Thursday, December 27, 2007

Dear Doctor

We work shoulder to shoulder with quite a few informal medical practitioners in the Sittilingi valley. Most of them have learnt the trade by careful observation of other practitioners and supplement or substitute theory with a common folk understanding of the body. Occasionally they refer cases to us and then we get reference letters like the following.

The Medical Officer
Tripal Hospital

Respected Madam & Sir

This certified that passant name Mr. M_________ dring the poisan so the recomtet the blood seckap to passant.

MHMS, DY&N, RAMP, FRHS, MF(Homeo-Nigeria)

Monday, November 26, 2007

Carpenter fixed my leg

A rural surgeon in Assam, an urologist by training has come up with an ingenious way of making up for his lack of expertise fixing complex fractures by internal fixation. He opens up the fracture site, then calls in the local carpenter whom he has taught the basics of surgical sepsis. The carpenter is quite adept at using standard orthopaedic drills, screws, metal plates, bolts and nuts to repair bones just as if they were delicate pieces of furniture. The urologist then repairs any vascular or nerve injuries and closes up. I guess the results would be comparable to that of the average Ortho registrar with only a few surgeries under his belt and in the absence of tertiary level orthopaedic care far better than leaving such cases untouched.

Wednesday, November 21, 2007

Public policy quacks

Another interesting presentation at ARSICON 2007 was one by Dr. Meenakshi Gautham on her study on the treatment of reproductive tract infections by informal medical practioners in the Tehri Gharwal region. I won’t attempt to summarise her findings here. I will only concentrate on the finding that almost all the practioners had no concept of the infectious etiology of urethral and vaginal discharge yet almost all prescribed antibiotics for such symptoms. When the actual rate of infection was calculated among symptomatic patients who were prescribed antibiotics it was found to be quite low (3-5% if I remember right). Most patients who got antibiotics did not need them.

These practioners were using a different theoretical framework, a traditional humoral understanding of the body to explain their patient’s symptoms. However they then proceeded to use antibiotics which have been developed using a modern biomedical framework. Since a formal medical education was inaccessible to them due to reason of money and language they had no means understanding this biomedical framework and this in turn made their prescription practice excessive and dangerous. Although it was not brought out in the study, they were possibly also aware of the fact that prescribing more antibiotics meant more profits and more incentives from pharmaceutical reps.

The traditional humoral understanding of the body is common sense knowledge in the region where they lived and worked. Most informal medical practioners learn what drugs to prescribe by careful observation of other doctors and it is hence not unnatural that they attempt to fit such observations into the theoretical framework in which is most familiar to them. They invest antibiotics which properties of ‘heat’ and ‘cold’ just like traditional medicines.

What I found interesting was the parallels that can be drawn between such a scenario and that of doctors writing health policy at state and national level. A large number of doctors in government committees are super-specialist clinicians with years of experience operating within the modern biomedical framework. Modern medical education ensures that even those who have spent years seeing patients from poorer, rural communities have no theoretical basis for understanding the social, cultural, economic and political realities of their patients. Those with post graduate degrees in Community Medicine don’t fare much better. It is quite likely that the surgeon mentioned in my previous blog entry might sit on a committee looking into ‘Tribal Health in India’.

Most assumptions on which policy is then based stem from common sense and years of observation. We have already seen how this can be a dangerous practice, since a large number of observations do not automatically mean that one has even begun to understand even the basics of the underlying phenomena. Indeed the resultant policy prescriptions produce results that seem similar to those of informal practioners. A lot of money gets spent, a few people get better and a large majority remain as they are.

If we are to ensure that policy decisions are made on rational grounds then we need to ensure that those making such decisions have both a deep theoretical and practical understanding of the social and political reality they are attempting to affect. Given the choice we would not entrust our bodies to a surgeon if we realised that he either didn’t have the necessary theoretical understanding of the human body or the requisite amount of practical experience. Policy interventions which affect the lives of millions of people deserve no less.

