QUACKERY: BANE OF EVIDENCE BASED PRACTICE AMONG HEALTHCARE PRACTITIONERS IN NIGERIA by NURSE OMOLOLA ADAMS
QUACKERY: BANE OF EVIDENCE BASED PRACTICE AMONG HEALTHCARE PRACTITIONERS IN NIGERIA
.
ANNUAL SCIENTIFIC CONFERENCE:
ASSOCIATION OF GENERAL PRIVATE NURSING PRACTITIONERS, OYO STATE CHAPTER.
VENUE: SUPER K HOTEL AND SUITES
PRESENTED BY:
NURSE OMOLOLA ADAMS OLATAYO RPHN, HHMC.
SEVENTH DAY ADVENTIST SCHOOL OF NURSING, ILE IFE, OSUN STATE.
ABSTRACT:
Health as a matter of right is recognized throughout the world for its intrinsic value. Nigeria is a signatory to the Alma Ata Declaration is committed to provide “Health for All” irrespective of any discrimination on the grounds of rich or poor and urban or rural. The National Health Policies are formed on the basis of this principle. But inequality of opportunities, the gross mismatch between the objectives and the resources available and the inability of the state to bring quality health care within the reach of all has increased the vulnerability of the people particularly the rural segment and led to the emergence of a new tier of physicians running a parallel and bane of evidence based practice of health care system and playing a formidable role in the rural health care market as rural health providers. This group of self-styled practitioners called quacks, despite in expertise is doing a good business in the villages taking advantage of the lacunal in the public healthcare system. As testimony to their legitimacy, they manage, certificates from unauthorized and unrecognized institutions.
INTRODUCTION
Quackery is one of the greatest menaces facing healthcare delivery globally. By definition, a quack is a person who pretends, professionally or publicly, to have skills, knowledge, or qualifications he or she does not possess. By extension, quackery connotes establishing or running a healthcare facility without qualified or certified personnel; or operating beyond the limits or scope of one’s specialization or expertise. In the field of healthcare delivery involving diagnosis, management and prevention of health issues, quackery can have unimaginable and damaging consequences for the populace.
It is an undeniable fact that in the last 56 years of Nigeria’s history, her health sector like other sectors of the country’s economy has had its good and bad times with uninspiring national health indices attributable to years of cumulative insults, lack of professional order and best practices, a weak private health sector, poorly developed social infrastructure, as well as policy inconsistency. Its troubling that after 56 years of Nigeria’s independence, her health system is still struggling to deliver health dividends of democracy to her long suffering people. Nigerians had expected that following the Walter-Harkness Ten Year Development Plans as well as the enunciation of the first National Health Development Plan in 1960, Nigeria before half a century of her independence would have achieved Universal Health Coverage with all her citizens having access to quality and affordable health care.
According to Merrian-Webster, the methods and treatments used by unskillful Doctors or by people, who pretend to be doctors. The term quack is a dipped from the archaic term “quacksalver” from Dutch meaning “hawker of salve”.
Stephen Barrett defines quackery “as the promotion of unsubstantiated methods that lack a scientifically plausible rationale” and more broadly as “anything involving our promotion in the field of health.
Evidence-Based Practice (CBP) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett 1996).
STEPS IN EBP
I want to highlight few steps in EBP in order to establish quackery.
1. Assess the patient:- start with the patient, a clinical problem or questions arises from the care of the patient.
2. Ask the question:- Construct a well built clinical question derived from the case.
3. Acquire the evidence: Select the appropriate resource(s) and conduct a search.
4. Appraise the evidence:- Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice).
5. Apply talk with the patient: Return to the patient - - integrate that evidence with clinical expertise, patient preferences and apply if to practice.
6. Self-Evaluation: Evaluate your performance with this patient.
The topic is a trending issue in our society as it has a monumental effects on healthcare industry. Various articles had been written on quackery is the healthcare industry. Quackery is a virus destroying the cells component that makes up the health care industry around the world. Quackery is a global phenomenon, which requires global participation in combating it.
The pointer, an online news outfit recently reported an article titled a Quacks in The Health Sector”, it read thus” Recently, Nigeria was ranked 197th out of 200 countries with undesirable health indices, spiraling morality rate and increasing cases of complications resulting from wrong medical diagnosis. Reports have it that the nefarious operations of dubious businessman masquerading as doctors has led to as unhealthy parading of care givers degenerating into grave diggers”. It further stated that “The operation of the quacks is one key reason the nation’s health care is tottering on the borders of incredibility and total lack of confidence. This, in turn, is what has been fuelling the rising trend of medical tourism and the consequent loss of foreign exchange in search of health care abroad. The quacks are said to be more accessible and in a society with visible poverty”.
The Supreme Court defines quack as “a person who does not have knowledge of a particular system of medicines but practices in that system. They include those who have not received formerly recognized training and have informal training through seminars, workshops, Private Hospital Trainings. They are not registered with any government regulatory body and operate outside of the purview of regulation. Barun Kanjilal, a renowned scholar, Indian, in his article “Harnessing the underground health market: the case of Indian Rural Medical Practitioners who practice modern medicine without any formal training or legal sanction represent the dominant group. The market is underground in the technical sense (since there is no legal sanction) but open in all practical grounds. To prevent malpractices and maintain quality of healthcare, rules and regulations defining a code of conduct for the healthcare professionals is provided by acts such as Medical Council Act…..Nursing & Midwifery Council of Nigeria Act 1979, the Consumer Protection Act of 1986, under the Medical Council Act the doctors are forbidden to indulge in any sort of advertisements of their dispensaries or professional qualification accept any gifts and must display their registration certificates and prescribe generic names of medicines rather than branded names. The Consumer Protection Act is supposed to give protection to people who suffer from inconvenience or discomfort caused by poor quality of medical care. But the quacks do not follow any rule relating to medical or nursing ethics and indulge in improper practices.
