India: Tamil Nadu bans unnecessary intersex pediatric surgeries!

Note: I am from Coimbatore, Tamil Nadu, a very progressive city in a very progressive state. And so, I may not be as objective in writing this, even though, Diversity, LGBT and Women's rights are a top priority for me and I recognize that India has yet to make immense progress.

An Introduction

India is a country steeped in tradition and superstition, both of which cause immeasurable pain to those who don't "belong". And of course, infants have no power to fight the ills they are subjected to. I come from Tamil Nadu, where female infanticide has been a very sad and despicable crime, that the Governments have fought over several years. Female children are seen as a burden, because of the heinous observance of "dowry", which has to be presented to the male side during marriage. This, and the ongoing suppression of women, and other heinous acts against them, extends to transgender and other people who are not perceived as "normal".

In Tamil Nadu, one of the states that is somewhat progressive, right wing forces have yet to fully have an effect. In that environment, transgender folks have been getting some rights and attention in recent times. Hijra, as they are known in India, they are now offered the status of a third gender - a glimmer of hope, given the ostracization and crimes against them.There is an insightful video of transgender issues from Coimbatore, my hometown:

Unnecessary Intersex Surgeries in Children - A Global Problem

If you believe that unnecessary surgeries among intersex children is localized to developing nations, you need a bit of a refresher (See link below). Rest assured, right down from the US, such surgeries are a plague on children, and cause them severe, irreversible physical and emotional trauma. Much awareness, education and regulation is needed to reverse this trend. 

In that sense, this news that under the direction of the High Court, the Tamil Nadu Government has passed an executive order to ban such surgeries, except under conditions where the health of the child is endangered is heartening. They are also claiming to form a committee to prevent abuse of the health condition exception. 

The careful review of exceptions is critical. California knows this the best. Having passed a law to enforce vaccinations, the State learned that the provisions for exceptions are routinely and heavily abused by extremely irresponsible Doctors and Parents. 

The Future

One has to wait and see if future Governments in Tamil Nadu, as well as other Governments in other States, and some day, perhaps the National Government of India will follow this lead. It is very difficult to predict how things will go. Women, and minorities of every kind are in danger in India, and face discrimination and victimization routinely. Add to this caste based crimes, honor killings and other issues, the future is still grim. One can only hope that well-meaning courts and governments can act with care and prudence to help intersex children, transgender people, homosexual people, women and other minorities in India.

Reference:

1. News on the ban on intersex surgeries: https://www.reuters.com/article/india-lgbt-intersex/indian-state-bans-unnecessary-surgery-on-intersex-babies-idUSL5N25O22X
2. Unnecessary Intersex Surgeries in the US: https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us
3. California tries to deal with vaccination exemptions: https://www.apnews.com/e82739a3289647d39b0cf1c791628e17
4. Image, Courtesy, Pexels: https://www.pexels.com/photo/adorable-baby-baby-feet-beautiful-266011/

Now, Nepal challenges India on Medical Tourism - what protectionism brings!

A few days ago, I wrote about India's Medical Device Market: http://chaaraka.blogspot.com/2017/04/indias-bizarre-medical-device-market.html

And then, today, I came across an article that makes things even more interesting. Turns out, Nepal is, as one should, taking advantage of the Indian Government's narrow minded attempts at making medical devices available to the market. While India's ominously named NPPA (National Pharmaceutical Pricing Authority - "Authority", puts a nice Democratic spin to things indeed) has decided to control stent prices (especially for drug eluting ones!) at ridiculous rates, at least two companies, Abbott and Medtronic proposed withdrawing from the market. And, it is possible, Boston Scientific wants/wanted to follow suit.

To further wrinkle matters, the NPPA apparently rejected requests by Abbott and Medtronic to pull out of the Indian market! Yes, and apparently so, because, there is no provision in the law to allow a company to withdraw its products from the Indian Market. Well, if companies did not hesitate about bringing their products to India, now they sure as hell will!

Getting back to Nepal, apparently, not only are Nepali Hospitals accommodating Indian patients, but also the Indian doctors that want to operate on them. In my last post, I had lamented about India losing out on medical tourism, and even I hadn't imagined the problem to be as deep as it is. Doctors from India already have lucrative opportunities to do small stints in the US and Europe, when local doctors, especially specialists, go away on vacation, or are unavailable otherwise. This, apparently extends to regions such as Dubai, Singapore, etc. and that is good for them. I am sure, exchanges happen the other way too, but when talent is displaced due to protectionism, it results in a loss of competitiveness. I assume Nepal is even cheaper than India. So, if you didn't have the price controls in place, even with the cost of the stents on market, and the travel expenses, Indian patients, and patients from around the world can only benefit from going to Nepal, not to say anything about the winning local economy.

