MODERN MEDICINE -- the Good, the Bad and the Ugly !
“Money is not everything, but it ranks up there with oxygen.”
-- Rita Davenport
I have documented some data here, but it is for you to interpret.
-- T Rama Prasad
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"Not getting into the 'whirlpool' of an ICU with a 'cytokine storm' is a profit of tens of lakhs of rupees." -- T. Rama Prasad
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THE GOOD
Modern medicine, which represents the epitome of technological innovation, has wiped out dreaded diseases like smallpox, and prevented epidemics and pandemics from wiping out populations. Immunisation averts three million deaths annually. I am not writing at length about the goodness of modern medicine, remarkable contribution of drug and allied industry, and the goodness of the doctors and the excellence of their service, as it is too well-known to all. We can’t think of an alternative in cases of emergencies, surgeries, and numerous infective and metabolic diseases. We should feel grateful for the service of all concerned with this.
There are excellent doctors, drugs and hospitals in modern medicine which saved the life of millions of people and alleviated the suffering of billions.
We have doctors and paramedical staff who are patient with both the patients and their relatives. Without a hint of irritation, the professionals answer all the zillion questions and allay every fear. And there are nurses who are cheerful and lightning-like in their response to the call bell and provide services as in a 5-star hotel.
Thanks to the industry, the giant pharmaceutical establishments and the huge research institutions all over the world which have elevated the ‘modern medicine’ to the enviable position that it is today. The credit for the discovery of 90% of all medicines goes to the pharmaceutical industry, may be by virtue of the money power it has. It takes about a decade and a billion pounds to introduce a new medicine in the market. And only one in 5,000 new compounds studied may be approved for marketing.
Tremendous strides and advancements have been made in various fields of medicine -- starting from the basics of nutrition, exercise and sleep to unimaginably complex surgical procedures. A lot of documentation is pouring in on the role of micronutrients ad antioxidants; a huge volume of literature on the benefits of varied types of exercise is available; and no less important is the advanced knowledge and technology connected with sleep which makes or mars one's health ... one may be surprised to see the advanced services in sleep physiology and medicine provided by organisations like 'Tuck Sleep' which is a non-commercial community devoted to improve sleep hygiene, health and wellness through creation and dissemination of comprehensive, unbiased and free web-based resources ( https://www.tuck.com & ksmith@tuck.com ).
It may be curious to know that an incredible feat of ‘creating’ a nose is being done! Prof. Alexander Seifalian of the Department of Nanotechnology and Regenerative Medicine of University College London is reported to have said (May 2012): “... This is a nose we are growing in our laboratory with a polymer matrix for a patient next month. It’s a world first. Nobody has ever grown a nose before. We are focussing on growing organs and body parts on order for replacement, using patient’s own cells...” Using ‘Stem Cells’, lab-made organs including tear ducts, blood vessels and windpipes are expected to be available soon.
It may be curious to know that an incredible feat of ‘creating’ a nose is being done! Prof. Alexander Seifalian of the Department of Nanotechnology and Regenerative Medicine of University College London is reported to have said (May 2012): “... This is a nose we are growing in our laboratory with a polymer matrix for a patient next month. It’s a world first. Nobody has ever grown a nose before. We are focussing on growing organs and body parts on order for replacement, using patient’s own cells...” Using ‘Stem Cells’, lab-made organs including tear ducts, blood vessels and windpipes are expected to be available soon.
There is another recent (Nov 2014) first in the world -- a baby born from frozen pre-puberty ovary tissues. One ovary of a child was removed and stored as she had to undergo treatment for sickle cell anaemia which may damage the ovaries. Ten years later, that ovarian tissue was grafted to the remaining ovary and a healthy son was born in Belgium.
In a world-first, a bionic eye has been implanted to restore central vision in an 80-year-old British man suffering from advanced dry age related macular degeneration (AMD) at the Manchester Royal Eye Hospital in 2015. It is yet another in the litany of ‘latest’, ‘newest’, ‘cutting edge’ and ‘avant-garde’ medical technology.
A world's first double hand transplant in child is reported to be successful in 2017 (The Lancet Child & Adolescent Health). The 10-year-old child, Zion Harvey, underwent surgery at Children's Hospital, Philadelphia (US) in July 2015 to replace both his hands by the hands of a deceased child. Harvey had a kidney transplant earlier.
A world's first double hand transplant in child is reported to be successful in 2017 (The Lancet Child & Adolescent Health). The 10-year-old child, Zion Harvey, underwent surgery at Children's Hospital, Philadelphia (US) in July 2015 to replace both his hands by the hands of a deceased child. Harvey had a kidney transplant earlier.
Apart from the rarest of the rare, highly complex interventions, procedures and surgeries are being done almost routinely all over the world to the great benefit of the humanity, but remember that it is the successes that come to light while the failures are often hidden and unknown even to the professionals. And, some wonder whether it is worthwhile undergoing the ordeal in some of the cases. Is it just to create a record and to boast about the advancements ?
THE BAD and THE UGLY
It is wonderful to see how far ‘modern medicine’ has come and we should all feel proud of it. But there are some worrying trends which may need course correction. Some happenings may sound like a bizarre, one-off case, but, of late, the language of medical care seems to have changed a bit. But you know what — it is high time we kept down our gavel of snobbery and dismounted our ‘modern medical’ high horse.
Now, let us turn to the flip side, the dark side of the ‘modern medicine’. There is no space to write a lot about the dark side of modern medicine either. Only some sampling of the bad is cited. While it may ruffle a few feathers, it may also provoke thinking. It is for you, the reader, to draw your own conclusions as to whether there is anything significantly bad with the modern medicine, after going through the books, links and the information given below. After all, you may feel that these are only aberrations which are few and far between and hence cannot be generalised, and that these blots are nothing when compared to the enormous good in the modern medicine, and that we shouldn’t read too much into these things – the things that are unduly magnified by media which have propensities to sensationalise. And, of course, you have your own experience with hospitals and doctors abroad and in homeland.
I am trying to put across facts in as neutral a manner as possible -- without bias, embellishment and imagery. I kept this ‘scribbling’ for a very long time in my computer without sharing with public for politeness sake and out of an ethical sense. But the subject and the debates have already appeared in the media for quite some time. They say that they spend millions and millions on R & D to serve the humanity by producing better drugs, creating novel equipment and formulating new protocols in medicine. Really ? The business model seems to have infected the medical profession. Ominous clouds are gathering over the profession, and certain deviations have come to be considered “normal”. Some may say that they have been working day and night, sacrificing their personal and family life. Are they working like that for serving the humanity ? For charity ? If monetary component is knocked out, some of them may not work like that. There lies the nobleness or lack of it. How many of them would work like that if a moderate fixed salary is given, without private professional income, incentives, cuts, commissions, etc. ? Dear sir / madam, no amount of spin and gloss would hide the bitter truth. Kindly go through the books, links and references mentioned in this text (many many more are there which are not cited) and also the 'Scribbling' titled 'RUN on MONEY' on his blog, with an open mind and critical analysis. I used the word “some” in the above sentences. It is for the reader, with his/her experience and knowledge, to say whether it should be “some”, “negligible few”, “many”, “majority” or “most”. Definitely, it can’t be “all”. All this is applicable to many countries across the world. Medical profession is such that it provides tremendous opportunities to serve the humanity, and also to inhumanly exploit if one wants to.
The spectrum is not the same in all the countries. In some countries the system is very clean and transparent while in some countries it is sordid and stinking. In the same way, some companies, some hospitals and some doctors are impeccably clean and honest. We have to be clear about what modern medicine stands for, what it does best, and conversely, also what it is not best at. I may add that you should read the entire writing, and the books, the links and the references cited in the text, in a holistic and impassionate way, before drawing conclusions or becoming furious. And I request you not to quote the contents of the text herein out of context to make others misunderstand.
The modern medicine could have remained entirely ‘good’ except for the societal changes -- materialistic trends, business attitudes, moral degradation, value depreciation and egoistic ambitions. Doctors and researchers are part of the society and are also human beings, vulnerable to venality. What seems to be the bane of the system globally is the fact that some in the field have largely shed their “nobleness” and started living in the ‘dog-eat-dog’ world with all the grey economy and vested interests. The industry is cleverly exploiting this ‘weakness’ through various kinds of funding, ‘grants’, ‘support’, ‘sponsorships’ and ‘offers’ – overt and covert. Many hospitals across the globe are profit driven and run on business models, and as such modern medicine is often overused and misused. In the name of “Evidence-based Medicine” needless exhaustive investigations and procedures are carried out, creating a delusion of relevance. More and more people are subscribing to the “animalistic doctrine of ‘Work – Consume – Die’ culture, dressed in subtle and gross deceptions.” Good and bad is present in every field, but we can’t ask for a replacement of a limb or life as in the case of a car or a machine when the repair work fails. While we cannot expect the professionals to be insulated from the defining materialistic ethos of our times, a reasonable humanitarian attitude would restore the ‘noble’ image of the profession. When greed is the principal motivator, concepts like ‘health for all’ lose all meaning. The following is an excerpt from the observation of a Bench of Justices of a HIGH COURT in India - Chennai: “A study conducted by Support for Advocacy and Training to Health Intiatives (SATHI), a NGO, states that big pharmaceutical companies bribe doctors through high value bribes such as smart phones, credit cards, e-vouchers and even female companionship... Thus, patients are compelled to pay more unnecessarily because of overpricing of drugs,” the judges said.
In this context, I am pasting hereunder an excerpt from my article titled "COVID Fear and Paranoia" which was published in the May 2022 issue (Vol. 119, No. 5) of the medical journal 'THE ANTISEPTIC'.
" ... Disinfectants
Out of fear, ignorance or vested interests, people were ‘disinfected’ of the Covid virus ! Even governments used disinfectants wrongly by forcing people to go through “disinfectant spray tunnels” during the ‘corona crisis’. The Supreme Court also found fault with the authorities in this matter. In some places, disinfectants were sprayed on people which is unscientific, barbarous and very hazardous. Most disinfectants, by nature, are potentially harmful and even toxic to humans and animals. 7
SCARY HOSPITALS
Dr. T. Rama Prasad
An artist’s expression of a hospital in COVID times
Fear of hospitalization
No, it’s not the fear of injections, procedures or ventilators when it came to ‘COVID hospitalizations’ especially during the ‘second wave’ in India. It’s the money factor – “a lakh a day with 10 days advance” in some hospitals. Fear of death forced even low income people (who ordinarily go to government hospitals) to seek in-patient treatment at private hospitals.
The story of ‘pandemic hospitalization’ goes like this – this morning (April 10, 2022), I read a revealing article, related to the pandemic hospitalization, written by Anand Neelakantan (author ofAsura, Ajaya Series, Vanara and Bahubali trilogy) that’s published in The New Sunday Express Magazine of April 10, 2022. (
https://www.newindianexpress.com/magazine/voices/2022/apr/10/standardise-private-hospital-ratesto-stop-exploitation-of-patients-2439271.html ) ; the following is an excerpt from that article 36 :
“ … The corporatisation of the medical profession is the greatest tragedy that occurred to Indians. The coronavirus pandemic laid bare the fangs of this monster for all to see. The private hospitals made a killing, literally and figuratively, during the pandemic, while the government hospitals gasped for breath. Most Indians are one medical crisis away from abject poverty, and the pandemic medical bills of both who survived or were dead stripped many of their life savings. Every PPE kit, every injection syringe and pills were used as a means to suck out money. It wasn’t that such exploitation was happening for the first time. Anyone who had the misfortune of being a patient or a patient’s relative would have experienced such heartless avarice from private hospitals at least once in a lifetime. The pandemic presented an opportunity for a windfall for private hospitals. It was a bumper crop season, where they made money irrespective of whether the patients survived or died. Many doctors have now become no better than salesmen struggling to meet their monthly and quarterly revenue generation targets for the corporates who employ them. Every possible test is forced upon the hapless patients, whether they require it or not. …” 36
One may read the full article of Anand Neelakantan to know more about the scenario of the BIG hospitals in India. 36 The situation seems to be in stark contrast to my “PAY WHAT YOU CAN Clinic” where one may pay whatever one wishes to for the service (http://drtramaprasad.blogspot.com/2017/04/what-you-can-clinic_30.html).37 In addition, one may read my blog ‘scribbling’ titled “Modern Medicine – the Good, the Bad and the Ugly” (https://drtramaprasad.blogspot.com/2017/04/modern-medicine-good-bad-and-ugly_30.html). 27
One COVID patient was billed $1.1 million in the US and another was billed Rs.16 lakh in India. These two bills may be genuine and reasonable for the service rendered, and the “seemingly high charges” may be necessary to make the hospitals economically viable and sustainable.
But the General Insurance Council moved the Supreme Court against alleged 'profiteering' by private hospitals in India. It was mentioned that, when objected, in one case, the bill of Rs.14 lakh was brought down to less than 4.5 lakhs ! 22 And it was reported that some laboratories and some private hospitals had an unholy nexus to promote hospital admissions -- by generating fake ‘COVID positive’ lab reports to drive patients, terrified by the lab results, into hospital beds for exploitation ! Magnification of the negative happenings by media led to enormous erosion of TRUST and alarming amplification of FEAR. Not unexpectedly, clever people hurriedly started COVID HOSPITALS, many being certified without the requisite facilities. And, oddly, some had converted their hospitals into “COVID-FREE HOSPITALS” (meaning that no COVID patients are admitted to prevent spread of COVID infection to others in the hospital) to attract non-COVID patients.
Due to the changing attitudes, values and morals, TRUST between patients and doctors evaporated. In this trust-deficient scenario, even a very honest and efficient doctor may be accused as a culprit. Recently, a gynaecologist in Rajasthan committed suicide when she was charged by police with murder of a patient (allegedly following a stir led by a local leader) after the unfortunate demise of her patient due to a postpartum haemorrhage. This incident prompted the World Medical Association (WMA), an international doctors’ body, to write to the Indian Prime Minister Narendra Modi urging him to stop the rising number of attacks on physicians and other health personnel in India, and to have cases examined properly and professionally before conclusions about civil and criminal liability can be made. The WMA also said that it supports the Indian Medical Association(IMA) which requested the Indian government to enact unambiguous and effective lawful means to stop the attacks on physicians and other health personnel (The Hindu, April 12, 2022). I am writing this here to underscore the FEAR phenomenon among the public and the medical profession as well due to the rot in our systems. 27, 23
Here is an excerpt from my article titled “Disastrous Second COVID Wave in India” and published in the medical journal, The Antiseptic of June 2021 – Vol. 118; No. 6; Indexed in IndMED; www.theantiseptic.in :
“ … No doubt, there are kind-hearted souls who practise medicine with humanism and sacrifice, but the ‘second wave’ made the ‘once-upon-a-time-noble profession’ seem like an unholy business in India. This is the horrendous facet of the ‘second wave’. … Chaos and confusion prevailed everywhere with overwhelming demand for treatment, hospital beds, drugs, medical materials and burial space too. Acute shortage of oxygen took away numerous lives. People died in ambulances outside hospitals while waiting for beds. Heartrending and urgent appeals for help went in vain. Relatives couldn’t do anything but watching the dear ones gasping for air. … The ruthless black market that fends on the artificial demand, clamour and patronage by some professionals is mutating faster than the virus itself -- shameful exploitation in the times of despair. Greed has become more infectious than the virus itself. Even hospitals, hospital staff and doctors jumped on the bandwagon to swindle and exploit helpless and hapless patients and their desperate kith and kin. Getting a hospital bed through a ‘backdoor’ route in Bangalore costed more than Rs. 30,000 and it might cost a lakh or two per day for treatment, while people were standing on a bed of shrieking cadavers. Hefty bribes of Rs.2 lakh were demanded for a bed in ICU in Jaipur – a male nurse was arrested who revealed his links with two doctors working at the hospital. People sold their assets, including their cattle and sheep, in an attempt to save their near and dear. Most of them mourned at graveyards.” 4 Read the full article to know more about the tragedy.
This painting may represent an artist’s surrealistic vision of a ‘COVID HOSPITAL’. The picture looks like a WHIRLPOOL. One who gets into a whirlpool gets sucked deeper and deeper into the waters and may never come out of it. Magnify the picture and see. There are blood stains all over, blood transfusion line, syringes, some 14 chambers, some people dancing, etc. How is this painting related to HUGE COVID HOSPITALS that Ananda Neelakantan may be referring to in his article cited above ?
One brainy staff member of a hospital answered in just one word : "RATHASARITHRAM" which may mean a surrealistic scenario of 'bleeding' the patients through 14 and odd specialities of a giant corporate hospital, while the owners dance with joy and the patients dragged deeper into the whirlpool !!!
Scary. People are scared of huge bills of needful and needless hospitalization, and needful and needless investigations, procedures, medicines, surgeries, etc. Hospitals are scared of bankruptcy if they can't make much money. Senior specialists are scared of losing jobs if they don't generate much money for the hospitals. Patients are scared of doctors. Doctors are scared of patients -- violence and medico-legal issues. As such, some of them are not treating "risky" cases. Doing the needless things is justified by the protocols based on "Evidence-based Medicine." Not doing them may land a doctor in a legal quagmire though.