Quackery is big business. Individuals spend billions of dollars every year looking for the next miracle cure. Consumers must learn to protect themselves by questioning what they see or hear in advertisement. The media that promotes these products usually do not regularly screen their advertisements for truth or accuracy. Prescription drugs undergo vigorus testing for safety and effectiveness before they are sold, and over-the-coutner medicines also are subject to a drug review process Dietary supplements are not required to undergo government testing or review before they are marketed, yet these products may have harmful effects that could present risks for people on certain medicines or with certain medical conditions. Individual who are aware of a questionable health product can contact the Federal Trade Commission or their state attorney general’s office.
REASONS FOR EFFECTIVE QUACKERY
1. Ignorance: Many consumers simply do not know the difference between health products that have been shown to be effective and those which have not. The same is true of health services. For example is it legal for someone to post a sign calling onself a “doctor”? Yes-it is legal as the person does not claim to be a “medical Doctor” or M.D – yet many in the general public would assume that person is a medical doctor.
2. Placebo Effect: The mind is a powerful influence on how we feel. The placebo effect means that we feel better because we think we SHOULD feel better. For example, if a person takes a vitamin pill believes he will have more energy, he may think he has more energy just because he believes he will have more energy, he may think he has more energy just because he is “supposed to” (even though the pill provided no additional energy-we get energy from foods, not from pills. Feeling energetic is easily controlled by the mind unless a person has a health problem that compromises energy levels.
3. Self-limiting Conditions: Some health problems are self-limiting. That means that the disease or conditions runs its course even if the person does nothing at all. Problems caused by viruses are like that they go through an active stage and then a latent stage. If a person practices quackery and the virus-produced problem go away, they may give credit to quackery when the problem would have gone away anyway. An example of this comes from the previous activity: if a person rubs his wart with a raw potato and it goes away, it did so because the virus that caused that wart had run its cause. Seventy percent of all health problems will go away if the consumer does nothing at all (initial face). Therefore consumers need to know the difference.
4. Slight of hand: This is the use of a magic trick: psychic surgery is an example of the kind of fakery that some quacks use to promote a false product. This is way common in our home movies and videos where the so-called doctors has some tricky and fakery signs of magic to promote care. At the long run, many consumers patronize such outfit.
CHARACTERISTICS OF QUACKERY
1. Progressiveness: Quacks follows legitimate science and say that whatever they are promoting is the latest greatest in science.
2. Profitable Business: Quacks are often very successful. Because there is “a sucker born every minute”, they make millions of dollars of those who fall for their schemes.
3. For Incurable Disease: Quacks exploit the health problems that modern medicine cannot cure. Persons living with AIDs, arthritis, cancers and Alzheimer’s Disease often fall prey to quacks because they want to believe that something will help their condition. Baldness and being flat-chested are also exploited by quackery. There are dozens of ineffective “cures” for these two conditions in magazines.
MOST VULNERABLE CONSUMERS
1. The Uninformed: Consumers are vulnerable to quackery if they do not know the facts. A good source of reliable information in quackery is the country’s health minister providing a platform to assess the registered healthcare facility. All unregistered facility to face the wrath of the law.
2. The Restless:- Consumers are at risk for exploitation if they expect quick results and are unwilling to take responsibility for their own health.
3. The Miracle Seeker: If someone believes that a wonder is possible, he or she may be taken in by someone promoting something sensational. A good rule of thumb is “if it sounds too good to be true, it probably is”.
4. The straw Grasper: These are desperate individuals. They may have a life threatening condition and want to believe there is hope when there is no hope. The quack is all too willing to provide the victim with FALSE HOPE.
5. Financial Strength: Individual with poor financial status patronized quacks. This is so because there is no standardization in quackery practices, it’s a money-ventured outfit, hence no quality nor standard care.
HOW TO IDENTIFY QUACKS
Quacks are easy to recognize. Quackery invests its efforts in propaganda directed at the public rather than in controlled research directed toward other professionals. This is true of all types of quackery, from mouthwash to laterite. The technique of quackery is usually the same regardless of the system.
1. Present false health claims confusingly: the technique is to tell a series of obvious truths followed by one life. The true statements in the series are often trivial. The series usually includes common places of preventive medicine.
2. Present bogus models of health, mankind, and even the universe: quackery invariably opposes the understanding of disease provided by empirical science. Holistic medicine (as the emphasis is perverted by quackery) implies, all disease has the same cause and may be treated in the same way. All disease indicates that the “whole person” is in need of remediation. Disease and therapy, because they affect individual “whole person” cannot be studied by examining a series. All quack claims are based on selected anecdotes. Disease being absent therapy may still be instituted to promote “wellness”.
3. Create fear of everything except quackery: Quacks create fear of familiar things (flour, sugar, tap water, etc) Quacks capitalize on and expand fear of unfamiliar things, Disease: quacks of course claim to detect and treat it sooner than anyone else can.
4. Spiritual forces: Quackery gets free publicity through many different churches, Mosques, both conservative and liberal. All target groups are told to have “faith” in quackery, and made of feel guilty about their own lack of faith.
