The Tribune, Chandigarh, India

Pranab at receiving end
Don’t let pesky callers get away with it

TWO years ago the Supreme Court took up a common complaint from cell phone users about unsolicited calls and suggested that since the “national-do-not-call registry” had not proved effective, it should be replaced by a “call registry”, requiring those willing to receive calls from telemarketers to register themselves. Those who had hoped for some relief after the apex court’s intervention underestimated the government’s ineffectiveness in dealing with this public nuisance. The issue once again cropped up when Finance Minister Pranab Mukherjee got a call from a telemarketer while he was in a meeting with Opposition leaders on Thursday.

Pranab’s discomfiture has woken up Communications Minister A. Raja. Provoked by wide media coverage of the incident, he has directed his Secretary to seek the operators’ explanation on what action they had taken to stop the social menace. Given the track record of the minister and his ministry, not much should be expected from this prompt action other than a possible sacking of the unfortunate caller. Even the Telecom Regulatory Authority of India has been sleeping over the issue. It is reported that the regulator is “trying to evolve some mechanism to stop unwanted telemarketing”. How many years does it take to nail the offenders, registered or unregistered?

If the TRAI or the Communications Ministry has absolutely no idea about how to handle the problem, it can at least act on the Supreme Court’s suggestion, to start with. Secondly, every service provider can be mandated to put in place an effective system to redress consumer complaints and ensure hefty fines on unwanted callers/institutions out to sell a bank scheme, some insurance policy or a housing plot. If the problem still persists, the licence of the defaulter needs to be cancelled. If the Communications Minister and the TRAI can’t stop the blatant invasion of citizens’ privacy, do they deserve to continue in their posts? Make way for someone who knows how to deal with telecom firms.

Social responsibility
Gates-Buffet initiative is exemplary

THE pledge by 40 US billionaires to give away at least half of their wealth to philanthropic purpose in response to a campaign by Microsoft chief Bill Gates and legendary investor Warren Buffet is an act of great magnanimity worthy of the highest commendation. Buffet, who owns the insurance and investment company Berkshire Hathaway Inc has in fact pledged 99 per cent of his wealth. As New York mayor Michael Bloomberg, who is himself a billionaire said recently, “The reality of great wealth is that you can’t spend it and you can’t take it with you.”

Considering that this year’s Forbes list of the richest people in the world featured two Indians in the top 10 — Mukesh Ambani and Lakshmi Mittal — and 10 of Asia’s top 25 rich are from India, Mr Buffet’s recent statement that he and Bill Gates will travel to India and China to meet wealthy individuals to motivate them to join the campaign, is noteworthy. Going by the philanthropic record of India’s rich in general, it is anybody’s guess if there would be any takers for the campaign in this country. With poverty and illiteracy running deep in India, there is much that people of means can do to provide succour to the teeming millions and to give mass education a boost. But the level of corporate social responsibility discharged by the Indian corporates falls far short of requirements. There is a general obsession to amass riches by means fair or foul and an equally strong urge to hoard wealth. A lot of the philanthropy is an eyewash and is designed to achieve political ends.

The multinationals, some of whom make a killing in India, spend much less towards corporate social responsibility than they do in their own countries. There is indeed need for public-spirited bodies to raise consciousness for greater corporate responsibility. That it is mandatory for all public sector oil companies to spend at least 2 per cent of their net profits on social responsibility is something which needs to be replicated in respect of all undertakings, public and private.

Thought for the Day

The night has a thousand eyes,/ And the day but one;/ Yet the light of the bright world dies,/ With the dying sun.

— F.W. Bourdillon

ARTICLE

The ignored revolutionaries
How they contributed to India’s freedom
by Kuldip Nayar

IT was a long haul, from New Delhi to Sacramento, near San Francisco in the US. Yet, the journey was worth undertaking despite the hazards at my age. It was a pilgrimage. This is the place where half a dozen Sikhs, staunch Marxists, led a contingent of people to India to light the flame of revolution in 1913. The purpose was to free India from bondage. They made two attempts through sea routes, roping in even a few Sikh regiments under the British.

