Thursday, 12 October 2017

Letter to Twitter

Twitter, Inc.
c/o Trust & Safety – Legal Policy
1355 Market Street Suite 900
San Francisco, CA 94103

To whom it may concern,

Violations of (Indian) The Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954 and The Homoeopathic Practitioners - (Professional Conduct, Etiquette & Code of Ethics) Regulations 1982

It has come to my attention that there are many Indian homeopaths and homeopathic medicines manufacturers who use Twitter as a form of promotion for their business. Some examples would include -

  • @HomeoPositive - Positive Homeopathy
  • @homeosure - Homeosure
  • @drcarehomeopath - Dr. Care Homeopathy
  • @drsantoshhealt2 - dr.SantoshHealthcare
  • @HomoeopathyDr - Dr. Naik Homoeopathy
  • @drrajneesh - Dr. Rajneesh Sharma
  • @Baksons - Bakson's Homoeopathy
  • @ShreeHomoeo - Shree Homoeo
  • @homeohealer - Dr.Ramesh Bhardwaj

There are many more of them. It is clear that all of them are in breach of Indian legislation and regulations. It is also likely that there are in breach of Twitter standards in that they are using the platform for illegal advertising. In some cases, it would appear that Twitter is in breach of Indian legislation by providing a platform.

Homoeopathic Practitioners Regulations
The Homoeopathic Practitioners Regulations ( effectively bar all forms of advertising beyond simple listings if changes to address, etc, occur. It also prohibits publication of case details outside of specialist media. To quote section 6.

  1. Advertising Solicitation of patients directly or indirectly by a practitioner of Homoeopathy either personally or by advertisement in the newspapers, by placards or by the distribution of circular cards or handbills is unethical. A practitioner of Homoeopathy shall not make use of, or permit others to make use of, him or his name as a subject of any form or manner of advertising or publicity through lay channels which shall be of such a character as to invite attention to him or to his professional position or skill or as would ordinarily result in his self-aggrandisement provided that a practitioner of Homoeopathy is permitted formal announcement in press about the following matters, namely :-
i) the starting of his practice;
ii) change of the type of practice;
iii) change of address;
iv) temporary absence from duty;.
v) resumption of practice
vi) succeeding to another’s practice.

  1. He shall further not advertise himself directly or indirectly through price lists or publicity materials of manufacturing firms or traders with whom he may be connected in any capacity, nor shall he publish cases, operations or letters of thanks from patients in non-professional newspapers or journals provided it shall be permissible for him to publish his name in connection with a prospectus or a director’s or a technical expert’s report
Additionally, the Regulations mention the need to comply with legislation.

Physician to obey law and regulation:-

A physician, –

  1. shall not act contrary to the laws regulating the practice of Homoeopathy;
  2. shall not assist others to disobey the law regulating the practice of Homoeopathy;
  3. shall act in aid of the  enforcement of sanitary laws and regulations in the interest of public health;
  4. shall comply with the  provisions of the Drugs and Cosmetics Act, 1940 (23 of 1940), Drugs and Cosmetics Rules, 1945; the Pharmacy Act, 1948 (8 of 1948); the Narcotic Drugs and Psychotropic Substances Act 1985 (61 of 1985); the Medical Termination of Pregnancy Act, 1971 (34 of 1971), the Transplantation of Human Organ Act, 1994 (42 of 1994); the Persons with Disabilities (Equal Opportunity and Full Participation) Act, 1995 (1 of 1996) and Biomedical Waste (Management and Handling) Rules, 1998 and such other related Acts, Rules, of the Central Government or the State Government  or the Local Administrative bodies relating to protection and promotion of public health.

The Central Council for Homeopathy is the statutory body responsible for enforcement of these regulations. However, it has devolved them to State level bodies.

Drugs and Magical Remedies Act
Although the Regulations do not specifically mention it, it is clear that compliance with the Act ( is a requirement.

This is arguably the most important piece of legislation covering advertising of homeopathic medicines as it places absolute prohibition on advertising medicines for certain diseases.

