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Vol VIII, Issue 4
Date of Publication: October 09, 2023
DOI: https://doi.org/10.20529/IJME.2023.051
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Editorials
If you can’t fix the problem change the standards
Abstract:
Over the last few months, established data systems in India have been the target of heated dispute, chiefly by members of the Economic Advisory Council to the Prime Minister, ranging from the inflation numbers [1], to the sampling frame for surveys done by the National Sample Survey Organisation (NSS), the National Family Health Survey (NFHS) and the Periodic Labour Force Survey (PLFS)[2], haemoglobin cut-offs for anaemia [3] and childhood growth standards, female labour force participation rate and life expectancy at birth [4]. The attempts to revise economic data systems has invited a raging debate [5, 6], prompting the government to set up a panel to review the NSS’s methodology. However, the arguments being made in favor of downward revision of nutritional standards have received much less scrutiny, except for a recent editorial which comments on the general problem of drawing up standards [7]. This is despite the fact that these proposals have already caught the fancy of the government. A policy decision has already been taken to discontinue gathering of data on Hb-levels as part of the quinquennial National Family Health Surveys, which would now be collected as part of a new Dietary and Bio-markers Survey. Neither the rationale for such a move, nor the details of the methodology of the new survey, or the time-frame within which such data would be released have been made available for public deliberation. Similarly, discussions have been initiated on devising “indigenous” growth standards for children [8]. Hence, it becomes imperative to examine the basis of these renewed calls for revision of existing standards.
Copyright and license ©Indian Journal of Medical Ethics 2023: Open Access and Distributed under the Creative Commons license ( CC BY-NC-ND 4.0), which permits only non-commercial and non-modified sharing in any medium, provided the original author(s) and source are credited.
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Comments:
Excellent edit piece. Manipulating research and data is the highlight of this new political regime. The change in anaemia benchmarks being suggested is pure politics as the current regime is unhappy that in their sabhka Vikas framework India’s malnutrition status is embarrassing for them. This manipulation of research and data cuts across the board in both science ( what we saw with covid vaccine research ) and Social sciences where research fellowships are now being granted on the willingness of researchers to accept topics of research that favor the ideas of the political regime. This is indeed a sad state of affairs with regard to science and data in India which politics are playing with. Those believing in science and democratic principles need to come together and challenge these developments to change standards to what suits politics rather than science. Also access to data and official statistics is becoming increasingly untransparent and this will ultimately harm scientific progress and genuine Vikas.
Nicely written editorial with facts and future consequences of lowering Hb cut-offs. Lowering the cut-offs will have long-term dangers, hence instead of diluting/lowering the standards additional efforts may be made to achieve it. We should not lower the standards to show unsolved problem solved.
A major ethical issue here is the politics of the medico-pharmaceutical industry, which has for decades, manipulated standards to boost sales in the context of medications that give them high profit margins. Clearly in the case of anaemia, there is little profit-based incentive to resist the lowering of the standard for anaemia, otherwise we would definitely hear an outcry.
Another ethical dilemma is the cost of food vs. medicines / nutritional supplements. It is an indisputable fact that the cost of iron rich foods – such as those mentioned in the article – are well beyond the reach of poor rural and urban women who are the most affected by iron-deficiency anaemia. And even in households that could afford such foods occasionally, there is much research to show that access to quality food within households is highly gendered, and thus skewed in favour of men and boys, which further aggravates the problem.
In states like Tamilnadu, the success of the mid-day program in schools, with nutritionally boosted foods on offer, has reduced the levels of anaemia among adolescent girls.