Driven to madness
Various unhealthy offshoots had grown up – ‘avatars’ of ‘disaster capitalism’. Many materials and drugs of unproven efficacy and safety were touted out of vested interests. 25 Pseudoscientific evidence pushed up the markets to record heights. This potpourri growth portends to be a travesty of quality of modern medicine. Speedy deaths, shifting strategies in the control strategies and the scientific uncertainties on several matters connected with Covid, combined with economic turmoil, made people fearful and paranoid – full of unrealistic feelings of mistrust, scare, deception, threat and death. Many of them were driven to shrinks for therapy, and some consumed, as a Covid-preventive, milk of asses bought at an exorbitant price ! 22
Anand Neelakantan's article is in the link below:
Recently, a gynaecologist in Rajasthan committed suicide. She was charged with murder after the unfortunate demise of her patient due to a postpartum haemorrhage. Led by a local leader, the relatives of the unfortunate woman created a stir, and the police charged the doctor with murder. As tragic as this event is to everyone concerned, it is also an indicator of how rotten our medical system has become.
The trust between doctors and patients has broken down irreparably. Being a doctor has become a thankless profession. It is also true that many doctors prefer to satiate their greed for money than gratitude from their patients. India has one of the lowest doctor-patient ratios in the world. We don’t even have the exact count of doctors practising in India.
It is estimated that around 20 percent of doctors on the Indian medical registry site have either died, retired, stopped the practice, or migrated. We have approximately 13.01 lakh allopathic doctors registered in the medical directory. So the missing doctors are around 2.6 lakhs. That makes the doctor-patient ratio of 0.74 for 1,000 people against the WHO recommendation of 1:1,000. Most of these doctors are concentrated in urban areas, making rural India a fruitful hunting ground for quacks.
The corporatisation of the medical profession is the greatest tragedy that occurred to Indians. The coronavirus pandemic laid bare the fangs of this monster for all to see. The private hospitals made a killing, literally and figuratively, during the pandemic, while the government hospitals gasped for breath. Most Indians are one medical crisis away from abject poverty, and the pandemic medical bills of both who survived or were dead stripped many of their life savings.
Every PPE kit, every injection syringe and pills were used as a means to suck out money. It wasn’t that such exploitation was happening for the first time. Anyone who had the misfortune of being a patient or a patient’s relative would have experienced such heartless avarice from private hospitals at least once in a lifetime. The pandemic presented an opportunity for a windfall for private hospitals. It was a bumper crop season, where they made money irrespective of whether the patients survived or died.
Many doctors have now become no better than salesmen struggling to meet their monthly and quarterly revenue generation targets for the corporate hospitals who employ them. Every possible test is forced upon the hapless patients, whether they require it or not. Though rules and laws exist, and our country has no dearth of well-meaning laws, most hospitals do not exhibit their rates for different tests and consumables.
This is in a country where even a roadside dhaba has to display its price list or have its licence revoked. The hospitality industry would give an arm and an eye for the premium the hospitals can charge for the sort of substandard rooms and beds they provide and get away with it.
One can always argue that it is only those who can afford would go to such hospitals. However, it is missing the woods for the trees. Hospitals are not a place of recreation for even the rich to go and spend their leisure time. It is a compulsion forced by destiny. The five-star hospitals that have mushroomed in many cities suck the best doctors out of the system by offering them huge salaries. In turn, they have to earn profits for their employers by finding ways and means to generate revenue from each patient.
This drives the health premiums for those who can afford health insurance. For the vast majority, who cannot even dream of insurance, the only refuge is the government hospitals. It would require loads of idealism for the harried government doctors, striving under the duress of overwork, fighting the system, dealing with the shortages and medicines to keep going without a nervous breakdown. Sooner or later, the lucrative private practice will tempt many of them. This vicious cycle is growing into a cyclone of social crisis.
We have rules and regulations and inspector raj for every aspect of our lives, but private hospitals are left scot-free to exploit patients. It is high time hospital rates were standardised. Like how hotels are classified, hospitals could be classified into two or three categories. The room rates, consumable rates, procedure rates and medicine rates need to be standardised for each category across the country. Health can remain a state subject, but a Central law is required for this classification and standardisation.
The doctors and hospitals need to justify each medical test done on the patients. Clinical audit statutory bodies should be formed to conduct random audits to see whether the hospitals are misusing these tests as a tool for profiteering. A central medical board with district-level regulatory body is the need of the day.
Anand Neelakantan
mail@asura.co.in
Author of Asura, Ajaya series, Vanara and Bahubali trilogy
This doesn’t mean that modern medicine is basically wrong but the ugly business outgrowths of this noble science need to be pruned. There is no mala fide intention in projecting the bad aspects of the good medicine, but the flip side is to be exposed for the good of the ‘modern medicine’ which is metamorphosing into ‘money medicine’. That 'bad medicine' culture is as widely prevalent as “corruption” in the world is no longer a secret. But the chaff has to be separated from the grain, lest you crush both.
Somewhere down the line, some have lost the mark of culture of concern for others which is the most important quality that makes a person a good human being. Hippocrates, the ‘Father of Medicine’ doesn’t know what happened to medicine since he left this world in 377 BC ! We still take ‘Hippocratic Oath’ with all hypocrisy. Talking about money in medicine was a taboo. It was a service-oriented profession. But this was long before commercialisation attacked this field, making it the business model it now is, driven by profits. I am writing this article with trepidation. It has huge potential for being misunderstood. One may have to find a gird robust enough to cope with the steep spike in anxiety and the stomach-plunging drop into depression that such of this information usually precipitates.
GLOBAL SCENARIO
“Diseases and deaths seem to go down when doctors go on strike
and their interventions cease !! ”
-- Prof. B.M. Hegde
You are looking askance. Stupid statement ? It looks ridiculous at first mention. Read what all is written about medicine on this page and come back to this quote. Then, you may find some sense in it. Prof. Hegde didn’t write this in a lighter vein. Evidence has been growing to validate this as a fact. In fact, a study proved this to be true (British Medical Journal, 2000, 320, 1561.1) !! “A five country study in Europe showed that in countries where there are more doctors per unit population, the health and longevity of the population was less than in those countries where there were fewer doctors for the same number of people. Higher doctor-patient ratio results in higher interventions and decreased health for the public” (Prof. B.M. Hegde). Another study of fourteen industrialised countries revealed similar shocking revelations (Journal of American Medical Association, 2000 : 284 : 483). Iatrogenesis has been rising at an exponential rate.
A news report (TNSE, July 24, 2011) quoted one envoy of the World Health Organization saying that the chance of dying in a plane crash is about one in 10 million; of dying due to medical error in treatment is one in 300; and of occurrence of medical error is one in 10 patients !
MEDICAL ERRORS & LIMITATIONS
Even in the US where there is a strict observance of protocols and a clearly defined standards of medical care and a system of medical auditing, medical errors are the cause for 40,000 to 80,000 deaths each year in the US, according to data provided by the American Medical Association. “The number one killer of Americans is the American medical system,” said Howard Straus, an American thinker, and a ‘Health Freedom and Natural Cures” advocate. Prof. B.M. Hegde wrote in one of his books:"...Over-investigations and unnecessary interventions have resulted in thousands of deaths, even in USA. The medical care in USA is the worst among the 14 developed countries studied." It is also widely known that the $2.8 trillion US health system has significant waste and errors and that between 25% and 30% of the health dollars go to services that do not improve health (http://thehealthcareblog.com/blog/2014/09/26/ceci-connoly-will-technology-replace-doctors/#more-76479 ). These observations strike a discordant note as the US gained high credibility in medical care as an epitome of professional excellence and technological innovation -- crème-de-la-crème of medical care in the world. For more on this subject, read under the heading “Medical care in the US & in India” on this blog. It remains to be seen how the ‘Obamacare’ (‘Affordable Care Act’) would work out.
Errors in diagnosis and treatment are common as our knowledge about health and disease is limited, fragmentary and changing. For example, what do we know about Idiopathic Pulmonary Fibrosis (IPF) ? Academicians urge us to differentiate IPF absolutely, by various investigations, from various other lung diseases under the blanket cover of Interstitial Lung Diseases (ILD) while saying that there is no satisfactory treatment for any of these, and that the combination of corticosteroids, azathioprne and N-acetylcysteine that had been in use for a long time increases mortality and hence should not be used. The bad effects of the latest antifibrotic agents pirfenidone and nintedanib may only be known after some time, and there is a long way to go before successful lung transplantation as treatment for these diseases becomes a reality. We don’t know the exact cause for the vague and overlapping disease patterns of IPF, COPD, Chronic Bronchial Asthma, ILD, Usual Interstitial Pneumonia, Nonspecific Interstitial Pneumonia, Hypersensitivity Pneumonitis, and so on. (Chest India Edition, Vol 6 # 5 2015). Doctors are scared worldwide about this problem.
It is quite shocking to know that for decades we didn’t know that open-heart-surgery patients were dying due to a deadly infection by Mycobacterium chimaera acquired through ‘cooling machines’ used to cool blood during surgery, This was revealed at the European Congress of Clinical Microbiology and Infectious Diseases (2017). Half of the known 110 heart-surgery patients (inserting devices, blood vessel graft, valves, etc.) died of this infection (http://www.health.nsw.gov.au/Infectious/alerts/Pages/M-chimaera-and-surgery-alert.aspx ).
If such is the case about medical errors in a highly developed country, one can imagine the magnitude of the problem in developing countries where the regulatory systems are rudimentary and commercial promotion is aggressive.
Can't ESCAPE from 'ESKAPE'
Mostly due to improper medication, drug resistance develops. And the resistant organisms lurking in hospitals are the most dangerous ones. One more study confirms the grave situation. The findings published in the Indian Journal of Microbiology Researching (December 2017) indicate that a whopping 131 strains of Acinetobacter out of 143 strains, in a tertiary hospital in Hyderabad, were found to be multi drug resistant -- resistant to Carbepenems, a class of antibiotics developed to treat drug resistant bacteria that have already developed resistance penicillin, cephalosporins, fluoroquinolone, ahminoglycosides, etc. Most of the bacteria were from endoscopy instruments and ventilators. The last resort would be to try Colistin or Tigecycline. Acenobacter is one of the six 'ESKAPE' bacteria that cause most hospital-acquired infections, even inside highly sterile Intensive Care Units (ICUs) of up-scale tertiary hospitals.
Can't ESCAPE from 'ESKAPE'
Mostly due to improper medication, drug resistance develops. And the resistant organisms lurking in hospitals are the most dangerous ones. One more study confirms the grave situation. The findings published in the Indian Journal of Microbiology Researching (December 2017) indicate that a whopping 131 strains of Acinetobacter out of 143 strains, in a tertiary hospital in Hyderabad, were found to be multi drug resistant -- resistant to Carbepenems, a class of antibiotics developed to treat drug resistant bacteria that have already developed resistance penicillin, cephalosporins, fluoroquinolone, ahminoglycosides, etc. Most of the bacteria were from endoscopy instruments and ventilators. The last resort would be to try Colistin or Tigecycline. Acenobacter is one of the six 'ESKAPE' bacteria that cause most hospital-acquired infections, even inside highly sterile Intensive Care Units (ICUs) of up-scale tertiary hospitals.
DOCTORS ARE TOOLS -- a new ‘avatar’ of MODERN MEDICINE
This morning, one patient from the West came to me with huge files of medical records and a suggestion for further investigations. I patiently went through the case. I couldn’t help smiling. Diagnostic images of various colours. I was as pleased as Sir Isaac Newton when he found colours of a spectrum from white light. I wished the “patient” a happy holiday and a comfortable return journey. No trophies for guessing why I wished so.
Most of the ailments can be to a great extent be diagnosed by listening to the patient patiently. And most of them can be alleviated by: a kind word; a patient ear; a little empathy; a relationship based on mutual trust and respect; a bit of common sense; and a little medicine. Often a battery of unnecessary investigations and procedures are done, even without touching the patient. The ‘common sense’ of a family doctor is more valuable than the ‘special sense’ of a specialist in most of the cases.
Doctors, in the modern era and the ‘highly developed hospital culture’, do not seem to have the ideal situation to do what they really like to do. They are moulded and continuously conditioned by circumstances and the industry to subserve the interests of trade, business-oriented hospitals and self rather than the patients. The system has become technologically proficient but emotionally deficient, inconsistent and incongruous.
There is an interesting article by Dr. Richard Gundima, Professor of Radiology, Indiana University School of Medicine ( http://www.kevinmd.com/blog/2014/09/hospitals-discourage-doctors-step-step-guide.html )which reveals how doctors are tuned to do what they would not naturally do as good professionals, and how they are indirectly forced to do things to improve the economy of huge hospitals and industry. And about how the doctors are goaded to maximise the profit making potential of equipment and facilities, and about how they are kept in the shadow of gigantic hospitals to prevent personalised attention and interaction with the patients which may avoid needless investigations and procedures ( http://thehealthcareblog.com/ ). Dr. Richard’s article is with reference to the scenario in developed countries.
Everything comes at a price, so does medicine -- this does seem to be the philosophy of the day. It is said that many of the doctors (and also paramedical personnel) in huge hospitals abroad are made to spend much of their time filling up forms in the ‘euboxic’ system, reviewing data, maintaining records of the ‘evidence-based’ treatment, dealing with medico-legal problems and administrative matters – spending as little as 15% of their time with the patients. It is said that, in the West, the attorney and the legal implications come into the mind of the doctor first rather than the patient, making ‘modern medicine’ a ‘defensive medicine’. It seems that nurses are pressurised to do work related to documentation more than the nursing job. Documentation, documentation and documentation is the buzzword and has become very important (allegedly more important than the patient) in getting accreditations and ‘business’.
This ‘epidemic’ is spreading to India too. Some ‘high-end, five star’ Indian hospitals are vying for various accreditations like the NABH, Safe I, ISO, JCI, etc. to embrace the lucrative ‘health tourism’ in a big way through aggressive marketing (as happening in the Kerala State) as indicated in the interesting article by George Jacob -- http://www.newindianexpress.com/columns/Of-the-Accreditation-Obsession-Afflicting-Keralas-Hospitals/2016/01/18/article3231571.ece . Read again what Dr. Richard wrote. And also go to http://www.thehindu.com/opinion/open-page/medicine-is-too-much-with-us/article4706929.ece written by Prof. B.M. Hegde who is the king of critical orators and writers on ‘modern medicine’.
CLEVER PLOY
And, the people in the West do not complain of needless tests, procedures and expensive treatment options, perhaps, as the bills are cleared by insurance companies, and doctors also do not complain, perhaps, as they get their fat pound of flesh. As medical care is prohibitively costly there, health insurance is taken by almost everybody who can pay the heavy premiums. It is a very clever ploy where the customer does not directly feel the pinch at the moment (though he pays heavily in the long term to keep the pharmaceutical industry, the hospitals and the insurance companies in good financial health !) and everybody in the line, from the top industries to the last grade employee in the hospital, is benefitted. Ask any citizen, patient, doctor or researcher there. Most of them would say that the system and the service are excellent. Excellent they are in certain aspects, no doubt; but superfluous and exploitative they seem to be in many aspects – designed by businessmen to create a huge trade. It is said that they can’t digest any adverse comment as the design is shrouded in a veil of scientific sophistication and grandeur, and the designer is always in the background, unseen, contributing, ‘controlling’ and designing medical education, research and protocols of treatment. A sizeable number of leading university professors are said to be the recipients of huge packs of money for being research advisers, consultants, speakers, etc. of industry. Consequently, it is alleged that it is the obligation of these men to ‘create’ opinion by lectures and publications in favour of the products. In fact, Richard Smith, former editor of British Medical Journal wrote that the leading journals of medicine are but the extended arms of the pharma and medical gadgets & equipment industry !! Disgustingly profit-driven. One may treat an uncomplicated problem in the 'old blind' fashion or use all the 'evidence-based modern medicine', gadgets, costly equipment, etc.