Speaking of tribal communities

I recently attended ARSICON 2007, the annual conference of a dedicated group of rural surgeons in India who form the Association of Rural Surgeons of India. The association is probably the only group of clinicians I have known who deeply and pragmatically care about the spiraling costs and increasing inaccessibility of basic surgical and medical care in India . For someone who spent five years as an undergraduate becoming increasing disillusioned with the rampant commercialisation at my Catholic institution their company was indeed uplifting.

Over three days I watched videos of extraordinary surgery aimed at minimalising costs for the patient, listened to a number of experienced speakers and generally became more absorbed in the art of surgery than at any given time during my years at medical college.

There was only one presentation that got a standing ovation and it is this presentation that disturbed me the most. A senior surgeon attempted to sum up ‘Tribal Health in India’ by presenting a few pictures of semi-clad forest dwellers, marsamic children and bloody bear attacks. All the pictures were 20 years old and in quite a few the person displaying tribal weapons was another rural surgeon, a fact that was not mentioned anywhere in the presentation. Tribals were portrayed as having ’No gods, no religion and only superstitious beliefs.’ No where was the actual name of the tribe portrayed mentioned. There were no statistics, no indication as to the reasons why tribal communities have been denied access to modern health care.. Scheduled Tribes constitute around 7% of the Indian population and actually are an extremely heterogeneous group. Such an incredibly simplistic representation did them an injustice to say the least.

What concerns me is that barring one or two surgeons, not a single person picked up the fact that the picture painted was crude and inaccurate. Here was a group of people who were not safely cocooned in an elite urban clinical practice yet after all their years in rural service they had no concept of what constituted a fair and representative description of tribal communities and what did not.

Like many other health systems, the Indian system is characterised by the fact that a majority of doctors come predominantly upper class, forward caste communities. A quick eyeballing of the ARSICON participant list will confirm this. If such doctors are truly desirous of understanding poorer, less privileged communities in order to help them then they need a basic theoretical framework in which to situate their understanding, This would be similar to the framework of anatomy, physiology, pathology and pharmacology which helps them understand surgical problems and techniques. Such a framework would include elements of basic sociology, anthropology, economics and political science and would help doctors navigate through the complex socio-political landscapes in which their patients are located.

Adding more theory to the MBBS course may seen to be an unfair demand at first. A quick review of the existing curriculum would reveal however that medical students are anyway burdened with a lot of complex biomedical theory which they have no use for. Why would anyone need to know the exact steps of the Kreb’s Cycle? Or the molecular structure of aminogylcosides? My suggestion is to replace this with basic social science theory instead.

Practicing here in Sittilingi it is ironical that when a young tribal woman is brought in after consuming poisonous plants containing cardiac glycosides I can elegantly describe the exact effect of the toxin on Na-K- ATPase cellular pumps but fumble when attempting to explain the social factors that caused her to attempt suicide in the first place. Neither can I fully explain the fact that pharmaceutical companies have decided that the specific antidote (digoxin Fab fragments) need not be marketed in India, a country where there is a large incidence of such poisonings. Such social and economic understanding would enable me to intervene much more effectively at both the individual and population level instead of merely being able to impotently explain the exact physiology behind her cardiac arrhythmias as she dies before my eyes.

Sunday, November 18, 2007

Operating in Chinese

In this era of globalisation in comes as no surprise to me that the artificial icepacks we occasionally use at our hospital have been manufactured in China. However I realise that a great many linguistic and cultural barriers have yet to be crossed when the instructions on the cover read as follows.

Operation Instructions
  • This element it is amazing not to have. “Store the cold foot” lowers the temperature fast to clear yp coldly and slowly.
  • Pack and open outside, the income -10◦C ice boxes or freezes are frozen hard and reservly soon.
  • It is insulate against heat protecting cold thing. In the case, according to protecting the cold demand, set up the quantity of good performance to pack into.
  • In the case the damage will not be polluted seriously protect the cold thing.

