Most codes on ethics in medicine prohibit advertising by doctors. There are good reasons for this prohibition. As professionals, it ill behoves us to publicly sing our own praises or solicit patients. We must await clients by referrals from colleagues or by word of mouth. Were physicians to advertise, patients run the risk of being lured to the one with the fanciest media coverage rather than to the most competent and experienced. This prohibition gains greater validity in a country such as India where ignorance and gullibility abound. This does not deprive the extraordinary physician of renown. Noteworthy contributions to medical theory or practice are legitimately published in medical journals after being subject to review by peers and can command admiration from colleagues.

Having known Dr. Aniruddha Malpani for several years and respected his abilities and expertise, I was unpleasantly surprised to run across his internet site www.drmalpani.com/pcss/index.htm.

The site advertises the Malpani clinic as ‘the best place to have a baby’. Clicking on ‘Read what the press has to say about our clinic and the services we offer’ takes one to a series of press reports featuring the clinic or statements made by Dr. and Dr. Mrs. Malpani. Here is an excerpt from this section:

“City doctor proclaims the end of male infertility … “IS THERE any viable option for infertile male patients to father a child? Yes, says a city-based doctor, who attains the distinction of being the first medico in the country to treat such patients successfully. The new treatment is expected to illumine the lives of many unhappy couples.

“Dr Aniruddha Malpani, a well known specialist in infertility problems, has successfully impregnated a woman with testicular sperms for the first time in the country. Besides, he has also achieved fertilisation with precursor germ cells like spermatids , which is contrary to the known scientific wisdom that only matured and developed sperms can initiate pregnancy…Dr. Malpani’s clinical success shows that even the most sterile patient can now be successfully treated by testicular sperm injection.

“However, the treatment charges are quite expensive, ranging around Rs 90,000 for a single attempt.

“This cost, though cheap compared to that of the western countries, is beyond the reach of many in our country,” Dr. Malpani laminated (sic) adding that the charges would gate (sic) reduced as the treatment percolates down to a wider strata of the society.”

The site also features three reports filed in the Times of India on 5 and 6 November 2000. These suggest that ‘medical tourism’ to India could be yet another source of foreign exchange for this country. Since the cost of treatment here

is a fraction of those in the West, Indian doctors can expect to attract patients frustrated by long waiting lists in their own countries. All three reports quote statements made by Dr. Malpani. Following on the heels of these reports was a letter by Dr. Malpani printed in the correspondence column of this newspaper, justifying advertising by Indian doctors on the web so as to attract such tourists and their lucre.

I remain unconvinced of the ‘benefits’ of advertising and am worried about its ill effects. For every Dr. Malpani who advertises one can expect scores of charlatans and quacks. Given the non-existent control on medical malpractice in India, and the example of ‘Dr. Majid’ who misled victims of AIDS for such a long time, advertising is more likely to worsen the plight of individuals who are already sick and desperate.

Given our circumstances, advertisement by doctors remains unethical even in the digital age.

Postscript: A section on the Malpani site offers Preimplantation Genetic Diagnosis – a technique used to rule out genetic disorders in the embryo- to select the sex of your baby. Since this technique enables identification of the sex of the test-tube embryo prior to implantation and the selective implantation of only those embryos that show up as male, Dr. Malpani’s clinic panders to families desiring baby boys. Presumably, embryos of the undesired sex are destroyed. Although Dr. Malpani concedes that this technique raises certain ‘worries and concerns’, his lengthy defence of such a practice suggests that he has convinced himself that no wrong is being done.