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Siachen dialogue |
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Quota for Jat Sikhs?
Poor boy vs power board
Flaws in development paradigm
7 Race Course Road
Drug reaction
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Siachen dialogue
The
two-day India-Pakistan talks on the Siachen issue in Rawalpindi concluded on Tuesday without any outcome. This is what was expected when both sides were giving hints of sticking to their stated positions. Defence Minister AK Antony had made it clear last week that “no dramatic announcement” should be expected as Pakistan was showing no sign of agreeing to India’s logical viewpoint that demilitarisation of the glacier was possible only when both countries’ troop positions on the Actual Ground Position Line were recorded and properly delineated on the ground as well as on the map. This is aimed at ensuring that Pakistani troops are not able to recapture the heights vacated by India. This is, however, not acceptable to Pakistan. It may reflect its real intentions. Yet one should not lose hope for a breakthrough at some later stage as both sides have agreed to continue the Siachen dialogue. Pakistan will have to provide proof that it is really serious about troop withdrawal from the glacier area as stated by its army chief, Gen Ashfaq Kayani. Shaken by the Gyari avalanche disaster on April 7 resulting in the killing of 140 persons, including 129 Pakistani soldiers, the top Pakistani General said: “We want this issue to be resolved and it should happen. It is a tough mission for us and them, which has its costs.” India, too, has been supportive of demilitarisation of the Siachen area but only after ensuring that Pakistan is never able to repeat its 1999 adventure. Pakistan’s problem is that it says something and does something else. It is faced with a serious financial crisis with US aid having been linked to its performance on the anti-terrorism front. China is not prepared to bail it out the way Pakistan wants it. Pakistan’s economy today survives mostly on aid from rich Arab countries like Saudi Arabia, but that is not enough. For Islamabad, therefore, there is no logic in maintaining its troop presence on the Siachen heights. Actually, demilitarisation of the glacier area is in the interest of development in both countries. The opportunity that has come with the realisation of this hard reality in Pakistan must be used to change the character of Siachen from the highest battlefield in the world to a glacier of peace.
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Quota for Jat Sikhs?
Though
Jats in Haryana and Rajasthan have held noisy protests to demand reservations in Central government jobs and educational institutions, Punjab Jat Sikhs have not yet even given a serious thought to the issue. Engaged largely in agriculture but perturbed at declining incomes, they focus more on farmers’ issues to improve their lot. Some may even take offence at being clubbed with “other backward classes”. They take pride in calling themselves progressive and forward looking. A Congress delegation, including Haryana Chief Minister Bhupinder Singh Hooda and Leader of Opposition in Punjab Sunil Jakhar, met Union Home Minister P. Chidambaram on Tuesday to take up the demands of this socially and culturally disparate group. A well-meaning Sunil Jakhar stressed that if the Jats were included in the OBC quota, then Jat Sikhs of Punjab should not be left out. It is true many Jats occupy top posts in Central and state services. Most of the present and previous chief ministers of Punjab and Haryana are Jats. It may, therefore, be hard for non-Jats to swallow that the members of the socially and economically dominating community should be dubbed “backward” and given concessions meant for the poor. The Jat demand for quota is rooted in economic backwardness. In recent years incomes have not matched expectations. The Jats are socially dominant but a large majority of those who depend entirely on agriculture have got left behind. Those who excelled in education, acquired right skills, moved to cities for work and took up small businesses or jobs have improved their lifestyles. To keep up with rising living standards around them, farmers take costly loans, buy vehicles they can do without and perform lavish social ceremonies, which all ultimately ruin them. In reservations they see a chance to catch up with others. The uneven spread of fruits of growth has raised social tensions and the Jat agitation is an obvious manifestation. The government should address the root cause, which is low agricultural productivity and growth. In any case, only the economic status of a community should be the basis for reservation.