Thursday, October 18, 2007

Dr. Claudio's One-Liners

Dr.Claudio Schuftan, runs the PHA-Exchange, an international mailing list for those interested in the People's Health Movement and working towards ensuring health as a human right. Here is a sample post containing a collection of some of his one-liners.

1. Half truths are like half bricks: you can throw them further.

2. The rich countries perpetuate the myth that expertise is the prerogative of the few.

3. If we made poverty and malnutrition contagious across the globe, their elimination would be remarkably rapid.

4. The rich like to speak of one world, but actually they are worlds apart of the realities of poverty with its ongoing HR violations.

5. When poor people are suffering and oppressed, the last thing they need is a God of docile love and meekness.

6. In international affairs (including international HR law), countries of the South most often react, but just reacting limits their choices.

7. "If I am not for myself, then who is for me? And if I am not for others who am I? And if not now, when?".

8. Stop reinventing the wheel. Start putting wheels on the wagon.

9. The future has many names: for the powerful few it is status-quo, for the bold (among the not-yet-powerful-many) it is an opportunity for needed structural changes (that will tackle HR violations at their roots).

10. Struggle is a principle of development; to be is to do.

11. Faith in the power of doing is better than doing nothing at all.

12. Either we unite, organize and cooperate closely or many more will continue dying unnecessary deaths… United, we all have an opportunity to make a difference… Divided we beg, united we demand

13. Action unites more than words; the latter usually divide.

14. "Raise hopes, don't destroy illusions".

15. We are not to preach, but to organize mass actions.

16. The name of the game is: Focus on lasting/sustainable results, not on any dogma!

17. Because men and women experience poverty differently, we need to work harder on the rights of women (and those of minorities).

18. Perhaps it is unrealistic to expect poor women to overcome deeply ingrained socio-cultural barriers just because we empower them financially through micro-credit operations and/or we train them in leadership. For their rights to be ultimately respected, more than that will be needed…

19. An economic system that has little or no use for better than half of the world's population can and must be radically transformed.

20. The world economic order works for the advantage of 20% of its population.

21. Neoliberalism globalizes poverty, not development.

22. The debt of poor countries has already been paid by ever-falling-terms-of-trade. (That is why the HR-based framework calls for debt relief for the poorest countries).

23. Money equals force in the market; therefore, those with money dominate. So world trade is a means of domination of the rich countries.

24. The laws of supply and demand can fix the market price of bread, tortillas, cassava or rice, but they do nothing to alleviate hunger as a key HR violation.

25. The invisible hand of the market has no capacity to imagine or create a decent society for all.

26. Globalization does not have a human face; it has a cynical human mask.

27. In the era of globalization, progress means inequality and for its staunch promoters, reason means self-interest.

28. There is enough for everyone's need, but not for everyone's greed.

29. In the struggle for the alleviation of poverty, the check has come back from the 'Bank of Justice' marked "insufficient funds".

30. Income for the poor is perhaps the best guarantee of health and food security.

31. It took Britain the exploitation of half the globe to be what it is today; how many globes would India need?

32. As the threat from the many HR violations we see worldwide increases, so does the cost of inaction.

33. Social justice and the universal respect of HR will not succeed if it remains the sole concern of intellectuals.

34. Death is a social disease: How often do we overlook this axiom?

Wednesday, October 10, 2007

Getting my priorities right

This month we are conducting an intensive campaign in the 21 villages of our health outreach programme to detect new cases of TB following a spurt in the incidence of the disease among newly returned migrant workers. This however sometimes adds a little surreality to my life.

Picture a bearded lab technician, a thin young doctor and an elderly Malavasi woman who is the local health auxiliary driving through the Avalur valley on a motorcycle. We stop at a house where the health auxiliary says she swears the man coughs a lot. He is not at home but has gone out with his goats. So the health auxiliary sets off down the road calling you his name while we sputter along behind her on the bike. Suddenly there is an answering call from up ahead. Soon an elderly man comes into view.

