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Prescriptions of harm to prescriptions of quality: Addressing the crisis of rationality and ethics in India. 处方的危害对处方的质量：解决印度的理性与伦理危机。
Indian journal of medical ethics Pub Date : 2026-04-01 DOI: 10.20529/IJME.2026.028
Anurag Bhargava
{"title":"Prescriptions of harm to prescriptions of quality: Addressing the crisis of rationality and ethics in India.","authors":"Anurag Bhargava","doi":"10.20529/IJME.2026.028","DOIUrl":"10.20529/IJME.2026.028","url":null,"abstract":"<p><p>In India, the pharmacy of the world, people still suffer poor access to essential medicines, and the impoverishing effects of out-of-pocket expenditure on purchase of medicines. Prescription audits reveal prescriptions of harm with prescriptions not aligned to treatment guidelines, with unnecessary, unsafe medicines, including irrational fixed-dose combinations that are a dominant feature of the pharmaceutical landscape in India.This situation represents a crisis of both rationality and ethics at macro, meso and micro levels represented by different institutions, and actors; and these need to be addressed. The article argues for a a unified national drug authority with transparent evidence-based approvals, removals of all irrational medicines, a stronger quality assurance system, comprehensive cost-based price regulation and improved availability of essential medicines. Prescribers need training in the concept of rational use of medicines, essential medicines and of generics, and should be subjected to regular prescription audits. It also suggests a need to widen the focus from quality of medicines alone to quality of prescription.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 2","pages":"121-130"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The quality challenge for generic medicines in India: An industrial policy-sensitive perspective. 印度仿制药的质量挑战：一个工业政策敏感的视角。
Indian journal of medical ethics Pub Date : 2026-04-01 DOI: 10.20529/IJME.2026.017
Dinesh Kumar Abrol, Rollins John, Nidhi Singh
{"title":"The quality challenge for generic medicines in India: An industrial policy-sensitive perspective.","authors":"Dinesh Kumar Abrol, Rollins John, Nidhi Singh","doi":"10.20529/IJME.2026.017","DOIUrl":"10.20529/IJME.2026.017","url":null,"abstract":"<p><p>This article provides an industrial policy-sensitive understanding of the problem of quality of Indian generic medicines supplied both to the domestic market and to weakly regulated markets in Asia, Africa, and South America. Most of these medicines come from micro, small and medium enterprises (MSME). While all drugs manufactured in the country must comply with standards under the revised Schedule M of the Drugs and Cosmetics Act, 1945, the deadline for MSMEs' compliance has been extended repeatedly, and even as of March 2026, drugs are manufactured in the country in two categories of manufacturing facilities - one compliant with the revised standards and another non-compliant with the revised standards. While double standards are unacceptable, the policy discourse on medicine quality focuses entirely on uniformity of standards, and their regulation, without setting an industrial policy-sensitive context for the reasons for poor quality, and for developing an appropriate response. We argue that the problem of medicine quality is closely connected to the structural changes in the industry after India signed the Agreement on Trade Related Aspects of Intellectual Property Rights. Large-scale enterprises depend on MSMEs - many of which are poorly equipped - for supplying branded generic medicines in the domestic market and poorly regulated markets abroad. Further, a sharp decline in the indigenous manufacture of raw materials and active pharmaceutical ingredients has left the industry vulnerable, because of its dependence on China for the import of these materials. We propose that poor quality must be addressed through industrial policy-specific changes, institutional collaboration, and technical support, not merely by closing down MSMEs. Quality assurance cannot depend on a system of inspection alone; quality by design must be built into the manufacturing process, and there must be strict enforcement of standards.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 2","pages":"98-107"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial intelligence in pre-hospital emergency medicine in Israel: Ethical and legal considerations. 以色列院前急救医学中的人工智能：伦理和法律考虑。
Indian journal of medical ethics Pub Date : 2026-02-27 DOI: 10.20529/IJME.2026.012
Rotem Waitzman, Moshe Z Abramowitz