5. Pretend to love the victim and to share his/her values: Quacks invariably appear “caring”, “considerate”, “helpful”, “loving”, “personally concerned”, “unhurried”. Quackery varies its appeal for different target groups, conventional lifestyle (family), alternative lifestyle (alternative), minority groups (cultural tradition), all lifestyles (altruism, fun, independence, love). Quackery makes indoctrination and treatment enjoyable. Quack propaganda uses humour as often as possible. Quack therapies care usually pleasant (People like health food, apricots, coloured lights, dancing, enemas, massages, music, individual attention). Quacks never get tired of telling their patient how much they “love” them. Quackery presents itself as “self-help”.
5. Offer false hope without making specific promises.
6. Operate as a bogus organization: Names include: Alternative, Balanced, Church, Foundation, Harmony, Holistic, Institute, life, Preventive, Research, Science, Wellness etc. Recently-founded organisation lobby and advertise. Quacks claim to be persecuted and misunderstood. They are fund of comparing themselves to Galileo and occasionally to Michael Servetus and Charles Darwin.
In a study conducted by Tuhin K. Das (2008) observed that quack plays an important role in the health sector in India, especially in the rural areas. But till now, there is no reliable estimate of the number of Quack in India and the extent of their services. Mostly Quacks are found in the rural areas, where they are the first source of medical care for the rural poor. The study reveals that the preference for quack is more or less income specific and age specific, and moreover, inspite of low cost of treatment under quack, effectiveness cannot be assured as in allopathy.
The rural people having low income prefer to be treated by the Quack because of their poverty but they do not take the risk to let their children be treated by them. Yet, it can be said that for the rural poor people, medical services offered by Allopathy. Obviously, the cost of treatment is an important part, which influences one’s choice of medical cure. But the effectiveness of any sort of medical treatment also plays another important role behind making a decision regarding medical care. When CER (Cost-Effectiveness-Ratio) is considered, treatment by quack is found to be cost-effect at least for cold and cough, fever (excluding typhoid and malaria), diarrhea and dysentery.
On the other hand, to judge the efficacy of the services provided by the quack, another aspect is to be taken into consideration. It is often found that the patient whose health state improves under any type of medical service, does not end to shift to other medical services for the recovery. Such non-transition also forms an alternative measure of effectiveness. It has been observed that the proportion of non-shifting patients who were initially treated by Allopathic doctors was most and that by quack was least. Thus, inspite of the low cost of treatment under quack (which is the main cause of lower CER), effectiveness (i.e recovery) cannot be assured as in Allopathy.
The Nursing and Midwifery Council Act 79, Section 21 where it dealt with unauthorized training stated as below “It shall be offence for any person without the approval of the Minister given on the recommendation of the council to train any person as a nurse or midwife or to provide any course of training or establish any school for such purpose or as one of its purposes; and any such person shall be liable.
a) On conviction otherwise than a High Court, to a fine of N1,000 or to imprisonment for a term of six months, or to both such fine and imprisonment;
b) On conviction in a High Court, to a fine of N2,000 or to imprisonment for a term of two years or to both such fine and imprisonment.
This subsection unveils who and how training should be conducted. Many private hospitals endangered the live of Nigerian by training the so called “auxiliary” who later returned to be quack by establishing a clinic without having required education and professional skills. The punishment may sound obscured as it does not reflect or march up with the offence. N1,000 or six month imprisonment or both as well N2000 or 2 years imprisonment is under-statement.
EFFECT OF QUACKERY ON THE SOCIETY
1. Poor health care delivery:- High numbered of quackery practices has taken over the health care system. Hence, there is a high patronage of quack which in turn provides unscientific care leading to greeter risk of health services.
2. Poor professional judgement, skill, discipline and lack of competence in health care setting.
3. Increase in complication arising from patronizing quacks which eventually increases death rate.
4. Quackery endangers the society by promoting hazardous healthcare, unskillful care and biased health care services in which the victim is transferred to a registered facility after complication set in.
5. Quackery is a profit-oriented organsiation disregarding qualify health care.
In recent time, various professional organizations raided some healthcare facility that promote quackery. NANNM, the professional union of Nigeria Nurses has been shutting down some health facilities in collaboration with Ministry of Health in Ogun State, Lagos State, River State, Oyo State and so on. This is to send signals to all health facility promoting quackery, professional misconduct and hazardous practices.
FACTORS ENHANCING QUACKERY
1. Poor governance at most levels of government.
2. Political instability, policy inconsistency and evidence lack of political commitment to health by most state and local governments in Nigeria.
3. Monumental corruption and infrastructural decay.
4. Undue politicization of the health sector coupled with declining professionalism and non-adherence to best practices.
5. Poor constitutional and legal framework for health in Nigeria, particularly the absence of a National Health Act that clearly makes the health rights of the people justiciable, that defines the roles and responsibilities of local, state and Federal Governments in the management of the three levels of healthcare.
6. Poor co-ordination, integration and implementation of health policies, programs, projects and donor support.
7. Poor funding and budgetary provisions for health, far less than the stipulated 15% of the National budget as prescribed by the World Health Organisation and affirmed by the 2001 Abuja declaration of African Heads of State.
8. Poor Health Human Resource (HHR) Development Plans and Reward System in the health sector, including poor remuneration, poor working conditions and poor motivation of the health workforce, as well as inadequate numbers and inequitable distribution of the health workforce.