Both times the revolutionaries, known as the Gadhari babas (the elderly revolutionaries), were betrayed by the agents planted within their ranks. The well-known intellectual, Hardyal, who was part of the Gadhar movement, also betrayed the babas and went over to the British side when World War I commenced. Communist leader Sohan Singh Josh, living in India, said that by changing sides, Hardyal brought shame on himself and his past. Barkatullah, also a revolutionary, stood firm on the side of the Ghadarites. His grave is visited by scores of people every day.

The British set up a tribunal to try those who had defied the Empire. Many were hanged with barely a ripple in India. Even today the country hardly knows their sacrifice. Only a few of the revolutionaries like Kartar Singh Sarabha and Sohan Singh Bakan are known in certain areas of Punjab. There is no mention of them in any textbook throughout India.

The labour settled in Canada too charted the Komagata Maru, a Japanese merchant ship, and sailed to India. The ship found no port on the way to Calcutta to berth. They too were butchered by the British. However, the difference between the effort from Canada and that from San Francisco was the difference of ideology.

From Canada a rich Sikh, Gurdip Singh, hired the ship to carry cargo but the Komagata Maru became the focus of revolution because the labour on the ship defied the owner and raised the standard of revolt. Mewa Singh, an unknown local priest, shot William Hopkinson dead in the Vancouver court where he was waiting to denounce the philosophy which the Gadhar Party was trying to expound.

The Komagata Maru incident provided the spark that lit the fire of defiance among the Indians abroad. The Ghadar, the party’s organ, wrote relentlessly to exhort people to revolt. Several thousand men living abroad caught the earliest boat to reach India.

Some five years ago, migrants from India settled in California —Sacramento is its capital — constituted the Gadhar Memorial Committee to organise functions in memory of the Gadhari babas. The committee holds a meeting every year on the second Saturday of July.

I was the main speaker this year. People from different parts of America thronged a big hall and sat through the four-hour-long meeting when half a dozen speakers dilated on the sacrifice and selflessness of the Ghadari babas and wished if India could let its countrymen know how a handful of ordinary men embarked on the task of ousting the British. Among the speakers was the Vice-Chancellor of Punjab Agricultural University, Ludhiana.

The Gadhari babas started the struggle from a small building which is there even today in the midst of living quarters of San Francisco. The Government of India has taken over the building and looks after its maintenance. New Delhi needs to spend more on setting up a museum to display things that are associated with the babas. One of their documents, already framed, says that a free India they envisaged would have a federal structure and would be called the United States of India.

The Ghadari babas were among the labourers who went to America and Canada in 1906 from Punjab, largely from the Doaba region. They constituted the Ghadar Party. They brought out a weekly in Urdu, Ghadar, to spread their message. Subsequently, they brought out its Gurmukhi edition. This reminded me of Harijan, launched by Mahatma Gandhi, to guide the national movement for independence.

The Sikhs were the backbone of the Gadhar Party. Gurmukhi was its language and the gurdwara its meeting venue. The party brought Sikhs back into the political mainstream and washed away the stigma on the community for having supported the British in the first national uprising in 1857. The party was secular. In one of the booklets which the Gadhar Party issued had one poem:

No Pundits or Mullahs do we need/ No prayers or litanies we need recite/ These will only scuttle our boat/ Draw the sword; this time to fight/ Though Hindus, Mussalmans and Sikhs we be,/ Sons of Bharat are we still/ Put aside your arguments for another day/ Call of the hour is to kill…

The difference was that the Gadhar Party had no compunction in propagating the use of force while Gandhiji’s faith in non-violence was unshakable. No doubt, he is responsible for winning us Independence, yet the sacrifice of the revolutionaries — Bhagat Singh, Rajguru and Sukh Dev came to the scene later — was not small in importance. They made the British falter in their confidence to rule India.