{"title":"Artificial intelligence in pre-hospital emergency medicine in Israel: Ethical and legal considerations.","authors":"Rotem Waitzman, Moshe Z Abramowitz","doi":"10.20529/IJME.2026.012","DOIUrl":"https://doi.org/10.20529/IJME.2026.012","url":null,"abstract":"<p><p>Artificial intelligence (AI) is rapidly transforming pre-hospital emergency medicine (PHEM). In Israel, systems already deployed at Magen David Adom and hospitals such as Sheba Medical Center, Ichilov Hospital, and Barzilai Medical Center demonstrate AI's potential to improve triage, despatch, and emergency preparedness. Yet, this accelerated adoption has outpaced ethical, legal, and institutional safeguards. This commentary analyses the governance challenges of AI in Israeli PHEM - focusing on informed consent, data ownership, bias, liability, oversight, and public trust - and proposes practical recommendations for responsible implementation. Six critical gaps are identified: (1) absence of patient-centred consent mechanisms; (2) fragmented data ownership and vendor dependence; (3) lack of equity audits; (4) unresolved liability standards; (5) insufficient institutional oversight; and (6) limited public consultation. These gaps pose immediate risks for patients and long-term threats to trust and legitimacy. To address these challenges, we propose the establishment of AI ethics committees, transparent consent protocols, a national data governance framework, mandatory fairness audits, clarified liability rules, and structured public engagement. Israel's experience underscores the need to build ethical frameworks in parallel with technological innovation, offering lessons for other healthcare systems seeking to balance innovation with accountability and patient rights.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Continuing the conversations on protection of constitutional rights during first production and remand in Magistrate Courts. 在初审及裁判官法庭还押期间，继续进行有关保障宪法权利的对话。
Indian journal of medical ethics Pub Date : 2026-01-01 DOI: 10.20529/IJME.2026.004
Jinee Lokaneeta, Zeba Sikora
{"title":"Continuing the conversations on protection of constitutional rights during first production and remand in Magistrate Courts.","authors":"Jinee Lokaneeta, Zeba Sikora","doi":"10.20529/IJME.2026.004","DOIUrl":"10.20529/IJME.2026.004","url":null,"abstract":"<p><p>Here, we respond to some of the thoughtful and critical concerns raised by the reviewers as our attempt to continue the conversations on the protection of constitutional rights during first production and remand in Magistrate Courts in Delhi. In particular, we respond to the comments about the role of the naib court, formally a part of the police and yet, as our observations show, functioning as a part of the administrative court machinery. We also focus on the reviewers' emphasis on semi state actors such as the doctors whose role during the pretrial process has rarely been analysed despite their crucial role. We hope that our report and conversations such as these will generate more attention towards this constitutionally and statutorily required safeguard with implications for the life, liberty, safety and dignity of those in custody.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"75-77"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rethinking medical liability in India: Supreme Court's call for judicial review and ongoing uncertainty. 重新思考印度的医疗责任：最高法院呼吁司法审查和持续的不确定性。
Indian journal of medical ethics Pub Date : 2026-01-01 Epub Date: 2025-07-29 DOI: 10.20529/IJME.2025.058
Ranjit Immanuel James, Omprakash V Nandimath, Balaji Jayasankar, Alexander Thomas
{"title":"Rethinking medical liability in India: Supreme Court's call for judicial review and ongoing uncertainty.","authors":"Ranjit Immanuel James, Omprakash V Nandimath, Balaji Jayasankar, Alexander Thomas","doi":"10.20529/IJME.2025.058","DOIUrl":"10.20529/IJME.2025.058","url":null,"abstract":"<p><p>The landmark 1995 judgment by the Supreme Court of India included doctors within the purview of the Consumer Protection Act (CPA) 1986, hinting that other professions, including legal services, could also fall under its ambit. However, in 2024, the apex court ruled in 'Bar of Indian Lawyers Through its President vs DK Gandhi PS National Institute of Communicable Diseases and Anr.', that lawyers are not liable for professional deficiencies under the CPA, emphasising the lack of universal standards for assessing dereliction of duty in legal services. Although this landmark verdict let advocates off the hook, it calls into question the Court's 30-year-old decision. This ruling has reignited the debate on whether doctors should be equated with other service providers under the CPA 2019, particularly in light of the rise in defensive medicine practices, which increase healthcare costs and erode doctor-patient trust. In this commentary, we will discuss the analysis and observations of the apex court in the DK Gandhi case, contributing to the ongoing discourse on medical liability under the CPA in India.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"41-44"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Weak campaign against predatory journals: structural issues. 反对掠夺性期刊的弱运动：结构性问题。