9. Worsening poverty and low level of health coverage for all Nigerians.
10. Inadequate involvement of health professional associations and communities in the planning, implementation, monitoring and evaluation of health policies, programs and projects; as well as in budget monitoring.
11. Weak private health sector coupled with inefficient utilization of health care resources.
12. Pervasive quackery in the health sector with poor enforcement of extant laws.
13. Poorly developed database and Health Management Information System, Coupled with poor use of Information Community Technology, particularly e-Health in advancing access to healthcare.
14. Conflicting professional regulatory laws/Acts in the health sector which has been a major factor responsible for disharmony in the health sector.
15. Weak Primary and Secondary levels of care with a weak Referral System, attributable to evident lack of commitment to the development of the primary and secondary healthcare systems by most local and state governments; and
RECOMMENDATIONS
1. Political commitment to health by all levels of government, particularly state and local governments with political leaders at local, state and federal government levels committing themselves to the utilization of public healthcare facilities in their communities, states and local governments rather than the frequent recourse to foreign medical care.
2. Transparent and sustained implementation of poverty reduction schemes to reduce household poverty.
3. Rapid expansion of the National Health Insurance Scheme with- commitment to Universal Health Coverage by government at all levels. This will substantially reduce quackery.
4. Sincere improvement in the budgetary provision for health to at least 15% of Nigeria’s national budget, backed with adequate release and effective utilization of available funds and resources.
5. Provision of modern and standard health infrastructure and facilities with sustained maintenance and facility/infrastructural upgrade; backed with a strengthened computerization, automation and public-private policy.
6. Urgent resuscitation, rehabilitation and strengthening of the secondary and primary healthcare systems with strengthening of the Referral System and employment of an adequate and appropriate mix of health manpower, including the employment of at least one medical officer of health per primary Healthcare Centre in each local Government Council.
7. De-politicization of the health sector with emphasis on professionalism, best practices and adherence to professional job description, ethics and values.
8. Concrete provisions for health in Nigeria’s constitution with the health rights of the people defined and made justiciable to empower them to demand accountability from the leaders.
9. Improved coordination, integration and implementation of health policies, programs, projects and donor support.
10. Committed implementation of the National Strategic Health Development Plan by all levels of government.
11. Improved Remuneration and welfare packages with universal application of wages in the health sector to encourage retention of health personnel in rural areas.
12. Involvement of health professionals, associations, communities and other stakeholders in the planning, implementation, monitoring and evaluation of health policies, programs and projects.
13. Ban on indiscriminate advertisement of herbal and medicinal products on the electronic and print media to save Nigerians from the untoward effect and dire complications of quackery exhibited by charlatans.
14. Empowerment of existing regulatory bodies and agencies with institution of stiffer penalties for quacks in the public and private health sectors; including the introduction of life imprisonment.
15. Government support for the private health sector through the institution of a private health and hospital development fund.
CONCLUSION
It is clear that quacks have become indispensable part of our society. There are variegated allegations against quacks but it seems their eradication would lead to further dilapidation of the rural healthcare system. Quacks are dangerous because they do not know the subject.
Quackery practice is illicit to the national health development. It denigrates health stability and proscribing longetivity of the populace. It’s a virus that requires total and complete destruction. All hands must be on deck to promote professional and legitimate medical practices. Awareness should be instituted on harmful effect of quackery patronage. Government, Private and Institutional health facilties should be accessible, available, affordable and equitable to all. Private Health facilities should not train ward maid, they in-turn establish their clinics and becomes quacks.
Thanks for Listening.
REFERENCES
Wikipedia (2017), Quackery cowas. wikipedia.org/wiki/Quackery # criticis_of_quackery_in_academia.
Meriam-Webster (2017). Definition of Quackery https://www.meriam-webster.com
Duke University Medical Centre (2017). Introduction to Evidence-Based Practice www.guides.inclubrary.duke.edu/c.php? g = 158201 & P = 1036021
Runi Datta (2013). The world of Quacks: A Parallel Healthcare system in Rural West Bengal. Journal of Humanities and Social Sciences, 10SR-HJSS, 14:2, 44-53 e-ISSN:2279-0837, P-ISSN:2279-0845.www.10srjournals-org.
Delors C.S. James (2004). Quackery, Nutrition and Well being A to Z, The Gale Group Incorpation-www.encyclopedia.com/sports-and-everyday-life/fuel-and-drink/food-and-cooking/quackery.
Quackery (2016). Four Reasons Quackery Seems To Work. www.windham-schools.org>classes>.
Edward R. Friedlander (1983). Quackery www.pathguy.com/lectures/quackery.txt.
Tuhin K. Das (2008). Quack: Their Role in Health Sector. Research Gate. https://www.researchgate.net/publication/228226314
Osahon Enabulele (2013). My assessment of Nigeria’s Health Sector Performance At 53. Sahara Reporters saharareporters.com/2013/09/30/my-assessment-Nigerians-health-Sector-Performance-53-dr-osahon-enabulele.
Adeola Salako (2017). Curbing quackery among healthcare providers in Lagos. The Nation. the nationlineng.net/curbing-quackery-among-healthcare-providers-in-lagos.
ARTICLES
Nurses are Professionals and not Medical Technicians (Part II) by Omolola Adams Nurses Arena Forum
nurserarena.com/news/nurses-are-professionals-(part 1) - by-Omolola-Adams/August.
Quackery – The virus Destroying Healthcare Sector by Omolola Adams RPHN
-Nigeria Student Forum: ngstudentforum.com.ng/indexophp?firstvar=P & secondvar=5127.