Confounding Issues and the Ultimate Losers!

I know I keep saying bizarre, but what shocks me is, apparently the NPPA, egged on by a court decision, and at least one organization, All India Drug Action Network, believes that price control is the way to police, regulate and prevent abuse of stents by hospitals, in their search for profits. Before we jump into further arguments on this, it is puzzling enough that the NPPA also wants the Cardiological Society of India to regulate and police itself, to prevent over-use of stents.

So what does the NPPA believe then? Price control works, but is not enough? Or do they doubt that price control would work? The whole thing looks like a mess, and I can tell you one thing - the ultimate and severe losses appear to be that of India's patients.

We'll keep watching the Indian Government and the industry and see what shakes out. It looks like the road ahead is long and bumpy.

References:

1. The article (loading issues and spelling errors lie ahead): http://www.firstpost.com/india/nepal-cashes-on-as-indias-price-cap-send-stents-disappearing-from-country-3427822.html

2. Image, courtesy Pexels: https://www.pexels.com/photo/glacier-snow-mountains-sunny-199/

Dr. Anbumani Ramadoss's contribution to Indian medicine: Eternal Shame

[Click on Post Title for Link to External Article]

For all those people blindly tolling the bells of progress in my country, Ramadoss serves as the "duh" reminder.

A very inept man, he represents everything that is a political stumbling block that hinders rapid progress of India. Not only does his existence have nothing positive to contribute to the nation, but he has also taken on a personal enmity with the Director of AIIMS, one of India's premier institutions to prove how low, demeaning and cheap his existence can be, and how much damage he could continually cause in a "democracy".

He has the full backing of Manmohan Singh, a man who, surprisingly enough, continues to fall in stature. Singh is only interested in keeping his party in power, which has naturally translated into an unabated freedom for Ramadoss to act like the veritable Bull in a China Shop.

This incident that appears more like a long drawn out battle in idiocy is a good example that highlights the weaknesses in India's democracy:

1. Just like the US Constitution, the Indian Constitution is weak in that parties in power can pass legislation that is fundamentally wrong - ethically, morally and legally. In India, the situation is worse, and continues to unravel despite an active Judiciary.

2. The caste systems that the British took advantage of have now become a weapon in the Indian Government's hands. This is something that can only contribute to some of the darkest pages of contemporary Indian History.

3. The Indian Press, and the force of public opinion is more or less a joke. While AIIMS continues to suffer through multiple strikes and government interventions, patients continue to suffer. The public has not taken a stand and has not represented its grievances against the situation.

4. Healthcare continues to be a very low priority issue in India.

5. Autonomy of institutions is also of very little concern to the Indian Government, the opposition, the press and the general public.

Given all these facts, and the very untenable situation created by parasitic ministers like Ramadoss, progress has a dim outlook in the Healthcare education and administration in India.

These facts are not factored in multiple assessments of the Indian Healthcare, Pharmaceutical and Medical Devices Industries.

It is indeed easy to fix a dollar amount X to any product/service unit, multiply it by a billion or a fraction thereof to come up with juicy numbers. This, however, does not represent the true market size of any industry in India.

Here are some very damaging scenarios that could play out in the presence of someone with as minimal intellectual capabilities as Ramadoss:

1. The quality of medical education can be diluted to the extent that Indian Doctors and Medical Institutions will lose their credibility and competitiveness in the world. This will severely hamper the future ability of India to fight off China and other emerging nations in terms of clinical trials, clinical research and related industries.

2. Irresponsible Healthcare Ministers can suspend or permanently stop clinical trials and research without logical reasons or explanations. It is very obvious where this will lead to.

3. Both 1 and 2, individually or collectively will also affect patient healthcare, both local and those coming in through medical tourism.

What India needs is responsible, educated ministers who need to be qualified for their portfolios. In the absence of such leadership, and in the presence of cretins like Ramadoss, all new and existing companies doing business in India within the healthcare or other frameworks will have to be very cautious and conservative in their approach and outlook.


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