BRIBES

BRIBES
WHEN a new brand of insulin hit the market in India recently, doctors were quick to switch patients to it. Not long afterwards the new drug's manufacturer took 15 physicians from Nagpur on a vacation with their families. Coincidence? Maybe so but 'patients were fine on the old drug,' says Vijay Thawani, Associate Professor in Pharmacology at the Government Medical College in Nagpur.




Such promotional excesses abound in developing nations which have been slow to adopt regulations and even slower to enforce them. The US, Canada, Europe, Australia and New Zealand/Aotearoa have over time adopted and revised codes on drug promotion. But bribery happens in the West, too. It's just more covert.



'It's becoming more subtle in all sorts of ways,' agrees Peter Mansfield, a general practitioner and director of the international watchdog group Healthy Skepticism. 'It creates a situation,' adds Mansfield, 'where physicians convince themselves it's good for patients.' Big Pharma has innumerable fingers in the prescribing pie. Doctors are flown to luxury resorts for lessons in public speaking, then paid well as 'opinion leaders' to tout the company's product. Millions of doctors every year attend 'continuing medical education' events: necessary to perform their job well, but often company-sponsored junkets that let advertising cosy up to and mingle with science. In such pharmaphysician relationship, it's difficult to distinguish between the genuine and the deceptive, between the pursuit of knowledge and the pursuit of profit.



Meanwhile, old-school kickbacks continue in violation of the codes and policies on drug promotion. Drug giant GlaxoSmithKline has been accused of using exotic holidays, stereos, World Cup soccer tickets and cash to bribe thousands of Italian and German doctors into prescribing its products. (1) In the US last June, AstraZeneca paid a $355 million settlement for a kickback scheme where doctors billed insurance providers for drugs they received free from the company. TAP Pharmaceutical Products--a joint venture of Abbott Labs and Takeda--pulled the same trick and settled for $875 million in 2001. (2)

National Family Health Survey 2005-2006 Disturbing facts about Haryana

National Family Health Survey 2005-2006 Disturbing facts about Haryana
Shining Haryana-Suffering Haryana-Health Front
The process of globalisation has lead to a situation where richest 20% of the population command 86% of the world GDP while the poorest 20% command merely 1(One) %. In other words this model of development and market oriented system, has divided the world in to “Shining World” and “Suffering World”,Similarly we can say that there are tow India,”Shining India” and “Suffering India”. Haryana cannot be an exception.”Shining Haryana and suffering Haryana are very obvious now.On one side of the road there is “Shining Gurgaon” and on the other side of the same road is “Suffering Gurgaon”.It can be said about every town or village also.
Public Health is an obvios causality of this process. There is a clear contradiction between the principles of public health and neoliberal economic theory. Public health is a “public good” i.e. its benefits cannot be individually enjoyed or computed, but have to be seen in the context of benefits that are enjoyed by the public. Thus public health outcomes are shared, and their accumulation lead to better living conditions. It does not mechanically transfer into visible economic determinants, viz income levels or rates of growth. Kerala, for example, has one of the lowest per capita incomes in India but its public health indicators as such are that approach the levels in many developed countries. Infant mortality rate in kerala is less than a third of any other large state in the country including Haryana. An important consequence of globalisation has been commonly described as the”Feminisation of poverty” as women increasingly had to strive to hold families together in various ways in the face of increasing pressures , main among them are increasing poverty, insecurity and ill-health.According to one estimate less than 10% of the $ 5.6 billion spent each year globally on medical research is aimed at the health problems affecting 90% of the world’s population.
The results of National Family Health Survey-III, about Haryana need an indepth analysis but seeing it on random basis it can be said that a state which is “Shining on one side is also suffering on the other side. Economically very much advanced but socially lagging behind,Haryana is well known on the map of the world regarding declining sex ratio.The under weight children under age 3 percentage is 42 in NFHS-III where as it was 35 and 35 in first and second NFHS surveys. The wasted group has 6,5,and 17% respectively in I,II and III NFHS.The percentage of Women whose body mass Index is below normal is 27% in NFHS-III where as it was 25.9% in NFHSII. Also the percentage of women who are overweight or obese has increased from 16.6 to 21.0. the percentage of anaemic ever married women age 15-49 has increased from 47.0(NFHSII) to 56.5(NFHSIII).
Similarly the percentage of pregnant women age 15-49 who are anaemic has increased from 55.5(NFHSII) to 69.7(NFHSIII). The percentage of women who want 2 sons has also increased from 95.2% (NFHSII) to 97.4%(NFHSIII).Paradox is that per capita expenditure on health has increased from Rest. 175.02 in 1998-99 to 243.27 in 2006-2007, though it may still be less.
A very challenging situation is emerging on health front in Haryana. The medical fraternity and paramedics have to rise upto the occasion and decide whether they are for “Shining India” only or are for “Suffering India” first and then “Shining India”. We must see the writings on the wall. The primary and secondary level health care is virtually collapsing in Haryana. In Rohtak district there are 5 CHC’s – Meham, Kalanaur,Chiri, Sampla and Kiloi. As per the norms there should be a surgeon, Physician, Pediatrician and gynaecologist in each CHC. Unfortunately there is not a single specialist in any of the above CHC’s.We must see the writing on the wall.

