Soumyadeep Bhaumik’s review of Indian medical papers—2 May 2013

soumyadeepbhaumikPeople say India is the land of frugal medicine, and a decade ago I would have agreed. But the advent of technology coincided with the rapid growth of private hospital chains in the Indian medical sector. Healthcare has become costly, with expenditure on everything including medicines becoming huge. This brings me straight to the most important event in Indian medicine, which has created ripples across the world—the rejection of Novartis’s plea for a patent of Imatinib in the Supreme Court. The move has triggered a flurry of reactions (you may want to sample my personal thoughts here), but the most remarkable has come from a group of more than 100 chronic myeloid experts (most of them with prominent ties to “BigPharma”) in the journal Blood, where they talk about how “Imatinib was (originally) developed as a ‘goodwill gesture’ by Novartis, and became a blockbuster, with annual revenues of about $4.7 billion in 2012.” It also gives the most engaging and balanced perspective on the issue of what determines a morally justifiable price for cancer drugs, making it clear in the end that they believe that unsustainable high drug prices in chronic myeloid leukemia and cancer are causing harm to patients and need to be reined in so that they do “not exceed values that harm our patients and societies.”  

Moving away from the intricately complex world of drug pricing, the journal Archives of Osteoporosis has published the first hip fracture incidence study from India—albeit from only one district in India—but nevertheless a great start. The study estimates that the incidence above 50 years is 129 per 100 000 of the population. This might actually be an underestimate considering that it only pooled data from orthopaedic centres in the district, and it shows the need for further nationwide studies and strategies in this respect thereafter.

A study published in the journal Radiation Protection Dosimetry finds that the “measured uranium content in 4% of water samples from Punjab has been found to be higher than the limit of 30 µg l-1 recommended by the World Health Organization (WHO) and US Environmental Protection Agency.” The study also notes that the estimated annual effective dose from drinking water sources is within the WHO norms. So what is the cause of the reported unusually high rates of cancer incidence in what was known as the “cotton belt of Punjab?” I used “was” because the region is now known as the “cancer belt.” The minister for health and family welfare stated this month in the Lok Sabha that the prevalence of cancer in the entire state of Punjab as indicated by the Indian Council of Medical Research (ICMR) was no higher than others states in India, but also goes on to add that the ICMR was unable to determine the true incidence or prevalence in Punjab owing to a lack of preliminary data like the date of first diagnosis, anatomical site, and even sex of patients in the surveys conducted. That brings us back to square one and also raises one vital question—which data do these surveys collect?

Talking of data brings us to the issue of the lack of Indian based data for evidence based medicine. One such India specific review that was published in the Indian Journal of Dermatology, Venereology, and Leprology on drug induced Stevens-Johnson syndrome and toxic epidermal necrolysis in the Indian population. Another very interesting regional specific study in dermatology was published in the Indian Journal of Dermatology about the histo-pathological changes in “Kangri cancer.” For the uninitiated this is only seen in northern India, almost exclusively in Kashmir, and is a heat induced skin carcinoma owing to the use of an indigenous method of acquiring warmth by an earthenware fire pot called a Kangri. It has done an analysis of about 30 patients “in whom skin changes due to Kangri use were present “for a span of just eight months.” I just wish that Indian researchers would undertake studies with larger sample sizes so that they are of greater value to the medical world.

The consensus statement of the Indian Academy of Pediatrics on “Integrated Management of Severe Acute Malnutrition” was also published. I would love to be around when such consensus statements use more than just under 70 words on how they actually reached the consensus. It is high time that the Indian government comes up with a programme similar to the National Institutes of Health (NIH) consensus development programme in USA to standardise the processes, bring in accountability, and ensure that potential conflicts of interests do not creep into the statement. The NIH consensus statements follow a “court model,” and a thorough systematic literature review forms the basis of such statements. Otherwise such statements make little sense.

P.S:  The youTube spoof about the delay of NEET-PG exam results using an extract of a Bollywood hit—”Swades ” provocatively titled Life of P.I (Post-intern) has gone viral among medical students. It successfully showcases the sorry state of affairs for MBBS doctors caught  in the quagmire of specialisation in India. Have a look here.

Soumyadeep Bhaumik is a medical doctor and independent medical researcher from Kolkata, India. He freelances for various national and international medical journals. Twitter @DrSoumyadeepB

Competing interests:  I have read and understood the BMJ Group policy on declaration of interests and declare that I have served a paid editor position in an Indian medical journal before and freelances for various national and international medical journals. No other relevant conflicts of interests.