-Nurses Arena Forum: nursesarena.com/articles/quackery-the-virus-destroying-healthcare-sector-by-Omolola-adams-rphn/Feb4,2017.
ANNUAL SCIENTIFIC CONFERENCE:
ASSOCIATION OF GENERAL PRIVATE NURSING PRACTITIONERS, OYO STATE CHAPTER.
VENUE: SUPER K HOTEL AND SUITES
PRESENTED BY:
NURSE OMOLOLA ADAMS OLATAYO RPHN, HHMC.
SEVENTH DAY ADVENTIST SCHOOL OF NURSING, ILE IFE, OSUN STATE.
ABSTRACT:
Health as a matter of right is recognized throughout the world for its intrinsic value. Nigeria is a signatory to the Alma Ata Declaration is committed to provide “Health for All” irrespective of any discrimination on the grounds of rich or poor and urban or rural. The National Health Policies are formed on the basis of this principle. But inequality of opportunities, the gross mismatch between the objectives and the resources available and the inability of the state to bring quality health care within the reach of all has increased the vulnerability of the people particularly the rural segment and led to the emergence of a new tier of physicians running a parallel and bane of evidence based practice of health care system and playing a formidable role in the rural health care market as rural health providers. This group of self-styled practitioners called quacks, despite in expertise is doing a good business in the villages taking advantage of the lacunal in the public healthcare system. As testimony to their legitimacy, they manage, certificates from unauthorized and unrecognized institutions.
INTRODUCTION
Quackery is one of the greatest menaces facing healthcare delivery globally. By definition, a quack is a person who pretends, professionally or publicly, to have skills, knowledge, or qualifications he or she does not possess. By extension, quackery connotes establishing or running a healthcare facility without qualified or certified personnel; or operating beyond the limits or scope of one’s specialization or expertise. In the field of healthcare delivery involving diagnosis, management and prevention of health issues, quackery can have unimaginable and damaging consequences for the populace.
It is an undeniable fact that in the last 56 years of Nigeria’s history, her health sector like other sectors of the country’s economy has had its good and bad times with uninspiring national health indices attributable to years of cumulative insults, lack of professional order and best practices, a weak private health sector, poorly developed social infrastructure, as well as policy inconsistency. Its troubling that after 56 years of Nigeria’s independence, her health system is still struggling to deliver health dividends of democracy to her long suffering people. Nigerians had expected that following the Walter-Harkness Ten Year Development Plans as well as the enunciation of the first National Health Development Plan in 1960, Nigeria before half a century of her independence would have achieved Universal Health Coverage with all her citizens having access to quality and affordable health care.
According to Merrian-Webster, the methods and treatments used by unskillful Doctors or by people, who pretend to be doctors. The term quack is a dipped from the archaic term “quacksalver” from Dutch meaning “hawker of salve”.
Stephen Barrett defines quackery “as the promotion of unsubstantiated methods that lack a scientifically plausible rationale” and more broadly as “anything involving our promotion in the field of health.
Evidence-Based Practice (CBP) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett 1996).
STEPS IN EBP
I want to highlight few steps in EBP in order to establish quackery.
1. Assess the patient:- start with the patient, a clinical problem or questions arises from the care of the patient.
2. Ask the question:- Construct a well built clinical question derived from the case.
3. Acquire the evidence: Select the appropriate resource(s) and conduct a search.
4. Appraise the evidence:- Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice).
5. Apply talk with the patient: Return to the patient - - integrate that evidence with clinical expertise, patient preferences and apply if to practice.
6. Self-Evaluation: Evaluate your performance with this patient.
The topic is a trending issue in our society as it has a monumental effects on healthcare industry. Various articles had been written on quackery is the healthcare industry. Quackery is a virus destroying the cells component that makes up the health care industry around the world. Quackery is a global phenomenon, which requires global participation in combating it.
The pointer, an online news outfit recently reported an article titled a Quacks in The Health Sector”, it read thus” Recently, Nigeria was ranked 197th out of 200 countries with undesirable health indices, spiraling morality rate and increasing cases of complications resulting from wrong medical diagnosis. Reports have it that the nefarious operations of dubious businessman masquerading as doctors has led to as unhealthy parading of care givers degenerating into grave diggers”. It further stated that “The operation of the quacks is one key reason the nation’s health care is tottering on the borders of incredibility and total lack of confidence. This, in turn, is what has been fuelling the rising trend of medical tourism and the consequent loss of foreign exchange in search of health care abroad. The quacks are said to be more accessible and in a society with visible poverty”.
The Supreme Court defines quack as “a person who does not have knowledge of a particular system of medicines but practices in that system. They include those who have not received formerly recognized training and have informal training through seminars, workshops, Private Hospital Trainings. They are not registered with any government regulatory body and operate outside of the purview of regulation. Barun Kanjilal, a renowned scholar, Indian, in his article “Harnessing the underground health market: the case of Indian Rural Medical Practitioners who practice modern medicine without any formal training or legal sanction represent the dominant group. The market is underground in the technical sense (since there is no legal sanction) but open in all practical grounds. To prevent malpractices and maintain quality of healthcare, rules and regulations defining a code of conduct for the healthcare professionals is provided by acts such as Medical Council Act…..Nursing & Midwifery Council of Nigeria Act 1979, the Consumer Protection Act of 1986, under the Medical Council Act the doctors are forbidden to indulge in any sort of advertisements of their dispensaries or professional qualification accept any gifts and must display their registration certificates and prescribe generic names of medicines rather than branded names. The Consumer Protection Act is supposed to give protection to people who suffer from inconvenience or discomfort caused by poor quality of medical care. But the quacks do not follow any rule relating to medical or nursing ethics and indulge in improper practices.
