The task of a book reviewer is to convey to readers the gist of the book and the reviewer’s educated feelings on its contents. Where the reviewer finds a discrepancy or observes representations that cause apprehension, duty demands that these be pointed out. This is the basis for my using quotations from Ms Sujatha Rao’s book and tagging them with statements based on my own understanding and experience.

Having been a medical practitioner since 1965, and worked for very poor patients in public hospitals from 1965 to 1998 I do have a little experience of the difficulties they face.

I am sorry that Ms Rao found my remarks “caustic”. The dictionary defines that word as indicating an ability to burn or corrode or, with reference to writings, sarcastic in a scathing and bitter manner.

None of these were intended.

I maintain that a person holding senior governmental positions in the health sector for years should be aware of the consequences of governmental efforts on preventive and curative measures and the actions of their agencies intended to improve the health of the population. Unless they are aware of deficiencies, they can take no corrective steps. When Ms. Rao states, even in her response, that it was only on reflection after retirement that she became cognisant of ground realities, I can only wonder about the methods employed to keep officers abreast of such realities whilst in office.

Ms. Rao again refers to weak leadership, low resources, and poor management as being responsible for the current dismal situation. I am not competent to discuss the role of a “politically powerful leader like Ghulam Nabi Azad” but do know that, first and foremost, it is the responsibility of those in power – ministers and bureaucrats alike – to set their own houses in order. When discussing unethical practices in medicine, we do not ask the public to rise in arms against the medical profession. Rather, we, in the medical profession, turn to others in our profession and use all means at our disposal to enable a return to the best forms of medical practice.

“Shrinking space and loss of autonomy for decision making” amongst bureaucrats should lead to a search for their causes. Why is it that the public perceives bureaucrats as being hand-in-glove with ministers and powerful politicians who serve as extra-constitutional sources of power?

Much has been written in the columns of this journal on the Medical Council of India. It is not necessary to cover that ground again. The crucial question is, “Who, in the Central Government, is responsible for making policies that dictate the functioning of this Council and for the monitoring of its activities?” The responsible ministries, departments, and individuals must take the blame for enabling the corruption that has besmirched the reputation of the Council.

The increasing tendency for those in government to expect the judiciary, the media, and civil society to do their jobs for them is to be deprecated.

People at large form a heterogeneous mass. The vast majority are hopelessly poor and struggle to keep body and soul together. A significant part of the remainder has an agenda that varies from self-aggrandisement to amassing more and more wealth. The few who work in the field and do their best for their patients under trying circumstances do attempt to engineer change, but can do so only with very small and at times faltering steps.

I am old enough to have discussed these matters with very senior and respected teachers in medical institutions in the country, many of them, alas, now dead. I have also had the privilege of discussing the problems in bringing about change for the better in public health with retired officers from the Indian Civil Service, a retired Cabinet Secretary in the central government and retired secretaries in state ministries. None of them would have condoned the statement “neither the powerful minister nor secretary actually has any power”.

The exercise of power, when untainted with self-interest or a longing for another sinecure after official retirement from government service, and a lack of fear can improve the current situation.

Trained horses are noble animals that have been tamed. I am reluctant to equate our senior bureaucrats with them. I expect bureaucrats to consider themselves no less than their “riders” – the ministers. I also expect bureaucrats to guide ministers – many of whom are woefully ignorant of the magnitude and significance of their tasks – towards the straight and narrow path that leads to the welfare of the people of India.