Taken for a medical ride

BookThree out of every five surgeries in three private hospitals in a Rajasthan town over the past six months were hysterectomies.

After an RTI application revealed the scandal—the hysterectomies were unnecessary and conducted for money—the story took a dramatic downturn on the ethical scale: doctors of the three hospitals went on strike.

Five days later broke the story that doctors in a Kerala government hospital delivered 21 babies in a two-day caesarian-section spree—all to ensure a decent leave for the Easter weekend, adding a sick medical patina to the term moveable feast.

Each such scandal adds to a mountain of unanswered questions, to the growing discomfort in India with the medical profession. Each family has its own set of horror stories regarding the practice of medicine. If this were to happen in Europe or America, the market would be flooded with books and documentary films exploring what is wrong.

Not so in India. You can expect an avalanche of books on Sri Sathya Sai Baba and what he did to heal so many bodies and souls. But nothing of consequence examining the medical sector. Not even when writing a book has become the stuff of party conversations, and everybody and his semi-literate neighbour is writing one, or at least threatening to.

This is why Nirmal Chandra Asthana’s book is important. The title does not beat about the bush: The Doctor is Cheating You: A Devastating Expose of Unethical Malpractices in the Medical Field. It predicts the scandals that the media brings to light (and then forgets). He has a 20-page chapter on “How female patients are exploited by unnecessary caesarians and hysterectomies”. A literature review of the “international pandemic of medically unnecessary caesarian births” is followed by arguments doctors give for why c-sections are so high in India. The most common being that the patients demand it, and the women are not prepared to go through a trial by labour. Asthana first points to the absence of any survey to support this contention, and then asks: “What has changed in the nature and character of Indian women that they are so scared of labour pain?” Then he draws the argument that women are misled or frightened into accepting c-sections.

A recent experience of a private hospital proves Asthana right. Sitaram Bhartia Institute in Delhi started an aggressive and concerted programme to lower c-sections, with the provision of medical audits. Their c-section rate declined from 70 per cent to 46 per cent—mostly by educating and preparing would-be mothers. But this hospital charges about as much for a vaginal delivery as for a c-section, so it does not have any incentive in pushing women towards surgeries. But this does not apply to most hospitals, which are closer to what Asthana’s book depicts.

It is rich with references and citations from several leading journals, and the author has done a competent job of literature review. (Did you know half the deliveries in West Bengal are through c-section?) The book takes on several topics one by one in direct chapter titles. He takes on the booming business of angioplasty, by-pass surgery and coronary stents. Blood pressure, the myths about the “aggressive treatment of diabetes”, the antibiotics racket, the pharma industry’s insidious influence, unethical trials. He even takes on the hype surrounding Yoga.

The book is a polemical exploration of what most people discuss in India, but nobody writes about: That India’s medical system is ethically one of the weakest in the world. That doctors regularly cheat the physically afflicted, and our medical system is focused around providing treatment for profit, not for providing health. What kind of a nation are we building here?

As much as the growth of the private sector healthcare is lauded, overall, India belongs in the dustbin of nations when assessed on healthcare. Of the total expenditure on health in India in 2005, the government spent less than 20 per cent. (This means Indians spend more out of their pockets on healthcare than most other countries—and not because they can afford it, but because they have no option.) Nepal (28 per cent), Sri Lanka (46 per cent) and Bangladesh (29 per cent) do much better, as does the US (45 per cent), where the private sector is strong. Western Europe, of course, is another story: Germany spent 77 per cent, France 80 per cent, and the UK 87 per cent.

The Indian government’s expenditure on healthcare is one per cent of the GDP—most developing countries spend above 3 per cent, and developed countries spend above five to six per cent. The government has left the health of Indian citizens to the profit motive.

But all this data remains academic unless somebody can show what this does to the medical system. Asthana’s book records that greed. The collapse of the Medical Council of India in 2009—it is due for reconstitution this year—means there is nobody really regulating the medical sector, which is privatising at breakneck speed. The consequences are never noticed because the media never really takes on the medical sector. It is well known that the biggest names in the medical business are very close to media houses. Most publishing houses would not publish such a book.

Asthana’s diatribe against the corruption in the medical world is much needed. Having said that, he is too self-congratulatory in parts (his website is thelastpoly- math.com ), like a one-man mission, a Rambo against the medical system. He is not cynical, but a little too self-involved.

A police intelligence officer, his reputation is that of a maverick, having written 17 books, including a compendium on improvised explosive devices. This book comes out of a visceral need to say something, an attempt to channel ethical disgust with what is happening in India’s medical world. That mood gets a little too overwhelming at points, the moral high ground a little disconcerting. But his scientific credentials bear out—Asthana is a nuclear physicist by training. He is obviously tackling something he is intellectually equipped to tackle. It takes a man like Asthana to say what desperately needs saying.

Another question that crops up while reading this book is: who are its intended readers? It is priced too high for a popular readership and deals too much in science for that. People on the inside of the medical system already know several things Asthana addresses, though nobody wants to write about it except a Left-influenced academic minority, which itself is limited in its reach.

The book is well worth a read for people of science. But it is recommended for anybody who is disconcerted by the inhumanity of the medical industrial complex, and how the government is promoting its avarice in the garb of growth.

Sopan Joshi is a freelance journalist in Delhi

Photo: Surya Sen