Tag: healthcare

The government’s enblightenment

The GMO debate is a fascinating object, even though participating in it often amounts to nothing but pain, frustration and lost time – especially if you’re pro-GMO foods. It’s fascinating because it’s one of a kind: one party has science on its side but little else, including good science outreach, and the other has sociology but also lots of overreaching rhetoric. There is also an unseen foe, the agrochemical company Monsanto, whose decades of indulgence in unethical practices and corporate recalcitrance to promote the sales of its fertilisers and genetically modified seeds have blighted the soil – both literally and figuratively – rendering hundreds of thousands of people around the world forever suspicious of genetic engineering vis-à-vis agriculture. One prominent outcome of this ‘enblightenment’ is that scientifically robust data no longer suffices to qualify GM products for regulatory approval, and any such approval, once granted, becomes automatically subsumed by doubts about corruption and subversion. Another outcome is the pall of cynicism that hangs over any public deliberations of GM products, especially regarding business practices – cynicism that effectively holds a gap open for unscientific, even pseudoscientific, arguments to slip into the debate and for untenable rhetorical methods, especially whataboutery, to find more purchase than might be warranted. Taken together, I think these are some reasons why the GMO debate has lasted for so long and why settling it to the effect of everyone being more accepting of GM seeds is going to be very hard.

It would seem some of these features are also visible, or are becoming apparent, on a different front. Baba Ramdev’s (I suspect) pseudo-Ayurvedic company Patanjali Ayurved has come under fire for falsely claiming an antiviral drug it has minted, called Coronil, was approved by the WHO for use against COVID-19. The WHO hasn’t granted any such approval – and the study backing up Coronil’s efficacy doesn’t seem to hold up to deeper scrutiny either. However, Patanjali Ayurved has stood its ground, most recently lashing out against the Indian Medical Association (IMA) for calling Coronil’s public launch on February 19, with Union health minister Harsh Vardhan in attendance as an honoured guest, despite its dubious credentials was “a slap and insult to the people of the country”. A spokesperson for Patanjali, S.K. Tijarawala, tweeted the company’s rebuttal on February 25, asking the IMA to focus on availing the people of India more affordable healthcare first and to abolish the practice of “commissions in the medical profession”. This is plain whataboutery – responding to one argument with another while also changing the topic. However, this counterargument is also likely to stick because access to affordable and good quality healthcare and over-charging in private clinics and hospitals are both big and rampant problems in India, thanks to the oversight of successive governments and the privatising tendencies of the current one. And even though Patanjali is resorting to whataboutery to advance this accusation, the issues’ shared relevance is likely to be able to hold the door open for someone – a minister, a political leader, a prominent doctor, anyone – to legitimise the contention, in much the same way Monsanto mass-poisoned the public impression of GMOs, thus allowing otherwise untenable anti-GMO arguments to survive for longer in conversation. Humming quietly in the background is of course the government’s profitable hypocrisy: of doing nothing to ensure the problems Patanjali is using to hide from the IMA’s complaint go away, dispatching two of its senior ministers to endorse Patanjali’s products despite the near-complete absence of reason in its ‘approval’ by the government, and allowing Patanjali to justify Coronil’s existence by offering it – in vague and therefore irrefutable terms – as a potential solution for India’s ‘access to healthcare’ problems.

Curious Bends – babies for sale, broken AIIMS, male gynaec and more

1. China has a growing online market for abducted babies

“Girls fetch considerably less than boys, but there is still a market for them. Old social patterns have re-emerged in the market, like the sale of girls into a household where they will be servants until they and the son of the house are of age to marry. Most abducted children are sold to new families as a form of illegal adoption, and are increasingly sold online, though some, mostly boys, are also trafficked for forced labour. I recently worked on an asylum case involving a young man forced into begging with a group of children under traffickers’ control in China. He is still so traumatised by the brutal physical punishments inflicted on the boys when they didn’t collect enough money that he can only talk about it in the third person: “they did this to the children”, never “they did this to me”.” (4 min read, theconversation.com)

2. Will it improve India’s poor healthcare if more research hospitals like the AIIMS are built?

“Barely 1-2% of the funds allocated to AIIMS, it observed, were being spent on research. As for education, even as India suffered from a lack of doctors, 49% of the doctors trained at AIIMS had “found their vocations abroad”. This staffing shortage was hurting AIIMS itself. Waiting time for surgery ranged between 2.5-34 months. With a high doctor-patient ratio, patients were barely getting four to nine minutes with doctors at the outpatient (OPD) department. The report flagged other shortcomings. AIIMS had failed to lead the modernisation of India’s public health infrastructure. CAG also noted delays in setting up medical centres, irregularities in the purchase of equipment, and so on.” (5 min read, economictimes.com)