Quackery is big business. Individuals spend billions of dollars every year looking for the next miracle cure. Consumers must learn to protect themselves by questioning what they see or hear in advertisement. The media that promotes these products usually do not regularly screen their advertisements for truth or accuracy. Prescription drugs undergo vigorus testing for safety and effectiveness before they are sold, and over-the-coutner medicines also are subject to a drug review process Dietary supplements are not required to undergo government testing or review before they are marketed, yet these products may have harmful effects that could present risks for people on certain medicines or with certain medical conditions. Individual who are aware of a questionable health product can contact the Federal Trade Commission or their state attorney general’s office.
REASONS FOR EFFECTIVE QUACKERY
1. Ignorance: Many consumers simply do not know the difference between health products that have been shown to be effective and those which have not. The same is true of health services. For example is it legal for someone to post a sign calling onself a “doctor”? Yes-it is legal as the person does not claim to be a “medical Doctor” or M.D – yet many in the general public would assume that person is a medical doctor.
2. Placebo Effect: The mind is a powerful influence on how we feel. The placebo effect means that we feel better because we think we SHOULD feel better. For example, if a person takes a vitamin pill believes he will have more energy, he may think he has more energy just because he believes he will have more energy, he may think he has more energy just because he is “supposed to” (even though the pill provided no additional energy-we get energy from foods, not from pills. Feeling energetic is easily controlled by the mind unless a person has a health problem that compromises energy levels.
3. Self-limiting Conditions: Some health problems are self-limiting. That means that the disease or conditions runs its course even if the person does nothing at all. Problems caused by viruses are like that they go through an active stage and then a latent stage. If a person practices quackery and the virus-produced problem go away, they may give credit to quackery when the problem would have gone away anyway. An example of this comes from the previous activity: if a person rubs his wart with a raw potato and it goes away, it did so because the virus that caused that wart had run its cause. Seventy percent of all health problems will go away if the consumer does nothing at all (initial face). Therefore consumers need to know the difference.
4. Slight of hand: This is the use of a magic trick: psychic surgery is an example of the kind of fakery that some quacks use to promote a false product. This is way common in our home movies and videos where the so-called doctors has some tricky and fakery signs of magic to promote care. At the long run, many consumers patronize such outfit.
CHARACTERISTICS OF QUACKERY
1. Progressiveness: Quacks follows legitimate science and say that whatever they are promoting is the latest greatest in science.
2. Profitable Business: Quacks are often very successful. Because there is “a sucker born every minute”, they make millions of dollars of those who fall for their schemes.
3. For Incurable Disease: Quacks exploit the health problems that modern medicine cannot cure. Persons living with AIDs, arthritis, cancers and Alzheimer’s Disease often fall prey to quacks because they want to believe that something will help their condition. Baldness and being flat-chested are also exploited by quackery. There are dozens of ineffective “cures” for these two conditions in magazines.
MOST VULNERABLE CONSUMERS
1. The Uninformed: Consumers are vulnerable to quackery if they do not know the facts. A good source of reliable information in quackery is the country’s health minister providing a platform to assess the registered healthcare facility. All unregistered facility to face the wrath of the law.
2. The Restless:- Consumers are at risk for exploitation if they expect quick results and are unwilling to take responsibility for their own health.
3. The Miracle Seeker: If someone believes that a wonder is possible, he or she may be taken in by someone promoting something sensational. A good rule of thumb is “if it sounds too good to be true, it probably is”.
4. The straw Grasper: These are desperate individuals. They may have a life threatening condition and want to believe there is hope when there is no hope. The quack is all too willing to provide the victim with FALSE HOPE.
5. Financial Strength: Individual with poor financial status patronized quacks. This is so because there is no standardization in quackery practices, it’s a money-ventured outfit, hence no quality nor standard care.
HOW TO IDENTIFY QUACKS
Quacks are easy to recognize. Quackery invests its efforts in propaganda directed at the public rather than in controlled research directed toward other professionals. This is true of all types of quackery, from mouthwash to laterite. The technique of quackery is usually the same regardless of the system.
1. Present false health claims confusingly: the technique is to tell a series of obvious truths followed by one life. The true statements in the series are often trivial. The series usually includes common places of preventive medicine.
2. Present bogus models of health, mankind, and even the universe: quackery invariably opposes the understanding of disease provided by empirical science. Holistic medicine (as the emphasis is perverted by quackery) implies, all disease has the same cause and may be treated in the same way. All disease indicates that the “whole person” is in need of remediation. Disease and therapy, because they affect individual “whole person” cannot be studied by examining a series. All quack claims are based on selected anecdotes. Disease being absent therapy may still be instituted to promote “wellness”.
3. Create fear of everything except quackery: Quacks create fear of familiar things (flour, sugar, tap water, etc) Quacks capitalize on and expand fear of unfamiliar things, Disease: quacks of course claim to detect and treat it sooner than anyone else can.
4. Spiritual forces: Quackery gets free publicity through many different churches, Mosques, both conservative and liberal. All target groups are told to have “faith” in quackery, and made of feel guilty about their own lack of faith.