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| Investors have their own problems. |
SCIENTIFIC FRAUDS
All pharmaceutical companies may not be following bad practices, but in his book, ‘Bad Pharma’ (http://en.wikipedia.org/wiki/Bad_Pharma ), published in 2012 in UK & in 2013 in US, Dr. Ben Goldacre, (as of 2014, he was Welcome Research Fellow in Epidemiology at the London School of Hygiene and Tropical Medicine)[ has dissected and exposed the perceived secret agenda of the $600 billion pharmaceutical industry alleged to be rife with corruption and greed. He gave a detailed account of how drug companies mislead doctors and harmed patients; about flawed clinical trials, suppression of unfavourable results and poor regulation; of diseases invented purely for profit and swollen marketing budgets; about doctors and academics on the pay rolls of pill manufacturers, etc. Some of the “scientific” documentation was said to be the product of “paid research” arranged by giant industrialists through seemingly independent researchers and doctors who conduct biased trials to bring out favourable evidence for their products and who can bury unflattering data (http://www.dietdoctor.com/cholesterol-lowering-drugs-heavily-criticized-australian-tv-documentary). The “BAD PHARMA” also gives detailed accounts of how research papers and even textbooks are written by ghost authors arranged by business giants. A review of this book is documented in Guardian which may be accessed at www.theguardian.com/books/2012/oct/17/bad-pharma-ben-goldacre-review . This link gives an idea about the sordid things that happen behind the glossy façade of ‘modern medicine’. It is also mentioned: “… Companies pay doctors to extol the virtues of their drugs and equipment on the conference circuit (spelling out the sources of information they want doctors to use) …” The weak defence of the industry on what all is documented in the book is that it all happened in the past and not relevant to the present. The critics say that the old murky commercial deals are the same now in a new guarded garb – in a very sophisticated difficult-to-catch design. Some information about fraud in cancer research may be accessed at http://www.pnc.com.au/~cafmr/online/research/cancer.html and https://www.facebook.com/LCSurvivors/posts/273639842729834 . You may read more on this subject under the headings: “CONFERENCES GALORE”, “INVENT NEW DISEASES & SELL MORE DRUGS”, “GENETICS, CANCER and COMMERCE” and “HEALTH CHECK-UP: how healthy is it ?” on this ‘home page’.
“Unless the thief decides to transform himself,
it is never possible to eradicate stealing.”
(“ thirudanai parthu thirunthavital thirutai olika mudiyathu..”)
-- Pattukottai Kalyanasundaram
Dr. Ben Goldacre wasn’t the lone litany in the narrative of lament over the illness of modern medicine. Read on.
According to the 900-page book “The Guide to the 4000 Useful, Useless or Dangerous Medicines” written by Prof. Phillippe Even, Director of the prestigious Necker Institute and Barnard Debre (dean of the largest medical faculty in France), a doctor and a Member of Parliament, half of the drugs prescribed in France are found to be useless or potentially dangerous to the patients, causing a waste of money equivalent to 8 billion pounds, 20,000 deaths and 1,00,000 needless hospital admissions, per year ! “Among those that they alleged were ‘completely useless’ were ‘statins’, widely taken to lower cholesterol” -- https://churchmousec.wordpress.com/2013/02/27/professor-philippe-evens-the-truth-about-cholesterol/. Prof. Even accused the pharmaceutical industry of pushing medicines through the health system at doctors who then push them on to patients. (The Guardian, September 14, 2012 –Kim Wilsher in Paris) ! Recently (2015) , the British-based drug giant Reckitt Benckiser has been ordered to pull some of its popular Nurofen pain killer brands off the shelves in Australia after a court ruled it made misleading claims. The same medicine, Ibuprofen lysine 342 mg was being marketed under different misleading brand names such as Nurofen Back Pain, Nurofen Period Pain, Nurofen Migraine Pain and Nurofen Tension Headache. Click on the following link to know more about this sordid state of affairs: http://www.thehindu.com/opinion/open-page/money-is-mammon-in-pharmaceutical-world/article4179010.ece . And also read under the heading “ADs, COSMETICS & GULLIBLE MODERN FOLK” on this ‘home page’.
The “MMR (Measles, Mumps and Rubella) vaccine-autistic enterocolitis” scientific fraud by some Westerners (www.bmj.com/content/342/bmj.c5258.full) is a recent textbook case of how falsified medical research could be published in internationally reputed Western journals with the intention of cheating the entire medical world for huge monetary gain at the cost of the health of innocent people. A high ranking researcher, Dr. Wakefield brought disrepute to MMR vaccine through his publication in The Lancet in 1998. This had raised the noise of ‘anti-vaxxers’ and has such an impact even after such a long time that a huge number of cases of measles were reported in the US in 2014 -15 due to refusal to be vaccinated. Dr. Wakefield was said to have applied for patents on a vaccine that was to be a rival of the MMR. This is one of the three recent all-time classic bogus science studies. The other two are: the Arpad Pusztai affair about genetically modified crops; andChris Malyszewiez’s MRSA hoax. To know about the clever ways of pharmaceutical industry to sell more drugs, go to http://drmalcolmkendrick.org/2013/08/02/who-shall-guard-the-guardians/ .
The MMR episode reminds one of a scientific flip flop in India. The diabetic drug, pioglitazone was ‘banned’ in India, and the ‘ban’ was revoked within weeks in 2013. There were accusations in the media coverage that the reason behind the ‘ban’ was based on adverse reports on pioglitazone from a diabetes research institution in India which received funding from a medical company whose new diabetes drug sitagliptin stands to gain if pioglitazone is unavailable ( http://www.medscape.com/viewarticle/808248 ; http://www.thehindubusinessline.com/opinion/ban-drugs-but-dont-suspend-them/article4967090.ece?homepage=true . ; http://www.thehealthsite.com/diseases-conditions/is-the-ban-of-pioglitazone-justified-expert-interview/ ).
The stem cell researcher, Dr. Hwang Woo Suk catapulted to international fame through his claims of producing the first stem cell line from a cloned human embryo and of creating 11 stem cell lines that genetically matched 9 patients with spinal cord injury, diabetes and an immune disorder. The findings were published in a highly reputed journal, ‘Science’ in 2004 and 2005. The ‘landmark’ and ‘breakthrough’ papers were subsequently retracted in 2006 by the journal after finding that they contained fabricated data and manipulated images. Consquently, the professor was dismissed from the Seoul National University, South Korea, and also was sentenced by a court for embezzling government research funds to the tune of $700,000.
Curiously, again in the arena of stem cell research, two papers on a path-breaking study on reversing adult mice cells into pluripotent cells were published in an internationally reputed journal called ‘Nature’ on January 30, 2014 which are suspected by many scientists across the world to be having fraudulent duplication of images.
CORRUPT RESEARCHERS
If you want to know more about how the “linear reductionist science of modern medicine” is coloured and authenticated in glitzy medical conference halls through glamorous multimedia projections by ‘corrupt’ leading researchers and the so-called ‘thought leaders’, read the voluminous writings of Prof. B.M. Hegde (www.bmhegde.com and Angioplasty.doc on the book “Angioplasty, Bypass Surgery, Myths, ……” by B.V. Ghokale ) which expose the secret fraud in generation and propagation of coloured modern medical knowledge, and the ways how industrialists are in cahoots with leading professionals to the detriment of common man and science.
FABRICATED RESEARCH
Whatever it is, the world seems to be running on money. It is said that there is a lot of money in various fields of medicine. Business barons seem to go to any extent to laugh all the way to the bank. They may even influence researchers and doctors to get favourable “scientific” evidence for their products – launched and yet to be launched – through “paid research.” There is too much of evidence on this. “The world famous not-for-profit Mayo Clinic, Rochester, US which spends $500 million a year on research concluded in 2009 that data about harnessing the immune system to fight cancer had been fabricated, resulting in the retraction of 17 papers in nine research journals.” Incidents of fraud in medical research are far too many to be ignored.
Results of scientific studies released on January 4, 2016 revealed that a lot of medical research was dubious. An accompanying editorial in PLOS Biology noted that a “credibility crisis” is ravaging scientific research. One of the studies in this journal analysed a random sample of 441 biomedical journal articles published in the last 15 years, and found that only one included a full protocol of the information necessary for evaluating and replicating the research. It is found that 85 per cent of research investment in the biomedical sciences – or US $200 billion of the worldwide investment in 2010 – was wasted ( http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002334 ).
Arnold S Relman, former Editor-in-Chief of New England Journal of Medicine, wrote: “If data have been cooked up and the results are plausible, there is no way peer review can catch the fraud.” Glorifying dubious data is the most fashionable and “authentic” way, using modern gadgetry, p-values, confidence intervals, data-dredging, mix-master techniques – otherwise called meta-analysis, baked biological plausibility and the final doctoring in clinical trials and studies.
The convincing proof of this fraud is evident from the announcement by the British Medical Journal that starting from January 2013 it will publish the results of human clinical trials only when there is a “commitment (by the sponsors) to make the relevant anonymised patient-level data” available on request, thus stripping the drug industry’s shroud of secrecy and preventing it from withholding/distorting drug safety/effectiveness data ( www.thehindu.com/opinion/editorial/welcome-move-on-clinical-trials/article4120371.ece ).
The infamous retraction of articles from The Lancet and The New England Journal off Medicine about the HYDROXYCHLOROQUINE in treating COVID-19 (2020) has drawn worldwide criticism about research and publication in medical journals. A cursory look at the following links gives the degree of deterioration.
https://healthimpactnews.com/2020/editors-of-the-lancet-and-the-new-england-journal-of-medicine-pharmaceutical-companies-are-so-financially-powerful-they-pressure-us-to-accept-papers/
https://www.thehindu.com/opinion/editorial/shine-a-light-the-hindu-editorial-on-retraction-of-the-lancets-research-paper-on-hydroxychloroquine-use/article31761420.ece
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext
https://theprint.in/health/why-researchers-are-questioning-lancet-study-that-linked-hcq-to-higher-covid-death-risk/432896/
https://in.dental-tribune.com/news/lancet-faces-severe-criticism-from-scientific-community-hydroxychloroquine-study-is-hiding-data/
https://medicalxpress.com/news/2020-06-lancet-hydroxychloroquine.html
Philippe Douste-Blazy, MD, is a cardiologist and former French Health Minister who served as Under-Secretary General of the United Nations. He was a candidate in 2017 for Director of the World Health Organization.
In a videotaped interview on May 24, 2020, Dr. Douste-Blazy provided insight into how a series of negative hydroxychloroquine studies got published in prestigious medical journals.
He revealed that at a recent Chatham House top secret, closed door meeting attended by experts only, the editors of both, The Lancet and the New England Journal of Medicine expressed their exasperation citing the pressures put on them by pharmaceutical companies. He states that each of the editors used the word “criminal” to describe the erosion of science.
“If this continues, we are not going to be able to publish any more clinical research data because pharmaceutical companies are so financially powerful; they are able to pressure us to accept papers that are apparently methodologically perfect, but their conclusion is what pharmaceutical companies want.”
The infamous retraction of articles from The Lancet and The New England Journal off Medicine about the HYDROXYCHLOROQUINE in treating COVID-19 (2020) has drawn worldwide criticism about research and publication in medical journals. A cursory look at the following links gives the degree of deterioration.
https://healthimpactnews.com/2020/editors-of-the-lancet-and-the-new-england-journal-of-medicine-pharmaceutical-companies-are-so-financially-powerful-they-pressure-us-to-accept-papers/
https://www.thehindu.com/opinion/editorial/shine-a-light-the-hindu-editorial-on-retraction-of-the-lancets-research-paper-on-hydroxychloroquine-use/article31761420.ece
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext
https://theprint.in/health/why-researchers-are-questioning-lancet-study-that-linked-hcq-to-higher-covid-death-risk/432896/
https://in.dental-tribune.com/news/lancet-faces-severe-criticism-from-scientific-community-hydroxychloroquine-study-is-hiding-data/
https://medicalxpress.com/news/2020-06-lancet-hydroxychloroquine.html
Philippe Douste-Blazy, MD, is a cardiologist and former French Health Minister who served as Under-Secretary General of the United Nations. He was a candidate in 2017 for Director of the World Health Organization.
In a videotaped interview on May 24, 2020, Dr. Douste-Blazy provided insight into how a series of negative hydroxychloroquine studies got published in prestigious medical journals.
He revealed that at a recent Chatham House top secret, closed door meeting attended by experts only, the editors of both, The Lancet and the New England Journal of Medicine expressed their exasperation citing the pressures put on them by pharmaceutical companies. He states that each of the editors used the word “criminal” to describe the erosion of science.
“If this continues, we are not going to be able to publish any more clinical research data because pharmaceutical companies are so financially powerful; they are able to pressure us to accept papers that are apparently methodologically perfect, but their conclusion is what pharmaceutical companies want.”
MAKE BELIEVE
It is said that people with vested interests have continuously been trying to reduce the “normals” (normal lower limits of blood pressure readings, blood glucose levels, etc.) so that many millions of normal people could be labelled as patients which means filling their coffers to the brim ! They try to do this by exerting great influence on organisations that formulate guidelines and recommendations through “paid orchestrated opinion” of the members of the committees and by creating “scientific” data through “paid research.”
New groups of patients are created by expanding the definition of disease. Time and time again, over the past few decades, health organisations and disease control bodies have lowered the “normals” in blood pressure, blood sugar, obesity indices, etc. bringing millions of normal people into ‘to be treated’ category, bringing a lot of cheer to the drug manufacturers. Medical representatives go on dinning into the doctors’ ears about the imperatives of treating such ‘normal’ people citing recommendations of WHO and other bodies. Being the last links between the manufacturers and the prescribing doctors, the medical representatives are subjected to great pressure by some executives of some companies to sell their products. They have their own owes. Go to http://www.nytimes.com/2016/08/11/business/international/abbott-india-suicide-inhuman-drug-sales-tactics.html?mwrsm=Facebook&_r=0 to see this scenario and how they are forced to do unethical practices and how a representative committed suicide unable to cope up with the stress and pressure to meet the targets, as recently as August 2016.
It is said that WHO receives more private money, $500 million per year, some of it from drug makers, than it receives from member nations. The deciding committees formed by WHO and NIH to formulate blood pressure recommendations were each stocked with doctors who were on the pay rolls of drug companies and had alleged ties with them (Seattle Times). It is alleged that bias plays an important role in their recommendations.
And the practising doctors simply swallow these “scientific” reports as gospel truth coming from authentic evidence. They are made to believe, through sponsored academic brainwashing, so many things which are not true. It has been said, for instance, that they are tuned to believe that the latest costly diuretics are definitely safer than the old cheaper diuretics. The literature is pumped in by their high-powered marketing strategies to brainwash the profession. The doctors (convinced or not – if not, just to feel satisfied that their co-professionals may not think that they are lagging behind in knowledge !) usually follow the new parameters and may scare the patients saying that “if you don’t take this treatment for life long, your life would be shortened.”
‘Attention Deficit Hyperactivity Disorder (ADHD) is a ‘new fashion’ diagnosis in children to soak them in dangerous drugs. American psychiatrist, Dr. Leon Eisenburg stated, a few months before his death, that ADHD is a fictitious disease which is created for the benefit of drug manufacturers and listed as a new disease in the “Diagnostic and Statistical Manual of Mental Diseases” of the American Psychiatry Association.
A company by name “American Biologics” marketed drugs and equipment for a non-existent epidemic (labelling it as the “Plague of the 21st century”) of Lyme disease in US (US Dept of Justice Press Release, Sept 17, 2010, www.justice.gov/usao/ksi. ).
Scientists from the 'Universite Paris est Creteil (UPEC)' in France issued a worldwide warning in late 2016 about the potentially hazardous side-effects (Chronic Fatigue Syndrome, Cognitive Dysfunction, myalgia, Dysautonomia, Autoimmune / inflammatory reactions' etc.) of the 'Aluminium adjuvant (Alhydrogel used in vaccines for children. Their findings were reported in the highly respected journal 'Toxicology' (https://healthcareinamerica.us/french-scientists-sound-the-alarm-about-aluminum-in-vaccines-crickets-from-media-and-health-d3fc0fe23079 ).
Scientists from the 'Universite Paris est Creteil (UPEC)' in France issued a worldwide warning in late 2016 about the potentially hazardous side-effects (Chronic Fatigue Syndrome, Cognitive Dysfunction, myalgia, Dysautonomia, Autoimmune / inflammatory reactions' etc.) of the 'Aluminium adjuvant (Alhydrogel used in vaccines for children. Their findings were reported in the highly respected journal 'Toxicology' (https://healthcareinamerica.us/french-scientists-sound-the-alarm-about-aluminum-in-vaccines-crickets-from-media-and-health-d3fc0fe23079 ).
“The most exquisite pleasure in the practice of medicine comes from nudging a layman in the direction of terror, then bringing him back to safety again.”
--Kurt Vonnegut
Generally speaking, a person who can work hard and help others enthusiastically may be considered as enjoying good health. That should be the definition of good health.
FOOLED TO BELIEVE
On reading these, even professors in medical colleges would be wondering as to how they are made to believe honestly all the written and spoken “scientific” data presented in conferences, CME programmes, journals, books and product literature in modern medicine. Were we not made to believe that various drugs were ‘most effective and least toxic’ before they were banned? Were we not made to believe that ‘scientifically formulated’ infant foods were lots better than the ‘ordinary’ breast milk, decades ago ? Were we not made to believe recently that ‘swine flu’ was a true pandemic ?
Allegations were made that the industry “invented” a pandemic by influencing World Health Organization (WHO) to declare “Swine flu” as a pandemic in 2009 so that a huge fortune can be made by scaring people and selling everything from facemasks to vaccines to drugs. Soon, the swine flu died on its own, not by interventions. A little later public in UK criticised the government for indirectly forcing the public to have swine flu vaccine by combining it with two other strains of the annual winter flu vaccines. They said that it is a government ploy to favour commercial establishments.
