Low-value health care in the COVID-19 pandemic
Authors: B Sadananda Naik
Journal: The Lancet Global Health (2021)

I read with interest the Comment by Soumyadeep Bhaumik and colleagues (September, 2021)1Bhaumik S John O Jha V Low-value medical care in the pandemic—is this what the doctor ordered?.Lancet Glob Health. 2021; 9: 1203-1204Summary Full Text Full Text PDF Scopus (9) Google Scholar on low-value medical care in India during the COVID-19 pandemic. I agree with all the facts highlighted and felt the need to offer some insight into the issues raised, as an insider who is practising medicine in India. Many of the drugs mentioned in the Comment (eg, hydroxychloroquine or ivermectin) do not make it into the prescription of any medical professional who practises evidence-based medicine. However, statutory obligations must be followed by all law-abiding citizens in any country. The public health departments of the Union Government and various state governments in India publish guidelines2Ministry of Health & Family WelfareGovernment of IndiaClinical guidance for management of adult COVID-19 patients.https://www.mohfw.gov.in/pdf/COVID19ClinicalManagementProtocolAlgorithmAdults19thMay2021.pdfDate: May 19, 2021Date accessed: June 6, 2021Google Scholar, 3Government of KarnatakaCircular: revised treatment guidelines for asymptomatic and mild symptomatic COVID positive persons in home isolation/home care and CCC.https://covid19.karnataka.gov.in/storage/pdf-files/cir-hws/Circular-Revised%20Treatment%20Guidelines%20for%20Asymptomatic%20and%20Mild%20Symptomatic%20COVID%20Positive%20Persons%20in%20Home%20Isolation-Home%20Care%20and%20CCC.pdfDate: May 1, 2021Date accessed: June 6, 2021Google Scholar and protocols to be followed by all medical professionals while managing patients with COVID-19. These guidelines are updated from time to time based on the changing scenario of the pandemic and are legally binding for medical professionals, however unscientific or irrational they are. The courts in India consider these guidelines issued by the public health departments as a credible source of reference while adjudicating litigations pertaining to COVID-19 patient management, because evidence-based medical publications are difficult to understand and interpret in the given situation. Moreover, medical professionals could be prosecuted for not following the guidelines published in strict laws such as the Epidemic Diseases Act, 1897, and the Disaster Management Act, 2005. This is also evident in the late policy decision to vaccinate pregnant and lactating women in India. Therefore, the state machinery is as responsible as the medical professionals in India for not following evidence-based medicine while treating patients with COVID-19. I declare no competing interests. Low-value medical care in the pandemic—is this what the doctor ordered?The humanitarian crisis India faces in the second wave of COVID-19—the rapid surge of cases, the collapsing health system, and the death and despair—are being documented in real time. However, the large-scale practice of low-to-minimal value care1 and its consequences have escaped notice. Full-Text PDF Open AccessLow-value health care in the COVID-19 pandemicIn their Comment, Soumyadeep Bhaumik and colleagues1 summarise the burden and consequences of non-evidence-based COVID-19 management in India, highlighting the need for evidence-informed guidelines on various aspects of clinical management and health care delivery. Full-Text PDF Open Access