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Black (money) hole!
Post-budget taxes |
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Smash MNC cartels
New trends in foreign policy
Two-wheeled impressions!
The BIG WORRY over Diagnosis
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Black (money) hole! THE Supreme Court has been going hammer and tongs against the octopus called black money but the lethal creature remains in fine fettle. There is reason for the apex court's activism. An astronomical sum of $1.7 trillion, whose enormity a common man cannot even comprehend, has been stashed away in foreign bank accounts, leaving the country in an anaemic state. While other nations like Malaysia in the neighbourhood who gained independence at almost the same time as India did gallop forward to almost join the developed world, our country has been struggling to provide even two square meals to its citizens. Whether it is health, roads or education, the country presents a sorry picture. How can things be any better when a large chunk of its wealth goes towards lining private pockets? Somehow, most of the black money trails lead to politicians. If they are themselves not minting billions, it is their proxies. This has been coming to light extraordinarily forcefully in the Hasan Ali affair. No wonder politicians only deliver speeches about cleansing the system but never walk the talk. It is a vicious cycle. A large portion of the black money is utilised to win elections. As a result, more and more undeserving people get elected and then further vitiate the system. The reputation of investigating agencies happens to be in the mud and the country figures so high on the corruption list. This politician-criminal-bureaucrat nexus has taken a stranglehold on the body politic. It is ironical because the country happens to have a Prime Minister whose personal integrity and honesty are above reproach. In his second term, he should make it a matter of honour to go after the corrupt with the same zeal that the Supreme Court is showing. Otherwise, his personal reputation can get besmirched by the numerous scandals that have erupted during his regime.
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Post-budget taxes THE Punjab Cabinet raised the purchase tax for wheat and paddy from 4 per cent to 5 per cent on Tuesday. Payable by the Food Corporation of India, the tax will fetch Rs 100 crore annually for the exchequer. The Centre pays the price ultimately and it will accordingly limit annual increases in the minimum support prices for wheat and paddy, which means farmers too will feel the heat. Farmers grow wheat and paddy and the FCI buys these, but the “farmer-friendly” state government imposes mandi taxes. This raises the cost of food for common people. In February Prime Minister Manmohan Singh had told the state chief secretaries that to tame inflation “there seems to be a strong case for abolishing mandi tax, octroi and local taxes, which impede the smooth movement of essential commodities”. The Punjab government extracts its price for giving “free power” to farmers. Experts suggest the Agricultural Produce Marketing Committees (APMC) Act should be amended to let farmers sell their produce direct to private buyers or even export. At present farmers have to sell wheat and paddy only to government agencies, which pay only the minimum support prices and not the market prices. Private firms keep off Punjab and Haryana mandis because of the high local taxes. A group of Central ministers has also favoured an amendment to the APMC Act to prevent cartels of traders from manipulating prices. It is true the cash-strapped Punjab government needs to raise revenue. But why do it after presenting a budget with no new taxes? A day after the budget on March 14 the government imposed a tax on commercial institutions and buildings coming up outside the municipal limits and having a covered area of more than 500 square feet. Then at its Tuesday meeting the Cabinet quietly cut VAT on truck and bus body fabrication from 12.5 per cent to 5 per cent, indirectly benefiting state politicians, including the Badals, running transport businesses. The questionable budgetary figures, the non-transparent slashing of the allocation for power, the post-budget tax hikes and tax concessions to the undeserving sections present a government less than honest in managing its affairs.
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Smash MNC cartels MAKING life-saving drugs available to the poor in developing countries remains a challenge. Prices tend to fall if competition is ensured among drug-manufacturing companies in the market. Quite often multinational corporations join hands to form cartels and jack up medicine prices. This is quite possible since the regulatory systems in the developing countries are often ineffective and open to influence. Therefore, Commerce Minister Anand Sharma’s comment at the CII-Exim Bank Conclave in Delhi on Monday that MNC cartels deny ordinary people an access to life-saving medicines comes as no surprise. Though the Commerce Minister referred to MNC cartels operating in poorer regions like Africa, the situation is not very different in India. Even though the drug prices are controlled by the Indian government, malpractices abound in the sector. Overcharging is common. The systemic laxity can be gauged from the fact that narcotics are easily available at chemist shops in Punjab. Identical medicines’ prices tend to vary vastly. Stents are not very expensive if bought in the open market, but when private hospitals offer these to heart patients in an emergency, they charge astronomical prices. A cleanup of the healthcare system is urgently required. The issue of providing access to life-saving drugs to the poor has been discussed at various forums, including the WHO and the WTO. Experts have suggested “differential pricing” as a solution. It means companies should charge different prices in different countries depending on the purchasing power of people. For long drug prices in countries like India had been low because domestic firms produced drugs originally made by MNCs by following a different process. The patent law was flexible. With globalization, drug MNCs are putting pressure on governments to protect their intellectual property rights. Companies which spend heavily on research and production of rare drugs need to get reasonable returns on their intellectual and financial investments. It is in this context that the idea of differential pricing has come up and is gaining wider acceptance.
