, a quack in the state of UP, moving on bicycle to visit patients in villages, has infected 33 people with HIV. He used the same syringe in all patients and now is running away from police(1).

The Unlicensed practitioners: I have previously also written in detail about the menace of unlicensed practitioners in Kashmir(2). There are various varieties of ‘healthcare providers’ like technicians (see Fig. 1) who are not legally authorised to practice any form of medicine. However considering the need for medical care, the rampant illiteracy and lack of awareness of people in Kashmir, these people have flourished. Even the religious preachers have jumped into this and the poor people have to pay the price. Strangely in Kashmir and in India in general, everyone criticizes the doctors but wants to himself practise medicine!

Figure 1. Medical Prescription written by an OT Technician

The Ayurvedic, Unani and Homeopaths: There is a surge in the number of people practising these forms of medicine. However most cross the line and prescribe the allopathic medicines. Their own drugs are not tested in animals nor on humans, are not standardized, and the adverse effects are not documented by any agency(3). It is established now beyond doubt that the amount of toxic metals present in these ‘drugs’ is alarming and can be disabling. Lead, mercury, arsenic and other metals are found in very high quantity(4). A commonly used herb, liquorice, produces severe electrolyte imbalance which can lead to paralysis. Another called black cohosh can lead to liver failure and death(5,6). Ways to improve their own brand of treatment should be their priority, rather than trying to “bridge” over to allopathy.

The Midwives conducting illegal abortions: Although Pre-Natal Diagnostic Techniques Act (PNDT Act 2017) bans detection of sex of the fetus and female feticide is a punishable crime, this practice is carried out by midwives and other illegal practitioners. One such person was recently raided and her group arrested from a rural area here(7).

The Illegal Sonologists, Infertility experts, Sex specialists: There are some non-medicos practising as Sonologists, Infertility experts and Sex Specialists. One such ‘Vaid” used to come from Delhi to Kashmir and stay in a top hotel here. After the turmoil this man has been replaced by many local ‘experts’!

The Illegal timings: Doctors working in SMHS, SKIMS-MC, JLNM, LDH, Gousia Hospital and other government hospitals are allowed to practice, but it is common knowledge that there are many among these who practice during the working hours. One can find them in the private clinics up to as late as 12 noon and then again at 2.30 pm in the afternoon. Some have started the routine of three days a week in the hospital and the other three days in the private clinic. The concerned Medical Superintendant has to check this.

The Posts which have been banned from practicing: The Director, the Principal, the BMOs and CMOs are not entitled to practice. If they practice, they too become illegal practitioners.

The Hospitals which are banned from indulging in practice: SKIMS is a tertiary care hospital meant for research. Unfortunately many from this prestigious institute clandestinely practice. Recently a sting operation exposed the tip of the iceberg(6). Discussions about whether non practising allowance is adequate or not is meaningless because the doctor has to abide by the rules of the place where he or she works. Again the Director has to be vigilant and inform the higher-ups in case of any breach.

The damage to the Private Setup: The above mentioned facts are the main reasons why the private setup in Kashmir is still in its infancy.

The alternate way out: Resignation from the government job and then you are free to practice.

The Negative effects of Illegal Practice:

Teaching suffers: The third year students need to be taught by senior doctors. Unfortunately, the junior PGs are assigned the job. Even the final year students are taught by the Registrars and not by Consultants.

Patient care suffers: The routine of a post emergency round by team of Consultants continues even today. On other days the patient is at the mercy of the house surgeon and the intern.

Negative impact on the juniors: who see the senior government doctors as their role models. Regrettably, these juniors do the same when they become Consultants.

Research takes a backseat: No surprise therefore, that for decades there has not been any breakthrough in research from these centers.

We sincerely hope the government of the day takes note of these problems and addresses them at the earliest so that the harmful effects of illegal practice are minimised. Also patient care will improve as well as the teaching of young doctors. Strict punishment to un-licensed practitioners will be a deterrent. Moreover doctors have to take moral responsibility and behave as the ‘cream of the society’.


1.    At least 33 infected with HIV in India after 'quack' uses tainted syringe: police. Reuters. February 6, 2018.

2.    Khan SA. The Unlicensed Practitioner in Kashmir (Editorial). Physicians Academy July 2008 vol 2 no 7:34

3.    Khan SA. Is Ayurveda safe? (Editorial). Physicians Academy. October 2008 vol 2 no 10:85-86 

4.    Saper RB, Phillips RS, Sehgal A, Khouri N, et al. Lead, Mercury, and Arsenic in US and Indian-Manufactured Ayurvedic Medicines Sold via the Internet. JAMA. 2008;300(8):915-923.

5.    Lin SH, Yang SS, Chau T, Halperin ML. An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci. 2003 Mar;325(3):153-6. PMID : 12640291

6.    Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl. 2006 Jun;12(6):989-92. PMID : 16721764

7.    Kulgam police apprehended culprits involved in illegal abortion. Kashmir News Observer. December 17, 2017.

Author Information: Dr. Sarosh A. Khan is Senior Consultant, Internal Medicine and Director Naseem Medical Center, Baghe-Mehtab, Srinagar, Kashmir, India. Pin: 190019. He is the Editor in Chief of Physicians Academy. Affiliations: Governing Council Member of American College of Physicians (India Chapter) from 2014-2017. Email:

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