Indian journal of medical ethics Pub Date : 2026-01-01 Epub Date: 2025-08-07 DOI: 10.20529/IJME.2025.061
Alain Braillon, Constant Vinatier, Florian Naudet
{"title":"Weak campaign against predatory journals: structural issues.","authors":"Alain Braillon, Constant Vinatier, Florian Naudet","doi":"10.20529/IJME.2025.061","DOIUrl":"10.20529/IJME.2025.061","url":null,"abstract":"<p><p>The International Committee of Medical Journal Editors (ICMJE) is an influential group of general medical journal editors, some from the five leading publishing houses, representing more than 50% of the market, and representatives of select related organisations. Working together to improve the quality of medical science and its reporting, they have rightly acknowledged the threat posed by predatory journals. However, we argue that ICMJE has overlooked deeper structural issues, particularly the publishing industry's own economic interests, thus hindering efforts to address this problem. It overlooked numerous initiatives aimed at systemic change, eg, the 2012 Declaration on Research Assessment, Transparency and Openness Promotion, and the Coalition for Advancing Research Assessment. Notably, models such as Diamond Open Access, which have the potential to address the issue of predatory journals, while also posing challenges to traditional publishers' interests, are not mentioned. By not addressing these concerns, there is a risk that the ICMJE's crusade against predatory journals could look like cartelisation.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"30-34"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The unacknowledged cadre: hurdles for MBBS graduates in Kerala's medical landscape. 未被承认的骨干：喀拉拉邦医学领域MBBS毕业生面临的障碍。
Indian journal of medical ethics Pub Date : 2026-01-01 Epub Date: 2025-11-07 DOI: 10.20529/IJME.2025.084
Anoop Prathapan
{"title":"The unacknowledged cadre: hurdles for MBBS graduates in Kerala's medical landscape.","authors":"Anoop Prathapan","doi":"10.20529/IJME.2025.084","DOIUrl":"10.20529/IJME.2025.084","url":null,"abstract":"<p><p>This personal narrative discusses challenges faced by MBBS graduates in Kerala's public healthcare system. Based on observations as a government medical officer, this essay examines a culture where professional skills and humane values are often overshadowed by a system that prioritises postgraduate degrees above all else. It questions the fairness of a structure that sidelines clinicians without higher qualifications, even when they are capable and dedicated. MBBS graduates often suffer a lack of decision-making power and are frequently excluded from institutional leadership and recognition. They are treated as a secondary group, becoming invisible, undervalued, and disempowered. The narrative draws comparisons with historical instances of institutional oppression and shows how extra-clinical talents are often ignored in favour of strict hierarchies. This essay advocates for a change toward a more inclusive and fair system where one's abilities and contributions are not judged solely by the number of degrees held.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"61-64"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethical and humanitarian considerations in allocating healthcare resources during infectious disease emergencies: A scoping review. 传染病紧急情况下分配医疗资源的伦理和人道主义考虑：范围审查。
Indian journal of medical ethics Pub Date : 2026-01-01 DOI: 10.20529/IJME.2026.003
Mohammad Reza Fallah Ghanbari, Mehdi Safari, Katayoun Jahangiri, Zohreh Ghomian, Mohammad Ali Nekooie
{"title":"Ethical and humanitarian considerations in allocating healthcare resources during infectious disease emergencies: A scoping review.","authors":"Mohammad Reza Fallah Ghanbari, Mehdi Safari, Katayoun Jahangiri, Zohreh Ghomian, Mohammad Ali Nekooie","doi":"10.20529/IJME.2026.003","DOIUrl":"10.20529/IJME.2026.003","url":null,"abstract":"<p><strong>Background: </strong>Infectious diseases can lead to emergencies, posing ethical and humanitarian challenges in allocating basic minimum and specialised healthcare resources. This study aims to investigate the ethical and humanitarian considerations in allocating healthcare resources during infectious disease-related healthcare emergencies.