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Poor boy vs power board
The
picture of the 10-year-old boy standing helplessly with no arms on his shoulders would move anyone. But not the Himachal Pradesh State Electricity Board, which is squarely responsible for maiming the Chamba boy for life. As it turns out, he is not the only one who has suffered grievous injury from power lines hanging low or loose. There are dozens currently living in the state, including linemen of the board, who will tell tales of lives ruined from electrocution because of absolute disregard to basic safety norms by the authorities. That it is not just carelessness but callousness on the part of the system becomes apparent from the fact that there is no policy in place for paying compensation to victims of such “accidents”. The payment of the ridiculous Rs 5,000 to the Chamba boy as relief is the result of that. The board authorities, the state government, and even the local elected representatives have failed to realise the gravity of the harm caused, and that they are all collectively responsible for it. An inquiry into the particular incident that happened in March is still on, which means no one has thus far been specifically held responsible. While it is not the “culture” to sack officials in such cases, a beginning has to be made. All field officers have to be made responsible for public safety in their areas, and the board itself has to ensure that funds for the purpose are available. Safety not being a priority per se is an issue in our society. We do not think twice before pushing loose wires into a socket without a plug. Power cables hanging low over roads and residential areas is a common sight anywhere. In Himachal, it is estimated that 2,000 additional poles are required to push up such cables. Compared to the total cost of power distribution, the cost of these poles would be insignificant, yet the board is unable to provide for it. This is a question of priorities. It just shows how cheaply we treat life, especially if it is someone in a poor or remote area, as in the case of Himachal.
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The awareness of our own strength makes us modest. — Paul Cezanne
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Flaws in development paradigm According
to the 66th round of the National Sample Survey carried out between July 2009 and June 2010, 66 per cent of India’s rural population lives on less than Rs 35 a day and nearly as many in cities on Rs 66 a day. The survey also points out that 10 per cent of the population at the bottom in the rural areas lives on Rs 15 a day, while in urban areas the figure is only a shade better at Rs 20 a day. “It may disappoint foreign companies eying India as a large market buoyed by a growing spending power”, as aptly put editorially in The Tribune (May 5). The Government of India appointed a Commission on Unorganised Enterprises under the Chairmanship of Dr Arjun
Sengupta. The unorganised sector, including agriculture and other sundry occupations providing livelihood to a large segment of the Indian population, covers 93 per cent of our workforce. The report of this commission states that 77 per cent of the Indian population lives with a per capita consumption of up to Rs 20 (in 2004-05). Since then the situation has not undergone a radical change. Elementary education and basic health services are two sectors which play a crucial role in the country’s productive potential. If the workforce is reasonably literate and fairly healthy, it contributes immensely to the country’s development. All those countries in the world which have made rapid strides in the field of development made immense investment in these two sectors in the early stages of growth. This is true of the advanced capitalist countries as well. In India, these two sectors unfortunately remain largely ignored. The government school education system is in a shambles, paving way for the private sector to enter into the field to mint money. Now private schools, euphemistically known as “public”, can be seen even in villages. The government schools, in fact, have become a dumping ground for the children of the weaker sections — freebies like midday meals, scholarships, free textbooks, etc, being the major attraction. According to a study conducted by the Programme for International Students Assessment, among 74 countries, Indian students rank second to the last, at the 73rd position, just above Kyrgyzstan. The fate of the recent decision under the RTE Act making it compulsory for private schools, except those run by minority communities, to admit 25 per cent students from the weaker sections, is beset with many problems. The only solution is to evolve a universal school system where children of the different strata of society study together. Government spending on health is below 1 per cent of the GDP, among the lowest in the world. Service delivery in government-run medical institutions is poor. A World Bank study found that half the treatments suggested by government doctors in India were likely to make the condition of patients worse, not better. This has led to the mushrooming of private clinics and hospitals in urban
centres, and quacks in villages. There are five star super-speciality private hospitals in big cities with latest gadgets and medical experts. Only the super-rich can afford to avail themselves of their services. They are business ventures and a patient is treated more of a client than a human being in need of alleviation of his suffering. Human touch is missing. One major cause for the veritable collapse of the educational and medical systems in the government sector is their bureaucratic management. The stakeholders have no say in running these institutions. Is it humanly possible, say in Haryana, to manage over 7000 schools and about a lakh of teachers by two bureaucrats sitting in Chandigarh? The same is true of the medical institutions. In some states the situation has improved where local committees of stakeholders have an important say in running these institutions. South Korea and China have succeeded in flooding the world market with goods the manufacturing of which requires no great university training. This has become possible with the help of widespread and efficient elementary education and basic health services. In contrast, even if India were to take over the bulk of the world’s computer software industry, this would still leave its poor, illiterate masses largely untouched, as rightly stressed by Amartya Sen and Jean