About 8,600 complaints of suspected adverse reactions to ‘swine flu’ vaccination during the epidemic were made to the Medicines and Healthcare Products Regulating Agency (MHRA-UK). ‘Inventing’ new “Superbugs” and making costliest antibiotics is another bright commercial idea !
“The head of health at the Council of Europe had raised questions about the role of pharmaceutical corporations in the declaration of H1N1 (swine flu) as a pandemic. Later, an investigation by the British Medical Journal found that medical experts advising World Health Organization on H1N1 had financial ties with pharmaceutical companies producing the vaccine for the (H1N1) pandemic. As all the developed countries stocked up on the vaccines, reportedly, the pharmaceutical companies made profits ranging from $ 7 – 10 billion” ( http://www.thehindu.com/todays-paper/tp-features/tp-sundaymagazine/pandemics-in-the-age-of-panic/article6625928.ece ). The trick is to create a panic across the world and make money by selling globally products which are made to be perceived as necessary. In fact, panic itself has become pandemic according to the medical scholars, Luc Bonneux and Wim Van Damme.
‘Tamiflu’(oseltamivir) sales hit almost $ 3 billion in 2009 mostly due to its use in the H1 N1 flu (Swine flu) pandemic. Now (2014) the respected research network, Cochrane Review found that ‘Tamiflu’ / ‘Relenza’ (zanamivir) had few if any beneficial effects, but did have adverse side effects that were previously dismissed or overlooked. The researchers observed that governments that stockpile the drug are wasting billions of dollars on a drug whose effectiveness is doubtful.
Over the past two decades, people and professionals had a thorough brainwash to believe that influenza vaccination is a must for those above 65 years to prevent fatal infections in this vulnerable age group. Results of a systematic review and meta-analysis, screening 5,707 articles, are just published in The Lancet Infectious Diseases (Vol.12, Issue 1, pp. 36-44, Jan. 2012). The study concluded that “evidence for protection by influenza vaccines in adults aged 65 years or older is lacking,” sending shock waves through the multi-billion drug industry which has been impressing everyone with “scientific evidence” of the life-saving protection by the influenza vaccines in this age group !!
Dr. Diana Harper, who was associated with the development of the vaccines, Gardasil and Cervarix, stated in 2009 that the vaccines were essentially useless and more dangerous than cervical cancer which they were supposed to prevent !
DENGUE VACCINE
Being in Singapore today (March 6, 2017), I happened to see in the newspapers here that the world’s first Dengue vaccine, DENGVAXIA, will be commercially available in Singapore starting this week, though it is not as effective against Den 1 and Den 2 (the common strains circulating in Singapore) as it is against Den 3 and Den 4 strains (http://www.straitstimes.com/singapore/first-dengue-vaccine-available-from-this-week ). The Dengvaxia has been given to a million children in Philippines. An 11-year-old boy died days after getting the vaccination, but it was said that he died of complications arising out of congenital heart disease. And ‘public health advocates’ are warning that the vaccine could increase dengue’s severity due to what is called “antibody-dependent enhancement”, three years down the road. The Executive Director of the Philippine Foundation for Vaccination said that there will always be people against vaccinations as there is no vaccine that is 100 per cent effective and safe ( http://www.straitstimes.com/asia/dengvaxia-given-to-a-million-kids-in-philippines ). Added to this confusion, is the study (2016) by an international team of scientists (York University, etc.) which found that vaccination against ‘Dengue fever’ can increase ‘Zika virus’ outbreaks.
As on December 5, 2017, the FDA of Philippines ordered suspension of sale, distribution and marketing of DENGVAXIA vaccine (of Sanofi Pasteur company) as it poses potential risk to those who never had dengue. The vaccine may cause severe form of dengue if exposed to the virus, in the case of persons who never had dengue before being vaccinated. The 733,000 public school children who were vaccinated are at risk. Introduced the vaccine in a hurry to make money !
As on December 5, 2017, the FDA of Philippines ordered suspension of sale, distribution and marketing of DENGVAXIA vaccine (of Sanofi Pasteur company) as it poses potential risk to those who never had dengue. The vaccine may cause severe form of dengue if exposed to the virus, in the case of persons who never had dengue before being vaccinated. The 733,000 public school children who were vaccinated are at risk. Introduced the vaccine in a hurry to make money !
Back at home, Madhavi Yennapu, Scientist, National Institute of Science, Technology and Development Studies, Delhi suspects that the idea of including expensive combination vaccines (pentavalent 5 in 1 vaccine) in the Universal Immunisation Programme is a ‘politico-economic’ move (THE WEEK, Feb. 17, 2013). And in 2017, a huge opposition to “MR vaccination to children” propelled by ‘social network media’ caused stupendous confusion to the parents in Tamil Nadu.
All this is a testament to our thoughtless tinkering with NATURE, causing ecological imbalance leading to more diseases, more vaccinations, more drugs, more side-effects and more confusion. We have to blame ourselves. Medical care has become a monumental conundrum.
FALLACY OF INFERENCES & SIDE EFFECTS OF DRUGS
Discrediting statins, today, draws flak and derision. It is a multi-billion dollar cholesterol-lowering drug industry. “In modern medicine, despite the scientific thinking, we do draw imaginary inferences and conclusions. We produce evidence that statins reduce cholesterol. And we produce evidence that high cholesterol results in premature deaths. So we infer that statins prevent early death. This is a fallacy ! The surrogate outcome of lowering cholesterol might not be, either not at all, or perhaps not very well associated with the real outcome of heart attack and death. We make everybody equate surrogate outcome with real outcome.” Evidence is growing to list statins as dangerous drugs (https://churchmousec.wordpress.com/2013/02/27/professor-philippe-evens-the-truth-about-cholesterol/ http://www.dietdoctor.com/cholesterol-lowering-drugs-heavily-criticized-australian-tv-documentary ; http://www.thehindu.com/todays-paper/tp-features/tp-openpage/a-plant-poison-becomes-a-moneyspinner/article5359616.ece). “Among those that they alleged were ‘completely useless’ were ‘statins’, widely taken to lower cholesterol.” Prof. Even accused the pharmaceutical industry of pushing medicines through the health system at doctors who then push them on to patients. (The Guardian, September 14, 2012 –Kim Wilsher in Paris) ! After all, high cholesterol may be just one of the various factors which contribute to early death.” “… that statins are a widespread conspiracy aimed at fleecing the public and ruining their health. In fact, the majority of studies show that men, just like women, die more from heart disease if they have low cholesterol levels. And yet doctors are busy prescribing cholesterol-lowering medication to millions of men around the world” — Campbell-McBride. Insulin resistance is a much more important factor for heart attacks in young men. To confound the confusion, research is directed to identify further subclasses based on particle size, density, chemical composition and so on -- small dense LDL particles (lllc, lllv, lVa, lVb), (4-7) Type B. And imagine the treatment protocols based on the myriad variants.
In fact, cholesterol is involved in immune system protection against potentially fatal gastrointestinal and respiratory infections and possibly even cancer. In the age group of above 60 years, cardiovascular-related deaths are less in the higher cholesterol stratum. Dr. John Abramson from the Harvard School of Public Health said that cholesterol is one of the most vital molecules and that it is bad science to think that getting rid of cholesterol is beneficial (2016). Even the American scientist, Aneel Keys, who established that consumption of saturated fat was related to heart disease thirty years ago said recently: “I have come to think that cholesterol is not as important as we used to think it was” (2016).
Showing a laundry list of drugs, many of my patients happily declare that they are keeping their cholesterol levels under control. Many of them think that drugs can correct anything wrong done by bad lifestyle. Many of them get a premature divine call ! Stress kills. Is there any safe drug which prevents stress ? Is there any drug which makes one not to worry about tomorrow ? Is there any drug which makes one contented and happy ? Is therapy quinoa for the body and mind ?
One may not be wrong if one says that no drug is absolutely safe and devoid of side effects – ranging from drowsiness to death. About 4.5 million out-patients and 2 million in-patients suffer from side effect of medicines annually in America alone where stringent systems are in place to regulate drug dispensation. Imagine the situation in countries where any drug may be purchased across the counter without a prescription.
Drugs are permitted to be sold on the evidence that they have greater benefits than danger, based on a scientific system that is ripe for abuse due to vested interests.
Most drugs have mild side effects. Some may have dangerous ill effects – cardiac arrest to cancer. Penicillin may cause itching or even death. The diabetic drug, Avandia or Actos may lead to heart attack or stroke. Accutane and some anti-depressants are linked to suicides. Lipitor, a commonly prescribed anti-cholesterol drug is held responsible for muscle pain and loss of muscle coordination. Testosterone replacement therapy with AndroGel may double the risk of heart attack. Painkiller, Vioxx and the drug, Risperdal used in Alzheimer’s disease are linked to stroke. Tamoxifen, a drug used in breast cancer patients was found to increase the risk of uterine cancer. The anti-diabetic drug, Actos may increase the risk of bladder cancer by 80 per cent. Some drugs produce clots and some promote bleeding causing brain damage or heart problems. Many elderly patients had their bones broken due to falls indirectly caused by the side effect of giddiness. Apart from the common side effects like nausea, vomiting, abdominal pain, loose stools, constipation, drowsiness, skin rashes, head ache, ill effects related to vital organs like brain, heart, kidney, liver, etc. cause lot of concern. Psychological disturbances are an added issue. For a little more on this subject go to http://www.drugwatch.com/side-effects/ .
A huge number of drugs like ‘glucagon-like peptide-1(GLP-1) analogues and dipeptidylpeptidase-4 (DPP-4) inhibitors for diabetes and Depo-provera for contraception which may make one vulnerable for fractures are introduced into the market which are ‘well validated regarding surrogate outcomes’ but not about ‘real-world outcomes’.
Dexfenfluramine (Redux), one of the two drugs in the combination known as Fen-phen, recommended for weight reduction, was approved in 1996 and later banned in 1997 because it caused major heart valve damage and pulmonary hypertension in thousands of patients and also killed many.
Authorities banned some drugs like Vioxx, Zelnorm and Baycol which were thought, with scientific evidence, to be ‘most effective and least toxic’ a decade ago . Often, the “pro-industry ‘paid’ cacophony” overshadows reports of adverse reactions. ‘Vioxx’, a pain killer and several other drugs were blamed for serious side effects. The cardiac-safety profile of a drug took centre-stage after the Merck’s pain killer, Vioxx was globally withdrawn after it was seen to be linked with heart attacks and strokes. Rosiglitazone, a drug used in diabetes, was banned in India. Troglitazone, Sibutramine, Rimonabant and several other drugs were on the lists of banned drugs.
Deoxy medroxy progesterone acetate (DMPA), an injectable contraceptive hormone drug, is cleared by the Drug Technical Advisory Board (DTAB) of India for use in the national Family planning Programme (FPP) from April 2016. Once injected, it prevents pregnancy for three months. Several health groups, women’s organizations and people’s networks have issued a joint statement protesting this move on grounds of safety of this drug (2015).
In good old days, we used to see research study findings occasionally and we used to take them seriously. Nowadays, everyday, media project sensational study reports saying that what was thought to be bad for health is now considered good and vice versa. And, we stopped to take them seriously.
In November 1961, thalidomide was taken off the market due to massive pressure from the press and public. Experts estimate that thalidomide led to the death of approximately 2,000 children and serious birth defects in more than 10,000 children, about 5,000 of them in West Germany.
In good old days, we used to see research study findings occasionally and we used to take them seriously. Nowadays, everyday, media project sensational study reports saying that what was thought to be bad for health is now considered good and vice versa. And, we stopped to take them seriously.
Controversies abound in medical research. ‘Cherry-picking’ of the results to make them look better or worse for the drugs is common depending on what one wants to conclude. In science one may argue either way. You may say that vegetarian food is good for health and is eco-friendly, citing innumerable studies. And you may say that consumption of vegetarian food is harmful to the environment and brings about adverse effects through ‘climate change’ because those foods require more resources to produce and have more greenhouse gas emissions per calorie (compared to non-vegetarian stuff), citing a study published in the journal Environment Systems and Decisions (2015).
One may quote some studies and say that moderate consumption of alcohol is beneficial and that coconut oil which contains short-chain fatty acids is good for health. ‘Amul’, the giant business concern in dairy products, issued a full page ad (The Hindu, Jan 28, 2017) wherein it is stated that butter is a “health food” in many ways and that consumption of high-fat dairy products reduced the risk of heart disease by a whopping 69% and that consuming high-fat dairy products is not associated with obesity. They cited scientific studies which endorsed the goodness of butter due to fat-soluble vitamins, vitamin K2, healthy short and medium chain fatty acids, 4-carbon fatty acid Butyrate, conjugated Linoleic acid, etc.
There is a lot of literature for and against ‘statins’. A recent study indicated that statins may prevent ‘venous thromboembolism’ in limbs and lungs. And, advocates of “Paleo Diet” profess that consuming unlimited non-vegetarian diet excluding almost all the vegetarian and dairy items is very good for health – reducing weight, cholesterol, blood pressure, etc.
Delusions of relevance are thus created while specious arguments of novelty continue. And we don’t know the magnitude of the so-called “paid research.” They produced evidence that E-cigarettes were safe. Now (2017), there is evidence from researchers at Texas Tech University in the US that E-cigarettes may pose a higher risk of stroke than tobacco smoking !! In 2018, US regulators ordered restrictions on sales of e-cigarettes. In one year (2017 - 18), there was a 78% increase in e-cigarette use among high school students and a 48% increase among middle school students. The FDA commissioner Scott Gottlieb said: "I will not allow a generation of children to become addicted to nicotine through e-cigarettes."
Scientists at the University of Bonn in Germany and Hebrew University of Jerusalem in Israel found (2017) that ‘cannabis’, a narcotic bad one, helps to keep brain from ageing !
Recent scientific evidence suggests that a couple of cups of coffee everyday keeps the cardiologist away !!! On the other hand, it is shown that even a small amount of caffeinated energy drinks may trigger serious heart problems especially in persons with familial congenital long QT syndrome (LQTS). Scientific evidence indicates that a little tea and a little dark chocolate are good for health ... and that adding a little zinc to coffee keeps schizophrenia away.
And how about dieting ?
It is generally believed that eggs are bad for heart due to their high cholesterol content. But, a large study (Beijing) now (2018) has shown that an egg every day could significantly reduce the risk of cardio-vascular diseases and hemorrhagic stroke due to the high quality protein, many vitamins and bio-active components such as phospholipids and carotenoids which are present in eggs.
There is a lot of documentation that 'blue light' of electronic screens and LED bulbs is detrimental to health, while a recent (2018) study published in the European Journal of Preventive Cardiology found that exposure to blue light decreases blood pressure, reducing the risk of developing cardiovascular diseases.
And, add to all this the findings published in Nature Reviews Cancer ... keeping babies in ultra-clean environments, with no exposure to common infections and away from other infants, during the first year of their lives can trigger leukaemia (the most common type of childhood cancer) (Institute of Cancer Research in the UK). And, a study presented at the American College of Allergy, Asthma and Immunology (2018) indicated that sucking of baby's pacifier (to clean it) improves the immunity of a child against development of allergies and asthma (by passing healthy oral bacteria, in the saliva of the parents on to the babies, which facilitate early development of the child's immune system). It's all a scientific conundrum. ... confusion ...
In recent times, there has been a wave of 'publication explosion' out of vested interests. Scientists vie for a place in media and are perfectly happy to publish an outlandish idea if it has even the tiniest sliver of a chance of not being wrong. Some of the research studies seem to be silly and otiose. An example: Oh, man ! if you stare at beautiful breasts for a few minutes a day, you may live longer by five years ! It's not a joke ... a study says that ... a five-year research study published in the New England Journal of Medicine (2014) found that those men who enjoyed a longing look at beautiful breasts had lower blood pressure, less heart disease and slower pulse rates compared to those who did not get their daily eyeful of busty beauties. The researchers observed that staring at the charms of a well endowed female is roughly equivalent to a 30-minute aerobics workout, and that looking at the breasts a few minutes daily cuts the risk of a stroke and heart attack by half, and that the average man can extend his life by four to five years. Believe it or not, this is what the research says. The following was my comment on this, before knowing that this "study and reporting" was a big fat FAKE. But, such ones are present in the real world of literature also. :
One may quote some studies and say that moderate consumption of alcohol is beneficial and that coconut oil which contains short-chain fatty acids is good for health. ‘Amul’, the giant business concern in dairy products, issued a full page ad (The Hindu, Jan 28, 2017) wherein it is stated that butter is a “health food” in many ways and that consumption of high-fat dairy products reduced the risk of heart disease by a whopping 69% and that consuming high-fat dairy products is not associated with obesity. They cited scientific studies which endorsed the goodness of butter due to fat-soluble vitamins, vitamin K2, healthy short and medium chain fatty acids, 4-carbon fatty acid Butyrate, conjugated Linoleic acid, etc.
There is a lot of literature for and against ‘statins’. A recent study indicated that statins may prevent ‘venous thromboembolism’ in limbs and lungs. And, advocates of “Paleo Diet” profess that consuming unlimited non-vegetarian diet excluding almost all the vegetarian and dairy items is very good for health – reducing weight, cholesterol, blood pressure, etc.
