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Changing scenario in Asia-Pacific
Chinese ‘assertiveness’ getting challenged
by G. Parthasarathy
China’s
new generation of leaders, including Vice-President Xi Jinping, popularly known as “Princelings,” will take charge within a year. They will inherit the mantle of ruling a country that has astounded the world by its path-breaking economic transformation. But they will also face the challenges of having to deal with reconciling the contradictions between an open economy, on the one hand, and an authoritarian and opaque political system on the other. This will happen in an era when people are increasingly yearning for democratic freedoms. The Hu Jintao era has been marked by an effort to subsume democratic aspirations by increasing resort to jingoism, reflecting what the Soviets described as “Great Han Chauvinism”. Military muscle was flexed and territorial claims on its neighbours ranging from Japan and Vietnam to the Philippines and India asserted. Will the new leadership follow this line, or will it seek to address democratic aspirations by greater openness and transparency is a question exercising the minds of governments worldwide?Just prior to the East Asia Summit on November 19, the Chinese Communist Party mouthpiece, “People’s Daily”, launched a broadside against India’s plans to bolster its defences on its eastern borders, warning that China had “precision-guided weapons” to “easily” eliminate any new forces India deploys. The article was critical of India’s expanding defence ties with China’s neighbours like Japan and Vietnam. China was, in effect, telling New Delhi that while it had the right to assist Pakistan to develop a new generation of plutonium-based nuclear weapons and guided missiles, India should not dare to develop defence ties with its neighbours like Japan and Vietnam. The Chinese diatribe against India continued even after the East Asia Summit. The official Xinhua News Agency carried an article on November 24 which commenced with a reference to “India’s jitters at the sight of China gaining prestige in Asia”. The article alluded to the 1962 border conflict when India “was beaten by the Chinese army”. It gratuitously mentioned: “Jealousy can sometimes be put in the same breath as inferiority.” Such Chinese rhetoric is not confined to India. China’s all neighbours that contest its irredentist claims of the entire South China Sea being an area of its “core interest” have experienced similar behaviour and rhetoric. Incidents in the East China Sea across disputed maritime boundaries with Japan have led to Japanese vessels being rammed by Chinese ships, followed by a ban on exports of rare earth materials by China to Japan. The Philippines has witnessed the Chinese using force to enforce maritime boundary claims, and Vietnam has periodically been subject to Chinese military force over disputed boundaries. China adopts a similar approach to issues of maritime boundaries in its dealings with South Korea and Taiwan. The Chinese now openly boast about possessing missile power to target aircraft carriers of America’s Pacific Fleet. While China insisted that it would handle the differences on its maritime boundaries with countries like Vietnam, the Philippines, Brunei and Malaysia bilaterally, India made the point in the East Asia Summit in Bali that issues involving maritime boundaries and the freedom of navigation had to be settled in conformity with the provisions of the UN Convention on the Laws of the Seas. Roughly 40 per cent of India’s trade with the United States traverses through the South China Sea. Moreover, its entire trade with Japan and South Korea traverses through the waters claimed by Beijing to be areas of its “core interest”. In these circumstances, undefined and contested maritime boundaries, where one party appears ever ready to use force, are seen as an impediment and inhibiting factor in the freedom of navigation. The East Asia Summit also saw another significant development. Despite Chinese reservations, five ASEAN member-states — Singapore, the Philippines, Brunei, Vietnam and Thailand — together with India, Australia and the US raised the issue of maritime boundaries and the freedom of navigation at the Bali Summit. Russia, Indonesia and five other members talked in general terms about maritime security. Only Myanmar and Cambodia avoided any reference to the issue. An embarrassed Premier Wen Jiabao, who was described by American participants as being “a little bit grouchy at first,” sounded conciliatory, but did not give up Chinese insistence on dealing with each neighbour separately and bilaterally. But, with the Americans deciding to participate actively in the East Asia Summit and reinforcing their security commitment in the Asia-Pacific, by agreeing to the deployment of forces in Darwin in Australia, the ASEAN states now appear satisfied that Chinese “assertiveness” will not go on unchallenged. Beijing would also have not failed to notice that the Australian decision to review and change its