FROM THE PRESS
Rational drug therapy?
The World Bank knowingly funded ineffective treatment for the potentially fatal falciparium malaria against the recommendations of the World Health Organisation (WHO), argues a paper in The Lancet.
In 2004, the Bank approved the purchase of over 100 million tablets of chloroquine, worth $1.8 million, for its Enhanced Malaria Control Project (EMCP) in India. The Rs 120-crore EMCP covers 1,045 primary health centres in 100 high-risk districts in Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Orissa and Rajasthan. More than 30 per cent of malaria cases in these areas were falciparum cases, and a proportion of these would develop complications.
Starting in 2003, WHO has recommended the presumptive use of chloroquine alone only in low-risk areas; combination therapy is recommended in high-risk areas where there is a high failure rate with chloroquine alone. However, the Indian malaria control programme did not adopt the changed guidelines till October 2005.
The authors write that the Bank erred in approving the loan when it knew that the medication would be used to treat drug-resistant falciparum malaria. “The quantities make it probable that millions of patients with falciparum malaria received such treatment inappropriately. Both money and lives are wasted by these decisions,” the paper said.
A rejoinder in the same issue of the journal defended the Bank’s Enhanced Malaria Control Project (EMCP) in India as in line with its policy to provide credit to on-going government-led strategy.
R Ramachandran. Malaria malpractice. Frontline, June 17-30 2006.
Doctors and cover-up?
What are the duties of a doctor in cases of suspected drug abuse? This question was asked when doctors at Delhi’s Apollo Hospital treated Rahul Mahajan, son of the BJP politician Pramod Mahajan, along with his father’s secretary, when they were brought in for emergency treatment following a drug overdose.
Police are investigating whether the hospital declared Mahajan to be more ill than he actually was, in order to prevent the police from interrogating him for more than 80 hours after his admission. Though the hospital’s medicolegal report states that he was stable and conscious when he was brought in, and his pulse and blood pressure were normal, the hospital reported that he was extremely critical and on a ventilator.
Earlier, the hospital reported that Mahajan had tested negative for 14 drugs including cocaine and heroin. Another lab report found that the heroin dose in his blood was over 30 times the permissible level. Further, there is evidence that hospital log book entries were over-written.
“…the hospital’s entire handling of the matter, raising suspicions of an attempt to cover up wrongdoing, does raise questions about the professional and ethical standards of even leading private, corporate hospitals. Perhaps it is time for the Medical Council of India to get more active in its task of regulating medical conduct.”
Editorial. Docs in the dock. Business Standard, June 14, 2006.
Brain-mapping’s compulsory – unless you’ve got the right connections
In fact, doctors are now becoming essential to interrogation in high-profile criminal cases – to inject “truth serums”, conduct “brain-mapping” and so on. It looks as if everyone who’s anyone has undergone these tests – the fake stamp paper “king” Abdul Karim Telgi, alleged gangster Abu Salem, and accused rapist Abhishek Kasliwal. The only celebrity accused to avoid being subjected to these techniques is Rahul Mahajan, who was accused of using illegal drugs which resulted in the death of one of his friends. Mahajan managed to get a High Court stay preventing the prosecution from subjecting him to brain mapping. It’s another matter that such practices are considered torture according to international opinion.
Staff reporter. Court reserves order on brain-mapping test on Rahul. The Hindu June 25, 2006
Malnutrition in Mumbai? No way!
Malnutrition is not just a tragedy of village life. More than 50 per cent of children in anganwadis in the country’s commercial capital suffer from various grades of malnutrition, according to non-governmental organisations in Mumbai. Several infants from slums in Bhandup, in north-east Mumbai, have been admitted to public hospitals with illnesses indicating severe malnutrition.
The government’s Integrated Child Development Services (ICDS) statistics indicate that half of the 1,267,497 children below the age of six in the city’s anganwadis were malnourished, 731 of them severely so. The simple fact is that the vast majority of the poor do not have food security. Ration cards cost Rs 3,500 to procure. Only one per cent of ration card holders receive rations, in Bhandup. In some areas where slums are considered illegal the residents are not eligible for water or sanitation facilities.
But the government begs to disagree. Government doctors hesitate to comment on whether the children admitted to hospital are malnourished, and the state’s health minister and the state Human Rights Commission insist that there is no case of malnutrition in Mumbai.
