Unwelcomed and devalued: Preachers of exclusion plagiarize from documents of inclusion

ABSTRACT

The All India Institute of Medical Sciences (AIIMS), New Delhi published guidelines, titled “Report of the Expert Group for framing Guidelines for admission of candidates with benchmark disabilities in postgraduate courses at AIIMS, New Delhi”, for doctors with disabilities seeking postgraduate admissions to the Institutions of National Importance. The expert group, which lacked representation of people with disabilities, in general, and doctors with disabilities, in particular, puts immense effort into justifying why trainees with disabilities must not join AIIMS, at times in bold and/or capital letters, and at other places, in an outright ableist language. In addition, there is blatant plagiarism from well-known advisories and guidelines which are known for promoting the inclusion of trainees with disabilities. Attitudinal barriers and biases remained incorrigible as sections of these documents were selectively abridged to justify prevailing exclusion practises. We link the connection of these members to the controversial National Medical Council guidelines for undergraduate admission of persons with specified disabilities, which were successfully challenged in courts, as well as to the identification of posts for employment at AIIMS. We justify disability accommodations by citing inclusive court interventions from India to emphasise that the notion of inclusive equality includes the provision for reasonable accommodations. It is high time that the motto “Nothing about us, without us” becomes a locus classicus for immediate change of these discriminatory guidelines, as well as the prescribing powers of such experts.

The Context

“When competent persons with disabilities are unable to realize their full potential due to the barriers posed in their path, our society suffers, as much, if not more, as do the disabled people involved. For it is denying to the nation the opportunity to be served by highly competent people who claim nothing but access to equal opportunity and a barrier-free environment.”

- Justice Dr. DY Chandrachud (in Vikash Kumar v UPSC, 2021)[1]

The All India Institute of Medical Sciences (AIIMS), New Delhi, is the conducting authority for the Institute of National Importance Combined Entrance Test (INI-CET) for postgraduate (PG) medical education in nine AIIMS, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), National Institute of Mental Health and Neurosciences (NIMHANS), and Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. In December 2021, the Sanjay Wadhwa Committee of AIIMS, New Delhi, published guidelines, titled “Report of the Expert Group for framing Guidelines for admission of candidates with benchmark disabilities in postgraduate courses at AIIMS, New Delhi”, for doctors with disabilities seeking PG admissions for the INI-CET January 2022 session.[2] The expert group, which lacked representation of people with disabilities, in general, and doctors with disabilities, in particular, was tasked with determining the speciality-wise suitability of various disabilities in accordance with the Rights of Persons with Disabilities Act (RPDA), 2016.[3] The expert group self-proclaimed this report to be “quite unique, perhaps revolutionary, with far reaching consequences (p 6), which may also be used as a reference if and when new post-graduate/super-specialty medical education courses are introduced in future (p 21).” This report has an immediate impact on the aspirations and careers of qualified candidates, as well as an indirect impact on the morale and aspirations of future generations of disabled candidates. We, medical educators and doctors with disabilities, wonder if this is the most ableist and exclusionary document in the history of medical education in India.

Stonewalling and Systematic Exclusion Practices

It is important to understand what prompted this exercise. The RPDA mandates a 5% reservation for candidates with disabilities in higher education, which includes MD/MS/MDS courses at all AIIMS. The Times of India reported that out of over 4000 PG seats in the various AIIMS from 2018 onwards (with two exams per year), 200 should have gone to those with disabilities if the 5% quota had been implemented.[4] Instead, only 17 students (<0.5%) have been allowed to pursue training. AIIMS, responding to an RTI request stated that only three learners with disabilities had been admitted to PG training courses, that too only in dental courses (2 in pedodontics and 1 in prosthodontics) between January 2018 and July 2021. During the same period, learners with disabilities were enrolled for PG training in other institutes of national importance, such as NIMHANS, PGIMER, etc.[4] This document appears to be an effort to justify AIIMS’s culture of stonewalling and systematically excluding trainees with disabilities while responding to calls for social accountability and inclusion. The document reeks of ableist attitudes and is replete with plagiarised content from other well-known documents promoting the inclusion of doctors with disabilities, such as the Welcome and Valued: Supporting Disabled Learners in Medical Education and Training guidelines from the General Medical Council (GMC), United Kingdom.[5]

Going through this report might be unsettling for anyone who believes in the capability of human beings and equal opportunities. The report makes effort in justifying why doctors with disabilities must not join AIIMS (at times in bold and/or capital letters) and other places in outright ableist language, which does not auger well for an official document by a premier institution in the country. Here are a few excerpts along with our counter:

• Learning material in medical subjects is in general NOT available in Braille or Audio-Books forms…Some people may have an erroneous notion that Psychiatry is a speciality where candidates with some limitations in physical abilities such as those who are hard of hearing, or have low vision etc., may be considered, but this is not true.

