MANJU HEGDE





India is more than a country. It is a vast continent with diverse ethnic, religious, and social classes of people living in harmony. They could show to the world the principle of unity in diversity. The bane of Indian people is the poverty level in the rural masses that still dogs the country. While there are the large number of people who are filthy rich in India, some of them making it even to the Forbes Fortune list, the majority does not know where the next meal comes from. Poverty is the womb of all diseases. Diseases originate in the human mind. The greatest stress for man is not knowing where his next meal comes from; the next most important cause is intense fear. The gulf between the haves and the have-nots is widening by the day in every part of this universe. In America this is the main cause for the newer epidemics of heart attacks, cancer and suicide. Whereas the poor, even in the rich countries, do not know where their next meal comes from and suffer from killer diseases, the rich, on the contrary, live in intense fear of the poor. It is the poor who form the bulk of terrorists, muggers, car-jackers, murderers, robbers and what have you. No one could go out of the house, in large cities like NewYork, with the certainty that he/she would return home safely at the end of the day! The rich, therefore, suffer from degenerative diseases basically because of the intense fear and frustration. Recent studies in the US have shown how important the mind is in the genesis of heart attacks and cancer.1 (Social support, hostility and other psychosocial conditions in coronary heart disease, editorial, Cardiovascular Review and Research June 2001 issue pages 332-334)



Independent India:



When the British left India in 1947 without any blood shed, they left behind abject poverty in the country, having looted it for well over two hundred years. Resurgent India inherited this very low-income group of the masses of people whose life expectancy at that time was just about 27 years. It is heartening to note that it is nearing 70 years today. The country has progressed very well. The foreign exchange reserve has crossed the all time high and today stands at $ 80 billion. India is the first country to have prepaid a large part of the loan and has now declared that it does not want loans from any nation. India has already come forward to give loans to small countries. But the gulf between the rich and the poor has widened, leaving behind large parts of the country still in poverty. The overall picture looks good in that the sanitation and the food position have improved dramatically. This is the main reason for the life expectancy to go up. Common belief is that doctors, hi-tech hospitals and, the modern drugs are the cause of health improvement. This reminds one of Oscar Wilde who said, “lies are the truth of other people.” This myth that modern hi-tech medicine is the cause of health improvement of the common man is the biggest lie that the drug and the technology lobbies want the public to believe, as this myth keeps their till moving. One would be shocked to know that American medical education, which most parts of the world emulate, is run mainly by the money from the drug companies!2 ( Drug Company Influence on medical education in the USA. editorial The Lancet, London 2000; 356: 781)



Be that as it may, health does improve only with basic amenities being given to people, but India still needs to go a long way, very long way indeed, to make its masses healthy. Even today 70% of the children have less than 50% hemoglobin because of rampant hookworm infestations in the rural areas. Malnutrition and diarrhoeal diseases take a very heavy toll of human lives, basically because of lack of clean water supply to villages. A recent UNIDO report noted that the developing world would have to concentrate on four fundamental aspects to improve the health levels of their masses:

* Clean drinking water for all.

* Three square meals a day uncontaminated by human and/or animal excreta.

* Avoiding cooking smoke from coming into the house. This kills children below the age of five of pneumonias and women of lung cancers and heart attacks.

* Economic empowerment of women in the village to be able to feed the hungry kids when the husband comes home drunk having spent all the money for alcohol. For any mother the greatest health risk is seeing her own kids go to bed on empty stomachs.



Poverty does kill people even in developed countries. A recent report in Ireland showed that in one year nearly 6000 people died basically because of poverty in that country.3 (Vivien Kilfeather, Institute of Public Health Report 2002) Poverty in the middle of plenty!



Present Scenario in India:



The present state of affairs, vis-a vis medical care delivery in India, could be compared to any developed country in the world. However, that does not mean that the health of the Indian masses has kept pace with the developments in the curative modern medical field. The hi-tech medical facilities in India are as good, if not better than, many of the advanced western countries. Increasing the number of doctors per population and increasing the number of hospitals has nothing to do with either life expectancy or mortality. Across the industrial world the numbers prove my point. United Kingdom has only 160 doctors for 100,000 population. Italy, on the contrary, has thrice that number (thrice as expensive also) but the life expectancy is almost the same, slightly better in the UK. This is no fluke. Ireland and Japan have around 200 doctors per 100,000 population compared to Belgium and Switzerland where there are 400 and 320 respectively. Life expectancies are the same all the same in all those four countries.4 (Andrew Oswald. Times, London April 25th, 2002)



Hi-Tech Five Star Hospitals:



We have more hospitals of the hi-tech variety in India than many other developed countries in the world. Every metropolitan city in India has more hospitals than hotels. Most of them over do things so much that most of them could easily be closed without detriment to human health in general! This is the situation in many countries. Recently, a large hospital’s cardiovascular surgical facility was forced to close down as the two doctors there were doing more than 50% coronary bypass surgeries on normal people to make money. One of the shareholders of this hospital made a profit of $ 67 million last year! This is the Tenet Hospital in Redding, Northern California. If that were so in the US one shudders to think of the problems in a country like India.