3. Prohibition of Advertisement of Certain Drugs for Treatment of Certain Diseases and Disorders.–
Subject to the provisions of this Act, no person shall take any part in the publication of any advertisement referring to any drug in terms which suggest or are calculated to lead to the use of that drug for –  
a) the procurement of miscarriage in women or prevention of conception in women; or  
b) the maintenance or improvement of the capacity of human beings for sexual pleasure; or
c) the correction of menstrual disorder in women; or  
d) the diagnosis, cure, mitigation, treatment or prevention of any disease, disorder or condition specified in the Schedule, or any other disease, disorder or condition (by whatsoever name called) which may be specified in the rules made under this Act:  
Provided that no such rule shall be made except,–
(i) in respect of any disease, disorder or condition which requires timely treatment in consultation with a registered medical practitioner or for which there are normally no accepted remedies, and  
(ii) after consultation with the Drugs Technical Advisory Board constituted under the Drugs and Cosmetics Act, 1940 (23 of 1940) and, if the Central Government considers necessary, with such other persons having special knowledge or practical experience in respect of Ayurvedic or Unani systems of medicines as that Government deems fit.

The Schedule lists the following conditions -

1. Appendicitis
2. Arteriosclerosis
3. Blindness
4. Blood poisoning
5. Bright’s disease
6. Cancer
7. Cataract
8. Deafness
9. Diabetes
10. Diseases and Disorders of brain
11. Diseases and Disorders of the optical system  
12. Diseases and Disorders of the uterus  
13. Disorders of menstrual flow  
14. Disorders of the nervous system
15. Disorders of the prostatic gland
16. Dropsy
17. Epilepsy
18. Female diseases (in general)
19. Fevers (in general)  
20. Fits
21. Form and structure of the female bust
22. Gall stones, kidney stones and bladder stones  
23. Gangrene
24. Glaucoma
25. Goitre
26. Heart diseases
27. High/Low Blood Pressure
28. Hydrocele
29. Hysteria
30. Infantile paralysis
31. Insanity
32. Leprosy
33. Leucoderma
34. Lockjaw
35. Locomotor ataxia
36. Lupus
37. Nervous debility
38. Obesity
39. Paralysis
40. Plague
41. Pleurisy
42. Pneumonia
43. Rheumatism
44. Ruptures
45. Sexual impotence
46. Smallpox
47. Stature of persons
48. Sterility in women
49. Trachoma
50. Tuberculosis
51. Tumours
52. Typhoid fever
53. Ulcers of the gastro-intestinal tract
54. Venereal diseases, including syphilis, gonorrhoea, soft chancre, venereal granuloma and lympho granuloma.

Some of the terms have very broad scope and potentially cover many different conditions/diseases. Asthma and AIDS were added at a later date.

“Any drug” must be understood in more broad terms than “any specific drug”. In the context of homeopathy, it is the claim to treat a condition with homeopathic medicines.

4. Prohibition of Misleading Advertisements Relating to Drugs.– Subject to the provisions of this Act, no person shall take any part in the publication of any advertisement relating to a drug if the advertisement contains any matter which a) directly or indirectly gives a false impression regarding the true character of the drug; or b) makes a false claim for the drug; or c) is otherwise false or misleading in any material particular.

Twitter, by publishing what is advertisments in the form of tweets would be in breach.

6. Prohibition of Import into, and Export from, India of Certain Advertisements.– No person shall import into, or export from, the territories to which this Act extends any document containing an advertisement of the nature referred to in section 3, or section 4, or section 5, and any documents containing any such advertisement shall be deemed to be goods of which the import or export has been prohibited under section 19 of the Sea Customs Act, 1878 (8 of 1878) and all the provisions of that Act shall have effect accordingly, except that section 183 thereof shall have effect as if for the word ‘shall’ therein the word ‘may’ were substituted.

Whilst this was written before the advent of the internet etc, Tweets, Twitter profiles and linked-to webpages could be considered “documents” in that they contain text. The uploading/creation of such “documents” could be considered export if the platform is based outside of India and/or the “documents” can be seen outside of India.

Twitter Terms
As Twitter makes clear -

  • Unlawful use: You may not use our service for any unlawful purposes or in furtherance of illegal activities. International users agree to comply with all local laws regarding online conduct and acceptable content.
As both the Regulations and the Act place prohibitions on promotion by Indian homeopaths, use of Twitter, except in very limited ways, would place them in breach of this.

Suggested Actions
Twitter could very easily remove offending tweets, remove links from profiles of Indian homeopaths and Indian vendors of homeopathic medicines. Twitter could also suspend accounts until the users are compliant with Twitter’s terms and conditions of use. Detecting violations of T&Cs is not difficult and suspect tweets and accounts could be easily identified.

Twitter would do well to engage with the Advertising Standards Council of India (ASCI).

It is also important to note that reporting breaches of local law regarding illegal marketing claims is almost impossible via Twitter’s tweet reporting system.

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