The recent news (11th August,2010) on a study published by Lancet Infectious Diseases (“Emergence of a new antibiotic resistant mechanism in India, Pakistan and the UK: a molecular, biological and epidemiological study” by Karthikeyan K Krishnasamy et.al) on a drug resistant bacterial gene, the so called super bug, named New Delhi metallo – beta – lactamase – 1 (NDM-1), tracing its possible origins to India has raised a furor among the Corporate hospitals like the Appollo and the Indian Health ministry.
All the hue and cry was not so much about antibiotic resistance, but a possible link to the medical tourism industry (now a booming sector in India) being responsible for the spread of resistance to developed nations such as the EU and that Indian hospitals not being safe for treatments. This is just an instance which proves beyond doubt that when profits are concerned, neither the corporate hospitals nor its mouth pieces in the health ministry will spare any effort at dealing with issue at hand, but go to any extent of shifting blame even taking a anti imperialistic rhetoric claiming the report to be ‘western plot’ to undermine Indian medical tourism industry.
It should be borne in mind that the so called medical tourism is a shame rather than a pride of India. A nation in which public health system is all but dysfunctional, with 80% of the health and medical expenses is forced on people themselves. This is the major cause of rural indebtedness (according to Govt. Published statistics), the very mention of India being a medical tourism hub is an insult to the majority of the people who have no such access to the highest standards of health care.
Whatever be the rights or wrongs in the study, it is beyond doubt that antibiotic resistance has emerged as a serious public health concern. One of the common causes of this is the overuse and abuse of antibiotics especially in developing countries like India. The chief reason for this includes the unethical promotion of the drugs by the pharmaceutical companies (doctor – company relationship), unregulated sale without prescription at drug stores, use of antibiotics for virtually every kind of infection (including viral), expectation from the patients to be prescribed an antibiotic and thus a trend has set in that extends from the pharmaceutical company to the doctor down to the patient, that virtually sees antibiotics as ‘magic bullet’ for any disease.
With no new antibiotics on the pipeline and researchers having reached a dead end as for as the research into newer antibiotics are concerned, health system is finding it increasingly difficult to cope with emerging newer antibiotic resistant strains of bacteria. The problem has been completely blown out of proportion with the presence of over 80,000 brands of drugs in the Indian market, many of them irrational combinations. Whereas World Health Organization (WHO) mandates only 250 essential drugs which could treat over 90% of the diseases concerned, but given the clout of the pharmaceutical industry whose influence extends from the Govt. to drug control authority to the judiciary, all the talk of rational use of drugs has been thrown into the air.
The problem is made all the more worse with the unhealthy and unregulated proliferation of private and corporate hospitals that looks at health sector as nothing more than a lucrative market waiting to be exploited. This flows from the distorted model of health care system followed in India, which has been exasperated by the onward march of capitalist globalization, with strong emphasis on individualistic, medically oriented, technologically driven solutions.
A system that addresses only curative aspect of health care, without addressing overall political-economic-social causes which are primarily responsible for the ill health of the population cannot solve the health problems of the people. Health is not merely about absence of disease, but the overall physical, social and mental well being (WHO), health care is only an aspect of it. Thus health is also access to nutritious food, safe drinking water, good housing, clean environment, social equity etc., which are equally responsible for the healthy living standards of the people. So a struggle for health is a struggle against capitalism which is solely responsible for unequal distribution of wealth, exploitation of people and resources, environmental destruction and much more.
What is required is an overall socio – economic transformation of society, meaning Socialism, by nationalisation and working people control over the big pharmaceutical companies, private medical hospitals, medical education and research. It is equally important to radically change the content of these services to a health care system based on the comprehensive primary health care model that starts from the ground up, to a pharmaceutical industry that is geared towards producing drugs which are affordable, rational and based on people’s needs, medical education that is reoriented towards service of the people and research that is socially relevant and based on ground realities.
And finally, we need to re-examine the way we look at microbes or any infectious diseases for that matter, unlike modern medicine that has been riddled with terminologies of war and look at microbes as terrorists that need to be wiped out. Apart from changing the social system that we live in presently, we need to find alternative approaches of dealing with infectious diseases without seriously hampering the delicate ecology of our planet.
NSA, Bangalore.