The modern medical facilities in India are of such good quality that the National Health Service of the UK is negotiating with many corporate hospitals in India to get their patients on the long waiting lists to be flown to India for elective surgeries. Many private hospitals are already in this business. Modern medicine has become a business these days and doctors are easily brainwashed by the drug and technology lobbies to do what they want them to do.5 (Is academic medicine for sale? Kaiserer A. New England Journal of Medicine 2000; 342: 1516-1518) When doctors went on strike in Israel recently death rate came down significantly.6( Siegel-Itzkovich J. Doctors’ strike in Israel may be good for health. British Medical Journal 2000; 320: 1561 page) Similar experience was there in Israel in 1983, Los Ageles County about ten years ago and, Saskatchewan in Canada fifteen years ago. Lately drug companies have been creating new diseases to sell their drugs. Female impotence is one such disease produced with the help of specialists by the Drug Company to sell viagra tablets!7 ( Moynihan R et.al. Selling Diseases. BMJ 2002; 324: 886-91)



Now it would become clear to anyone that modern hi-tech medicine is not a panacea for human ills. However, modern medicine is definitely a boon to the suffering humanity as it could “cure rarely, comfort mostly, but console always,” in the words of the father of medicine, Hippocrates. The problem with the present modern medicine is that it claims to do good to healthy people by changing their body parameters, even when they are healthy. This is labeled as doctor-thinks-you-have a disease syndrome. This is the bane of modern medicine. Time evolution in the human body does not follow linear rules. Changing the initial state partially with drugs or surgery, in healthy people, might not hold good as time evolves.



In the long run all interventions in healthy people results in higher deaths and disability. This is the reason for the fall in death rate when doctors do not interfere with healthy peoples’ lives. The medical profession, along with the drug lobby, has turned even an advanced nation like the USA into a nation of hypochondriacs! This is just to make big money.6 (Kelvin A Benarde - You’ve Been Had! Book, Published by Rutgers University Press 2003.) The screening industry is another big fraud on the public. Doctors have been predicting the unpredictable all these years making everyone anxious.



The problems lie in medicine’s difficulty in defining the normality, the devil of false positives and their poor understanding of time evolution and natural history of diseases. “Simple minded enthusiasm for screening-combined with industrial opportunity to make fat profits-may mean that soon none of us will be normal. We will be screened for every kind of cancer…..It is always hard to put a case for not knowing, but economists-cold hearted beasts that they are-have a wonderful notion of rational ignorance” writes Dr. Richard Smith, the editor of the British Medical Journal in his editorial in the journal of April 26th 2003. (BMJ 2003; 326: 893) Ignorance can be bliss.



India, thus, does not lag behind the world community in this rat race for the latest in technology, but all that is for the rich and the powerful. This brings to mind the Mathew Law in the Bible, of course with the wrong connotation. “He who hath shall be given.” The poor in India are that way happy in that the ravages of this kind of modern medicine do not touch them. More than 80% of Indians (80% of world population also) lives without any influence from modern medicine. So far so good. There is another side of the coin that must be made known in this context. In India we have a mix of the good, bad and the ugly even in the field of human health. Whereas the life expectancy of a new born child in the southern state of Kerala and, in my own district of South Kanara, is as good as that of a child in Europe today, the picture in north Indian states like Bihar and eastern Uttar Pradesh, the life expectancy is at the level of Sub Saharan Africa. This shows the distribution of literacy levels as also the poverty standards.





Despite all these the health expectancy of an average Indian is very high compared to the advanced west. Health expectancy is the number of years a newborn baby could expect to live well without the help of doctors and medicines. Many of our able bodied villagers would not have seen doctors all their lives and some of them, the ratio might be the same elsewhere, are centenarians! Medical facilities also are distributed without consideration for the need in society. The highest incidence of diseases are seen in the poor population of the villages while the large number of specialists and sub specialists are seen in large cities. This kind of disparity exists even in the west. A thinking senior doctor of Wales, Tudor Edward Hart, calls this the inverse care law.



While there were only sixty odd medical colleges and as many large teaching hospitals in India around 1947, we have hundreds of medical colleges and as many private corporate hi-tech hospitals in larger cities. Unless and until the economic prosperity reaches the poor in the villages and they are literate the health disparity would continue. India could still show case itself as the most advanced medical center in the world. Even Pakistani children come to India for heart surgery. The media blows up these simple events into large events. The truth again is otherwise. While the third world countries still have a large burden of valve heart disease in children due to lack of sanitation and warm dry homes for children, we make a fuss about a rare congenital heart child being treated for a small hole in the heart. No one bothers to treat valve disease, as the victims are very poor children. A study in the USA in the last decade did show how even in that country the improvement in health standards and deaths were predominantly due to the change in life style and affluence (59.4%) while the role of modern hi-tech medicine was miniscule (3.4). The latter, however, gets the limelight and media claptrap. Story is the same in India.