"Do you cough a lot, Aiya?", I ask as I dismount the bike. "Not really", he says, "But I occasionally have shooting pains down the side of my leg." "No cough? No fever? No weight loss?", I persist. "No, just leg pain", he replies. "He does cough", says the health auxiliary testily, possibly upset that her find is no longer allowing her prove that she has indeed surveyed the village for people with possible symptoms of TB. "Well, I occasionally cough at night", he finally admits. He soon finds himself sitting side-saddle on our motorcycle which is parked on the middle of the road while I auscultate his chest. The lab technician mutters darkly about the value of time. "Can you give us some sputum to test?", I ask. "I don't want a plastic cup", he says, viewing the proffered sputum cup suspiciously, "But if you have medicines for my leg pain I will surely take that."

Saturday, September 29, 2007

Jesus has them too

I guess that even evangelists occasionally manage to slip up. Especially when introducing a new convert to Christian culture and foreign sounding Christian names. So it happened that a few days ago a heavily pregnant Jesus walked into our labour ward providing me with ample opportunity to scream at the top of my voice "Push, Jesus, Push" and generally blaspheme in bad Tamil as she delivered a perfectly cute baby into my hands. Not many doctors from Catholic medical colleges get to say that two months after graduating they were already good enough to successfully deliver Jesus (smirk).

Mein Akela Nahin Hoon: The Story of Dr. Binayak Sen

Thursday, September 13, 2007

Return to Slow Medicine

Today I walked in on a scene in our labour ward that would have been unusual in almost any other hospital I have known. We have two beds for women in the first stage of labour and Dr. R., the other junior doctor at Tribal Hospital was sprawled out on one of them, fast asleep. His hand however, reached out towards the other bed where it was grasped lightly in the hand of a sleeping woman exhausted by her prolonged labour. Both had been up for the last twelve hours, ever since the woman stepped into the ward. Dr. R., whose inclination for working with obstetric cases I must admit far surpasses mine, had spent a good bit of the preceding hours talking to the patient, massaging her back and generally coaxing her through a difficult, prolonged labour.

The idea of a doctor and patient falling asleep together while holding hands has the potential to cause a variety of responses amongst those in the medical field ranging from disapproval to alarm to dismissal as something that can occur only when a doctor has absolutely no other demands on her time. All these responses stem from the fact that as doctors we are trained to see patients as clinical cases first and as scared and suffering neighbours second. Right through my medical education at a big city hospital I had to imagine the situations and surroundings from which my patients came from and what it would like to be one of my patient's neighbours. None of my actual neighbours was ever seen by me since we were only allowed to practice our skill on the poorer patients in the general wards.

Working at Tribal Hospital in a re-education of sorts. There is no need to imagine my patients as neighbours. They are in fact my neighbours, working and living in the same environment as me. Almost all the staff except the doctors are women from the adjoining villages. Patients are no longer a row of bodies clothed in identical hospital garb. Instead most of them are personally known or related to the ward sisters. If you work here for a few months you would have visited a good number of the villages from most of our patients come from. I no longer send discharged patients to imaginary places but to streets I may have walked down myself.

The reason we spend time with our patients is simply because in such an environment ignoring someone who is sick or frightened is plain rude.

Tuesday, July 10, 2007

Can I still disagree?

I wont discuss the intricacies of the arrest of Dr. Binayak Sen, a noted paediatrician and human rights activist in Chhattisgarh. Much has already been written about it. The SaveBinayak site is an excellent starting point. The internet activist can sign petitions here and here.