Most learners today read on screens. Soft copies of voluminous medical texts are easier to handle, annotate, revise, and at times, are far cheaper. Medical books were made available in audio format more than 50 years ago for recording for the Blind in the case of Dr. David Hartman, a psychiatrist.[6] Case studies suggest that even legal blindness is no hindrance to a successful medical career, including a career in psychiatry.[7,8] Agreeably, Braille texts are cumbersome. However, soft copies can be read using refreshable electronic Braille displays. Even dual sensory impairment like deaf–blindness is no barrier, as the UK has already admitted a deaf–blind medical student.[9]

• There is no country in the world, developing or developed, where ALL the persons with disabilities are considered suitable to pursue any/all the courses. Some of the non-clinical medical specialities are also now more demanding and challenging… There are no part time PG medical courses at AIIMS or in India.

No country in the world, developing or developed, considers suitability according to impairment extents or types. Disability is located in the person–environment interactions and appropriate environmental modifications can be made to support learners with disabilities. Based on disability, learners are provided with relevant reasonable accommodations and assistive technologies.[10]

• One must accept the fact that ‘everyone cannot do everything’!

Such a statement cannot be used to justify the culture of systematic exclusion. A less offensive statement would have read, “Everyone can and should be supported to do anything they aspire to.” The professional regulator of medical education and practise in the UK stresses that even if there are no trainees with disabilities in the course at the moment, medical schools have a responsibility to anticipate the requirements of such trainees. They emphasise, “Doctors may acquire a condition or disability at any stage of their career…Disabled doctors in training must be supported to participate in clinical practice, education and training.”[5]

• The physical capability also includes the ability to work in a Team, as well as independently, that is, without the assistance of an intermediary.

Intermediaries or access assistants have been used globally to support students and residents with disabilities.[11,12,13] Intermediaries serve as appropriate disability accommodation to those with restricted hand movements and visual disabilities (which are outright rejected for specialisation in the AIIMS report) so that they can demonstrate their competence without altering the standards.[14] Section 3 (5) of the RPDA also mandates the government to take necessary steps to ensure reasonable accommodation for persons with disabilities.[3] Denial of disability accommodation thus amounts to discrimination and is therefore punishable under our disability legislation.

• AIIMS is trying to strike a balance between the “statutory rights” of candidates with disabilities, the “limitations which the disability may impose” on the discharge of duties expected of a professional qualified in the course, and the “legitimate interests” of educational institutions in “preserving the integrity of its programs.”

This statement implies that the rights of persons with disabilities exist counter to the institution’s rights to preserve training standards and the discharge of routine duties. This oppositional stance is not borne out in the evidence or in any systematic observation. Training standards can be maintained or brought low by both disabled and non-disabled learners, and this is similarly true for the discharge of duties with compassion. Experts here have resorted to besmirching disabled learners as being insincere, inept, and even incapable. What has been forgotten is that in today’s day and age of competency-based medical education, there exist many workarounds and methods to train and assess learners, which make seeming inabilities irrelevant. For example, a person with mobility impairments may not need to demonstrate basic life support interventions. Rather, competency would involve demonstration of the knowledge and awareness of when to intervene, how best to proceed, adherence to techniques, etc., Trainees must acquire such competencies but not how they must attain them (e.g. using sight, hearing, speech).[15] Inclusion experts in USA have critiqued the speciality boards’ overemphasis on competencies to “perform” certain skills and utilise “spoken words” as they fall in the purview of disability accommodation for residents with mobility and speech disabilities, which renders the acquisition of these skills in a particular way discriminatory.[16]

• One may argue that a candidate who has any disability and has completed undergraduate medical education programme should be considered automatically suitable for any PG medical education programme! But a careful examination… will clearly indicate the significant and vast difference.