policies regarding the sale of uranium to India was announced during President Obama’s visit to Australia. This happened after Secretary of State Hillary Clinton coined a new term, “Indo-Pacific”, to describe the Asia-Pacific region during formal bilateral discussions with Australia. To add to China’s concerns, reflected in the Chinese media, President Obama announced that Mrs Hillary Clinton would soon visit Myanmar, regarded by the Chinese as their backyard. Myanmar’s new dispensation is showing signs of wanting to get free of China’s suffocating embrace. These developments have vindicated India’s view that Myanmar does not wish to become a Chinese client state. India quite rightly resisted American pressures at the highest level to ostracise Myanmar’s military rulers. India’s answer to the Chinese diplomatic bluster was effectively given on November 22 when its candidate for a place in the UN’s Joint Inspection Unit A. Gopinathan, India’s Permanent Representative to UN offices in Geneva, trounced his Chinese rival Zhang Yan by 106 votes to 77. Zhang Yan, currently China’s Ambassador to India, is best known for his arrogance. He recently told Indian reporters to “shut up” when they asked him questions about Chinese maps depicting the whole of Jammu and Kashmir as Pakistani territory. A Mandarin speaking friend of mine who met Zhang Yan just after he had arrived in India was shocked when the arrogant envoy remarked: “The Indian media must understand that they cannot treat China in this manner”. India is not a Chinese vassal state, forever ready to kowtow to the whims of the Middle Kingdom’s envoy, Mr Ambassador. The decision to invite the Dalai Lama to address the World Buddhist Conference in the Capital was laudable. Timing the visit to Delhi by State Councillor Dai Bingguo for talks on the border issue to coincide with this conference smacked of diplomatic ineptitude. Worse still, succumbing to Chinese pressure and cancelling the participation of the President and the Prime Minister at the conference was craven and
demeaning.
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MIDDLE |
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Slapstick
by Uttam Sengupta
A
slap on the back is not quite the same as a slap on the butt. Ask K.P.S. Gill. He would know. Distance does make a difference as far as slaps go. Like chalk and cheese, a slap on the wrist is again quite different from a slap on the face, with one standing for token punishment and the other wounded pride.If ever there is a contest though, or as and when the Indian Olympic Association decides to include slapping as a competitive sport in the national games, the Indian policeman will easily leave others behind. The practised ease with which our policemen rain slaps is ample testimony to the fact that the vicious slap has been elevated by them into an art form. Most of us can recall seeing policemen holding the victim by the scruff of his or her neck, or the long hair if she happens to have them, tilting the target to one side and then, wham, slap, bang, slam. It seems a fad had gripped the United Kingdom not very long ago. They called it ‘Happy Slapping’. It consisted of identifying an unsuspecting victim, usually a stranger, and slapping him in public. The accomplices would be close at hand to record the shock and surprise registered by the victim-visuals that the entire group would then proceed to watch and enjoy together. In the United States, students popularised what is known as ‘celebratory slapping’ or the ‘high five’. The expression now finds a mention in the Oxford Dictionary and the act involves raising your hand and slapping someone’s open palm with your own. Trust Americans to convert it into a ‘National High Five Day’ when you go around spreading cheer by ‘high-fiving’ complete strangers. In this season of slaps, I recall two memorable slaps, one of which led to an electoral defeat. A villager had the gumption to show his thumb to a Chief Minister’s convoy. Unfortunately for him, the CM, who was on his way to a public rally during an election campaign, spotted the thumb and decided to have a chat with the villager. The convoy stopped and security men dragged the offender to the CM’s presence. While the CM only wanted to know his caste, loyal and outraged ministers merrily slapped him till the police took him away and put him in the lock-up. The story, given the front page treatment by newspapers, eventually cost the CM the election. The same Chief Minister, a year later, publicly slapped a rickshaw-puller when the latter confessed that his children did not go to school. “If you don’t send them to school, I will put you behind bars,” threatened the CM after administering two tight slaps to the poor man. But when the media caught up with the rickshaw-puller a few hours later, the victim looked pleased enough. He was used to getting slapped every day, he explained. Policemen slapped him around and so did some passengers. But for the first time in his life, he exulted, he had been slapped in his own
interest.