The Ghadarite committee is preparing to celebrate in 2013 the centenary of the babas’ movement. I wish the Government of India could participate in the celebrations to recall their role. Gandhiji paid a tribute to the bravery of the revolutionaries in his reply to Sukh Dev’s letter. “The writer is not ‘one of many.’ Many do not seek the gallows for political freedom. However condemnable political murder may be, it is not possible to withhold recognition of the love of the country and the courage which inspires such awful deeds. And let us hope that the cult of political assassination is not growing if the Indian experiment succeeds, as it is bound to, the occupation of the political assassin will be gone forever. At any rate, I am working in that faith.”

Revolution has such a cleansing effect that people give up their selfish way of living and adopt a policy that involves all in a battle for egalitarianism. Today’s India has to remember this the most.

MIDDLE

Portrait of a lady
by Harish Dhillon

THERE is in my house, a photograph of a lady. A simple photograph, in a simple frame. Yet every visitor, who comes to the house, stops to look intently at it. They comment on how beautiful the lady is – and she is one of the most beautiful women I have ever seen, on the grace and dignity with which she stares into the camera, on her regal bearing and the air of authority that she exudes. And then, after all these comments, they turn to me and ask; “Who is she”? And I always answer with a deep feeling of pride; “She is – was my Mamiji.”

Yes, she is in the past tense now because she died in the early hours the other day. Her name was Mrs Lakhinder Nakai, widow of Lt-Gen JS Nakai. My first memory of her goes back to when I was in class VI in Sanawar. My Mamaji had just got married and on the way for their honeymoon in Shimla, they stopped to meet my sister and me. Apart from the very welcome gifts of food and money that she brought, my heart warmed to her because of her beauty and grace.

She was a perfectionist in every way and she could not tolerate any thing less in those around her. This became especially difficult when her husband became an army commander. When she tried to impose her deep sense of propriety on the wives of the junior officers, she was called ruthless, arrogant and snobbish. But many of these young officers’ wives, in years to come, were grateful to her for the so called ruthlessness and what it had taught them.

With those she cared for she was generous to a fault. Seeing my bare lobby, she went home, rolled up one of her exquisite carpets and had it delivered to me.

Many remember her for much more than her demand for perfection. They remember her as spending day after day persuading the civil administration to make land available to mother Teresa for setting up a home for the destitute and the dying. They remember her for her concern for the welfare of the young army wives who lived a lonely life in separated family accommodation while their husbands were posted to field areas.

In the end, life was not kind to her. She was struck by Parkinsons, in a particularly virulent form. She wasted away, became frail and weak, a sad shadow of her former self. But she retained her dignity till the very end. She did not want people to see her condition and feel sorry for her. She saw this in my eyes, the last time I went to see her and, after a polite five minutes, she said, “Harish – please go.”

I know people will still come to my house. They will stop in front of that portrait and they will ask; “Who is this”? And I will tell them, with my heart swelling with pride; “This is a lady, who kept her dignity even in the face of death. She is my Mamiji!”.

OPED — HEALTH

Clinical trials in India: Need for bioethics
Radha Saini and Sukhwinder Singh

The practice of using poor people as guinea pigs for the clinical trials goes on with impunity
India has a global market share of almost 50 per cent in the clinical trial business at present
Proper informed consent must be obtained from every research participant and in case an individual who is not able to give informed consent ,the consent of legal guardian must be taken and it should be totally on a voluntary basis in a way to protect the client’s autonomy

THE recent directions of the Medical Council of India state that health care providers are not entitled to endorse any specific pharmaceutical company product to patients and also not to conduct any drug trial on patients without proper ethical considerations. The amendment further states that no research study or clinical trial should be conducted on human beings without taking into consideration the bioethics and hence no one shall be subjected without his/her consent to medical or scientific experimentation.