What is troubling for someone not involved in the local intrigues of the case is the strong statement that the Chhattisgarh State Government makes with such an action. By going after a man who strongly sided with non-violent, democratic means of countering State excesses and negligence the government is slamming shut the door to democratic activism and dissent. Taking up the line of George Bush, people can now choose to be either 'with us or against us'. The Chhattisgarh Special Public Securities Act, under which Dr. Sen is charged has sweeping powers and contains wording that can be interpreted in such a manner that a number of seemingly innocent acts can be construed as 'waging war against the State'. The Act seems to be targeted more towards so called 'Naxal sympathisers' than any armed revolutionary. Here is where the danger lies. Since the Naxal movement claims to represent and fight for the most oppressed sections of Indian society, the landless farmers and tribals, any person seen as sympathising with these people is now seen as a potential Naxal.

I grew up in the heart of the democratic movement that hoped to represent the poor and the oppressed in India. Never have I heard anyone openly admire Naxalite violence or any other sort of violence for that matter. People on the ground do sometimes however, acknowledge the frustration and hopelessness that occasionally drives people to take up arms. For the first time I am witness to a new fear within the community. People are now acutely aware of the value of political correctness in an atmosphere where a single careless sentence or act can be misconstrued as supporting violence aganist the state. Overnight the community has woken up to the fact that the political support from the middle class which viewed activists as people who have taken a much respected but less beaten path has evaporated. Any sort of activism is now seen as a bunch of idealists creating a nuisance at best and at worst activism is seen as terrorism. The line between democratic and non democratic dissent is fast eroding.

An environment in which you can get away with anything provided that you can create enough spin to make people believe that your enemies/victims are 'terrorists' is deeply disturbing. The vulnerableness of groups with no access to mass media and other channels where they can sufficiently and honestly portray there version of the truth is great. Skillful control of most Indian media by a nexus of businessmen, politicians and corporates contributes to this environment in which all protest has become theatre whether the script involves violence or not.

Any free and just society needs to provide space where citizens can confront the government and other powerful institutions. It is imperative for concerned people to fight to maintain and expand this space for democratic, constitutional ways of disagreeing with the Powers That Be. While there is still time and space.

Phoenix blog

Its time to resurrect the blog. Again.

A quick update. My long drawn out medical studies are finally over and from August 2007 I will start work at the Tribal Health Initiative in Sittilingi, Tamil Nadu as a junior doctor. I hope this change in my setting will be reflected in a change in perspective and content of this blog. I hope to delve deeper into understanding the chaos which is the Indian health system and use this blog as a platform for opinion and discussion. As of now I am using this rare free month to travel as much as I can within North India.

Thursday, March 08, 2007

Brecht sums up my reflections on the near completion of my degree

To The Students Of The Workers’ And Peasants’ Faculty

So there you sit. And how much blood was shed
That you might sit there. Do such stories bore you?
Well, don’t forget that others sat before you
Who later sat on people. Keep your head!

Your science will be valueless, you’ll find
And learning will be sterile, if inviting
Unless you pledge your intellect to fighting
Against all enemies of all mankind.

Never forget that men like you got hurt
That you might sit here, not the other lot.
And now don’t shut your eyes, and don’t desert
But learn to learn, and try and learn for what.

A Worker’s Speech To A Doctor

We know what makes us ill.
When we are ill we are told
That it’s you who will heal us.

For ten years, we are told
You learned healing in fine schools
Built at the people’s expense
And to get your knowledge
Spent a fortune.
So you must be able to heal.

Are you able to heal?

When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.

The pain in our shoulder comes
You say, from the damp; and this is also the reason
For the stain on the wall of our flat.
So tell us:
Where does the damp come from?

Too much work and too little food
Makes us feeble and thin.
Your prescription says:
Put on more weight.
You might as well tell a bullrush
Not to get wet.

How much time can you give us?
We see: one carpet in your flat costs
The fees you earn from
Five thousand consultations.

You’ll no doubt say
You are innocent. The damp patch
On the wall of our flat
Tells the same story.

- Bertolt Brecht

Friday, February 23, 2007

Look at the Dalit basti!

