Assessing the Indian Medical Association (IMA), a 400,000-member professional organisation operating across diverse political, social and healthcare environments over nine decades, is a challenging task. Such an attempt was recently made in the article, ‘The Indian Medical Association’s role in federal and state policy processes in India: a scoping review’, published in Health Policy and Planning in May 2026. Conducted primarily from Vancouver, Canada, the review was authored by four researchers, three of whom are of Indian origin and have published on Indian health systems and policy. This commentary examines both the strengths and limitations of that effort.
The Double Filter Problem
The article is classified as a scoping review, but its conclusions ultimately derive from a relatively small body of literature that largely consists of interpretations of the IMA’s actions and positions. Thus, the material under study here is not the IMA itself, but the limited academic and commentary literature published about it. That literature was produced by observers making sense of individual events — each occurring at a different time, in a different part of the country, and triggered by different circumstances — through the lens of their own assumptions. This review’s authors, in turn, are interpreting that body of work. By the time a conclusion reaches the reader, the original reality has passed through several filters: the event itself, the observer’s framing, the publication and editorial processes, and the review’s own extraction and synthesis. Each filter introduces selection, emphasis, bias, and potential distortion. The authors acknowledge this in part in their limitations section, noting that some commentaries carry “more opinionated perspectives”.
Academic research tends to concentrate on conflict, controversy, regulatory disputes, and legislative debates, since these generate visible events and leave documentary records. More routine organisational activities — such as continuing medical education, vaccination campaigns, disaster response, ethics seminars, professional development programmes, and public health outreach — rarely become subjects of policy research. Consequently, the available literature is more likely to capture moments when the IMA is opposing or contesting policy rather than presenting the broader spectrum of its activities.
The Insider’s Perspective
The IMA is not a historical institution accessible only through archival sources. It remains active, with an accessible national leadership, state and local branches, working committees, and numerous office-bearers responsible for a wide range of professional, educational, public health, and policy activities.
While a scoping review is a legitimate methodology for mapping existing evidence, the absence of any direct engagement with current or former office-bearers is a notable limitation, given the article’s stated aim of characterising the IMA as an organisation.
While a scoping review is a legitimate methodology for mapping existing evidence, the absence of any direct engagement with current or former office-bearers is a notable limitation, given the article’s stated aim of characterising the IMA as an organisation. Consequently, the article does not discuss the organisational realities of the IMA, including the fact that its office-bearers perform these functions on a voluntary basis alongside their clinical responsibilities. Such engagement would not necessarily have validated the IMA’s positions; it would have offered insight into how policy decisions are debated internally, how priorities are set, where the limitations lie, and how positions evolve across successive leaderships. Such nuances are not acknowledged — surprising for a study of this scope.
Doctors who actively contribute to the organisation’s work are likely to view it differently from those who do not — each vantage point offering a partial picture. Maintaining consistency of goals through constantly changing leadership and adapting to the needs of successive generations are obvious challenges for any professional organisation. Criticism from fellow professionals is therefore neither unexpected nor unwelcome, as such feedback frequently helps the ship stay on course.
The Right Question About Lobbying
IMA’s involvement with policymakers has been discussed in detail in the review. It is not uncommon for healthcare policies to be drafted by well-intentioned individuals whose day-to-day experience of healthcare delivery may be limited. As a result, practical shortcomings are expected, creating a need for feedback from practising clinicians and professional organisations. It is well within the IMA’s responsibility to engage with policymakers on behalf of both doctors and patients to iron out the wrinkles — policies that seem well-intentioned but might prove counterproductive in the long term.
The relevant question, therefore, is not whether the IMA lobbies policymakers — every major professional association in the world does. It is whether such engagement improves or impedes health outcomes.
The review frequently characterises the IMA as reactive to policy reform. But this is simply how organised professional associations work: reforms originate in governments and regulatory bodies, and associations respond to proposals they believe will affect their members, their patients, or professional standards. Reactivity alone should not be interpreted as evidence of obstructionism.