Dreze. Another major flaw in the Indian development paradigm is the serious social imbalance it is causing in society. India tops the list of dollar billionaires in Asia and is among the top five in the world. Fifty Indians were on the Forbes list of billionaires in 2011, making up over 20 per cent of the GDP. One study estimates that now 10 per cent of Indians own 53 per cent of the country’s wealth, while the poorest 10 per cent own only 0.2 per cent. The most glaring instance is the 27-storeyed mansion built by an industrial magnate by spending Rs 8000 crore with eight lifts, three helipads, a hanging garden and a battery of servants to house a five-member family in Mumbai while almost half of its population lives in jhoparpattis or on footpath. According to the International Food Policy Research Institute, 21 per cent of the Indian population is undernourished, nearly 44 per cent of its under-five children underweight and 7 per cent of them dying before they reach five years of age. India’s rank in the 2011 Global Hunger Index at 61 out of 81, places us seven notches below Rwanda. We are also below Sri Lanka, Nepal and Pakistan. Employment in the formal sector has remained virtually stagnant from 26.7 million in 1981 to 27 million in 2006 — a phenomenon of jobless growth. Now in the wake of economic meltdown in the world, India is faced with a steep fall in the value of the rupee and a steady decline in GDP growth. Economic imbalances beyond a point are bound to generate violent conflicts at the political plane and a variety of crimes in the social field. The problem has been further compounded by a series of mega scams which shows that the greed of a large section of our ruling elite has become a bottomless pit. A polity devoid of ethical norms tends to degenerate into a monstrous entity. No system can survive with the help of force alone once it starts losing legitimacy and ideological hegemony in society. The present socio-political scenario is causing a great strain on Indian democracy which must be saved and strengthened as it provides its citizens numerous rights for which a lot of blood has been shed in the Arab World and elsewhere. The least the Indian democracy needs today is a strong civil society comprising professional associations, unions, NGOs, a vigilant media, pressure groups and public-spirited individuals. Various progressive measures like the RTI Act, the
NAREGA, the Forest Act and the RTE Act are the outcome of the pressure exercised by civil society. The process needs to be further
strengthened.
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7 Race Course Road Sachin
Tendulkar, now an MP, having refused to have a bungalow in the Capital, prompts me to go down memory lane to revive and share my past association with Prime Minister Manmohan Singh’s official residence in New Delhi. It was then not as fortified and inaccessible as it is today, thanks to the increased security concerns now. I spent some time during my student days with my uncle, who stayed just about a couple of hundred yards from that place in the late sixties. Of course, then it wasn’t the PM’s house, but some Cabinet minister, probably Mr Pranab Mukherjee, stayed there. There was an avenue of huge tamarind trees, in a row in front of the lined bungalows. The back-street called Teen Murti Lane had more jamun trees and citrus plants with big green-khattas to grow on them. And while on our way to school, we had some of the fruity delicacies stone-dropped straight from their clinging. No security guy at the gates ever stopped us in our pre-school and after-school sporty activity. The drain that divided our flats and 7 Race Course Road led up to Teen Murti Bhawan, where Pandit Jawaharlal Nehru lived till his death. Close by was the Bal Bharti School on the embankment of the nullah. This place came alive in the evenings with small-time vegetable vendors, who spread their stuff in the light of the improvised kerosene wick-lamps. They’d be seen running for cover, leaving their stuff behind but collecting cash from under the sack-seat in the event of a raid by the municipality staff. Even if someone mischievously shouted, “Arre, committee wale aa gaye!”, there was a big commotion. Even the customers knew that they would return when the committee squad had left the place, but none walked away with even a single onion lying unattended. The famous Gymkhana Club was nearby, and we could often see players inside having their lawn tennis sessions. The Race Course was opposite the club where the jockeys were seen walking the horses in circular pathways. The Polo Ground too was close by, tucked between the Air Force Station and Safdar Jung Airport. We could see engineless gliders hovering in the sky. These gliders were pulled on the runway by a jeep and when they gained enough height, the rope was unhooked. It was a delight to see these activities then and at a stone-throw distance from 7 Race Course Road. There was a cinema house by the name ‘Race Course’ and you would have to really take part in a race to get tickets if a popular movie was on. I saw ‘Haqeekat’, ‘Upkar’, ‘Ankhen’ and ‘Gun for the Sabestian’. The hutments there had one Bhaiya Ram whose grocery was the most popular shop in the area. Delhi Transport Corporation buses, mostly of red colour, had their stop right in front of 7 Race Course Road. Bus numbers 9 and 14, I vividly remember, plied between Moti Bagh and Kingsway Camp via the flower-pot hanging boulevard in Darya Ganj, close to the Lal Quila. And yes, the exact spot where they had a DTC stop was called Race Course. Via this route those who went to their offices on bicycles were the ‘babus’, living in places like Sarojini Nagar, Vinay Nagar and Moti Bagh. Their offices were located in Bhawans on either side of Raj Path. Having spent a part of my childhood in the vicinity of the hallowed place, I visited Race Course Road again in the early eighties when Nargis Dutt and Devi Lal lived in the bungalows at the back on Teen Murti Lane. But today, like the security scenario, even the visibility of the address — 7 Race Course Road — has
changed.