3. Confessions of an Indian male gynaecologist

“Many of my patients confess that they prefer a male doctor to a female one. I don’t know why. But not every woman who walks into my room is comfortable. There is always a nurse in the room as I am scared that some woman will level baseless allegations over the physical examination. Unlike men, women have many health problems. Seeing all that they go through has made me respect them. My wife says I am more like a woman. That I have too much compassion.” (2 min read, openthemagazine.com)

4. Personalising cancer care, one tumour at a time

“Mitra’s CANScript has gone a step further. A simpler analogy would be the bacteria sensitivity tests that are commonly used today. Just as a pathology lab takes a swab, cultures it and tests it against all available antibiotics to finally help a doctor prescribe the right antibiotic, CANScript runs a test against the biopsy from the patient and gives a score card for the drugs to be used. In clinics it is currently used in six solid tumors (breast cancer, gastrointestinal, glioblastoma, head and neck squamous cell carcinoma and colorectal) and two blood cancers. Three other cancers – lung, cervical and melanoma—are under lab testing. However, the limitation with CANScript is that it requires very fresh tumour.” (5 min read, seemasingh.in)

5. What your bones have in common with the Eiffel Tower

“So how did Eiffel design a structure that’s strong enough to withstand the elements, and yet weighs about as much as the air surrounding it? The secret lies in understanding the shapes of strength. It’s a lesson we can learn by looking inwards… literally. By studying our bones, we can discover some of the same principles that Eiffel used in designing his tower.” (11 min read, wired.com)

Chart of the Week

“Now there are nine powers, and the kind of protocols that the cold-war era America and Soviet Union set up to reassure each other are much less in evidence today. China is cagey about the size, status and capabilities of its nuclear forces and opaque about the doctrinal approach that might govern their use. India and Pakistan have a hotline and inform each other about tests, but do not discuss any other measures to improve nuclear security, for example by moving weapons farther from their border. Israel does not even admit that its nuclear arsenal of around 80 weapons (but could be as many as 200) exists. North Korea has around ten and can add one a year and regularly threatens to use them. The agreements that used to govern the nuclear relationship between America and Russia are also visibly fraying; co-operation on nuclear-materials safety ended in December 2014. America is expected to spend $350 billion on modernising its nuclear arsenal over the next decade and Russia is dedicating a third of its fast-growing defence budget to upgrading its nuclear forces. In January this year the Doomsday Clock was moved to three minutes to midnight, a position it was last at in 1987.” (3 min read, economist.com)

nuclear

Caste, healthcare and statistics

In late November 2014, the esteemed British medical journal The Lancet published an editorial calling for the end of casteism in India to mitigate the deteriorating health of the millions of rural poor, if nothing else. The central argument was that caste was hampering access to healthcare services. Caste has been blamed for hampering many things. As Amartya Sen and Jean Dreze write in An Uncertain Glory (2014), “… caste continues to be an important instrument of power in Indian society, even where the caste system has lost some of its earlier barbarity and brutality”.

To append healthcare to that list wasn’t a big leap because casteism in India has had a tendency to graduate access to the fundamental rights even. The editorial cites a lecture that the social activist Arundhati Roy gave last year, during which she mentions the example of a doctor who wouldn’t treat a patient because the latter is of a lower caste. At the same time, the appending had to be a controversial leap because it implies that those who are responsible for the ineffectual provision of healthcare services could in some way be ignoring – or even abetting – casteist practices.

Anyway, three responses to the editorial (whose links are available on the same page) provide some clarity on how caste contributes directly and indirectly to the country’s distinct health problems by interfering in unique ways with our class divisions, economic conditions and social inequalities. They can be broadly grouped as age, inheritance and wealth.

1. Age

The first letter argues that the health effects of caste are best diagnosed among older people, who have been exposed to poverty and the effects of caste for a lifetime. Citing this study (PDF), the correspondents write:

The study reported that several health measures, including self-rated overall general health, disability, and presence of a chronic disorder, are similar between scheduled tribes, scheduled castes, Brahmins, Kshatriyas, Vaishyas, and Shudras in people aged 18–49 years. However, people aged 50 years and older in scheduled tribes and castes were reported as having poorer self-rated health and generally higher levels of disability than those in less impoverished groups, which suggests that the longer the exposure to poverty, the greater the effect on the ageing process.