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Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful. — Herman Cain
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New trends in foreign policy AFTER emerging from a situation two decades ago, when the country was bankrupt and internationally isolated following the collapse of the Soviet Union, India can derive satisfaction with what has been achieved since then. The nuclear tests of 1998 and the end of global nuclear sanctions by the Nuclear Suppliers Group have led to worldwide recognition of India as a legitimate nuclear weapons power. It is now for India to negotiate skilfully with partners like Russia, France, the US and Canada to see that the agreements on nuclear power it signs are economically advantageous and meet the highest standards of transparency and nuclear
safety. With a sustained high rate of economic growth and increasing integration with the global economy, India is now a member of the G 20 and the expanded East Asia Summit comprising the members of ASEAN together with the US, Russia, Japan, China, South Korea, Australia and New Zealand. It is closely linked to emerging economic powers like Russia, China, Brazil and South Africa through forums like BRICS and IBSA. It is only a question of time before India joins the Shanghai Cooperation Organisation, laying the grounds for a larger profile in Central Asia. But it is crucial that despite its economic progress, India has to retain its strategic autonomy if it is to be respected internationally. India’s candidature for permanent membership of the UN Security Council (UNSC) has been endorsed by all its permanent members except China, which remains distinctly obstructive. But, given the absence of consensus on the size and composition of an expanded UNSC, It is evident that there is still a long way to go before India’s ambitions on this score are fulfilled. In the meantime, there have been unambiguous suggestions from the US and even its client states like the United Kingdom, suggesting that India would be considered worthy of a permanent seat in the UNSC only if the “international community” (a euphemism for the NATO members) is satisfied with how India “behaves” with its voting on important contemporary issues as a non-permanent member of the UNSC. These are pressures India will have to be resisted and deftly deflected. Despite these Western blandishments, New Delhi appears to have shaped the broad contours of how it will deal with pressures involving typical Western double standards on “human rights” and their pet topic of “Responsibility to Protect”. One is all too aware of how NATO did not hesitate to dismember Yugoslavia in the 1990s after virtually demonising the Serbs. Force was then used to carve out and recognise Kosovo—an action mercifully not sanctified even now by a majority of the UN member-states. The UN General Assembly resolution of 2005 on the “Responsibility to Protect” has been used at the convenience of the NATO members to pressurise and seek to remove regimes alleged to be guilty of “war crimes, genocide, ethnic cleansing and crimes against humanity”. Needless to say, NATO would not dare to act on anything the Russians do in Chechnya, or against Chinese clampdowns in Xinjiang, or Tibet. Genocide in Rwanda will be long ignored because it is a poor African country with no oil or mineral resources. NATO will turn a blind eye when a Sunni minority ruling elite in Bahrain clamps down on the Shia majority in the country because the US Fifth Fleet has bases there. But if Colonel Gaddafi clamps down in oil-rich Libya he is targeted with a “no fly zone” and bombed by the virtuous British and French, with American backing. There now appears to be a clearer enunciation of Indian thinking on such issues. After consultations with like-minded emerging powers like Brazil and South Africa, India made it clear that on issues like developments in Libya, it will first seek consultations with regional groupings like the Arab League and the African Union before finalising its response. Rather than blindly following the Western lead, India would seek to forge and back a regional consensus in formulating its policies. This would mean that in developments in sub-Saharan Africa, Indian policies will take into account the prevailing views and a consensus, if any, in the African Union. On Zimbabwe, the advice of South Africa would be more important than that of Whitehall. In Myanmar, India will seek to promote and back a consensus evolved in consultation with ASEAN. The views of the GCC would be of primary importance in formulating policies on developments like the Shia-Sunni divide in Bahrain. This policy makes it clear that India is not going to be a rubber stamp for Anglo-American and NATO policies of selective use of force against the regimes considered distasteful. Over 17000 Indians living across Libya have safely returned home, thanks to commendable work by Indian Ambassador Manimekalai and her staff. Col Muammar Gaddafi knows that India is not exactly pleased by his use of air-power against his own people (as Pakistan is regularly doing in Baluchistan and in its tribal areas). India nevertheless joined hands with Russia, China, Germany and Brazil in abstaining on the March 17 Security Council resolution on Libya because of the absence of carefully considered guidelines on the use of force amidst a raging civil war, the lack of specificity on the countries and organizations undertaking the military effort and the absence of any clarity on how a political solution would be evolved to end the Libyan impasse. The fiasco in Somalia and the attempt for “regime change” in Iraq demonstrate how misguided external intervention can have disastrous consequences. India is concerned that the military intervention in Libya is going to result in a prolonged stalemate and growing radicalisation in West Asia. It will inevitably be perceived there as an attempt to partition an oil-rich Muslim country. If “gunboat diplomacy” was the hallmark of European colonial powers in the 19th century, “no fly zone” NATO diplomacy seems to be the order of the day after the Cold War. Lessons will be learned only after European powers, who have no appetite for real combat and body bags in tough places like Afghanistan, face the wrath of people opposing them, as the Americans did because of the ill-advised military interventions in Lebanon in 1983 and in Somalia in 1993. Tired and tied up in Iraq and Afghanistan, the Americans understandably appear more cautious in taking the lead in intervening in Libya. It is heartening that despite serious controversies in Parliament on issues ranging from the WikiLeaks disclosures to the 2G spectrum scam, our parliamentarians were unanimous in opposing the use of force by NATO members in
Libya.