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Drug reaction India
represents a powerful force in the international pharmaceutical market having one lakh formulations of around 1,100 basic drugs in the market. To avoid this hazard, last year the Planning Commission of India had set up a working group to review the drug regulatory mechanism in the country. One of the main tasks of this panel was to have a strategy in place so as to weed out irrational drug combinations from the Indian market. Most such irrational drug combinations are sold casually, with or without prescription. Often such drug combinations are prescribed by doctors, or are freely available over the counter inducing self medication and causing danger to public health and safety. The pharmaceutical industry, at least in India, has yet to introduce its innovative new molecules of drugs in the market. Nevertheless, most companies manufacture many so-called novel products, which are just combinations of two or more drugs in the existing drugs’ list. The focus is not on actual research, but to fill their coffers by combining together existing drugs and selling these as panacea. The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community. These broad guidelines were given by experts at a conference of on the rational use of drugs, convened by the World Health Organisation (WHO) in Nairobi in 1985. Formulations containing two or more drugs in combination in a fixed ratio are called fixed-dose combinations
(FDCs). Drugs having the same effect of action are known as homergic drugs while two drugs are said to be heterergic if these do not cause response of the same quality. Homergic drug combinations have advantages of reduced dose and increase in therapeutic actions (e.g. Sulfamethoxazole plus
Trimethoprim) while heterergic drug combinations have advantages of decreased untoward reaction (e.g. Furosemide plus
Spironolactone), prolonged duration of action (e.g. Probenecid plus Penicillin), decreased resistance (Amoxicillin plus Clavulinic acid) or decreased metabolism (e.g. Levodopa plus
Cabridopa). FDCs can be both rational as well as irrational. The 16th essential medicines list of the WHO has 351 essential medicines, including 26
FDCs. The national list of essential medicines of India has 354 essential drugs, including 14 drug combinations. Despite this information and concern over increasing drug resistance, more than 70 dangerous FDCs are being sold in India under more than 1000 brand names; some of them are categorised here.
Problems with irrational
fdcs
Unfortunately, the Indian population is exposed to many such combinations of drugs which are irrational and uncalled for. Many pain killers are combined together, violating the principles of pharmacology. For instance, the controversial drug
Nimesulide, banned in several countries due to its adverse effects on liver, is freely available over the counter in India as fixed-dose combination
(FDC) with Paracetamol. Efficacy gain with such combination is unlikely, rather both drugs are
hepatotoxic. There could be synergistic escalation of side-effects, which could be detrimental to the patient both medically and financially. Similarly, Diclofenac and Tramadol
(non-opioid analgesic) are combined with Paracetamol, another irrational combination. Another commonly prescribed FDC in diarrhoea is that of quinolones and nitoimidazoles (e.g. Norfloxacin with
Tinidazole, Ciprofloxacin with Tinidazole, Ofloxacin with Ornidazole). It is a combination of an
anti-biotics with anti-parasitic, and is overused, abused and misused in
diarrhoea, gastro-intestinal infections, pelvic inflammatory diseases and gum infections. Injudicious use of such combinations can cause drug or antibiotic resistance. A study published in the Indian Journal of Medical Ethics, carried out on 2,163 physician prescriptions for
diarrhoea, found that 59 per cent of prescriptions were for FDCs, which is unethical and may expose a patient to higher risks of adverse drug reactions and resistance. Many times, patients self medicate. For example, for anaemic patients, ferrous salt of iron is considered better than ferric salt due to its better absorption. But still many patients prefer or are prescribed costlier iron syrups which contain ferric