Delusions of relevance are thus created while specious arguments of novelty continue. And we don’t know the magnitude of the so-called “paid research.” They produced evidence that E-cigarettes were safe. Now (2017), there is evidence from researchers at Texas Tech University in the US that E-cigarettes may pose a higher risk of stroke than tobacco smoking !! In 2018, US regulators ordered restrictions on sales of e-cigarettes. In one year (2017 - 18), there was a 78% increase in e-cigarette use among high school students and a 48% increase among middle school students. The FDA commissioner Scott Gottlieb said: "I will not allow a generation of children to become addicted to nicotine through e-cigarettes."
Scientists at the University of Bonn in Germany and Hebrew University of Jerusalem in Israel found (2017) that ‘cannabis’, a narcotic bad one, helps to keep brain from ageing !
Recent scientific evidence suggests that a couple of cups of coffee everyday keeps the cardiologist away !!! On the other hand, it is shown that even a small amount of caffeinated energy drinks may trigger serious heart problems especially in persons with familial congenital long QT syndrome (LQTS). Scientific evidence indicates that a little tea and a little dark chocolate are good for health ... and that adding a little zinc to coffee keeps schizophrenia away.
And how about dieting ?
It is generally believed that eggs are bad for heart due to their high cholesterol content. But, a large study (Beijing) now (2018) has shown that an egg every day could significantly reduce the risk of cardio-vascular diseases and hemorrhagic stroke due to the high quality protein, many vitamins and bio-active components such as phospholipids and carotenoids which are present in eggs.
There is a lot of documentation that 'blue light' of electronic screens and LED bulbs is detrimental to health, while a recent (2018) study published in the European Journal of Preventive Cardiology found that exposure to blue light decreases blood pressure, reducing the risk of developing cardiovascular diseases.
And, add to all this the findings published in Nature Reviews Cancer ... keeping babies in ultra-clean environments, with no exposure to common infections and away from other infants, during the first year of their lives can trigger leukaemia (the most common type of childhood cancer) (Institute of Cancer Research in the UK). And, a study presented at the American College of Allergy, Asthma and Immunology (2018) indicated that sucking of baby's pacifier (to clean it) improves the immunity of a child against development of allergies and asthma (by passing healthy oral bacteria, in the saliva of the parents on to the babies, which facilitate early development of the child's immune system). It's all a scientific conundrum. ... confusion ...
In recent times, there has been a wave of 'publication explosion' out of vested interests. Scientists vie for a place in media and are perfectly happy to publish an outlandish idea if it has even the tiniest sliver of a chance of not being wrong. Some of the research studies seem to be silly and otiose. An example: Oh, man ! if you stare at beautiful breasts for a few minutes a day, you may live longer by five years ! It's not a joke ... a study says that ... a five-year research study published in the New England Journal of Medicine (2014) found that those men who enjoyed a longing look at beautiful breasts had lower blood pressure, less heart disease and slower pulse rates compared to those who did not get their daily eyeful of busty beauties. The researchers observed that staring at the charms of a well endowed female is roughly equivalent to a 30-minute aerobics workout, and that looking at the breasts a few minutes daily cuts the risk of a stroke and heart attack by half, and that the average man can extend his life by four to five years. Believe it or not, this is what the research says. The following was my comment on this, before knowing that this "study and reporting" was a big fat FAKE. But, such ones are present in the real world of literature also. :
GREAT MEDICINE' !
No pharmaceutical side-effects. But plenty of erotic side-effects ! Ultra-modern scientific research !
This may be what is called "Fallacy of Inferences." Sponsored (read paid) research is in vogue in pharmaceutical industry. In a lighter vein it may be said that in this case, perhaps, somebody who is planning to start a chain of "BREAST SHOPS" is sponsoring such studies !
In modern medicine, despite the scientific thinking, we do draw imaginary inferences and conclusions. We produced evidence that the drugs called statins reduce cholesterol. And we produced evidence that high cholesterol results in premature deaths. So we infer that statins prevent early death. This is a fallacy ! And we make millions of dollars by marketing statins. The surrogate outcome of lowering cholesterol might not be, either not at all, or perhaps not very well associated with the real outcome of heart attack and death. We make everybody equate surrogate outcome with real outcome. Evidence is growing to list some statins as dangerous drugs.
-- Dr. T. Rama Prasad, 'Pay what you can' Clinic, Perundurai, India
These are just a few examples ... there are many more !!!
NEEDLESS PROCEDURES
NEEDLESS PROCEDURES
It may be interesting to read http://www.wakingtimes.com/2013/08/13/12-medical-tests-and-procedures-even-doctors-claim-are-useless/ wherein the needlessness and hazards of 12 medical tests / procedures are detailed -- induction of labour or Caesarian delivery before 39 weeks; Routine annual PAP tests; Routine CT scans to evaluate minor head injuries; Stress tests using echo-cardiographic images; Tight control of diabetes in the elderly; Electroencephalography in cases of recurrent head ache; Routine treatment of GERD; Routine lipid profile tests; Routine mammograms; Routine Prostate Specific Antigen tests; Routine colorectal cancer screening and Routine Bone Mineral Density scans.
Mammography: Mammography has gained popularity globally over the years as a “safe” investigation to detect breast cancer early. But, recent evidence indicated that mammography, a cancer screening test to detect abnormalities in breasts, may help “wandering” cancer cells to thrive and grow faster. Of late (2016), the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) recommended that mammography be used routinely only for women aged over 50, to detect cancer, as false positive results, over-diagnosis (which may lead to needless and possibly dangerous interventions) and possibly radiation-induced cancer are the possible harmful effects of mammography screening which may be more hazardous to younger women.
Nearly 300 patients of three cardiologists in the US have filed lawsuits against the doctors in 2015, claiming they performed needless procedures and surgery on them. It is alleged that the three doctors received nearly $5 million in combined Medicare payments in 2012 (http://www.pressreader.com/india/the-new-indian-express/20151019/282054800877368/TextView ).
THE BAD LAST LAP & FAMILY DOCTORS
Conspicuous is that in ‘modern medicine’ we, doctors, seem to arrogate too much with the little knowledge we have. We give the impression that once a patient is admitted into a ‘high-tech’ hospital, everything can be taken care of. The fact is that when nature fails to a great extent, nothing much can be done except to prolong the life (suffering) by a short period of time and make the last lap of the journey to the graveyard through the Intensive Care Unit a miserable and a very expensive one – an exercise in futility. Much of the money, technology, expertise and time is being spent on this very short last lap without letting the patients have a dignified exit from this world.
Family doctors play a very important role in ‘palliative care’. Unfortunately, the tribe of the ‘family doctors’ has almost become extinct. They used to go to the homes of the patients and follow up, even up to the graveyard like family members. Some terminally ill patients really require only palliative care at home to make them as comfortable as possible until the end under the care of a family doctor. There is no meaning in pushing these patients into heroic treatment options in the very expensive ‘Critical Care Units’ just to prolong the life for a short while more (with more suffering, both to the patients and the relatives, due to treatment with bewildering gadgets all around, tubes inserted into all the passages in the body, ventilators, monitors, needles, knives, surgery, chemotherapy, radiotherapy, etc.). Go to http://www.thehindu.com/todays-paper/tp-features/tp-openpage/for-a-tranquil-farewell/article5906770.ece to read an interesting article titled “For a tranquil farewell” wherein is a vivid description of one who left the world peacefully without falling into the “trap” of intensive treatment options.
Also read about the “passage to dear death” in the article http://www.thehindu.com/todays-paper/tp-features/tp-openpage/passage-to-dear-death/article6920719.ece wherein the writer lamented about the practice of extracting money from the hapless victims by doing distressing investigations and surgeries in the name of ‘evidence-based medicine’ and intensive care, fully knowing that they may only be exercises in futility.
The present day consternation about ‘modern medicine’, despite its rationality and utility, is about the deviations in development and application of it with ulterior and selfish motives – mostly related to murky commercial deals, collusion with health insurance companies and monetary exploitation of patients. Everyone wants a slice of the pie. All the medical care seems to be up for sale, and kickbacks and commissions are rampant. This is an open secret. The erosion of standards and values in research, reporting, marketing and application of the science to humanity calls for critical comments to stem the rot. Much of the private funding for research focuses on projects which are likely to beget hefty profits. Trade gives certain medical products and procedures a specious appearance of novelty. Is it necessary for commerce to be so diabolic ?
“Do not make money in the sick room,” wrote Hippocrates, the Father of Medicine who left this world in 377 BC. That was the time when medical care and ethical behaviour were absolutely inextricable. He must be turning over in his grave on knowing the ‘high-tech modern methods’ of making money in the medical and pharmaceutical field.
We have come a long way from the ancient age of talismans and conjurers to the modern age of scientific tricksters.
SCENARIO IN INDIA
Perhaps, the same holds good for medical profession also !
For politeness’ sake, I did not want to write on the Indian examples of ‘the Bad and the Ugly’ and the malfeasance (to be polite to Indian medical fraternity and India). They may ruffle a few feathers and offend some. Is the scenario bad in India ? Perspicaciously, I may say that we don’t have reliable statistics and information. While I am chary of writing on the Indian scenario, certain sordid happenings in India that baffled everyone abroad are too serious to ignore. And the loud projections in the media made many aware of the malaise. And the media are too eager to dip into the reservoir of sensations though they may be mere aberrations. Thus, the profession has made its fair share of negative headlines while ignominious incidents grabbed headlines nationwide. As such, I quote a bit of documentation and present a brief on what people expressed about the situation. The debate surrounding may be mere rhetoric. I am keeping my comment to the minimum.
Of course, some attitudinal changes in the provider and consumer have occurred all over the globe, but certain trends set in India leave one shocked. I hasten to add that things are not uniformly bad throughout the country. There are gross regional variations. In some regions, the practice of medicine, even in government hospitals, is very good. Some companies, some hospitals and some doctors are impeccably clean and honest. Some Indian doctors have such an expertise that they frequently go abroad to do surgery on request. Doctors spend a good bit of their life studying the tough subject of medicine and work, sacrificing their personal and social life without looking at the clock. Many private practitioners in India accept fees according to what the economically poorer patients can afford, and they treat some patients free of cost. Read about my service under the heading ‘Pay what you can’ Clinic on this blog.
Doctors have their own grievances. If they charge Rs.500 for 30 minutes of their precious and valued time, people think it is too much. If the same amount is charged by doing some needless investigations or procedures, the same people think that they got value for the money. A few doctors may be exploiting this psychology and reality, and doing needless investigations. Thismight have been blown out of proportion by media hyperventilation and fulminations to give the profession a bad image. Sensational media coverage occupied a lot of mind space of the public. But, feeling is as important as fact, sometimes more so.
One may feel that my comment is too soft and kind to the concerned professionals and business houses in contrast to the following observation by a HIGH COURT in January 2020:
https://www.thehindu.com/news/national/tamil-nadu/cartel-of-doctors-pharma-firms-and-labs-fleecing-patients-says-high-court/article30518025.ece (THE HINDU, January 10, 2020).
Some may even think that this is normal just as is with bribery and corruption elsewhere in many fields !
One may feel that my comment is too soft and kind to the concerned professionals and business houses in contrast to the following observation by a HIGH COURT in January 2020:
https://www.thehindu.com/news/national/tamil-nadu/cartel-of-doctors-pharma-firms-and-labs-fleecing-patients-says-high-court/article30518025.ece (THE HINDU, January 10, 2020).
Cartel of doctors, pharma firms and labs fleecing patients, says High Court
Observing that a cartel of doctors, pharmaceutical companies and diagnostic laboratories was fleecing patients, the Madras High Court on Wednesday wanted to know when a separate union ministry for pharma would be created and when a Uniform Code of Pharmaceutical Marketing Practices would be brought into force to control unethical marketing practices.
Justices N. Kirubakaran and P. Velmurugan raised the questions in an interim order passed by them on an income-tax appeal preferred by a private pharmaceutical company which had spent ₹42.81 lakh in 2012-13 towards sales promotion expenses, which included payments made to doctors for promoting the company’s medicines, and claimed tax exemption.
“It is being said that medical mafia is controlling the pharmaceutical field and they are responsible for overpricing of the drugs. For the purpose of promoting their drugs in the market, it is being said, the companies are giving incentives such as providing hospitality and foreign trips to doctors who prescribe their medicines.
“A study conducted by Support for Advocacy and Training to Health Intiatives (SATHI), a NGO, states that big pharmaceutical companies bribe doctors through high value bribes such as smart phones, credit cards, e-vouchers and even female companionship... Thus, patients are compelled to pay more unnecessarily because of overpricing of drugs,” the judges said.
Though such overpricing was prohibited under Section 3 of the Drug (Price Control) Order of 1995 and there was also a body titled National Pharmaceutical Pricing Authority (NPPA) to keep a check on such illegal activities, “the mechanism is stated to be powerless to take action,” the Bench added.
Further, the Medical Council of India (MCI) had taken note of doctors being bribed by pharmaceutical companies in 2009 and amended the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations of 2002. The amendment prescribed punishments ranging from a fine of ₹5,000 to suspension of medical practice for more than one year.
“Inspite of the above regulations, companies and doctors are indulging in malpractices. Therefore, there should be an integrated approach to bring down malpractices by the Union Ministry of Health and Family Welfare, NPPA, MCI and the Income Tax department by taking appropriate proceedings,” the court said.
It directed Assistant Solicitor General G. Karthikeyan to submit by January 20 the details of action taken by MCI, NPPA and other authorities against erring doctors as well as pharmaceutical companies in the last five years.
This is not a statement by somebody. It is from the BENCH of JUSTICES of a HIGH COURT. Read once again the paragraph above printed in red colour ... how shameful and condemnable ! Is this anymore the NOBLE PROFESSION ? Kaliyuga medical profession ! That's the height of ugliness in Modern Medicine.
If you have the time, go to the following link and read the interesting article titled “Why I will never allow my child to become a doctor (in India)”:
If you have more time, read about and see the semi-documentary film “Placebo”by Abhay Kumar, to know about the (http://www.firstpost.com/bollywood/placebo-review-this-documentary-on-aiims-shows-us-the-grim-reality-of-medicine-in-india-2507802.html ) grim reality and suffering of the medical students in popular medical colleges like the All India Institute of Medical Sciences, Delhi. And read the article http://www.thehindubusinessline.com/todays-paper/tp-others/tp-blink/resident-evil/article9221514.ece to know how the state of medical education in India ruthlessly drives one to mental and physical stress, sometimes leading to suicides.
OUR IMAGE ABROAD
In the developed countries, the “bad” is of a “polished” nature, stylishly presented in ivory towers, very sophisticated, couched in scientific garb, oblique and not easy to prove, whereas in India some of the “bad” appears to be of a “cheap and mean” order, more direct and transparent, both in research and day-to-day medical practice. It seemed to be so blatant that it attracted the attention of the internationally renowned British Medical Journal (BMJ).
What do the people abroad think of the ‘modern medicine’ in India ? Go to the following link to know the answer: http://timesofindia.indiatimes.com/home/stoi/all-that-matters/Stop-corruption-or-other-nations-could-turn-away-Indian-doctors-Fiona-Godlee/articleshow/44372779.cms (October 5, 2014). The British Medical Journal sparked off a furious debate in India's medical fraternity when it published an article in May 2014 titled 'Corruption ruins the doctor-patient relationship in India', followed by an editorial written by eminent gastro-intestinal surgeon Dr Samiran Nundy. Fiona Godlee, the journal's Editor-in-Chief, spoke to Rema Nagarajan about their decision to launch a campaign against corruption in healthcare, starting with India.
The Editor-in-Chief said: “ … We are a medical journal but we are not a journal for doctors in the sense that we speak out for health, in the best interest of the patients and the public. And sometimes, doctors' interests are not aligned with patient interests. When Dr David Berger, who is a member of our editorial board wrote of his experience of working in India (about the cut practice and corruption in medical practice) we immediately thought this is something we should pursue. We have a long standing relationship with medicine in India and we have high readership in India and therefore our likelihood of being able to make a difference seemed higher.
Corruption in healthcare is a global problem and not just limited to India. The problem in India is that there is a system where there is corruption in governance generally, and corruption in medicine is just one part. That created an additional challenge for the doctors who might think we got to behave in this way in order to just exist. What we will be saying is that the doctors need to stand up and say that this is not ok and their professional bodies need to stand up and say it is not ok. The private medical schools that are burgeoning in India need to be properly overseen so that the new generation of Indian doctors coming through have proper ethical and moral codes and as said in the editorial, if that doesn't happen, there are ways in which other countries in the world where Indian doctors want to go and practice can say we won't accept you unless your bodies make the necessary changes.
You have enormous pressure from the commercial world to give certain treatment. By pressure, I mean financial incentives. We know that doctors are paid to give certain treatment; doctors are paid to enter patients into certain trials; we know that doctors are paid to speak and promote some treatments. It really is a combination of the sense of needing additional income, the opportunity and inadequate oversight and regulation that makes it possible for them to do this. And I think there is a tolerance of it within India generally because of the extent of
corruption across the whole country in every field.”