Without supporting evidence, this remains a supposition based on attitudinal biases. The authors of this article have done specialisation with the lived experience of mobility disability in both legs, visual disability, as well as multiple sclerosis (all of which are barred in the AIIMS report) and have done specialisations while working in prominent institutions. Similarly, our organisation of health professionals with disabilities has disabled people from all of the major specialities, as well as those who are pursuing or have done super-specialisations in urology, plastic surgery, hematopathology and endocrinology. Institutions will be unable to support disabled learners unless they collect the experiences of disabled people who have completed PG medical education.

• Not all services through the Civil Services Examination are open for all the candidates with disabilities…There are some Physical Standards for UPSC civil services, specifically for the technical services namely, the Indian Police Service (IPS), the Indian Railway Traffic Service (IRTS), Delhi Andaman and Nicobar Police Service (DANIPS), Pondicherry Police Service (PONDIPS) and the Indian Railway Protection Force Services (IRPFS) such as height, weight, chest, etc.

On 25 March 2022, the Supreme Court issued an interim order permitting physically disabled people who passed the civil services (mains) exam to apply provisionally for positions in the IPS, the IRPFS and the DANIPS, deeming the request “fair and acceptable.”[17]

Academic Ableism

What is more concerning and damaging for the reputation of AIIMS is the blatant selective plagiarism of one-third of the document from well-known advisories and guidelines on promoting the inclusion of doctors with disabilities. Table 1 shows a comparison of the plagiarised content from various sources, which includes a regulatory guideline,[5] a published paper in a society journal,[18] and an article on persons with lived experience.[19] Attitudinal barriers and biases remained incorrigible as sections of these documents were selectively abridged to justify prevailing exclusionary practices. Panellists today cannot hide behind even feigned ignorance of best practices and standards with regard to inclusion. AIIMS has even used the name of the Supreme Court of India to misquote a selectively plagiarised sentence (p 10) [Table 1] talking about American disability legislation.[18]

Table 1.

