The Pakistan Medical and Dental Council (PMDC) has asked five private medical colleges to close shop and have placed a number of other private medical colleges on the provisional recognition list. While this action of the Council is commendable, it is too little and too late. The practice of medicine in general and medical education in particular is in shambles and the PMDC is to a great measure responsible for this deplorable situation. The sooner the Council cleans its own house, the better for the profession. The election of Dr. Zafar Hayat as chairman of the Council is a step in the right direction.

The proliferation of medical colleges - both private and government - has reached a scandalous proportion in our country. Take the example of two new government medical colleges, one in Swat and the other in Dera Ismail Khan, started in the NWFP last year. The then government of the province, more out of political expediency than actual need, ordered the opening of two new medical colleges. An unholy alliance of politicians, bureaucrats, and a compliant medical establishment said a loud amen to that shortsighted decision. Never mind that the existing two medical colleges in the province - Khyber at Peshawar and Ayub at Abbotabad - are in constant need of experienced staff, equipment and capital improvement. Somehow the powers that be, considered the start of a medical college no different than starting a primary school. In the past one year both of these colleges have remained a little more than paper institutions, functioning in make-shift buildings. Some of the teaching is done by the visiting staff from other colleges and the rest by the clinicians. It is akin to having a geologist teaching anthropology or a surgeon teaching pathology. The appointed deans of these colleges end up spending their time making rounds of the provincial secretariat for funds or making frequent trips to the other two medical colleges to secure short-term services of badly needed teachers.

The proliferation of private medical colleges is another scandal. Most retiring teachers from government medical colleges consider it their God-given right to inflict their so-called expertise on the people. In many instances, these are nothing but get-rich schemes that prey on the innate desire of Pakistani parents to send their children to medical colleges. Naturally, the rejects from government colleges end up in these private medical colleges. With a few exceptions, many of these colleges are nothing but diploma mills run in the basements or back alleys.

This state of affairs is very reminiscent of the state of medical education in the United States in the 1800’s. At the end of last century there was a glut of medical colleges and universities that imparted dubious education and awarded spurious diplomas and degrees. A comprehensive report by the Carnegie Foundation outlined the pathetic state of higher education at many of the institutions. The medical education was discussed in a separate report prepared by Abraham Flexner, a public health specialist.

The Flexner Report published in the early 1900’s, set strict standards for medical education in the United States. As a direct result of that report a great many medical colleges were obliged to close. The Flexner Report has been credited for standardizing medical education in America and Canada. By putting undergraduate medical education on solid footing, it has also been responsible for the spectacular advances that we have witnessed in the past century.

The PMDC is responsible for setting standards for medical education, and to some extent, medical practice in Pakistan. That it has failed in its mission on many occasions is widely known in the medical community. That

PMDC, under the influence of its deeply entrenched permanent staff has engineered approval of questionable medical colleges is also well known. It is also a fact that on behest of interested parties PMDC had in the past approved foreign diplomas, mostly from Vienna, that are not considered for academic appointments even in the country that issues them. Sanity prevailed and under protests of the medical community, the diplomas were de-recognized. But not before a few of the diploma holders had been admitted through this back door. Today those half-baked specialists hold academic positions in some of the established medical colleges in Pakistan.

The recognition of Afghan medical degrees is another murky area that has cast doubt on the credibility and integrity of PMDC. There are at this time several medical colleges in Peshawar that are run by Afghans and their Pakistani collaborators. Some of these colleges function in small private homes and bungalows. The admission criteria to these colleges is almost non-existent, the education third rate and theoretical at best and examinations self-administered without the supervision of a credible examining body. They award MD degree to their graduates. The PMDC, most likely under political pressure and self-interest of some of its officials, decided to recognize these degrees if the candidate could pass a standardized examination. The administered examinations are a farce and success can be guaranteed for a price. Many such MD’s are now working in government establishments in the NWFP.

The PMDC must come out of the shadow of its entrenched leadership and should come clean. De-recognition of some private medical colleges is a step in the right direction. They should adopt the standardized educational requirements that are the norm in many other countries. Perhaps they should ask the Aga Khan Medical College to help write such requirements. Why is it, and the question begs for an answer, that the graduates of that college do consistently better than the graduates of other medical colleges in Pakistan?

To impart medical education should be a noble and sacred responsibility. It has been turned profane by opportunistic politicians, a compliant bureaucracy and greedy entrepreneurs. We need to sort out the sordid mess that our medical education and our medical practice have become. The constitution of a blue ribbon health commission is the crying need of the moment.