Look at the dalit basti
What plight of humans!
From the belly rises fire,
But the chulha can not be lit.
- Bahinabai Chaudhari (1888-1951)

I am not in chains, not in chains:
I a neither diseased nor I am a healer.
Am not a Moman nor a Khafir am I,
Neither a Mulla nor a Saiyed,
Why ask Bulle Shah his caste?
Neither I created caste, nor am I born in one.
- Bulleh Shah (1680-1748)

Brahmin, Vaishya, Shudra or Kshatriya,
Dom, Chandal or Mlechchha: All have the same soul.
They can all attain purity, singing hymns to God:
It will liberate both – self and generations.
- Ravi Das (1398-1448)

Sugar cane is rough; the juice in it is sweet,
The bow is not straight but the arrow is,
River zigzags, but not the water in it.
Chokha isn’t beautiful but the God in him is.
Why get misled by outward appearances?
- Chokha Mela (14th century)

Actions, says Dadu, rank higher that one’s caste,
Think not, therefore, of anything else;
Social ranking is tainted,
Illumined are only noble thoughts.
- Dadu Dayal (1544 – 1603)

Immortal is the land I come from;
There are no Brahmins, Kshatriyas, Shudras or Vaishyas
No Mughals or Pathans, nor Saiyeds or Shaikhs;
The message humble Kabir brings, in essence, is:
Let’s go to that land.
- Kabir (1398-1518)

This set of poems is from a calender designed by Loknaad.

Saturday, February 03, 2007

The Aphorisms of Rudolf Virchow

Rudolf Ludwig Karl Virchow (1821 – 1902) was a German doctor, anthropologist, public health activist, pathologist, prehistorian, biologist and politician. His famous report titled Report on the Typhus Epidemic in Upper Silesia is an absolute classic and established him as one of the founding fathers of social medicine. Among his many talents Virchow was adept at coming up with catchy aphorisms. These are some of my favourites:

“Medicine is a social science, and politics is nothing but medicine on a large scale.”

“It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.”

“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.”

“The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”

“My politics were those of prophylaxis, my opponents preferred those of palliation.”

“Virchow had a comprehensive vision. Pathology, social medicine, politics, anthropology. My model.” – Paul Farmer. Mine too :-)

Sunday, January 28, 2007

A community health oriented Indian Christian

‘The Jews expected a messiah, and perhaps they had hopes of Jesus. But they were soon disappointed. Jesus talked a strange language of revolt against existing conditions and the social order. In particular he was against the rich and the hypocrites who made religion a matter of certain observances and ceremonial. Instead of promising wealth and glory, he asked people to give up even what they had for a vague and mythical Kingdom of Heaven. He talked in stories and parables, but it is clear that he was a born rebel who could not tolerate existing conditions and was out to change them. This was not what the Jews wanted, and so most of them turned against him and handed him over to the Roman authorities.”
- Jawaharlal Nehru (1949, 85)

“Christ took pity on people and came to their aid, whether they were spiritually ill as a result of sin or physically sick. His attention was given to the sick person with whom he frequently talked, showing his preference for the poor but without excluding anyone in need who appealed to him.

Jesus considered suffering and sickness as forming part of the ‘less human’ situation and we are asked to endeavour to make these ‘more human’.”

“Since Christians are the leaven, we must reach out towards the masses by providing simple, accessible and promotional health care according to our own possibilities, modest as they are, or in conjunction with the public services, where this is allowed.”
- cf populorum progression, 20

“And because the life of Jesus has the significance and transcendence to which I have alluded, I believe that He belongs not solely to Christianity, but to the entire world; to all races and people, it matters little under what flag, name or doctrine they may work, profess a faith, or worship a God inherited from their ancestors.”
- Mahatma Gandhi

Wednesday, January 24, 2007

Action Heroes Wanted

Blank Noise is a public and participatory art project working both online and on the streets of Bangalore, Mumbai , Delhi, Chennai and Hyderabad. Blank Noise seeks to recognize eve teasing as street sexual harassment and establish it as an issue.