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Two-wheeled impressions! Virtually
on the ‘pillion’ of this middle, I reserve my right not to be sued by two-wheeler producing companies, since what I shall be hiking with is just the impression created in the minds of people about the personality of the people who rode those two-wheelers before Pankaj Kapoor’s ‘Splendor’ era dawned. Remember the ad when he suggestively reconnoitres the curves of the two-wheeler; a biking experience recalled with an eye gone blind, though! Let’s go wrooming then! Call me subjectivity-possessed or self-conceited, but my father had in his youth, one of the first Jawas (later Yezdi) of the three imported, as the first consignment reaching Delhi in 1949, for ‘just’ 1700 bucks. Till it tossed out of the market, the brand was a guarantee of the owner’s ‘most eligible bachelor and a gentleman’ status. The way it was put in the first gear, with a polished and pointed shoe, could make any girl of those times swoon and drool, before opting for a marital-pillion. Royal-Enfield was real royal. In style as also in looks. The exhaust-sound of dhub-dhub-dhub-dhub announced its robust, well-meaning and dependable character. The Army and the police professionals had a near-crush on it. And they looked awesome in their uniform riding it, as if the bike was a natural part of the enforcement guys’ paraphernalia and ensemble. The bike has been known for its balance — literally. It earned a sobriquet — Bullet — for its ‘customer-killer-instinct’ Rajdoot was another brand which suited the field operators, at a slightly lower functional level of bureaucracy, business and delivery-services. In fact, being comparatively economical, this brand became a darling of the toiling classes, of whom the milkmen dominated the scene, driving with tight-hanging containers, like a moving Christmas tree. Before I move on to the scooters, a mention of the rearview mirror, on all the three brands here, is interesting to recall. Bullet had two on either side; Jawa had one on the right; and Rajdoot either didn’t have any, or one dangling on to its handle! In the scooters category, Lambretta was masculine in appearance and preference. It had two bonnet-covers on either side. Also it had two funny bicycle-like seats. Generally bank managers, advocates et al preferred them. Vespa in its later avtar of Chetak Bajaj became a sudden craze for all and sundry. It had a huge premium on it and the wait too used to be long. People in the pre-Maruti era, if they were something in their social reckoning, would invariably go for it. It was sleek and curvy and was more feminine. Women preferred it though! Priya was another name worth mentioning. I remember in my school, a boy from an affluent family had an engine mounted on his bicycle and it was other lesser mortals’ envy and the owner’s pride. Then came the moped. It was a ‘cross’ between a mobike and a bicycle. Some had chains and pedals too like you have in bicycles. Generally the clerks and babus preferred them for their fuel-efficiency and low cost. Harley Davidson and BSA were only imported, though the former, of late, has reached India. Kinetic, Scooties, Karizma, Pulsar, Enticer, Yamaha Fireblade, BMW Bikes Hayabusa, Yo Bike have still to find their own brand of buyers. But yes, many of them don’t need jhik-jhi-jhik kick-start but button-ignitions to wrooooooooooooom!
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The BIG WORRY over Diagnosis These investigations are necessary. The labs are welcome additions but their growth is haphazard, their utilisation without any definite direction or control. Let us evaluate the relevance of the investigations and these laboratories.