Comparison of text copied in the AIIMS report from various sources

AIIMS Report[2] (Italicised font shows plagiarised content)	GMC UK’s Welcomed and Valued[5] (Italicised font shows original content)
All medical students and doctors, regardless of whether they have a long-term health condition or a disability, need to meet the competences set out for different stages of their education and training (pp 7, 8)	All medical students and doctors in training, regardless of whether they have a disability (including long-term health conditions), need to meet the competences set out for different stages of their education and training in order to ensure patient safety. (p 5)
All medical students need to meet the academic requirements of their course. This is true of AIIMS as well. (p 8)	All medical students need to meet the academic requirements of their course. (p 39)
we at AIIMS believe that students with disabilities should be welcomed to the profession and valued for their contribution to patient care. (p 8)	As the professional regulator, we firmly believe disabled people should be welcomed to the profession and valued for their contribution to patient care. (p 3)
Patients often identify closely with medical professionals with lived experience of ill health or disability, who can offer insight and sensitivity about how a recent diagnosis and ongoing impairment can affect patients. Such experience is invaluable to the medical profession as a whole, and illustrates the importance of attracting and retaining disabled learners. (p 8)	Patients often identify closely with medical professionals with lived experience of ill health or disability, who can offer insight and sensitivity about how a recent diagnosis and ongoing impairment can affect patients. Such experience is invaluable to the medical profession as a whole, and illustrates the importance of attracting and retaining disabled learners. (p 24)
AIIMS is ready to consider requests for adjustments, but only have the obligation to make the adjustments which are reasonable. (p 8)	Organisations must consider all requests for adjustments, but only have the obligation to make the adjustments which are reasonable. (p 3)
All medical students and doctors in training, regardless of whether they have a disability (including long-term health conditions), need to meet the competences set out for different stages of their education and training in order to ensure patient safety (p 10)	All medical students and doctors in training, regardless of whether they have a disability (including long-term health conditions), need to meet the competences set out for different stages of their education and training in order to ensure patient safety. (p 5)
These are the absolute requirements for medical students and doctors in training in order to progress in their studies and practice going on to Registration with Statutory Councils/Bodies (p 10)	These are the absolute requirements for medical students and doctors in training in order to progress in their studies and practice. (p 5)
A request for an adjustment can be declined if it is not deemed ‘reasonable’. (p 10)	A request for an adjustment can be declined if it is not deemed ‘reasonable’, but it is unlawful not to consider reasonable adjustments at all. (p 51)
There is no set definition of what ‘reasonable’ means. What is ‘reasonable’ can only be decided on a case-by- case basis. (p 10)	There is no set definition of what ‘reasonable’ means. What is ‘reasonable’ can only be decided on a case-by-case basis, and will always depend on the individual person and their circumstances. (p 52)
core components of skills and procedures to be practiced on different occasions, and in different settings, such as out-patient departments, in-patient (p 9)	These outcomes must be demonstrated on different occasions and in differentclinicalsettingsasa professional in the workplace (p 37)
AIIMS Report[2]	Bhandari, Neena[19]
There is a dearth of specific data on the prevalence of disability in the medical in general, and prevalence of specified disabilities in particular. (p 8)	There is a dearth of specific data on the prevalence of disability in the medical profession.
Hospitals generally sprawl over different levels and large areas, which can pose a challenge for doctors with disabilities. In many developing countries, elevators often do not work due to power shortages, most of the doors are not automated and the ramps may not exist, may be dirty and/or crowded. (pp 8, 9)	Hospitals generally sprawl over different levels and large areas, which can pose a challenge for doctors with disabilities. In many developing countries, elevators often do not work due to power shortages, doors are not automated and the ramps are dirty and crowded.
The challenges doctors with disabilities face are not a developing country problem alone, but they exist in developed countries as well. (p 9)	The challenges doctors with disabilities face are not a developing country problem alone, but they exist in developed countries as well.
AIIMS Report 2021[2]	DeLisa JA, Thomas P[18]
It is important to remember that the core mission of medical education has not changed – the goal is still to train competent and compassionate physicians – the strategies for achieving that mission may have somewhat evolved, during the past decade or so. (p 5)	Though the core mission of medical schools and training programs has not changed—to train effective, competent and compassionate physicians best able to serve the needs of society—the strategies for achieving these goals have changed. (p 7)
It may be determined by taking into consideration many important factors such as the physical capability, the extent of rehabilitation, the requirements of the PG course with regard to successful training and practice in terms of Observation, Communication, Motor Functions, Intellectual-Conceptual, Integrative and Quantitative Abilities, and Behavioural and social attributes etc., (p 6)	In 1979,…the panel concluded that a candidate for the MD degree must have abilities and skills in the following areas:[17] 1. Observation—performed in a reasonably independent manner 2. Communication skills 3. Motor skills—performed in a reasonably independent manner 4. Intellectual-conceptual, integrative, and qualitative abilities 5. Behavioral and social attributes (p 7)
The Rights of Persons with Disabilities Act, 2016 does not prevent medical colleges from selectively accepting the most highly qualified applicants, nor does it impose any obligation on the medical colleges to lower their standards! (p 10)	The ADA does not prevent medical schools from selectively accepting the most highly qualified applicants, nor does it impose any obligation on medical schools to lower their standards. (p 11)

Sections of the GMC on the provisions of reasonable accommodation find no mention in this document. In contrast to these expert recommendations, GMC UK doesn’t prescribe a priori inclusion or exclusion of learners into medical training based on their disability type or extent.[5] Plagiarised content includes an admission of flouted accessibility norms such as the lack of elevators and accessible ramps as a challenge for including doctors with disabilities in medical education. AIIMS, with an annual budget of Rs 3,800 crore and with the status of being India’s apex medical institution, should by now have complied with the RPDA mandate and Accessible India Campaign but yet remains inaccessible.[19] Thus, noncompliance cannot be used to justify exclusion.

