How do I cheat thee? Let me count the ways. Elizab-eth Barrett Browning’s love poem could be the passion cry of our healthcare system. If only we replaced love with cheating. Because our healthcare system is not about care. It hardly cares what happens to patients, it doesn’t even pretend to love us. It’s about carelessness and apathy laced with greed. And as this week’s revelations show once again, it seems to be geared to deceive us. I cheat thee to the depth and breadth and height/My soul can reach…
Let’s start with the disclosure that drugs banned in several major nations are on sale in Incredible India. The Parliamentary Standing Committee on Health and Family Welfare has exposed, with irrefutable evidence, how drug companies collude with the drug regulator to push through drugs that are not allowed elsewhere. In more responsible nations, some of these drugs have been banned, some never released for sale, some withdrawn. But in apna India, pharmaceutical companies conspire with the Central Drugs Standard Control Organisation and “independent medical experts” to get the green signal and sell these unsafe drugs to us. Well-meaning doctors prescribe these for you and me, our little children and our ailing parents and grandparents.
Among the random samples the investigation picked up, 33 per cent were not allowed to be sold in developed nations including the United States, the United Kingdom, Canada, Australia and European Union members. Even if the drugs were not banned elsewhere, they violated regulatory procedures like conducting clinical trials before getting approval. In 28 per cent of the random sample, mandatory trials had not been conducted.
Few practising doctors have the time or inclination to learn about the drugs they prescribe, or keep abreast of new findings, so most patients are blindly given medicines pushed by sales representatives. In short, the medical system is ruled by the drug industry, from the level of the sweaty man with a tired briefcase at the doctor’s chamber right up to the refined power brokers in snazzy suits who influence drug control and government policy. The patient’s interest is irrelevant.
And the culture of opacity and awe that medical practitioners are cocooned in doesn’t help. Everyone from doctors to technicians is programmed to be high-handed and tight-lipped with patients. Given this anatomical defect of the medical personnel, patients just get a list of medicines, they normally don’t even get to know what the course of treatment is likely to be, and even the most aware patient can’t figure out the possible dangers of specific medications. Unless they do their own research in the medical literature available on the Internet. And even then, their fears are brushed aside by the doctor, usually with a snort and a clipped order to do as they say.
Among the several dubious drugs we are subjected to are Nimesulide injections, which are freely prescribed for pain relief, and Buclizine, that is used arbitrarily as an appetite stimulant for kids. Then there are drugs that may be allowed sparingly for specific treatments but are otherwise prohibited. Letrozole is one such. Women who seek medical assistance in having a baby in India are routinely put on a heavy dose of Letrozole, which is actually a cancer medication meant specifically for post-menopausal women. If there are rules, there are ways to get around it. As long as there is no accountability and the patient’s rights are ignored, in the battle between the patient’s health and the drug industry’s sales revenue, the patient is bound to lose. Especially because it is an invisible battle. The drug industry, the medical system, mindless doctors, crafty government bodies are all supposed to be on the patient’s side. I cheat thee to the level of everyday’s/Most quiet need, by sun and candle-light./I cheat thee freely…
The other big health news this week is the arrest of Pradeep Shukla, the former director of the National Rural Health Mission (NRHM) and principal secretary of Health and Family Welfare in Uttar Pradesh. The IAS officer is accused of embezzlement in the `5,700 crore NRHM scam. Several others have been arrested already in this scam, and the CBI says it has its eye on many more, from senior bureaucrats to medical officers and even district magistrates. Where the government allocates a tiny percentage of its total budget to health, stealing from the poor and ailing villager’s share of healthcare is akin to murder. Rural healthcare lacks pretty much everything — from hospitals to doctors, infrastructure to medicines. No wonder people prefer to die in peace at home rather than make the arduous journey on foot or bullock carts to die in pain and frustration in pathetic hospitals and healthcare centres.
But even if you are not sick, you may still get hit by careless government policies. Babies die following vaccination. Even the celebrated pulse polio campaign has not reduced childhood lameness. Vaccines need to be meticulously monitored, the cold-chain needs to be protected, and post-vaccine dangers need to be examined before we force parents to follow a mandatory vaccine schedule. Medical experts have spoken out against the National Vaccine Policy announced last year, particularly attacking the secrecy in which the policy was rushed through. It is not designed to strengthen national public capacities for immunisation programmes, they say, but attempts to justify spending public money on privately produced vaccines based on industry-manufactured statistics. Urgent focus areas, like improving operational efficiency, the surveillance of vaccine preventable diseases and adverse events following immunisation have been brushed aside.
To top it all, the Medical Council of India (MCI) is in a shambles. This week, the Indian Medical Council (Amendment) Bill, 2012, was passed in Parliament, giving another year’s extension to its board of governors. This board had replaced the elected body of the MCI, for what it was worth, following the arrest of its president Ketan Desai for graft. It’s not the happiest time for medical matters in a democracy.
I cheat thee with the passion put to use/In my old griefs, and with my childhood’s faith./I cheat thee with a love I seemed to lose/With my lost saints…
If we are serious about our health, we need to be more proactive, and demand accountability and information. It is our health. We are the major stakeholders. Yet we have been watching for years, as if it was a Shakespearean tragedy. Sadly, it is our own life story. We had better accept that we have a role in it.

The writer is editor of The Little Magazine. She can be contacted at: sen@littlemag.com