The relevant question, therefore, is not whether the IMA lobbies policymakers — every major professional association in the world does. It is whether such engagement improves or impedes health outcomes. Answering that question requires direct examination of policy outcomes rather than inference from a limited body of secondary literature.
From Critique to Better Policy
This points to a paradox: the engagement the review characterises as reactive is often what identifies the practical flaws in well-intentioned reform.
The Clinical Establishment Act illustrates this. Conceived to improve the quality of clinics and hospitals across the country, certain stringent provisions instead had unintended consequences — raising the overhead and staffing costs of smaller establishments, and with them the cost of treatment for patients. Whether or not one agrees with the IMA’s position, its participation ensured that practical concerns about implementation costs and unintended effects became part of the policy debate.
The IMA’s Position on Other Systems of Medicine
As an organisation of doctors trained in modern medicine, one of IMA’s goals is to uphold evidence-based medicine, and that responsibility includes challenging unscientific and misleading claims which may endanger public health. For instance, anti-vaccine propaganda has been promoted by certain healthcare practitioners in India, and unless these claims are comprehensively debunked, the safety of the public remains at stake. The official position of the IMA has long been that each recognised system of medicine should practise within its own approved curriculum, and that crossing those boundaries — a practice termed “mixopathy” — serves neither the patient nor the integrity of the system involved.
By the same token, the IMA holds that integrating alternative systems without rigorous scientific validation risks diluting the body of scientific medical knowledge — knowledge built, tested, and refined through the collective efforts of researchers across the world. This is not, as the review frequently characterises it, a merely “Western” system, but a global one. This position is sometimes interpreted as opposition to alternative systems of medicine, an impression reinforced by the authors’ assertion that ‘restriction of traditional medicine’ constitutes ‘one of the IMA’s seven main policy domains’. In reality, the organisation’s concern has primarily been with cross-practice and unscientific claims, not with opposing other recognised systems of medicine.
A Broader Public Health Role
The review gives the impression that the IMA is primarily concerned with private practice. However, its membership includes doctors from both the public and private sectors, and its activities extend beyond issues affecting private practitioners alone. Nevertheless, since around 70 percent of outpatient and 58 percent of inpatient healthcare in India is delivered through the private sector, the prominence of private-sector issues in the literature is not unexpected.
Amid the largely critical literature, the paper acknowledges the IMA’s role in major public health initiatives, including the Global Polio Eradication Programme. It also notes that the organisation’s sustained advocacy on ending violence against doctors contributed to protective legislation in 23 Indian states since 2009. Violence against healthcare workers is a serious and growing problem. This is an example of the organisation identifying a genuine threat to healthcare delivery and helping translate that concern into legislative action.
Given the methodology’s dependence on limited secondary and tertiary sources, and the geographic and temporal fragmentation of what has actually been studied, its conclusions about the IMA as an organisational entity should be treated as hypothesis-generating rather than definitive.
None of the above criticisms negates the review’s contribution. The paper succeeds in identifying recurring themes in the existing literature and demonstrates the continuing importance of the IMA in shaping health policy in India.
A Valuable First Step
This review is a valuable first attempt to bring scattered evidence together, but given the methodology’s dependence on limited secondary and tertiary sources, and the geographic and temporal fragmentation of what has actually been studied, its conclusions about the IMA as an organisational entity should be treated as hypothesis-generating rather than definitive. By demonstrating that only 37 papers have examined one of the largest, if not the largest, physician organisations in the world, the authors have implicitly issued a challenge to Indian health policy researchers. The real work — primary interviews, ethnographic observation, state-level comparative studies, and longitudinal analyses of policy outcomes — remains to be done, and is best undertaken collaboratively with those embedded in the system. In that sense, the review’s greatest contribution may be the research agenda it opens up.
Dr Rajeev Jayadevan is the former president of the Cochin Branch of the Indian Medical Association and was Co-Chairman of the National IMA COVID Task Force.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.