You have enormous pressure from the commercial world to give certain treatment. By pressure, I mean financial incentives. We know that doctors are paid to give certain treatment; doctors are paid to enter patients into certain trials; we know that doctors are paid to speak and promote some treatments. It really is a combination of the sense of needing additional income, the opportunity and inadequate oversight and regulation that makes it possible for them to do this. And I think there is a tolerance of it within India generally because of the extent of
corruption across the whole country in every field.”
A ‘British Medical Journal’ publication on September 3, 2015 ( http://www.bmj.com/content/351/bmj.h4312 / http://www.bmj.com/content/351/bmj.h4312.full.pdf+html ) reveals the well kept secret of the unethical revenue targets set for doctors working in India’s profit driven hospitals that lead to expensive but unnecessary tests and surgery that also comes with the risk of harm.
Subsequent to the publication of the articles in the BMJ in 2014 which sparked a global debate, the Parliamentary Standing Committee on Health and Family Welfare tabled a report in the Parliament in March 2016 which laid bare the failure of the Medical Council of India (MCI) to oversee quality and integrity in health services in India (http://www.newslaundry.com/2016/03/31/standing-committee-on-health-rips-apart-mci/ ). The committee caustically criticised the MCI (whose president was arrested in 2010 on a graft charge leading to the council being temporarily superseded in 2010) for being a “biased” organisation acting against larger public health goals. The report observed that the MCI has failed in its mandate as a regulator of medical education and profession leading to entrenched corruption in medical education and healthcare delivery systems in India, and that there is an urgent need to take decisive and exemplary action to restructure and revamp India’s regulatory system of medical education and practice. It has made stinging criticism of the functioning of the council as also of the lapse of the health ministry for being a mute spectator for decades and not taking action to stem the rot.
Again, an editorial comment in the BMJ in 2016 further focussed on the deplorable situation, and called for a radical revamp of the MCI (http://www.thehindu.com/news/national/british-medical-journal-calls-for-radical-revamp-of-mci/article8418954.ece ). The BMJ praised the parliamentary committee and urged the Indian government to take immediate steps for the overhaul of country’s medical education regulator, the MCI (http://www.ibtimes.co.in/british-medical-journal-urges-indian-govt-overhaul-medical-council-india-673095 ). The report is a severe indictment of the MCI and the Central government for failing to stop ‘sale’ of medical seats, having conflicts of interest influenced by corporate hospitals, sanctioning recognition and accreditation to unworthy institutions, etc. By government’s own admission, the systems are considerably corrupt (http://www.thehindu.com/opinion/editorial/medical-council-needs-urgent-therapy/article8423556.ece ).
It may be recalled that the president of the MCI was arrested by the CBI, and the President of India signed an ordinance on May 15, 2010 to dissolve the Executive Council of the MCI. The president of the MCI who was supposed to be the highest controller, guardian and watchdog of the standards of medical education and the ethics of medical profession all over India was alleged to have gorged in enormous sums to the tune of Rs. 1,800 crore (as reported by media) to facilitate official recognition to some substandard medical colleges through illicit means. One is completely flummoxed by the scandalous 'Mother of medical scams' of the 'Father of medical ethics’! This episode appears all the more squalid as it involves the highest guardian of medical ethics who embraced hubristic power.
The CBI had arrested (September 2017) a retired Orissa High Court judge and five others in connection with a medical college admissions scam. ".. The medical college is a black business of thousand crores, one single MBBS admission giving 1 crore and PG set 3-4 crores stimulated the opening of so many Private medical colleges in our country in last few years. In last days CBI has arrested Health Secretary of Puducherry and another IAS officer from state beside it arrested CENTAC or Central Admission Committee chairman, vice chairman and coordinator and Medical director of 07 private medical colleges of Puducherry. .. "
Read more at: https://www.docplexus.in/#/app/posts/7943943d-d74d-4836-aee4-8caeb0fa51d8?utm_term=Email-No-View-2Big-22Sept17&utm_campaign=Email-No-View&utm_medium=Email&utm_source=Docplexus&utm_content=CTA
The Medical Council of India, which is supposed to be the nation's conscience keeper when it comes to medical education and services, suffered the ignominy of being "fined" t pay up an "exemplary cost" of Rs. 1 crore by the Madras High Court for indirectly helping private medical colleges its on code on 50 - 50 medical college seat surrender (docoplexus, May 4, 2017).
The famous Latin query “QUIS CUSTODIET IPSOS CUSTODES ?” (meaning “Who watches the watchmen ?”) is very relevant to the systems wherein it is often the wrongdoer who is authorised to correct the wrongdoers. And it is like Satan quoting scriptures !
The CBI had arrested (September 2017) a retired Orissa High Court judge and five others in connection with a medical college admissions scam. ".. The medical college is a black business of thousand crores, one single MBBS admission giving 1 crore and PG set 3-4 crores stimulated the opening of so many Private medical colleges in our country in last few years. In last days CBI has arrested Health Secretary of Puducherry and another IAS officer from state beside it arrested CENTAC or Central Admission Committee chairman, vice chairman and coordinator and Medical director of 07 private medical colleges of Puducherry. .. "
Read more at: https://www.docplexus.in/#/app/posts/7943943d-d74d-4836-aee4-8caeb0fa51d8?utm_term=Email-No-View-2Big-22Sept17&utm_campaign=Email-No-View&utm_medium=Email&utm_source=Docplexus&utm_content=CTA
The Medical Council of India, which is supposed to be the nation's conscience keeper when it comes to medical education and services, suffered the ignominy of being "fined" t pay up an "exemplary cost" of Rs. 1 crore by the Madras High Court for indirectly helping private medical colleges its on code on 50 - 50 medical college seat surrender (docoplexus, May 4, 2017).
The famous Latin query “QUIS CUSTODIET IPSOS CUSTODES ?” (meaning “Who watches the watchmen ?”) is very relevant to the systems wherein it is often the wrongdoer who is authorised to correct the wrongdoers. And it is like Satan quoting scriptures !
The Honorary Secretary, PPLSSS of theIndian Medical Association, TN, wrote in a publication of the Indian Medical Association, TN that “... Acquiring medical degree is now become very easy. But empowering knowledge is not that much easy. Degree can be purchased knowledge cannot be. As you know, little knowledge is always harmful. ” (TIMA News Letter, vol.03, issue 11, December 2010). To know more about the “Great Medical Education Bazaar” in India go to http://www.thehindu.com/opinion/open-page/the-great-medical-education-bazaar/article4841270.ece . And there is a much bigger “bazaar” for paramedical courses offered by institutions with no proper facilities for educating and training.
The “Vyapam Scam - 2015” – medical college admissions and examinations fraud, a series of mysterious deaths and powerful figures on the dock – is a blot on our systems ( http://www.thehindu.com/sunday-anchor/autopsy-of-a-scam/article7411616.ece ).
Here is another bit to know about what people abroad think of our medical care.
While casually going through a newspaper in Singapore (TODAY, MediaCorp, MCI(P)046/06/2014 Singapore, December 23, 2014, TODAYONLINE.COM) I came across an article entitled “Bribes buy India worst maternal care among G20 nations” wherein it is mentioned: “ … India has the worst standard of maternal care in any major economy. … For every 100,000 live births in India, 190 women die, ranking the country with Indonesia at the bottom of the Group of 20 nations. .. Although everyday bribery is rife throughout India, the petty fees extracted from poor women seeking maternity care are especially pernicious. The graft extends from hospital staff who demand money to change bandages, to elected officials and top bureaucrats responsible for fixing up the state hospitals. Everyone up and down the rung of hierarchy is engaged in corrupt practices. …” BLOOMBERG (http://m.todayonline.com/chinaindia/india/bribes-buy-india-worst-maternal-care-among-g20-nations ). And 120 women are dying everyday in India during childbirth. 17 per cent of the world's deaths during childbirth occur in India, killing around 45,000 women annually (WHO - 2016 report). Estimates indicate that 56,524 newborn babies die each year in India due to resistance to first line antibiotics, possibly acquired due to overuse of antibiotics in humans, agriculture and livestock. Three ‘superbugs’, Klebsiella, Acinobacter and E.coli are linked with more than half the infections in the infants (Lancet, 2016). The study reveals a scary situation in India’s neonatal care. The news grabbed the headlines (http://www.thehindu.com/todays-paper/tp-national/superbugs-kill-babies-as-antibiotic-re stance-rises/article9113230.ece ). There is no space to write about deaths due to other health problems. I rest the case.
The ‘Sydney Morning Herald’ (Feb 28, 2015) published an article titled “Indian doctors shed light on massive medical procedure scandal” based on a report by an NGO, SATHI (Support for Advocacy and Training to Health Initiatives) ( http://www.smh.com.au/world/indian-doctors-shed-light-on-massive-medical-procedure-scandal-20150228-13rg1f.html#ixzz3k1s7ioEn ). It mentions:
“…For years, Indians have suspected that doctors operate unnecessarily, order unwarranted tests and procedures, take kickbacks for referring patients and behave like rapacious robber barons rather than carers.
Now the horror stories that used to form the subject of dinner-table banter - such as cardiac surgery prescribed for a shoulder pain that got better with exercise - are coming straight from the horse's mouth.
They (doctors) have told the Pune-based NGO which produced the report, SATHI (Support for Advocacy and Training to Health Initiatives), that private hospitals have become so commercialised that maximising profit underpins every aspect of treatment.
In the report, it is mentioned that doctors talk of how a reference for an angioplasty can earn a doctor a kickback; of how doctors order CT scans and MRIs that are not required; and of doctors referring patients to a clinic for electrocardiograms purely for the sake of getting the commission (in India).
Given the gruesome state of most Indian government hospitals, where there are sometimes two patients to a bed, private hospitals have flourished.
Having made massive investments and faced with intense competition, many hospitals try to recoup their investment through such unethical means, including setting revenue ‘targets’ for doctors to meet.”
Go to http://www.inquisitr.com/2370619/newborn-baby-eaten-alive-by-rats-in-hospital-d+octors-have-a-horrifying-response-to-grieving-parents/ to know more.
MEDICAL MALPRACTICE
It is extremely rare for a newspaper of the stature of THE HINDU to publish an article of the size of a full page (page 9, May 2, 2018, The Hindu -- http://www.thehindu.com/opinion/op-ed/a-cure-for-medical-malpractice/article23994053.ece ) on a topic. The title of the article is "A cure for medical malpractice" which is an in-depth study of the subject. The writer, while detailing the shameful and horrific malpractices in private medical practice in India, states that: "The experience of most people attests to the fact that the police, the medical councils, and the health departments work against the patients and for pharmaceutical companies, insurance companies and private hospitals." The three families, who each lost a child (after paying hospital bills ranging from Rs. 15 lakh to Rs. 45 lakh) in what they consider to be cases of malpractice, have opened a can of worms / Pandora's box and started a movement to seek strict regulation of private hospitals which are alleged to be involved in large systematic and structured loot of desperate patients. Read the entire article to have an idea of the shameful scenario.
MEDICAL MALPRACTICE
It is extremely rare for a newspaper of the stature of THE HINDU to publish an article of the size of a full page (page 9, May 2, 2018, The Hindu -- http://www.thehindu.com/opinion/op-ed/a-cure-for-medical-malpractice/article23994053.ece ) on a topic. The title of the article is "A cure for medical malpractice" which is an in-depth study of the subject. The writer, while detailing the shameful and horrific malpractices in private medical practice in India, states that: "The experience of most people attests to the fact that the police, the medical councils, and the health departments work against the patients and for pharmaceutical companies, insurance companies and private hospitals." The three families, who each lost a child (after paying hospital bills ranging from Rs. 15 lakh to Rs. 45 lakh) in what they consider to be cases of malpractice, have opened a can of worms / Pandora's box and started a movement to seek strict regulation of private hospitals which are alleged to be involved in large systematic and structured loot of desperate patients. Read the entire article to have an idea of the shameful scenario.
Economic compulsions or greediness ?
An obstetrician asked a full-term pregnant woman for a date of her choice within the next five days for doing an elective caesarean surgical delivery. The woman consulted an astrologer who said that the next Sunday would be ideal. When the woman expressed her wish, the doctor said that it would cost her double the charges if it is done on a holiday like Sunday and that the charges would also be double if it is during night time on any day. It may be difficult to understand the economics in the Indian scenario. Poor thing, how else to survive ?
It is no wonder that we are looked down upon.
"A bedridden patient was assured by the doctor that he would soon
be able to walk to and fro his workplace.
With the success of the treatment, the patient did walk and
had to walk to and fro (because he had to sell his car to pay the doctor's fees !!)."
"A bedridden patient was assured by the doctor that he would soon
be able to walk to and fro his workplace.
With the success of the treatment, the patient did walk and
had to walk to and fro (because he had to sell his car to pay the doctor's fees !!)."
BITTER REALITIES
“123 of UK’s Killer Doctors From India” is the bold headline in a newspaper (TNIE, 31 Dec. 2012). By using ‘freedom of information laws’, the Sunday Telegraph found that India is the country with the biggest single number of doctors (123 over the last 5 years) who were removed or suspended from the register of the General Medical Council of UK because of their professional incompetence. An Indian-origin surgeon, in the UK, is being sued for doing needless prostate cancer operations for patients who did not have the disease (The Heart of England NHS Trust, TNIE, August 13, 2016).
Also read under the subheading “FALLEN STANDARDS” (THE VALUE OF OUR DEGREES AND EDUCATION) on this ‘home page’ about The Daily Telegraph report on May 6, 2014 which used GMC-generated figures to claim that doctors from India are four times as likely to be struck off the U.K. medical register than those who are trained in U.K.” (The Hindu, May 11, 2014). And, newspapers carried the news that the CBI has unearthed a racket in the recently held AIIMS postgraduate examinations and manipulation in Optical Mark Recognition (OMR) sheets, with the arrest of seven persons (The Hindu, Vol. 134, No. 135, 2011). This reflects our standards !
The rot seems to have started long ago. Prof. V.S.Ramaswami, MBBS, BSSc, MPH (Johns Hopkins, USA) (Worked as a Professor at various medical colleges)wrote to me as long back as September 9, 1987:
Dear Dr.Rama Prasad, September 9, 1987
"... There is no place for scholars and intellectuals like you. And liars, Nixons and their like have their heyday. Medical and other professions have reached their lowest ever levels, and ethics and professional efficiency have no place in the commercialisation of the profession. A generation of teachers has been wiped out and so there is none eager or competent to teach and none eager to learn ... "
--- V. S. Ramaswami
An article in Health Affairs journal reveals appalling truths about the common medical service in public hospitals in India. A doctor is viewed as a health risk to the patient ! The study revealed that a doctor spends just two minutes for diagnosis and treatment. The rate of correct diagnosis was as low as 22 per cent and the rate of correct treatment was less than 50 per cent ( http://www.thehindu.com/opinion/open-page/doctors-in-the-dark/article4253548.ece). When Titanic sank, most of the passengers of high income group (1st class ticket holders) could be saved while most of those from lower income (3rd class ticket holders) group could not be. Life boats were limited in number and the 1stclass ticket holders were given preference. Same is the case in our health sector also. Only the rich can get treatment perceived as “good” in high-end hospitals.
SPURIOUS STUFF
We can’t be sure even as to whether an antibiotic capsule contains a medicine or chalk powder ! Spurious drugs are marketed widely in the world. What is shameful for us is that, according to WHO, 35 per cent of the world’s spurious drugs are produced in India – worth nearly Rs.4,000 crore, which is about 20 per cent of the domestic pharmaceutical business. A study revealed that the quality of some batches of packaged water was worse than the ordinary tap water. And so also is the quality of several items in the market.
OUR RESEARCH STUDIES
The apocalyptic scenario of field trials of drugs and vaccines in India can be perceived from the recent episodes mentioned below. Trials of a vaccine for cervical cancer had to be abandoned due to deaths in the tribal areas of Bhadrachalam in Andhra Pradesh in November 2009. It is reported that 637 deaths occurred in 2010 due to participating in drug trials (http://www.getholistichealth.com/37970/feds-sued-for-secrets-on-hpv-vaccine-deaths/. ). Serious morbidity resulted when poor ‘volunteers’ were given the trial drug, ‘exemestane’, an anti-cancer drug at Piduguralla in Andhra Pradesh. Poor “Guinea pig Indians” are available aplenty at a low price and rules can be circumvented easily. Lenient regulation and less litigious ‘volunteers’ make India a favourite for Contract Research Organisations (CROs). That is why, in India, as of June 2011, 1,866 clinical trials were registered with the Clinical Trials Registry of India (CTRI). “Madhya Pradesh has witnessed a raging controversy over illegal and unethical drug trials being conducted by government doctors, and Indore has had the dubious distinction of emerging as the hub of such trials” (The Hindu, Jan. 5, 2012).