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OPED
Health |
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Expired drugs To take or not to take
Dr Ravi K Gupta
Expiry dates on the medications and vitamins are a conservative estimate by the manufacturers to ensure quality, say some studies. In many instances, medicines past their expiry date are safe but may not be as effective or potent
 Should
we discard all medicines from our home medicine kit that have passed their expiry date and replace them?If someone is administered an expired medicine, is he/ she going to suffer a serious side effect? If someone is having a sudden and severe neck or back pain during midnight, and the only painkiller available in the medicine kit is past its expiry date, should the patient take it or keep on suffering? Most of us may have faced these dilemmas at one time or other. But the question is that what happens to the potency and safety of the drugs that have passed their expiry dates. The website of Harvard Medical School (HMS) Family Health Guide says that the expiration dates on the medications and vitamins are a conservative estimate by the manufacturers to ensure quality. In most instances, expired medications are safe but may not be as effective or potent once past their expiry date.
FDA ruling
 Before 1979, it was not mandatory for drug manufacturers to mention the expiration date on the products. For the first time in 1979, the Food and Drug Administration (FDA), US, made it necessary under the law for all drug manufacturers to mention the date up to which the full potency and safety of the drug was certified. This resulted into the start of a new era of discarding drugs that had passed the date of expiry mentioned on their packing. Thus it caused huge losses to the bulk purchasers of the drugs, especially in government health departments and the US Army, forcing them to replace the unused expired drugs with a fresh stock.
In 1985, this loss was noticed by the US Army authorities when they were faced with the task of destroying and replacing the stockpiled expired drugs worth more than a billion dollars. This triggered the process of testing the efficacy and safety of the expired drugs. The task of testing was assigned to the FDA by the US Army. Accordingly, the FDA tested more than a hundred prescriptions and over-the-counter medications and observed that 90 per cent of the expired drugs were still safe and potent; the oldest drug tested had expired 15 years back at the time of testing. The study pointed out that the expiry date did not really indicate a point at which the medication was no longer effective or had become unsafe to use. This report was published in the Wall Street Journal (March 29, 2000), which was reported by Laurie P. Cohen. At present, there is a programme being run jointly by the Department of Defence and the FDA, US, known as “Shelf Life Extension Program” (SLEP) that is meant to defer drug replacement costs for date-sensitive stockpiles of pharmaceuticals by extending their useful life beyond the manufacturer's original date of expiry. The SLEP started in 1986 and has started providing online service since 2005.
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Dos and Don’ts
- Most outdated medications, whether prescription or over-the-counter, are usually not harmful. If the medications have been stored under good conditions, they usually retain much of their potency for at least one to two years following their expiry date, even after the container is opened.
- One should not consume any pills that have become discoloured, turned powdery, or smell bad; any liquids that appear cloudy or filmy; or any tubes of cream that are solidified or cracked.
- To help maintain potency, the medications should be stored in a closet or cabinet located in a cool and dry room.
- The medicine kit should not be stored in the bathroom where the heat and humidity from hot water showers/ steam can cause medications to break down, lose potency and, occasionally, even become harmful.
- Similarly, their storage in the kitchen next to the gas stove, washbasin or dishwasher is not advisable.
- It should be ensured that the bottles are tightly sealed after use.
- Also, the medications should not be mixed in one container because chemicals from different medications can interact to interfere with potency or cause
toxic side effects. If two or more medications have been mixed, they should be discarded.
- A few medications, like insulin and some liquid antibiotics, do degrade quickly and should never be used beyond the expiry date.
- If there are any doubts about the safety or potency of a particular expired drug, it is wise to consult a pharmacist who does not have any conflict of interest.
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Drug disposal
- Disposal of the expired drugs properly is equally important to avoid the harmful environmental effects and prevent accidental use of discarded expired drugs by the children and animals. A 1996 report of how expired medications are being disposed of found that 1.4 per cent of respondents returned medications to a pharmacy, 54 per cent disposed of medications in the garbage, 35.4 per cent flushed medications down the toilet or sink, 7.2 per cent did not dispose of medications, and 2 per cent related that they used all medications before expiration.
- Ideally, one should follow the advice and instructions for the disposal of the expired medications as rendered by the manufacturer, if they are provided with. However, if there are no such instructions, it is advisable to take out the medicines out of their containers and mix them with something like cat/ dog litter or dirty household waste to which the children and pets are not attracted to.