Blank Noise project Bangalore calls for women/ girls/ ladies/ of all ages, languages, colour, and shape to be participate in a street intervention on Sunday January 28th. By participating you will be celebrated as a BNP Action Hero. Confirm /ask questions at 98868 40612. This street intervention will be approximately 1.5 hours ( 5 - 6 30 pm).

Find out more at the Blank Noise Project Blog

Sunday, January 21, 2007

Communicable disease among rabbits


Rabbits they say
Are very scarce to-day
My diagnosis?

- Spike Milligan


Caught in the center of a soundless field
While hot inexplicable hours go by
What trap is this? Where were its teeth concealed?
You seem to ask.
I make a sharp reply,
then clean my stick. I'm glad I can't explain
Just in what jaws you were to supporate:
You may have thought things would come right again
If you could only keep quite still and wait.

- Philip Larkin (1955)


The mongrel cat came home
Holding half a head
Proceeded to show it off
To all his new-found friends

He said, "I've been to where I like.
"I've slept with who I like.
"She ate me up for breakfast.
"She screwed me in a vice.
"But now,I don't know why I feel so tongue tied."

I sat in the cupboard
And wrote it down in neat

They were cheering and waving
cheering and waving
twitching and salivating
like with myxomatosis.

But it got edited fucked up
Strangled beaten up
Used as a photo in Time magazine
Buried in a burning black hole in Devon

And now, I don't know why I feel so tongue tied.
Don't know why I feel so skinned a- live.

My thoughts are misguided and a little naïve
I twitch and I salivate
like with myxomatosis.

You should put me in a home or you should
Put me down
I got myxomatosis.
I got myxomatosis.

Yeah and no one likes a smart arse
But we all like stars(Oh please)
That wasn't my intention(blah blah)
I did it for a reason (reason)

It must've got mixed up
Beaten up
I got myxomatosis.
I got myxomatosis.

And now, I don't know why I feel so tongue tied.

- Radiohead. Hail the Thief (2003)


A baby rabbit
With eyes full of pus
This is the work
Of scientific us

- Spike Milligan

Myxomatosis (from the Greek μύξα (mucus), and ματώνω (to bleed)) is a disease which infects rabbits. It is caused by the myxoma virus. First observed in Uruguay in the early 1900s, it was deliberately introduced into Australia in an attempt to control rabbit infestation there.

Wednesday, January 17, 2007

Novartis, drop that case!

In August 2005 I had written two articles on this blog on the rewriting of the Indian patent laws using the controversy surrounding Gleevec, an anti-cancer drug by Novartis to illustrate the issue. Under the new patent regime, large pharmaceutical companies could take out product patents which would allow them to monopolise production of new drugs and increase prices.

In January 2006, Novartis' patent application for Gleevec was rejected on the grounds that the drug was a new form of an old drug and therefore was not patentable under Indian law. This enabled patients with certain cancers to access the drug at a price of around Rs. 9000 ($200) a month as opposed to a price of 1,15,000 ($2600) which was the price of the drug elsewhere.

Currently Novartis is suing the Indian Government in order to have the patent decision overturned so that it can sell Gleevec at the same price in India as in other countries. If Novartis wins the case and succeeds in getting the provision of Indian law changed to resemble patent laws in wealthy countries, it could mean that fewer and possibly no generic versions of newer drugs will be able to be produced by Indian manufacturers during the first 20 years after discovery of a drug and India will no longer be able to supply much of the developing world with cheap essential medicines.

Sign a petion to demand that Novartis drop its case against the Indian Government.

Read more about the issue at the Medecins Sans Frontieres site.

Another acorn!

How can you resist a blog subtitled "Epidemiology, truth and counter cultures" ? Rakhal has been a great friend, philosopher, guide and cousin over the years but seems to have kept his blog in the closet. Until now.

Tuesday, January 02, 2007

The oak tree out of which the acorn fell

After a large amount of persuasion and calming of apprehensions the NarayanBlog is up and running! Read and leave sweet encouraging comments here.