While the officials of Tata Memorial Hospital deny, the San Francisco-based pathologist, Dr. Eric Suba said in January, 2016 that adequate informed consent was not taken from those in the unscreened group of cervical cancer studies at the Tata Memorial Hospital, and that at least 254 women in the “no screening” control groups had died due to multiple flaws and flouting of ethical principles in randomised clinical trials (http://www.thehindu.com/news/cities/mumbai/news/us-doc-faults-studies-on-cervical-cancer/article8191389.ece ). Poor Indians are exploited for research. The US funded clinical trial for the cervical cancer screening method resulted in the death of 254 poor Indian women. Many of these deaths could have been prevented if ethicality in clinical trials was cared for (http://www.newindianexpress.com/editorials/No-Excuse-for-Using-Poor-Women-as-Guinea-Pigs/2014/04/22/article2181672.ece ).
Everything seems to be pleasantly “fixed” in India ! High-end doctors, Professors and an authentic Ethics Committee (EC) to conduct these trials are said to be in place. And ‘pleasantly’, in India, it seems that many of these high-end people can be “purchased” with payoffs in the form of a consulting fee or honorarium, equity in the form of stocks, stock options or other ownership interests and intellectual property rights from patents, copyrights and royalties from such rights, and so on !
BUSINESS ATTITUDE
We have ‘commercial package’ rates for tests, procedures, surgery and treatment. And we have ‘attractive’ discounts and festival offers. An advertisement, reading “...One free dialysis for every 10 dialysis within one month ... Dialysis Rs.500 with best doctors ...” appeared in The Hindu newspaper of November 18, 2002. And here is a huge front page (end to end in the top space—where the headlines would be) advertisement (The Hindu, Sept. 25, 2011) screaming: “64-Slice CT Heart Angio ... 50% Off Rs. 4950/- ... offer upto 31st Oct.’11 ... Book today ... send DD/Cheque before 27th Sep.’11.” Another demeaning ad reads: “.. Over forty? It is time to fix a date for mammogram, and the cost has come down, for this holiday season, from Rs.3950/- to just Rs.1750/- ..” (TNIE, Oct. 9, 2011). And, very recently one popular ‘Test-tube baby’ hospital advertised (The Hindu, May 27, 2016) about their “Basic Package – Rs. 1 lakh ”, “Standard Package – Rs. 2 lakh” and “Premier Package – Rs. 3 lakh”, at any of its centers in 4 cities, with 0% interest EMI payment option, for fertility care that may lead to "little miracles at smaller cost." It seems that one may have a choice of “models” of babies to be “made”, according to one’s budget – Basic babies / Standard babies / Premierbabies with an option to “buy” them on instalment payment terms ! Somebody else may offer other “models” under “VIP Package”, “Royal Package”, “Superkings Package”, “Digital Package” and so on with increments of Rs. 1 lakh for each “model” ! Wonderful business refinements to ‘Reproductive Medicine’ which make the deal ‘consumer friendly’ ! Analogically and interestingly, there was an ad, just below the above mentioned ad, offering expensive 'E-Class Benz' cars on low interest EMI instalment payment terms with 'assured buy-back' facility. But, there may not be an 'assured buy-back' for the 'budget babies' !
Some hospitals and doctors put up huge posters on roads with photographs of specialists and / or details of ‘offers’ and concessions for their service. News pops out now and then of success of rare / novel / complex surgeries with photos of surgeons and patients. Not a single one of the numerous failures is reported, perhaps because it is swept under the carpet or not “paid” for.
With the changing times, aberrant tones of the past seem to have acquired a "normal" colour now.
PICTURE IMPERFECT
What had hitherto been a silent epidemic has unwittingly harnessed much headline space gathering graver proportions and a groundswell for scandals by the day. Utterances by the public, and exposures in the media (press, TV, social sites on the internet, etc.) indicate that several malpractices are in vogue -- that some hospitals and many of the scan centres & laboratories in India give a ‘commission’ / ‘cut’ to the professionals who refer patients to them (In fact, a cheque No.641019036 for Rs. 700/- dated 15 June, 2011 was sent even to me by a hospital when I referred our cook for surgery. I didn’t send the cheque for collection, but I gave the amount to the cook saying that it was refunded by the hospital as a concession. And ‘Scan centres’ offering a ‘commission’ to the referring doctors is commonplace in India.); and that some pharmaceutical companies offer “buy one and get one free” packages to doctors apart from various kinds of “offers”, “cuts”, “commissions”, “gifts” and “sponsorships.” All these unpleasant and embarrassing words including “bribe” are euphemistically referred to as “facilitation fees” / “interpretation fees” / “referral fees” / “liaison fees” !! Even the parliamentary standing committee cited above observed that “it seems that the Medical Council of India (MCI) has become captive to private commercial interests.” The MCI amended its code of ethics so that the individual doctors who are prohibited from accepting these “bribes” may do so when seven or more of them form a “Society” / “Foundation” / Association / “Trust” as these are sanctioned exemption !! The Department of Pharmaceuticals has proposed (2017) to restrict gifts and trips offered to doctors and pharmacists to Rs. 1,000. The draft proposal under review of the law ministry forbids drugmakers from making false claims on the curative abilities and efficacy of drugs.
I hasten to add that all are not on this path, but many consider it as “normal” today. Interested readers may download more shocking information on this subject at
(1) http://www.thehindu.com/opinion/open-page/doctors-let-us-care-for-the-sick-not-look-at-their-purse/article2153728.ece written by a former Additional Director of Health about ‘cut practice’, needless tests, discounts, gifts, sponsorship for conferences, birthday parties, unholy nexus among doctors and others, etc.;
(2) http://www.thehindu.com/opinion/open-page/we-doctors-didnt-sign-up-for-sainthood/article2233675.ece ) written by a paediatrician who justifies the actions of the doctors who think that the following are not wrong under the present circumstances: (a) Doctors paying 25 per cent of the fees to local lower level cadre of medical practitioners -- RMPs – to get patients, (b) Doctors accepting kickbacks from hospitals to which patients are referred to, (c) Doctors advertising to get patients, and (d) Doctors getting ‘gifts’ (‘offers’/ ? bribes). The writer seems to think that the doctors “got to behave this way in order to just exist” in the words of the editor-in-chief of the British Medical Journal as quoted in the text above.
(3) www.ndtv.com/article/india/caught-on-camera-for-bribes-doctors-will-prescribe-you-anything-574334 which is the documentation of an investigative sting operation by TV journalists regarding bribes for doctors for pushing medicines;
(4) http://uhc-india.org/uploads/TheHindu_Opinion_Op-Ed_Diagnosisofaprolapse.pdf which is a story of unnecessary hysterectomies done by doctors ‘driven-by-profits’ written by a doctor who was on the High Level Expert Group to develop a blue print on universal health coverage;
(5) http://www.thehindu.com/opinion/op-ed/article3804283.ece written by one who was part of a fact-finding mission on behalf of UNICEF describing the sordid practices of unethical and unnecessary hysterectomies to harvest profits by surgeons of modern medicine;
(6) https://mail.google.com/mail/u/0/?tab=wm#inbox/14a++b5368c22c26b9 which is a study report showing that 44% of the patients were advised unnecessary surgery, according to second opinion, presumably for monetary gain;
(7) http://www.thehindu.com/todays-paper/tp-features/tp-openpage/of-diagnoses-and-second-opinions/article6797838.ece of an interesting experience of an individual of second opinions on diagnosis and treatment;
(8) http://www.thehindu.com/opinion/open-page/lest-my-oath-become-hypocritical/article5032880.ece wherein a paediatrician laments about the so-called service-oriented hospitals too falling in line with the commercial enterprises, and expecting the employed doctors to make money for the hospitals by unholy and unethical means.
(9) http://www.thehindu.com/opinion/open-page/health-checkup-how-healthy-is-it/article2801701.ece wherein I wrote about the “the Good, the Bad and the Ugly” of health check-ups.
(10) http://blogs.timesofindia.indiatimes.com/toi-edit-page/when-doctors-take-bribes-how-entrenched-conflict-of-interest-in-indian-healthcare-endangers-patients/ written (April 26, 2016) by the Senior Consultant & Vice-Chair, critical Care & Emergency Medicine of Sir Gangaram Hospital, New Delhi about entrenched conflict of interest in Indian healthcare and bribing of doctors by pharmaceutical companies. He cited a couple of studies published in medical journals (JAMA & BMJ) which established that bribing the doctors through gifts, funding for conferences, sponsoring for conference travel / holidaying, etc. did influence prescription practices in favour of the sponsoring pharmaceutical and medical devices industry. He wrote: “When your doctor prescribes a medicine saying it’s the best for you, are you sure it’s in your best interest, or was he taken on a luxury cruise last summer by the pharmaceutical company which sells that medicine ?”
Is it flattering to read the contents of these links ? Is it necessary for the noble profession to be so diabolic ?
An article in Health Affairs journal reveals appalling truths about the common medical service in public hospitals in India. A doctor is viewed as a health risk to the patient ! The study revealed that a doctor spends just two minutes for diagnosis and treatment. The rate of correct diagnosis was as low as 22 per cent and the rate of correct treatment was less than 50 per cent ( http://www.thehindu.com/opinion/open-page/doctors-in-the-dark/article4253548.ece ). When Titanic sank, most of the passengers of high income group (1st class ticket holders) could be saved while most of those from lower income (3rd class ticket holders) group could not be. Life boats were limited in number and the 1st class ticket holders were given preference. Same is the case in our health sector also. Only the rich can get treatment perceived as “good” in high-end hospitals.
Dr. Anamika Ray, an academician and mother of a three-year-old child died due to medical negligence at a Delhi hospital in 2015. In June 2017, the Delhi Medical Council directed that names of two doctors be removed from the State Medical Register in connection with this case. Dr. Ankuran Dutta, husband of this lady lead a nation-wide campaign against this medical negligence and founded the "Dr. Anamika Ray Memorial Trust" to fight against what he calls "medical terrorism." The trust observes June 25 as the "Patients' Rights Day" (TNIE, 24.07.2017).
An article in Health Affairs journal reveals appalling truths about the common medical service in public hospitals in India. A doctor is viewed as a health risk to the patient ! The study revealed that a doctor spends just two minutes for diagnosis and treatment. The rate of correct diagnosis was as low as 22 per cent and the rate of correct treatment was less than 50 per cent ( http://www.thehindu.com/opinion/open-page/doctors-in-the-dark/article4253548.ece ). When Titanic sank, most of the passengers of high income group (1st class ticket holders) could be saved while most of those from lower income (3rd class ticket holders) group could not be. Life boats were limited in number and the 1st class ticket holders were given preference. Same is the case in our health sector also. Only the rich can get treatment perceived as “good” in high-end hospitals.
Dr. Anamika Ray, an academician and mother of a three-year-old child died due to medical negligence at a Delhi hospital in 2015. In June 2017, the Delhi Medical Council directed that names of two doctors be removed from the State Medical Register in connection with this case. Dr. Ankuran Dutta, husband of this lady lead a nation-wide campaign against this medical negligence and founded the "Dr. Anamika Ray Memorial Trust" to fight against what he calls "medical terrorism." The trust observes June 25 as the "Patients' Rights Day" (TNIE, 24.07.2017).
SORDID HAPPENINGS
NRHM SCAM: National Rural Health Mission (NRHM) has become a scam of sorts. The former Union Minister, Ram Vilas Paswan urged, on August 23, 2012, Prime Minister Manmohan Singh to order a CBI enquiry into alleged termination of pregnancies and hysterectomies of over 16,500 poverty-stricken women during the past two years by the Bihar government (The Hindu, Aug. 24, 2012). He alleged that criminals, in league with government doctors, forced women (at least 40 per cent of whom were unmarried !!) to undergo abortions and unnecessary operations in a bid to loot the money granted for their treatment. He described this as“State-sponsored murder of unborn children.”
At a cost-free camp in Pendari village of Chhattigarh’s Bilaspur district (India), organised by the district health department on November 8, 2014, 83 hapless women underwent family planning surgery (laparoscopic tubectomy) in one day. After the surgery 16 of them died and 30 were struggling for life. All the victims were below the age of 32 and belonged to the below poverty line category. It seemed to be a botched sterilisation drive to meet targets. The women were due to be given an ‘incentve’ of Rs.1,400 each for undergoing the surgery. Just one doctor and one health worker carried out the operations on 83 patients in less than 5 hours which could not have been possible if standard operation procedures including proper sterilisation of instruments were followed. Around the same time, at a Primary Health Centre in Kushinagar in Uttar Pradesh a surgeon was reported to have done 42 similar surgeries in just 90 minutes resulting in complications and deaths. Only one laparoscope was said to be used. Pressure to meet the family planning targets and payment to doctors based on the number of surgeries done might have played a role in the tragedy. The bureaucratic insouciance drives health officials and doctors to score kudos of achievement. The possibility of spurious drugs as a cause for the ignominy was also under scanner (TNIE, 12 Nov, 2014) ( http://www.thehindu.com/opinion/editorial/editorial-on-women-death-in-bilaspur-due-to-sterilisation-process/article6595787.ece. ). Later, a fact-finding team that probed the deaths listed various lapses which lead to infection, septicaemia and death (The Hindu, Dec 2, 2014). International media and even UN agencies picked up this news.
Now it is time for some history. Cut back to 1975–76. To know about how men and women were rounded up and forcibly sterilised during the ‘Emergency Rule’ of over 20 months from June 25, 1975 and also about how, even in later decades, through incentives, women (even between the ages of 20-26) were being induced to undergo sterilisation operations unscientifically, even by using bicycle pumps instead of insufflators which pump carbon dioxide for laparoscopy, go to http://www.thehindu.com/opinion/columns/Kalpana_Sharma/kalpana-sharma-on-the-lack-of-focus-on-womens-deaths-due-to-sterilisation/article7382567.ece . & http://www.newindianexpress.com/magazine/voices/Ghost-of-Emergency-Begs-the-Question-Do-We-Have-True-Democracy-in-India/2015/07/11/article2911256.ece . The doctor who justified the use of bicycle pumps and did 60,000 tubectomies was awarded by the government !
MATTERS OF CONCERN
“Doctor (Kidney Specialist) arrested in kidney racket case” is the headline in newspapers today (June 14, 2013). It is suggested by many that the CB-CID should take up the issue as such rackets involving doctors, hospitals, brokers and donors are spread across the country. It is commonplace that such unethical practices go off the bridle in all the fields with or without the connivance of the officials. Five top doctors of a prestigious hospital in Mumbai were arrested and the human organ transplants licence of the hospital was suspended in connection with ‘kidney selling scandal’ in August 2016 (http://www.ndtv.com/mumbai-news/after-top-doctors-arrests-more-trouble-for-mumbais-hiranandani-hospital-1442528 ).
“Ovum Sale and Surrogate Womb Racket Surface …” is the headline of a news report (TNIE, January 9, 2014). It is stated that a woman was forced to illegally ‘donate’ her eggs 18 times and to be a surrogate mother. She was also forced to ‘donate’ one of her kidneys. The 27-year old woman revealed certain facts in her dying declaration.
The licenses of a doctor couple running an IVF clinic in Mumbai were suspended (2016) by the Maharashtra Medical Council for three months following complaints that the couple made promises of guaranteed pregnancy on their clinic website and even offered refund if the treatment failed (http://www.thehindu.com/news/national/mci-cautions-doctors-against-no-cure-no-payment-promises/article8500457.ece).
A court in Trichy, in 2015, sentenced three persons, including two doctors, to one-year imprisonment for botching up cataract surgeries, leading to 66 people losing their vision, at an eye camp in Perambalur on July 29, 2008 (http://timesofindia.indiatimes.com/india/2-doctors-hospital-MD-get-jail-for-surgeries-that-cost-66-their-vision/articleshow/47021367.cms ). And recently (June 2016), eight of the 23 patients operated for cataract at the Mettur Government Hospital, Salem district lost their eyesight and were offered a compensation of Rs. 3 lakh to each of the victims of the botched up surgery (TNIE, August 12, 2016).
It is reported that doctors at a top-notch hospital (Fortis Hospital) in New Delhi operated upon 24-year-old Ravi Rai’s left leg instead of his fractured right leg (The Hindu, June 23, 2016).
The Delhi government cancelled (December 2017) the license of a top-notch multi speciality hospital in the capital of the country (Max Hospital) as it declared a new-born baby dead and packed it off in a polythene bag despite the infant being alive. The family of the infant found signs of life just before performing the last rites !
The Delhi government cancelled (December 2017) the license of a top-notch multi speciality hospital in the capital of the country (Max Hospital) as it declared a new-born baby dead and packed it off in a polythene bag despite the infant being alive. The family of the infant found signs of life just before performing the last rites !