As a matter of fact, more than two-thirds of pharmaceutical company based clinical trials are conducted in developing countries as compared to developed countries. It is estimated that one in four clinical trials in the world are now conducted in India and the turnover for the industry is expected to touch $ 1.52 billion by this year (2010).

India has a global market share of almost 50 per cent in the clinical trial business at present. The main reason behind conducting clinical trials in India and many other developing countries is the fact that many of the mission hospitals and charitable hospitals are fund starved, have poverty stricken patients, and hence high enrolment rates and good patient compliance which provide a smooth platform to unscrupulous medical practitioners for their vested interests, gifts and monetary allowances .Thus the practice of using poor people as guinea pigs for the clinical trials goes on with impunity.

Every clinical trial being conducted on human population must adhere to four basic principles of ethics, namely principles of autonomy, beneficence, non-malfeasance and justice. The work of the Institutional ethics committee (IEC) is to not only review the proposed research protocols but also to timely monitor the working of these trials with a view to evaluating the compliance of ethics during the period of trial.

In the case of drug trials appropriate approval must be obtained from the Drugs Controller General of India (DCGI) as is necessary under Schedule “Y” of the Drugs and Cosmetics Act, 1940, amended in 2005. But the question arises as to what extent in actual the pharmaceutical companies obtain the clearance from the DCGI. The investigator should also get approval of the ethics committee of the institution before submitting it to the DCGI.

Every clinical trial must register with the Clinical Trial Registry of India (CTRI) of the ICMR before its beginning and enrolling study participants. The Indian Good Clinical Practices (GCP) based on international guidelines issued by WHO and International Committee on Harmonisation (ICH) provide operative guidelines for ethical and scientific standards for the designing of trial protocol.

Proper informed consent must be obtained from every research participant and in case an individual who is not able to give informed consent, the consent of the legal guardian must be taken and it should be totally on a voluntary basis in a way to protect the client’s autonomy.

Informed consent can be waived in the conditions where research is done in emergency situations, publicly available information, documents, records and biological samples from deceased individuals, leftover samples after clinical investigations etc. At every step the confidentiality of the client must be safeguarded.

All research participants are also subjected to free ancillary care i.e. care/treatment which a client may require during the time he is undergoing the trial. So in such a case all payments, reimbursements and medical services to be provided to the participants should be approved by the IEC.

Similarly every research participant is also liable to get post-trial assess and special care must be taken when trials are to be conducted on pregnant women, lactating mothers, children and other vulnerable populations involving mentally challenged individuals and handicapped people.

The investigator must safeguard the confidentiality of research participant unless a court of law demands it, or there is a threat to a person’s life, in case of severe drug reaction. Proper compensation for accidental injury, temporary or permanent impairment must be provided by the sponsor pharmaceutical company and this must be decided at the beginning of the trial. There is also a need to have a strong pharmaco-vigilance programme to monitor the adverse effects of drugs.

The results of the study also must not be disclosed to the media unless proper ethical background is formed and necessary permissions are obtained from sponsors, principal the investigator and the institution and that must always be with objective to benefit the community at large.

The Medical Council of India has also amended criteria for appointment of medical teachers and hence every assistant professor, lecturer will have to publish sufficient number of papers before being promoted to the post of Associate professor or Professor. Young staff that does a lot of research and writing may be forced to share authorship and at times give away the first authorship. Hence they are left on the whims and fancy of their bosses or respective Heads of Departments.

The Medical Council of India must form stringent guidelines related to ethics involved in conducting the clinical trials and this will not be effective unless and until some punitive measures and laws are made and implemented. Licenses of such doctors need to be cancelled /revoked by the state councils and at the same time deterrent punishments be given to them.

The need of the hour is a massive, propulsive and compulsive propaganda about the bioethics education in medical and nursing practice. Let us all save our poor patients who on one side are afflicted and cursed with deadly diseases and hence find it all the more hard to cope in terms of finances and resources and on the other side, unknowingly become guinea pigs in the hands of such unscrupulous physicians who for their vested interests even do not hesitate to bring a shame on the noble Hippocratic oath and self-respect.

