Quacks in anorectal practice in India

Most human beings will do almost anything to prolong their lives or relieve themselves from the suffering of a disease. Others will do anything to exploit these desires by selling what they claim to be magical remedies even for incurable diseases. "Quack" is one of the several names used for those who pretend to practise medicine but without training, qualification and registration from the appropriate council or authority (1). Although some may be harmless, many are very dangerous.

Quacks in surgery are mainly in the treatment of anal canal diseases where they are often more popular than trained and registered practitioners. One can find their advertisements in every city and town.

Anorectal diseases are considered a divine curse and a matter of shame, so victims of fake doctors suffer without complaining. Patients from all walks of life and sections of society seek treatment from these charlatans. Educated and affluent people visit them clandestinely, either because mainstream treatment has failed to give relief or a cure, or because they are too shy to discuss the ailment with their family physician.

Patients also visit unqualified practitioners because of their publicity gimmicks claiming a faster, cheaper and sure cure (2). In contrast, general or family practitioners are less enthusiastic in treating these ailments. A misconception also prevails that surgery for anal ailments is followed by severe pain, incontinence, bleeding and so on, and that treatment by these people is just a "treatment" involving no surgical intervention. What’s more, unqualified practitioners charge much less than real doctors do.

Some patients are happy, when their ailments get cured. But many must repent the visit for life.

Many of these "specialists" claim to provide instant relief from piles using corrosive injections that cause severe inflammation and pain. They say they practise traditional herbal medicinal therapy but use toxic chemicals and then try to correct the resultant infection with antibiotics and analgesics used in veterinary practice. The reuse of needles without sterilisation also puts patients at risk of blood borne infections.

Injection sclerotherapy is generally considered to be safe. However, it needs knowledge of anatomy of the region and the skill to inject the medication in the correct dose, depth and direction. Misapplication results in complications including severe pain, injection site haemorrhage and ulceration. Phenol injections given without aseptic precautions and in the wrong dose can have severe consequences. The injection of corrosives can cause complications like necrotising fasciitis, septicaemia and renal failure.

"Ksharasutra" is an established and proven ayurvedic therapy provided that the treating doctor is well versed with the anatomy and basics of anal fistula pathology. Wrongly done, it can cause severe pain, infection, pelvic cellulitis with progression to shock and death.

According to a study, there are around 1.5 million unqualified and unregistered practitioners in India, i.e. more than the number of qualified doctors (3). Patients who suffer the complications of their treatment are shy to come forward consult the appropriate experts (4). Medical associations and law enforcing agencies are supposed to deal with these charlatans (5). But apathy on the part of enforcement agencies has allowed these fraudsters to thrive.

To distinguish themselves from quacks, doctors should display their certificates in their clinics, abiding by the new code of ethics of the Medical Council of India. The public must be educated about the dangers of being treated by unqualified practitioners. Awareness must be created about anal canal diseases and their scientific treatment.