However, there is an obvious problem in assessing older people and attributing health concerns unique to their age to a single agent. Hindus, who comprise the religious majority in India, traditionally revere their elders. The young are openly expected to ensure that their elders’ economic security and social dignity are not significantly diminished once they retire from full-time employment. Such promises on the other hand are not prevalent in other religious groups. To be sure, that “longer exposure to poverty leads to more health drawbacks” is not entirely flawed but the intensity of its effects may be confounded by traditional values.

2. Inheritance

A paragraph from the second letter reads,

People should only marry within their caste, which can lead to consanguinity. This antiquated tradition has resulted in an unusually high prevalence of specific autosomal recessive diseases in specific community or caste populations, such as diabetes, hypertension, ischaemic heart disease, mental impairments, mental illness, spinocerebellar ataxia, thalassaemia, and sickle-cell diseases.

While increasing literacy rates, especially among the younger age groups, are likely to reduce caste gaps in literacy over this decade, caste seems to have left some population groups with an unenviable inheritance: of the effects of detrimental biological practices. One of the studies the letter’s authors cite provides a p-value of 0.01 for consanguinity being a determinant of diabetic retinopathy (that’s strong evidence). And inter/intra-caste marriages are a prominent feature among caste-based social groups.

3. Wealth

The author of the third piece of correspondence is disappointed that The Lancet saw fit to think dismal healthcare has anything to do with caste, and then adds that the principal determinant across all castes is economic status (on the basis of a 2010 IIPS study). In doing so, two aspects of the caste-healthcare association are thrown up. First, that casteism’s effects are most pronounced on the economic statuses of those victimized by its practice, and that is one way of understanding its effects on access to reliable healthcare. Second, that the statistical knife cuts the other way, too: how do you attribute an effect to caste when it could just as well be due to a failure of some other system?

Curious Bends – Lack of scientific temper, Sikkim’s gamble, disappearing rare fauna and more

1. Will the most advanced Indian state’s gamble payoff?

“Sikkim’s own energy needs of 409 megawatts (MW) were met by 2012, and Chamling already sells 175 MW of extra power to India’s power-starved northern grid. If all 26 hydel projects come on stream, Sikkim should generate 4,190 MW of electricity. But there are a few problems.” (7 min read, indiaspend.com)

2. India has the cheapest flights in the world

“India’s airline industry is a mess. Taxes are sky-high, infrastructure is poor and profit margins are razor thin. A string of carriers have gone out of business, and many others are struggling to stay afloat. Yet the big winners might be price-conscious consumers — and any carrier strong enough to survive the price wars that have made India the cheapest place to fly on Earth.” (3 min read, cnn.com)

3. Scientific temper? No, thanks.

“I persuaded Professor Nurul Hasan, then Education Minister, to have the following clause included in Article 51A in the 42nd Amendment of the Constitution in 1976: “It shall be the duty of every citizen of Indian “to develop the scientific temper, humanism and the spirit of enquiry and reform.” But India has not produced any Nobel Prize winner in science in the last 85 years – largely because of the lack of a scientific environment in the country, of which scientific temper would be an important component.” (5 min read, thehindu.com)

+ The author, Puspha Bhargava, is the founder-director of the Centre for Cellular and Molecular Biology at Hyderabad, and chairman of the Southern Regional Centre of Council for Social Development.

4. Why India’s healthcare remains abysmal

“The reason India’s healthcare indicators remain abysmal is not just a question of money (after all, ours is one of the fastest growing economies). The problem is a persistent rash of doublespeak that denies the people a coherent healthcare system. While successive governments have committed to various goals, no government programme has yet focused on the three most important problems facing India’s health at once: a mismanaged regulatory climate, corruption, and the caste system.” (5 min read, scroll.in)

5. India’s rare faunas are disappearing faster than scientists can discover them

“At the World Parks Congress in Sydney in October, the International Union for Conservation of Nature said their information on the biodiversity that the Western Ghats contained was “deficient” and cautioned that the region was under tremendous pressure from population within and without, from untrammelled resource extraction, residential and recreational development and large-scale hydroelectric projects. “We must know all that exists there before it goes extinct,” says Vasudevan. “Not that we’re not we’re doing much to prevent that.”” (4 min read, qz.com)

Chart of the week

“The 2014 general elections were estimated to be India’s most expensive—and the Narendra Modi-led Bharatiya Janata Party (BJP) broke the bank on the way to its biggest ever election victory. In all, the BJP spent Rs 714.28 crore ($115 million) on the 2014 general election campaign. But its worth remembering that this is only what the parties declare before the Election Commission—and that India’s election campaigns are awash with black money, booze and other persuasive items.” More on Quartz.

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