R.S.Dahiya

bantwara

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P.G. Medical Education Regulations, 2000

P.G. Medical Education Regulations, 2000

Gender and Health

Gender and Health
1. Abolish all coercive laws, policies and practices that violate the reproductive and democratic rights of women, including the two child norm.
2. Stop coercion in the use of contraception. Make user-controlled contraceptives available.
3.Guarantee comprehensive, quality health services (preventive, promotive and curative) for women, that are accessible, accountable, irrespective of capacity to pay. Special provisions – resources and implementation- to be made to address health issues specific to women. For example, access to safe abortion services
4.Assure women of gender-specific health entitlements (maternity leave, abortion leave, sterilization leave, creches, toilets) in public and private employment. A national scheme for maternity entitlements in the informal sector, on the lines of the “Dr. Muthulakshmi Reddy Maternity Benefit Scheme” in Tamil Nadu (including cash support of Rs 1,000 per month for six months for care during pregnancy and after delivery), should be introduced.
5. Register all deaths and initiate audits of all maternal deaths.
6. Ensure safety, transparency and accountability in all clinical trials, and guarantee that the post-trial benefits of research are made available to women even from marginalized groups. Ensure disclosure of funding and of potential conflict-of-interest in all clinical trials, medical research and publications.
7. Make mandatory the inclusion of women’s organizations and women’s health advocates on ethics committees, from national to local and institutional level.
8. Regulate use of invasive reproductive technologies in the private sector, that covers surrogacy, genetic engineering, cloning and intensive ARTs.
9.Recognise violence against women as a public health issue and ensure provision of necessary services. Ensure prosecution and conviction of violators of the Prevention of Domestic Violence against Women and Girls Act as also the PCPNDT Act.
10. Include the topics of ‘Violence against women’ and ‘sexuality and gender’ as part medical and paramedical curricula to equip medical professionals deal in a sensitive manner with survivors of
violence, including domestic violence. Train forensic experts on the social aspects of sexual assault and rape, collection and retention of proof in cases of individual or mass sexual violence.
11 Repeal Section 377 of the Indian Penal Code, and other laws, policies and practices that discriminate on the basis of sexuality.

R.S.Daahiya

Child Health and Nutrition

Child Health and Nutrition
1.National policy on Child health and nutrition should be formulated with urgency. This must ensure policies and technical interventions follow the overall approach of decentralization, selfreliance
and promotion of food security and local economies. A clear ‘ no conflict of interest’ needs to be demonstrated by any agency that is allowed to work on child health and nutrition
issues.
2. A high-level overseeing mechanism (e.g. empowered steering committee along the lines of the NRHM) should be created to ensure convergence and accountability in the entire range of interventions concerned with child nutrition.
3. Universalization with quality” should be the overarching goal for ICDS in the 11th Plan with adoption the two worker model.
4. 10% of all Anganwadis be converted to Anganwadi-cum-crèches.
5.Centre to retain full financial responsibility for the ICDS with no increase in the fiscal burden to the states.
6.Infant and young child feeding counseling and support should be recognized as one of the core “services” both in ICDS and NRHM, with a clear budget head. Special sub-scheme to give appropriate supplementary nutrition to children in the age group 6 months to 3 years.
7. A phased withdrawal and closure of the pulse polio programme and the reintegration of polio immunization into the Universal Immunization Programme.