5. Pretend to love the victim and to share his/her values: Quacks invariably appear “caring”, “considerate”, “helpful”, “loving”, “personally concerned”, “unhurried”. Quackery varies its appeal for different target groups, conventional lifestyle (family), alternative lifestyle (alternative), minority groups (cultural tradition), all lifestyles (altruism, fun, independence, love). Quackery makes indoctrination and treatment enjoyable. Quack propaganda uses humour as often as possible. Quack therapies care usually pleasant (People like health food, apricots, coloured lights, dancing, enemas, massages, music, individual attention). Quacks never get tired of telling their patient how much they “love” them. Quackery presents itself as “self-help”.
5. Offer false hope without making specific promises.
6. Operate as a bogus organization: Names include: Alternative, Balanced, Church, Foundation, Harmony, Holistic, Institute, life, Preventive, Research, Science, Wellness etc. Recently-founded organisation lobby and advertise. Quacks claim to be persecuted and misunderstood. They are fund of comparing themselves to Galileo and occasionally to Michael Servetus and Charles Darwin.
In a study conducted by Tuhin K. Das (2008) observed that quack plays an important role in the health sector in India, especially in the rural areas. But till now, there is no reliable estimate of the number of Quack in India and the extent of their services. Mostly Quacks are found in the rural areas, where they are the first source of medical care for the rural poor. The study reveals that the preference for quack is more or less income specific and age specific, and moreover, inspite of low cost of treatment under quack, effectiveness cannot be assured as in allopathy.
The rural people having low income prefer to be treated by the Quack because of their poverty but they do not take the risk to let their children be treated by them. Yet, it can be said that for the rural poor people, medical services offered by Allopathy. Obviously, the cost of treatment is an important part, which influences one’s choice of medical cure. But the effectiveness of any sort of medical treatment also plays another important role behind making a decision regarding medical care. When CER (Cost-Effectiveness-Ratio) is considered, treatment by quack is found to be cost-effect at least for cold and cough, fever (excluding typhoid and malaria), diarrhea and dysentery.
On the other hand, to judge the efficacy of the services provided by the quack, another aspect is to be taken into consideration. It is often found that the patient whose health state improves under any type of medical service, does not end to shift to other medical services for the recovery. Such non-transition also forms an alternative measure of effectiveness. It has been observed that the proportion of non-shifting patients who were initially treated by Allopathic doctors was most and that by quack was least. Thus, inspite of the low cost of treatment under quack (which is the main cause of lower CER), effectiveness (i.e recovery) cannot be assured as in Allopathy.
The Nursing and Midwifery Council Act 79, Section 21 where it dealt with unauthorized training stated as below “It shall be offence for any person without the approval of the Minister given on the recommendation of the council to train any person as a nurse or midwife or to provide any course of training or establish any school for such purpose or as one of its purposes; and any such person shall be liable.
a) On conviction otherwise than a High Court, to a fine of N1,000 or to imprisonment for a term of six months, or to both such fine and imprisonment;
b) On conviction in a High Court, to a fine of N2,000 or to imprisonment for a term of two years or to both such fine and imprisonment.
This subsection unveils who and how training should be conducted. Many private hospitals endangered the live of Nigerian by training the so called “auxiliary” who later returned to be quack by establishing a clinic without having required education and professional skills. The punishment may sound obscured as it does not reflect or march up with the offence. N1,000 or six month imprisonment or both as well N2000 or 2 years imprisonment is under-statement.
EFFECT OF QUACKERY ON THE SOCIETY
1. Poor health care delivery:- High numbered of quackery practices has taken over the health care system. Hence, there is a high patronage of quack which in turn provides unscientific care leading to greeter risk of health services.
2. Poor professional judgement, skill, discipline and lack of competence in health care setting.
3. Increase in complication arising from patronizing quacks which eventually increases death rate.
4. Quackery endangers the society by promoting hazardous healthcare, unskillful care and biased health care services in which the victim is transferred to a registered facility after complication set in.
5. Quackery is a profit-oriented organsiation disregarding qualify health care.
In recent time, various professional organizations raided some healthcare facility that promote quackery. NANNM, the professional union of Nigeria Nurses has been shutting down some health facilities in collaboration with Ministry of Health in Ogun State, Lagos State, River State, Oyo State and so on. This is to send signals to all health facility promoting quackery, professional misconduct and hazardous practices.
FACTORS ENHANCING QUACKERY
1. Poor governance at most levels of government.
2. Political instability, policy inconsistency and evidence lack of political commitment to health by most state and local governments in Nigeria.
3. Monumental corruption and infrastructural decay.
4. Undue politicization of the health sector coupled with declining professionalism and non-adherence to best practices.
5. Poor constitutional and legal framework for health in Nigeria, particularly the absence of a National Health Act that clearly makes the health rights of the people justiciable, that defines the roles and responsibilities of local, state and Federal Governments in the management of the three levels of healthcare.
6. Poor co-ordination, integration and implementation of health policies, programs, projects and donor support.
7. Poor funding and budgetary provisions for health, far less than the stipulated 15% of the National budget as prescribed by the World Health Organisation and affirmed by the 2001 Abuja declaration of African Heads of State.
8. Poor Health Human Resource (HHR) Development Plans and Reward System in the health sector, including poor remuneration, poor working conditions and poor motivation of the health workforce, as well as inadequate numbers and inequitable distribution of the health workforce.
9. Worsening poverty and low level of health coverage for all Nigerians.
10. Inadequate involvement of health professional associations and communities in the planning, implementation, monitoring and evaluation of health policies, programs and projects; as well as in budget monitoring.