salts. Omeprazole/Pentaprazole/Ranitidine is prescribed for gastritis. Combination of these agents with anti-nausea drugs like Domeperidone is used as first line-drug for gastric reflux where a single drug might suffice. On February 10, 2011, the Ministry of Health and Family Welfare banned the sale and distribution of a cold-and-cough drug Phenylpropanolamine due to serious adverse effects like stroke and rise in blood pressure. Despite the ban, FDCs containing this banned drug are freely prescribed and available over the counter. Similarly, the Drug Controller-General of India
(DCGI) has issued banned notifications on many FDCs, like Analgin plus
Pitofenone, vitamins B1 plus B6 plus B12, Cyproheptadine plus Lysine, etc but manufacturers are yet to pay any heed to such notifications. Many FDCs have been popularised by pharmaceutical companies and are flourishing rampantly violating the WHO-approved list of 26 rational drug combinations. Such irrational combinations need to be tackled by appropriate authorities in judicious manner
Combinations under scanner
An expert committee was constituted, three years before by the DCGI to scrutinise 294 drug combinations. Out of 294 drug combinations, 200 combinations of drugs lack clarity on their status. Most irrational drugs have formulations not found in the list of approved drugs of any developed nation.
Drug &
Cosmetic Act 1940
When two or more drugs are combined for the first time, the product is treated as a new drug and like for every new formulation, manufacturers have to generate efficacy and safety data before seeking approval from the
DCGI. But rules are flouted with impunity. As mentioned above 294 such drug combinations lack the DCGI approval but the state drug controllers have cleared these drugs even when they do not have legal power to do so. Drug combinations have to be supported by randomised trials to prove that drugs in combination are more efficacious than single drug.
Measures to promote the rational use of drugs
Comprehensive efforts are needed to curb this increasing menace of irrational
FDCs. This would help tackle the issue of increasing drug resistance. Drug regulatory bodies (national as well as local), physicians and consumers, all need to cooperate to achieve this target.
Dr Gautam is Professor, Department of Pharmacology, and
Dr Aulakh is Assistant Professor, Department of Paediatrics, Government Medcial College & Hospital, Chandigarh
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Rational fixed-dose combinations in the essential drugs list of WHO Benzoic acid + Salicylic acid Trimethoprim + Sulfamethoxazole Ethinylestradiol + Levonorgestrel Isoniazid + Rifampicin (W) Amoxycillin + Clavulanic acid (W) Efavirenz + Emtricitabine + tenofovir (W) Imipenem + Cilastatin (W) Isoniazid + Rifampicin + Pyrazinamide (W) Lamivudine + Abacavir (W) Lopinavir + Ritonavir (W) Zidovudine + Lamivudine + Nevirapine (W) Mifepristone + Misoprostol Medroxyprogesterone acetate + Estradiol cypionate (W) Lamivudine + Zidovudine + Abacavir (W) Lamivudine + Zidovudine Isoniazid + Ethambutol (W) Ethinylestradiol + Norethisterone Artemether + Lumefantrine (W) Ferrous salt + Folic acid (W) Neomycin + Bacitracin Pyrimethamine + Sulfadoxine Carbidopa + Levodopa Rational fixed dose combinations in national essential drug list (in addition to the
who list) Isoniazid + Thiacetazone Acriflavin + Glycerine Lamivudine + Nevirapine + Stavudine Aluminium hydroxide + Magnesium hydroxide
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Banned fixed-dose combinations
Penicillin and sulfonamides. Cyproheptadine with lysine or peptone. Loperamide with furazolidone. Vitamins and analgesics Trimethoprim with nitrofurantoin. Anti-diarrhoeals with electrolytes. Haloperidol with any anti-cholinergic agent. Phenylbutazone with any other drug. Phenobarbitone with hyoscine.
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Despite this forceful presence, India hardly has a proper drug regulatory mechanism in place which can keep a check on the sale of various drugs in the market or their usage, whether as over-the counter (OTC) medicines or as prescribed by doctors.
Atropine/scopolamine in analgesics and antipyretics.