More and more like the following are harnessing a lot of space in the press:
‘A 10-day-old baby under intensive care was alleged to have died due to rat bites in Guntur Government General Hospital in August 2015 (http://www.inquisitr.com/2370619/newborn-baby-eaten-alive-by-rats-in-hospital-d+octors-have-a-horrifying-response-to-grieving-parents/) ;
‘A 12-day-old baby is alleged to have died in an incubator due to rat bites at the Kasturba Gandhi Hospital for Women and Children (TNIE, August 28, 2012)’; https://www.inquisitr.com/2370619/newborn-baby-eaten-alive-by-rats-in-hospital-doctors-have-a-horrifying-response-to-grieving-parents/
A three-day-old boy baby was stolen from the Government Mohan Kumaramangalam Medical College Hospital on October 26, 2016 (The Hindu, October 27, 2016);
The following is an excerpt from a report in The Hindu of September 25, 2016: “ .. On Wednesday night when The Hinduaccompanied Gurmeet Singh to the ward in Patna Medical College Hospital where there were 11 patients waiting for him, there were no signs of a doctor or nurse in the ward which was stinking with streams of urine and pale blood on the floor. A fetid smell of untouched left-over food given free by the hospital filled the air (http://www.thehindu.com/news/national/the-patna-man-who-cant-abandon-the-abandoned/article9144909.ece );
‘A 10-day-old baby under intensive care was alleged to have died due to rat bites in Guntur Government General Hospital in August 2015 (http://www.inquisitr.com/2370619/newborn-baby-eaten-alive-by-rats-in-hospital-d+octors-have-a-horrifying-response-to-grieving-parents/) ;
‘A 12-day-old baby is alleged to have died in an incubator due to rat bites at the Kasturba Gandhi Hospital for Women and Children (TNIE, August 28, 2012)’; https://www.inquisitr.com/2370619/newborn-baby-eaten-alive-by-rats-in-hospital-doctors-have-a-horrifying-response-to-grieving-parents/
A three-day-old boy baby was stolen from the Government Mohan Kumaramangalam Medical College Hospital on October 26, 2016 (The Hindu, October 27, 2016);
The following is an excerpt from a report in The Hindu of September 25, 2016: “ .. On Wednesday night when The Hinduaccompanied Gurmeet Singh to the ward in Patna Medical College Hospital where there were 11 patients waiting for him, there were no signs of a doctor or nurse in the ward which was stinking with streams of urine and pale blood on the floor. A fetid smell of untouched left-over food given free by the hospital filled the air (http://www.thehindu.com/news/national/the-patna-man-who-cant-abandon-the-abandoned/article9144909.ece );
'A woman delivered a baby near a drainage in a public area as she couldn’t pay a bribe to a woman conservancy worker to get into a government medical college hospital (The Hindu, April 18, 2013)';
‘CMC Hospital, Vellore is directed to pay compensation of Rs. 3 lakh for a surgical lapse (Deccan Chronicle, August 24, 2011)’;
‘Nitrous oxide given instead of oxygen at the Kanyakumari Government Medical College Hospital leading to coma and death ( TNIE, May 5, 2012)’;
‘Ten persons lost sight due to cataract eye surgery complication in Chikhodra (The Hindu, July 22, 2012)’;
Eighteen patients died in one day (Dec 2-3, 2015) due to power failure (owing to heavy rains causing flow of water into generators’ rooms) in a high-end hospital of “international standards” in Chennai for which the State government laid the blame at the hospital’s doors (http://www.thehindu.com/todays-paper/18-die-as-power-goes-off-at-hospital/article7950370.ece);
“At least twenty two people were killed in a fire that swept the dialysis ward of the Institute of Medical Sciences and SUM Hospital in Bhubaneswar and engulfed the intensive care unit,” reported The New Indian Express of October 18, 2016;
"30 children die in UP hospital due to 'oxygen shortage', " is the headline on the front page of a newspaper (TNIE, August 12, 2017). Later, the figure was revised to 60. This occured in a medical college hospital in Gorakhpur. It is alleged that the deaths were due to a drop in the oxygen supply pressure in the systems. It is reported that the supplier of oxygen to the hospital stopped the supply because of non-payment of dues from the medical college hospital to the tune of 69 lakhs of rupees. No amount of explanation would make us less despicable;
Some 35 babies died in five days in Kolkata's BC Roy Hospital in September 2013;
In August 2015, 61 children died in a span of 13 days at a government childcare facility in Odisha;
In Ajmer, 16 newborns died in two weeks in May 2016, again in a government hospital.
Of course, this is only the tip of the iceberg. Scores of villagers would be dying everyday due to pathetic and non-existent healthcare facilities in their neighbourhood. Despite the absolutely abysmal state of healthcare, the India's allocation of 1.2 per ent of the GDP for healthcare has not been significantly raised. Compare the per capita healthcare expenditure of $60 with Chia ($300) or Brazil ($1000) -- the World Bank estimates. Our infant mortality rates and maternal mortality rates are still comparable with sub-Saharan Africa.
‘CMC Hospital, Vellore is directed to pay compensation of Rs. 3 lakh for a surgical lapse (Deccan Chronicle, August 24, 2011)’;
‘Nitrous oxide given instead of oxygen at the Kanyakumari Government Medical College Hospital leading to coma and death ( TNIE, May 5, 2012)’;
‘Ten persons lost sight due to cataract eye surgery complication in Chikhodra (The Hindu, July 22, 2012)’;
Eighteen patients died in one day (Dec 2-3, 2015) due to power failure (owing to heavy rains causing flow of water into generators’ rooms) in a high-end hospital of “international standards” in Chennai for which the State government laid the blame at the hospital’s doors (http://www.thehindu.com/todays-paper/18-die-as-power-goes-off-at-hospital/article7950370.ece);
“At least twenty two people were killed in a fire that swept the dialysis ward of the Institute of Medical Sciences and SUM Hospital in Bhubaneswar and engulfed the intensive care unit,” reported The New Indian Express of October 18, 2016;
"30 children die in UP hospital due to 'oxygen shortage', " is the headline on the front page of a newspaper (TNIE, August 12, 2017). Later, the figure was revised to 60. This occured in a medical college hospital in Gorakhpur. It is alleged that the deaths were due to a drop in the oxygen supply pressure in the systems. It is reported that the supplier of oxygen to the hospital stopped the supply because of non-payment of dues from the medical college hospital to the tune of 69 lakhs of rupees. No amount of explanation would make us less despicable;
Some 35 babies died in five days in Kolkata's BC Roy Hospital in September 2013;
In August 2015, 61 children died in a span of 13 days at a government childcare facility in Odisha;
In Ajmer, 16 newborns died in two weeks in May 2016, again in a government hospital.
Of course, this is only the tip of the iceberg. Scores of villagers would be dying everyday due to pathetic and non-existent healthcare facilities in their neighbourhood. Despite the absolutely abysmal state of healthcare, the India's allocation of 1.2 per ent of the GDP for healthcare has not been significantly raised. Compare the per capita healthcare expenditure of $60 with Chia ($300) or Brazil ($1000) -- the World Bank estimates. Our infant mortality rates and maternal mortality rates are still comparable with sub-Saharan Africa.
It is reported that doctors at a top-notch hospital (Fortis Hospital) in New Delhi operated upon 24-year-old Ravi Rai’s left leg instead of his fractured right leg (The Hindu, June 23, 2016).
 |
| This is the reason why people with some purchasing capacity go to private hospitals -- http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/a-hospital-sans-doctors-power-and-water/article19972074.ece |
Such of these happenings which occur across wide swathes of India stay branded on our minds forever. And in the process, they expose us to social opprobrium. It would be a Herculean task to reform the Augean stables of medical care which has been described as a sea of mediocrity with a few islands of excellence. Perhaps, it takes divine intervention only to stop this trend.
It is alleged that, in India, most of the mishaps in medical care go unrecorded, mislabelled, hushed up, glossed over -- and that rarely one takes up a case against an erring person or hospital, despite the activity of consumer protection bodies, while a rare case of creditable success catches the headlines.
NEEDLESS SURGERY
Is all that surgery necessary? Doctors in Andhra Pradesh are alleged to have rampantly performed hysterectomies in 2010 to get a higher payoff from government medical insurance schemes. India now has several ‘internet portals’ that offer a second opinion, such as ‘mediangels.com’ and ‘apkadoctor.com’ which run on the premise that surgical interventions in India are overdone. MediAngels, a second opinion services centre in Mumbai has an uncomfortable finding that traumatizes every family whose member has been advised surgery. Almost 44% of the 12,500 patients for whom surgery was recommended were advised against it by their second opinion consultants.” (https://mail.google.com/mail/u/0/?tab=wm#inbox/14ab5368c22c26b9 ). Unnecessary surgery is not new in medicine, though. Even in the United States of America, in 2014, orthopaedic surgeons were accused of overdoing total knee replacement surgeries by almost a third.
“For a man with a hammer in the hand and wanting to use it,
everything here looks like a nail needing hammering.-- Mark Twain
NEEDLESS MEDICINES
It is said that India is a paradise for pharmaceutical industry. Many medicines are misused and irrationally consumed, whether prescribed by a doctor or purchased over the counter without prescription. This lead to more morbidity and drug resistance, even evolution of ‘superbugs’ which can’t be controlled by any medicine. Many of the highly drug-resistant diseases are due to nosocomial (acquired from hospitals having infectious patients) infections. In 2010, India consumed 13 billion units of antibiotics, the highest score in the world, according to a report in the journal The Lancet Infectious Diseases(August 2014). Antibiotic resistance went up sharply making many infections untreatable even with the most powerful antibiotics. There has been an increase of resistance by E. coli bacteria to third-generation cephalosporins from 70 to 83 per cent; to carbapenems (the ‘last resort’ antibiotic) from 8 to 13 per cent and to fluoroquinolone from 78 to 85 per cent, according to a paper published on March 3, 2016 in PLOS Medicine. Neonatal sepsis, pneumonia deaths in children and the elderly, and drug resistance in tuberculosis have alarmingly increased. Is this all due to ignorance, paucity of legislation or vulnerability to venality ?
HIGH TECH -- HIGH GAIN
In most cases what the maladies require are a few pills and a little common sense, not ideas of top-heavy academic approach which is not without hazards, let alone the staggering bills. When the bills are paid by ‘somebody else’ – employers or insurance companies, ceiling is the only limit, not the need.
For instance, when a tech-savvy patient, loaded with ‘Dr. Google’s information’ suggests to a doctor of some needless investigations and unlikely diagnoses, the doctor may happily hand over a laundry list of investigations and treatment options as the bills would be reimbursed by companies. “Whose bread you eat, his song you sing !” This “singing of the song” is loved by many big hospitals and even by some researchers and academicians – not the least, the industrial bosses who compose the tune !!
‘CTs, MRIs, PETs, US scans, echos, endos, angios, tomos and biopsies’ are wiping out the ‘last-century clinical skills’ and common sense. No doubt, the high-tech gadgets and procedures are of immense value in the diagnosis and treatment of some cases. It is said that providing such facilities in a private set up in India would be economically unviable unless a minimum sustainable number of cases are present. Thus, here comes the devil of unnecessary investigations and treatment.
“If there’s one item of expense in India which can clean out a person’s savings, it is medical costs. A recent (2015) NSSO survey found that private healthcare was prohibitively expensive for most treatments. Still Indians preferred it. Most people had no formal health insurance.”
“Evidence-based medicine” (rather “Defence-based medicine”) requires a lot of investigations and procedures which often benefit to a great extent everybody in the line -- the band-master (the manufacturer) who dictates, indirectly, the protocols of medical care being the most benefitted. The medical profession is accused of becoming commercial, pampering the industry’s interests (in a ‘quid pro quo’ fashion), to trump patients, knowingly or unknowingly.
While awareness of health and availability of advanced medical care is increasing in India, concern about exploitation by needless investigations and treatment is also on the rise. People are eager to go to hospitals even for trivial problems, but they have a nagging feeling of suspicion. Many suspect that even the “free medical camps” conducted in the private sector ( with or without co-sponsorship by social service organisations) is a farce to ‘collect’ patients for their ‘medical business’ and that the shallow pseudo-service is meant to lend some visibility and publicity by creating a veneer of charity. Trust is eroded.
DEATH OF TRUST
Across the country, in recent times, people attacked doctors, even murdered a lady doctor (in Thoothukudi on Jan 2, 2012), and vandalized hospitals for alleged professional negligence (30 incidents in Tamil Nadu alone during the past 6 months). Doctors went on strike to protest and to urge enforcement of Hospital Protection Act to protect them “from unruly mobs which attack hospitals to extract money” (TNIE, May 1, 2015). It may be shocking to know that the Maharashtra Association of Resident Doctors (MARD) demanded (2016) that the resident doctors be provided with guns (firearms) to protect themselves from assault by patients, following the 40th incidence of violence against doctors at the Government Medical College Hospital in Nanded in one year (https://www.docplexus.in/#/app/posts/f96aa883-cea8-431f-9ccf-d4bbd199ef43?utm_term=Email-Digest-0-morn&utm_campaign=Email-Digest&utm_medium=Email&utm_source=Docplexus.in&utm_content=CTA ). (http://www.ibtimes.co.in/maharashtra-doctors-demand-gun-licenses-government-self-protection-676842 )
All this is a direct fallout of erosion of mutual trust and the helplessness to prove culpability. This lack of trust had grown even in the US which like India has a dominant profit-driven private sector. In the US, the public go for “litigational violence” through attorneys whereas here they resort to physical violence. "
They don’t seem to see that the violence is a direct fallout of the erosion of the trust that doctors take decisions in the patient’s interest and of a sense of helplessness. The US and India report the highest number of attacks on doctors by patients (physical violence in India and “litigational violence” in the US). It is no coincidence that both are countries where healthcare delivery is dominated by a profit-driven private sector" (April 26, 2016 -- http://blogs.timesofindia.indiatimes.com/toi-edit-page/when-doctors-take-bribes-how-entrenched-conflict-of-interest-in-indian-healthcare-endangers-patients/ ).
In good old days (even until half-a-century ago), a doctor was equated to GOD and the medical practice was considered to be a sacred service to humanity. The doctor was almost a member of the patient’s family. And the tribe of the ‘family doctor’ is extinct now. It was unthinkable that a doctor would be sued or attacked by his patients and that doctors too would go on "strike" and go to the streets to draw attention to their grievances. Why this change now ? Why the ‘gods’ are being attacked now ? Is the doctor just another vendor now ? Who is at fault ?
Trust is the bedrock of medical profession. When trust is eroded, suspicion starts growing. When suspicion takes root, everything looks like exploitation, particularly when money plays a dominant role. And when the ‘trust factor’ vanishes, any service becomes a pure ‘business’ transaction which starts with doubting. Lack of trust is the root cause for all these attacks and vandalism. But why trust is melting away ? Why people suspect the noble profession’s service now ? What is the wrong with the system in India now ? What happened to the impeccable and irrefutable sanctity and credibility of the noble profession ? There is a lot in these embarrassing questions for all the doctors to ponder and cogitate. Perception matters more than legislation.
Though many ‘associations’ and individuals in the industry and the profession deny large scale deterioration, the damage has been done. Most of the doctors may be having high standards of values and ethics. But we have an overriding vociferous minority which equates professional success to money-making, and defining ways and means to the industry for profiteering. What has come to light may just be the tip of an iceberg. The writing is on the wall. It is no more easy to cover ourselves up with the glory of the term ‘Noble Profession’. It is now difficult to score respect for ‘serving’ at odd hours and 24/7, ‘sacrificing’ personal and social life. People nowadays ask: “Are you doing all this free of cost ?” Instead of stoking the embers further, one has to take a hard look beyond the parochial medico-legal aspects of the problem, as this is only a superficial manifestation of a deep malaise of complex socio-economic issues. There is more to it than what meets the eye. We have to ruminate on this and do some introspection and soul-searching. Also, we have to give a thought to the editorials and other writings in the links cited above. If the remarks of the Editor-in-Chief of the British Medical Journal (vide supra) are not a sad commentary then it is difficult to fathom what will be. All the lapses pointed out must be given a quick burial and the sick systems of health care be given urgent therapy. Image is important; legislation is secondary
THE VANISHING VALUES
The values are depreciating exponentially as we speak. The malaise is deep rooted. No amount of spin or gloss can hide the painful truth.
Hippocrates, the “Father of Medicine” who left this world in 377 BC must be turning over in his grave on knowing the prevailing medical scenario in this materialistic world.
And, here is a reprint from the FACEBOOK:
And, here is a reprint from the FACEBOOK:
"METICULOUS MEDICINE". ........ Dec 5, 2017
Dear father Hippocrates,
Why do you now turn in your grave which you entered in 377 BC as "Father of Medicine" ? We have only made your "mediaeval medicine" modern. And what you read in the newspaper clipping is just normal in this 'Kaliyuga', and it is just the tiny tip of the iceberg ... just part of evolution, perfectly in tune with 'Darwin's Theory'. I don't want you, dad, to go to the link http://drtramaprasad.blogspot.in/…/modern-medicine-good-bad… , as reading it may land you in ICU to relish our dainty delicacies of research which may lead you into further complications. I close this letter, dad, remembering your outdated "Hippocratic Oath."
Yours lovingly,
T. Rama Prasad.
T. Rama Prasad.
Space constraint draws the curtains on further expedition into this subject.
THIS IS AN ABRIDGED TEXT OF MY SCRIBBLING. CLICK HERE TO SEE THE FULL TEXT. -- T. Rama Prasad |
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