- Finally they should be disposed off after sealing them in plastic bags. The expired medicines should not be flushed down the toilet unless specifically instructed to do so because of the earlier reported risk of the resistant bacteria in the aeration tanks of sewage treatment plants by the antibiotic substances present. The exceptions to the rule are narcotics and controlled substances, which are often flushed to prevent unintentional use, overdose and illegal abuse.
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Shelf life
Taylor and others in a paper titled “Stability profiles of drug products extended beyond labelled expiration dates” presented the data from the Department of Defence/US Food and Drug Administration (FDA) Shelf Life Extension Programme, which tests the stability of drug products past their expiration date. The paper presented in 2002, showed that 84 per cent of 1,122 lots of 96 different drug products, stored in the military facilities in their unopened original container, were expected to remain stable for an average of 57 months after their original expiration date. Some US Army studies on Valium, for example, show that the drug is stable and completely safe and effective for up to eight years after manufacture. Tablets of ciprofloxacin, an expensive antibiotic, were found
completely safe and effective when tested nine and half years after the expiry. An issue of The Medical Letter quoted not only the above study but also of others showing expensive medications like Amantadine and Rimantadine maintaining their stability after storage for 25 years under ambient conditions and retained full anti-viral activity after boiling and holding at 65-85° C for several days. Regenthal and coauthors in 2002 observed that the drug Theophylline, in tablet form, showed 90 per cent stability even after 30 years beyond the expiry date. The Medical Letter also quoted that most drugs stored under controlled conditions retain 70 per cent to 80 per cent of their potency for one to two years after the expiration date, even after the container has been opened. But it must be noted that the current US Pharmacopoeia [USP] standard is generally 90 per cent potency. With new individual pill packaging techniques, however, it is highly likely that USP acceptable potency would be the norm over the same time period. Although in certain cases, the effects of expiration of a drug has been observed to be in the form of some loss of potency of the drug over the period of time, which can range from as little as 5 per cent of loss of potency to 50 per cent loss of potency, but many drugs are likely to have a reasonably good potency even after five to10 years of expiry. However, in the case of some antibiotics, the chemical has been reported to get transformed into a new form after the expiration date, which may be harmful. This was reported by Frimpter and others in the Journal of American Medical Association in 1963 (JAMA. 1963;184:111-113) in the case of expired tetracycline that resulted into side effect on the kidney although the observation and conclusions of the authors are being contested by some other medical scientists. In a recent article, Richard Altschuler has quoted Francis Flaherty, a former director of the testing programme of FDA saying, “expiration dates put on by manufacturers, typically have no bearing on whether a drug is usable for longer. A drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful. Manufacturers put expiration dates on for marketing, rather than scientific reasons. It’s not profitable for them to have products on a shelf for 10 years. They want turnover." Mr Altschuler has also quoted Joel Davis, who has been former FDA expiration-date compliance chief as “with a handful of exceptions - notably nitroglycerin, insulin, and some liquid antibiotics - most drugs are probably as durable as those the agency has tested for the military. Most drugs degrade very slowly. In order to maintain the potency and safety of the drugs, however, it is mandatory that these are stored in a refrigerator and not exposed to direct sunlight, heat and humidity.” Thus, it is now an undisputed fact that in the case of liquid antibiotics, nitroglycerine, insulins and the drugs meant to save life-threatening situations, one should not take the risk of taking the drugs that have crossed the expiry dates. Administration of majority of other drugs, however, beyond the date of expiry is very unlikely to result into any
serious side effects.
Safety strategies
In the light of the foregoing information, the question remains as to what should be done with the drugs that have passed the expiration dates mentioned by the drug manufacturer, especially in the case of bulk purchasers in the government sector. The US military has devised a programme of extension of shelf life of the expired drugs by getting them tested from the FDA. It may be worthwhile for the developing countries also to explore the possibility of identifying/ developing such national organisations like FDA so that if the need arises, such shelf extension programmes can be undertaken. Till the strategies of testing of such medications are developed, the individual users can check the advice rendered by the Harvard Medical School on its website: http://www.health.harvard.edu/fhg/updates/update1103a.shtml
and by Johns Hopkins on its website:
http://www.johnshopkinshealthalerts.com /alerts/prescription_drugs/
JohnsHopkinsPrescriptionDrugsHealthAlert_677-1.html
The writer is Associate Professor, Orthopaedics, Government Medical College Hospital, Chandigarh
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