Why Lived Experience Matters

Neither the social nor the medical model of disability grasps the essence of the lived experience of having a disability.[20] Medical students’ lived experiences reveal a stigmatising culture[21] and the invisibility of inclusive pedagogy in medical education.[22] On the clinical side, disabled physicians’ own experiences make them more empathic and humanise the patient–provider connection.[23] When it comes to clinicians with disabilities, the phenomenological ethics discourse establishes respect and empathy as it connects the patient’s existential crisis of their impairment that is anchored in their own life experience to that of the health professional with a disability. The transition to a phenomenological attitude puts the medicalized attitudes and preconceptions about disability on hold and fosters engagement with an ethics of reflection and listening.[24] In addition, disability is also viewed as a beneficial rather than a bad life experience in the Basotho ontology of disability, which encourages people with disabilities to participate in all aspects of life.[25] When disability is viewed positively, it empowers people with disabilities, whereas when it is viewed as a deficit, it excludes people with disabilities.[26] Apart from the moral, ontological, and epithetic justification, lived experience has also been considered an expertise by statutory bodies like the Court of Chief Commissioner for Persons with Disabilities, Government of India, who wrote to all states and union territories that at least one of the members of the interview boards be a person with disability to ensure that candidates with disabilities of non-discrimination and any bias against them on the grounds of their disabilities.[27] Also, legally, Article 4 (3) of the Conventions on Rights of Persons with Disabilities (CRPD) makes it binding to actively involve people with disabilities in policy implementation and decision-making processes.[28]

Five of these 7 AIIMS experts in the Wadhwa Committee, none of whom have lived experience of disability, were also part of the committee that framed the National Medical Commission’s (NMC) guidelines for admission of candidates in NEET UG and PG. These non-disabled experts in their ivory towers jumped at the chance to frame NMC standards, which now adhere to competency-based medical education (which none of the AIIMS follow), and assumed that those with low vision, hearing impairment, specific learning disabilities, and psychological disabilities are unfit to pursue medical education; this exclusion remains unfounded. It took the Supreme Court, state high courts, representation and litigation from the collective Doctors with Disabilities: Agents of Change as well as critique by global disability leaders to quash some of these ableist guidelines, which thereby allowed candidates with upper limb disability, low vision, hearing impairment, psychosocial disability and dyslexia to join undergraduate and PG medical education.[29,30,31] In one instance, the West Bengal High Court also penalised the state while compensating the litigant with disability with Rs 3 lakh for the lost academic year.[32]

Unlike these high priests of exclusion sitting atop citadels of ableism, in countries, developed and developing, collaborative consultations in line with the motto Nothing About Us, Without Us contextualize such advisories. In the year that the AIIMS experts made the controversial guidelines for NMC in India, the GMC in UK, after multiple consultations with people and doctors with disabilities, produced the Welcomed and Valued guidelines to support learners with disabilities in medical education and training.[5] In the same year, the Association of American Medical Colleges produced the seminal guidelines based on the Lived Experience Project on how to foster a welcoming culture and climate for learners and physicians with disabilities.[33] The International Council for Disability Inclusion in Medical Education is compiling best practises globally to support learners and trainers with disabilities in medical education and practise, and the report will be out in mid-2022.[34]

Inclusive Court Interventions from India

The Report also places riders on those with cerebral palsy calling it as “an important disabling condition” where the person may have “other deficits also such as visual, hearing, speech-language, higher mental function, epilepsy etc.”.[2] All of the later impairments were used by these same experts as exclusionary criteria for admission in the NMC guidelines. Even now, they have banned all those with upper limb disabilities in PG. They seem to be unaware of the landmark judgement by the Supreme Court of India (SC) where the right to employment of a person with cerebral palsy (with the inability to hold a chalk to write on a board) who was denied a teaching post was upheld by invoking the concept of reasonable accommodation for the first time back in 2010.[35] Once again, in the Jeeja Ghosh matter, the SC reiterated:

• Equality not only implies preventing discrimination (example, the protection of individuals against unfavourable treatment by introducing anti-discrimination laws), but goes beyond in remedying discrimination against groups suffering systematic discrimination in society. In concrete terms, it means embracing the notion of positive rights, affirmative action and reasonable accommodation.[36]

Dr Vikash Kumar, an MBBS graduate with dysgraphia (writer’s cramp) was denied the facility of a scribe in the UPSC examination. In a landmark judgement, the SC once again reiterated that doctors with disabilities can accomplish their duties if provided disability accommodations:

• As the Committee on the Rights of Persons with Disabilities noted in General Comment 6, reasonable accommodation is a component of the principle of inclusive equality. It is a substantive equality facilitator. The establishment of this linkage between reasonable accommodation and non-discrimination thus creates an obligation of immediate effect. Under this rights-based and disabled-centric conceptualization of reasonable accommodation, a failure to provide reasonable accommodation constitutes discrimination. Reasonable accommodation determinations must be made on a case-by-case basis, in consultation with the disabled person concerned. Instead of making assumptions about how the relevant barriers can be tackled, the principle of reasonable accommodation requires dialogue with the individual concerned to determine how to tackle the barrier.[1]