</p><p><strong>Methods: </strong>This research employed a scoping review approach following Arksey and O'Malley's framework. Keywords related to the research topic were searched for in medical subject headings, including PubMed, Scopus, ProQuest, Embase, and Web of Science, covering the period from 1992 to 2023.</p><p><strong>Results: </strong>Out of 4,013 articles, 13 relevant articles were extracted for final review. Findings reveal a limited application of humanitarian principles, with ethical principles like equity and justice dominating hospital-level decisions. Equity was defined under the ethics theme, and achieving equity can be considered the central theme of the framework of humanitarian principles. Humanitarian principles guide aid in crises; but ethical principles shape broader human conduct. Also, there is a significant relationship between ethics and humanitarian principles.</p><p><strong>Conclusion: </strong>This study emphasises the need to integrate humanitarian and ethical principles into resource allocation to ensure their effective implementation in healthcfare delivery, particularly during infectious disease outbreaks, to prevent discrimination and injustice. Additionally, establishing practical criteria aligned with humanitarian principles is essential for equitable resource distribution in pandemics.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"10-18"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Archives, mental health systems, and the history of mental health in colonial South India: Critical questions. 档案、精神卫生系统和殖民时期南印度精神卫生的历史：关键问题。
Indian journal of medical ethics Pub Date : 2026-01-01 Epub Date: 2025-12-06 DOI: 10.20529/IJME.2025.092
Sathya D, Sudarshan R Kottai
{"title":"Archives, mental health systems, and the history of mental health in colonial South India: Critical questions.","authors":"Sathya D, Sudarshan R Kottai","doi":"10.20529/IJME.2025.092","DOIUrl":"10.20529/IJME.2025.092","url":null,"abstract":"<p><p>Emerging trends in the history of mental health globally emphasise the need to critically examine the history of mental health, and this applies to colonial India as well. However, despite the inseparable relationship between social hierarchies (such as race and caste) and mental health outcomes, we find that archival sources on mental health in colonial South India remain inaccessible, limiting researchers' ability to understand the complexities and nuances of this relationship. Despite an extensive search through state archives, records of mental health institutions, and other government departments, anticipated sources remain elusive. We argue that mainstream mental health systems exhibit a lack of sensitivity to the socio-historical roots of mental health crises and are plagued by systemic issues, such as staff shortages and limited access to sources, which contribute to a poor understanding of marginalised peoples' experiences. Mental health systems need to deepen their awareness of the socio-historical determinants of human suffering. This is vital to realising an ethical, people-centred mental healthcare ecosystem.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reflections on medical ethics: A review of three Hindi online streaming series - Human, Pill, and Kaala Paani. 对医学伦理的反思：对三部印度在线流媒体系列——《人类》、《药丸》和《卡拉·帕尼》的回顾。
Indian journal of medical ethics Pub Date : 2026-01-01 Epub Date: 2025-08-16 DOI: 10.20529/IJME.2025.064
Indraja Sharma, Ashok Seervi
{"title":"Reflections on medical ethics: A review of three Hindi online streaming series - Human, Pill, and Kaala Paani.","authors":"Indraja Sharma, Ashok Seervi","doi":"10.20529/IJME.2025.064","DOIUrl":"10.20529/IJME.2025.064","url":null,"abstract":"<p><p>In the governance of healthcare, medical ethics is fundamental to ensuring transparency and protecting patient rights. Medical dramas are increasingly shaping public perception of medical themes, fuelling public debate on medical ethics. In this reflective piece, we examine how three popular Hindi web series, Human (2022, Disney+Hotstar), Pill (2024, Jio Cinema), and Kaala Paani (2023, Netflix) explore critical issues, such as clinical trial ethics, medical litigation, and epidemic response management. Although these narratives raise public awareness, they often dramatise complex regulatory frameworks, which can lead to the misinterpretation of real-world medical practice. We evaluate how these portrayals align with real-world bioethics and healthcare regulations, assessing entertainment media's dual capacity to inform public understanding and potentially mislead audiences about critical ethical dilemmas in the Indian healthcare landscape.</p>","PeriodicalId":517372,"journal":{"name":"Indian journal of medical ethics","volume":"XI 1","pages":"45-48"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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