Healers and their medicines can be panaceas; they can also kill. In Pakistan, where regulation of healers and their armamentarium is comical at best, more healers and their medicines are damaging health than alleviating suffering. Whereas there is a strict regulation of all aspects of allopathic mode of treatment and medicines, virtually no control is placed on "traditional medicine." This includes all tabibs, homeopaths, ayurveds, faith healers and other self-professed specialties. In a country, where only 20-30% of the population is a regular beneficiary of the regulated allopathic medicine, such blatant disregard of the health of majority of our population is appalling. Majority of our population is at the mercy of quacks; our government condones it.

The quacks, uncertified doctor, hakims and homeopaths, practising in this country can officially prescribe any medicine that does not come under the purview of allopathy. Allopathic medicines disguised as traditional medicine however qualify. There are no checks and balances. Countless tabibs concoct their own pills, majoons, sugar pills, etc., and dispense them freely. The art of alchemy truly thrives in Pakistan. Unfortunately, we do not have too many Ibne Sinas peddling their commodities in the street corners. A disaster awaits those who dare use these often funny looking products. The irony is that people keep going back to these quacks to give them a thriving business. Why? Perhaps because the patients do not have any alternative or may be because they do actually get relief from their illnesses. Setting aside the consideration of placebo power in treating diseases, the ability of quacks to heal is worth questioning.

There is no doubt that traditional and herbal medicine has an important place in treating diseases. Many of today's well-known allopathic drugs, aspirin, quinine, reserpine, etc., came anecdotally from the use of plant and animal sources of drugs. Those who know the science and art of using these sources should do well; but these experts are quite rare. Most people take advantage of the country's discriminatory rules that favour traditional medicine to exploit the ignorant and destitute.

A most serious aspect of quackery has recently become extremely alarming. The traditional medicines of quacks which were at best useless and at worst induced minor toxicities now come fully armed with allopathic molecules, which are truly potent and have the potential of serious side effects. It is not known how many allopathic drugs get disguised as traditional medicines but one such drug that is difficult to hide is the drug, steroid. This contamination of traditional medicine came to light in studying the quacks doing well in treating illnesses that require immediate treatment such as in the case of asthma, skin allergies, inflammation, etc. There is no doubt that in the eastern medicine and homeopathy there are drugs quite useful for these diseases. However, to induce a quick effect, the quacks rely heavily on the magical power of steroids.

Steroids are chemicals found in body; types of steroids include hormones that govern many body functions including sexual differentiation, puberty and defence against diseases. The steroids are essential but their excess produces effects that include:

• Reduced inflammation.
• Improved kidney functions.
• Increased stomach secretions and ulcers.
• Feeling of happiness followed by depression.
• Hollowing of bones leading to severe arthritis.
• Delayed wound healing.
• Increased muscular power initially followed by loss of muscles.
• Normalized blood pressure.
• Increased ability to cope with stress.
• Decreased resistance to infectious diseases.
• Elevated blood sugar level and diabetes.
• Increased fat and cholesterol levels in blood.

The net effect of the use of steroids is that the entire body control system is badly affected causing long term illnesses and physiologic dependence on these chemicals. Since the effects of steroids are dramatic, specially in relieving inflammation, asthma, allergy, etc., they prove handy in imparting quick relief to patients and make a believer out of them. But what they really turn out to be are addicts. Now they are really hooked on.

In allopathic medicine, steroids are often used as the last resort therapy; the quacks do not have the patience. They go for a kill on day one. Unfortunately, once exposed to steroids, all other modes of treatment become useless. Now even the best of the allopathic (or even hikmat) medicine can be of little help. The patient has been irrevocably violated. And now he must revert to his quack for continued relief. Chained to steroids, the patient is now a slave that pays. This is how the quacks proliferate their practice.

Unlike the system of professional referrals in allopathic and ethical traditional medicine, the quacks rely solely on the word of mouth publicity. In a society that thrives on the many retinues of illnesses, one can not help remembering what Mirza Farhatullah Baig wrote humorously but quite realistically regarding the art and science of teemardari. We are indeed a sitting duck for quacks. We love to be exploited, we take solace in suffering and above all we reward those who violate us. At least that what seems to be the policy of our government. Shunning totally away from the menace that hits two-third of our population is not a simple matter. It takes a great deal of planning and bred callousness.

The abuse of steroids in hikmat and homeopathic medicines is increasing steadily. The import figures show that the quantity of steroids imported in this country is about 2-3 times higher over what is needed to manufacture the approved registered drugs. Where is the rest of this steroid going? Well, one route is through unlicensed practitioners of medicines--the quacks of Pakistan.

To evaluate how widespread this problem is, we collected samples of hikmat and homeopathy from several sources in the city. The samples were sealed and sent to a laboratory where they were coded and tested for traces of steroids. Fortunately, like their effects on the body, steroids shine through many chemical tests giving unequivocal evidence of their presence. Here are the results:

60% of all hikmat samples dispensed in unsealed bottles had steroids.
20% of all homeopathic samples in unsealed bottles had steroids.
None of the sealed homeopathic samples (imported) had any steroids.

This study confirmed the long talked-about fears that steroids are freely used by tabibs and homeopaths. Depending on the illness, your chances of getting exposed to steroids in the hand of quacks are almost 100% if you complain of asthma, skin and other allergies. Of course, there are ethical tabibs and homeopaths. However, if your tabib or homeopath does a miracle in treating these diseases, chances are he may be using more than just the power of suggestion. Question him and send a small sample of his prescription to this newspaper. Include your complete name, address and a contact phone if available. Identify the tabib or homeopath who dispensed it. We will test it after confirming your identity. Results of our findings will appear in this newspaper.