Need for investigations Three to four decades ago a doctor solely depended upon his clinical examination for establishing the diagnosis of the problem and its sequel. Hands, eyes, ears and nose of the doctor cannot enter the body cavities of the patient (skull, chest and abdomen). The diagnosis could not be certain and mostly used to be very late when cure was a remote possibility. In contrast to this, the present-day doctors do not examine the patient at all, of course exceptions are always there. A large number of patients complain that doctors do not get up from their cozy chairs and all they get in return for the fat consultation fees are slips for investigations. Ideally speaking, a detailed history of the patient should be followed with full systemic examination from head to toes, a provisional diagnosis made; the patient is prescribed medication and asked to undergo specific investigations. Such a systematic routine will establish the correct diagnosis, evaluate the stage of the disease and also assess the patient for his problems. A large percentage of consultants feel that 60 to 70 per cent of patients can be reasonably diagnosed and evaluated only by a good clinical examination. Every senior consultant can recall a number of cases where omission of clinical examination has led to gross errors in spite of sophisticated investigations. Just to give an example, a 70-year-old man was diagnosed to be having lung cancer on the basis of X-ray and CECT scan of the chest. He came to me for second opinion and gave history of urinary problems. His rectal examination revealed a large sized tumour of the prostate gland. The FNAC confirmed my diagnosis of cancer of the prostate and the lung lesion was metastasis. Another patient referred for urgent surgery, had CECT of the abdomen suggesting impending perforation of appendix. Rectal examination revealed constipation. Simple enema cured his problem. Advising investigations without a clinical examination is like going on a tour without having any information about either the route or the destination. Profs. V.K. Kak and S.K.Khanna, eminent surgeons, opine that all the investigations are at present advised not because they are essential but because of other reasons; and this is true to a greater extent in the private sector. It is common knowledge that specialists employed in private hospitals are coaxed to raise the hospital revenues; and prescribing unnecessary and costly investigations is an easy way to achieve this.
Evaluation Relevant sophisticated and high-tech investigations are very important but the mere presence of the facility does not help. The clinician should know what specific investigation to advise and more important is also to interpret the result because a good percentage of investigations are not reported correctly. The man behind the machine always remains more important. Health care lately has become a very attractive business venture and laboratories for various investigations are mushrooming rapidly. There is an acute shortage of competent experts to man these labs and error in their interpretation may lead to serious problems. Take for example Fine Needle Aspiration Cytology (FNAC) carried out to establish the diagnosis of breast cancer. Afalse positive interpretation will result in removal of breast and a false negative will lead to a delay in proper management of cancer. Both are serious errors. These problems are seen more frequently in investigations like CT & MRI scans, angiography, Radioactive Isotope studies etc. Ultrasound examination, done very frequently, is cent per cent performer dependent. Varying results are, therefore, common. Mammography is another example, which has come in a big way because of the increasing incidence of breast cancer all over the world. Twenty to 25 per cent of biopsies done for suspicious mammography findings are negative, a big disadvantage but presently there is no better alternative. The error is not only due to non-availability of competent specialists but because of the busy schedule also. A good CT scan of abdomen takes slices at 3 to 5 mm distance and 80 to 100 pictures need to be evaluated and in a busy lab, a specialist finds it difficult to spare that much time.
Quality It is a common experience that investigations from different labs give varying results (blood sugar levels of 102 and 140 mgs %); and even the treating doctor does not know which one to rely upon. Unfortunately in our country there is no standardisation of labs and more importantly no stiff penalties for such gross negligence. Need for good equipment, their proper maintenance, availability of quality chemicals is as much essential for reliable results as the meticulous procedures. A large number of investigations are very sensitive, requiring not only proper procedure and reliable chemicals but also proper collection and storage. A recent trend has started to get samples from all over the country through their collection centres and the tests are carried out in their central labs. Naturally one is apprehensive about their modus operandi - collection, storage and transport.
What can be done? Investigations are important and an integral part of management of a patient. These will continue to play an important role but surely one has to look into different aspects of this and all-out efforts should be made to make it more patient friendly. Kak, Khanna and Suri are not alone to feel that marketing forces are calling the shots in all fields of patient management and investigations are no exception. High-tech radiological imaging can be beneficial but must be used very sparingly and only when absolutely necessary because it exposes the body to dangerous ionizing radiation - radiation that is proven to cause cancer. MRI and ultrasound examination can be substituted for an investigation that gives ionizing radiation to the patient. The writer, a former Senior Prof. & Head of Surgery, PGI, Chandigarh, is a former President, Association of Surgeons of India
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Investigations