11. Weak private health sector coupled with inefficient utilization of health care resources.
12. Pervasive quackery in the health sector with poor enforcement of extant laws.
13. Poorly developed database and Health Management Information System, Coupled with poor use of Information Community Technology, particularly e-Health in advancing access to healthcare.
14. Conflicting professional regulatory laws/Acts in the health sector which has been a major factor responsible for disharmony in the health sector.
15. Weak Primary and Secondary levels of care with a weak Referral System, attributable to evident lack of commitment to the development of the primary and secondary healthcare systems by most local and state governments; and
RECOMMENDATIONS
1. Political commitment to health by all levels of government, particularly state and local governments with political leaders at local, state and federal government levels committing themselves to the utilization of public healthcare facilities in their communities, states and local governments rather than the frequent recourse to foreign medical care.
2. Transparent and sustained implementation of poverty reduction schemes to reduce household poverty.
3. Rapid expansion of the National Health Insurance Scheme with- commitment to Universal Health Coverage by government at all levels. This will substantially reduce quackery.
4. Sincere improvement in the budgetary provision for health to at least 15% of Nigeria’s national budget, backed with adequate release and effective utilization of available funds and resources.
5. Provision of modern and standard health infrastructure and facilities with sustained maintenance and facility/infrastructural upgrade; backed with a strengthened computerization, automation and public-private policy.
6. Urgent resuscitation, rehabilitation and strengthening of the secondary and primary healthcare systems with strengthening of the Referral System and employment of an adequate and appropriate mix of health manpower, including the employment of at least one medical officer of health per primary Healthcare Centre in each local Government Council.
7. De-politicization of the health sector with emphasis on professionalism, best practices and adherence to professional job description, ethics and values.
8. Concrete provisions for health in Nigeria’s constitution with the health rights of the people defined and made justiciable to empower them to demand accountability from the leaders.
9. Improved coordination, integration and implementation of health policies, programs, projects and donor support.
10. Committed implementation of the National Strategic Health Development Plan by all levels of government.
11. Improved Remuneration and welfare packages with universal application of wages in the health sector to encourage retention of health personnel in rural areas.
12. Involvement of health professionals, associations, communities and other stakeholders in the planning, implementation, monitoring and evaluation of health policies, programs and projects.
13. Ban on indiscriminate advertisement of herbal and medicinal products on the electronic and print media to save Nigerians from the untoward effect and dire complications of quackery exhibited by charlatans.
14. Empowerment of existing regulatory bodies and agencies with institution of stiffer penalties for quacks in the public and private health sectors; including the introduction of life imprisonment.
15. Government support for the private health sector through the institution of a private health and hospital development fund.
CONCLUSION
It is clear that quacks have become indispensable part of our society. There are variegated allegations against quacks but it seems their eradication would lead to further dilapidation of the rural healthcare system. Quacks are dangerous because they do not know the subject.
Quackery practice is illicit to the national health development. It denigrates health stability and proscribing longetivity of the populace. It’s a virus that requires total and complete destruction. All hands must be on deck to promote professional and legitimate medical practices. Awareness should be instituted on harmful effect of quackery patronage. Government, Private and Institutional health facilties should be accessible, available, affordable and equitable to all. Private Health facilities should not train ward maid, they in-turn establish their clinics and becomes quacks.
Thanks for Listening.
REFERENCES
Wikipedia (2017), Quackery cowas. wikipedia.org/wiki/Quackery # criticis_of_quackery_in_academia.
Meriam-Webster (2017). Definition of Quackery https://www.meriam-webster.com
Duke University Medical Centre (2017). Introduction to Evidence-Based Practice www.guides.inclubrary.duke.edu/c.php? g = 158201 & P = 1036021
Runi Datta (2013). The world of Quacks: A Parallel Healthcare system in Rural West Bengal. Journal of Humanities and Social Sciences, 10SR-HJSS, 14:2, 44-53 e-ISSN:2279-0837, P-ISSN:2279-0845.www.10srjournals-org.
Delors C.S. James (2004). Quackery, Nutrition and Well being A to Z, The Gale Group Incorpation-www.encyclopedia.com/sports-and-everyday-life/fuel-and-drink/food-and-cooking/quackery.
Quackery (2016). Four Reasons Quackery Seems To Work. www.windham-schools.org>classes>.
Edward R. Friedlander (1983). Quackery www.pathguy.com/lectures/quackery.txt.
Tuhin K. Das (2008). Quack: Their Role in Health Sector. Research Gate. https://www.researchgate.net/publication/228226314
Osahon Enabulele (2013). My assessment of Nigeria’s Health Sector Performance At 53. Sahara Reporters saharareporters.com/2013/09/30/my-assessment-Nigerians-health-Sector-Performance-53-dr-osahon-enabulele.
Adeola Salako (2017). Curbing quackery among healthcare providers in Lagos. The Nation. the nationlineng.net/curbing-quackery-among-healthcare-providers-in-lagos.
ARTICLES
Nurses are Professionals and not Medical Technicians (Part II) by Omolola Adams Nurses Arena Forum
nurserarena.com/news/nurses-are-professionals-(part 1) - by-Omolola-Adams/August.
Quackery – The virus Destroying Healthcare Sector by Omolola Adams RPHN
-Nigeria Student Forum: ngstudentforum.com.ng/indexophp?firstvar=P & secondvar=5127.
-Nurses Arena Forum: nursesarena.com/articles/quackery-the-virus-destroying-healthcare-sector-by-Omolola-adams-rphn/Feb4,2017.
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