Ms Radha Saini underwent long-term training programme on Bioethics funded by the NIH AND the Fogarty International Centre, USA, under the auspices of the ICMR, New Delhi, and is working as Lecturer in Gian Sagar College of Nursing. Dr Sukhwinder Singh is Vice-Chairman of Gian Sagar Educational Trust,Ramnagar

Unfounded fears of doctors
By the enactment of the Consumer Protection Act, the government has provided the consumer an alternative to the civil courts, where admittedly the litigation is not only expensive but also drags on for decades
Major-Gen Satinder Kapoor (retd)

IN the article “The Doctor and the Consumer Protection Act” (July 12), Dr Gurinderjit Singh has recommended that the medical professionals should be excluded from the ambit of the Consumer Protection (CP) Act because the Benches of consumer fora are likely to commit errors in their orders and because the complainant has to pay no court fee many frivolous complaints are being filed. The apex court, having discussed all aspects related to dealing with the cases of medical negligence, in a landmark judgement, in the case of the Indian Medical Association Vs VP Shanta, had held that the treatment given by medical professionals comes under the purview of the CP Act. It was also the view of the court that the medical professionals cannot be left out of the ambit of the CP Act merely because they belong to the medical profession and that they are governed by the Indian Medical Council Act, which puts them under disciplinary control of the Medical Council of India/State Medical Councils, as it gave no solace to a sufferer of medical negligence and as such his right to seek redress could not be extinguished.

By the enactment of the Consumer Protection Act, the government has provided the consumer an alternative to the civil courts, where admittedly; the litigation is not only expensive but also drags on for decades. The government, through the Consumer Protection Act, has promised to provide “cheap and speedy” justice to the consumer.

This Act, even though pro-consumer, adequately protects the doctors as well. It is settled law that in cases of alleged medical negligence, a doctor or a hospital cannot be held to be guilty merely because the patient did not respond favourably to the treatment. It is also settled law that the negligence has to be proved by cogent evidence. It is understood by the Bench that there is inherent danger in performing certain operations or procedures and once the patient has been informed of these and subsequently something goes wrong, the doctor or the hospital is not to be held liable.

As long as the doctor possesses the requisite medical qualification to treat the patient and the required infrastructure, facilities, equipment and para medical staff to treat the patient as well as to meet expected emergencies is available and the treatment given is as per accepted norms/protocol, the doctors and the hospitals have nothing to worry.

The law is also settled that a doctor cannot be held negligent only because another doctor would have performed better or would have adopted a different line of treatment or procedure. A doctor is only expected to treat a patient as any other doctor of average competence would do and to follow anyone of the accepted norm/procedure or practice. The result of the treatment is of no consequence in coming to the conclusion regarding medical negligence.

Now looking at the other side of the coin, we have a helpless and hapless consumer who is to grapple with sickness as well as financial stress due to expenses of treatment and who in an unfortunate situation has also to deal with litigation involving medical negligence. In our country where quacks treat patients, medical practitioners without any recognised degree are countless, homoeopathic doctors are administering allopathic injections and are prescribing allopathic medicines, nursing homes/clinics are being run under most unhygienic conditions, patients are being treated without proper diagnostic tests, no record of treatment or diagnosis is maintained, wrong limbs, organs or teeth are being operated or extracted, operating instruments are being left inside the body, no proper receipt for the payment is given, doctors employed in government hospitals perform operations in private clinics/hospitals without making any entry in the treatment record for fear of discovery, recommendation to push a sufferer of medical negligence to a civil court is not only against the statute but is also inhuman.

It beats all logic that a doctor wants to avoid adjudication of a complaint by the consumer fora, where the Bench, in addition to a retired judge with vast judicial experience, also has two dignified and mature members, drawn from society, to take a more balanced view.

The writer is a former member of the State Consumer Dispute Redressal Commission, UT, Chandigarh