No such dialogue happened and the assumptions of one expert (the chairperson of the AIIMS report) were accepted as the benchmark by NMC while debarring candidates with dysgraphia in UG and PG medical education:

• It may be noted that in the disability of Dysgraphia, a person’s fine motor skills are affected and particularly interferes with their ability to write coherently. Such persons would not be in a position to pursue medical education and therefore should not be considered eligible for pursuing medical education. (As per the reply affidavit on behalf of Board of Governors in supersession of Medical Council of India in Satendra Singh vs UOI WP (C) No. 1788 of 2019 -Corrigendum to the minutes of meetings of BOG MCI dated 25.02.2019).

In another judgement, the SC directed the National Testing Agency (NTA) to rectify the injustice by providing disability accommodation to a NEET aspirant with dysgraphia.[37] The candidate who went all the way to the SC might not have any idea of the bigger injustice in NMC guidelines which puts a blanket ban on those with dysgraphia to pursue MBBS. The same is not explicitly mentioned in either the NEET brochure or the NMC guidelines, highlighting attitudinal barriers toward candidates with disabilities.[38] The AIIMS report, too, does not consider doctors with learning disabilities (dyslexia, dysgraphia etc) or those with both legs physical disability worthy of PG as it finds no mention in the disabilities suitable for any of the 37 specialities at AIIMS.,[2] A similar barrier exists for aspirants in family medicine at AIIMS, which is wrongly clubbed with community medicine.[2]

Some of the same panellists have been involved in apportioning identified jobs for quota-based employment at AIIMS on the basis of body parts.[39] Persons with visual, auditory, and psychosocial impairments find no inclusion in this institute. It sets a bad precedent and deprives society at large of interactions with diverse individuals. The portrayal of disability as pitiable, unfortunate, subhuman, and malevolent within this document is exasperating for any person with disability, their caregivers or rights activists. Some of these experts have gone so far as to demand that disabled individuals are incompatible with medical education, especially if they are visually, auditorily or psychosocially disabled.[40] Furthermore, these experts advise the medical fraternity to be cautious as many persons feign disability to obtain an advantage in selection. In a SC decision, Justice DY Chandrachud dismissed such allegations, saying:

• Undue suspicion about the disabled engaging in wrongdoing is unwarranted. Such a view presumes persons with disabilities, as a class, as incompetent and incapable of success absent access to untoward assistance. The disabled confront stereotypes in several aspects of their day to day lives. One of them is that they do not perform as well as others. Like other stereotypes, this one is also totally flawed and contrary to reality. Such an ableist premise is inconsistent with the approach to disability enshrined in the Conventions on Rights of Persons with Disabilities (CRPD) and the RPDA 2016.[1]

Based on a complaint with the Ministry of Health, AIIMS and a subsequent follow up with RTI, AIIMS was constrained to inquire about the issue, and the Research Integrity and Publication Ethics Committee concluded the following: “While there was an overlap of some sentences with freely available guideline documents, since it is a guideline for admission purpose of students, same did not amount to any breach of intellectual property”.[41] We leave it up to the readers to decide on the integrity of this panel. The AIIMS report (which amounts to 30% similarity) comes under level 1 (similarities above 10% to 40%) of the University Grants Commission’s, Promotion of Academic Integrity and Prevention of Plagiarism in Higher Educational Institutions Regulations, 2018. The penalty for this level is a withdrawal of the document, which AIIMS has not yet done.

Conclusion

Clearly, the ableist views and opinions have percolated heavily into the AIIMS report outlining the inclusion of doctors with disabilities in PG medical education. They are not in step with the CRPD and the RPDA, 2016. They fall far behind and appear to have regressed when considering the global scenario. As India has ratified the CRPD, Article 4 (3) is legally binding on expert committees to engage with people with disabilities and disability organisations before passing such unanimous illegal directives that are against the convention. Ableist attitudes and biases have further influenced the inclusion and employment of persons with disabilities in quota-based employment. It is high time that the motto Nothing About Us, Without Us becomes a locus classicus for immediate change of these discriminatory guidelines as well as the prescribing powers of such experts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.