Healers or Predators? Healthcare Corruption in India

Healers or Predators? Healthcare Corruption in India



[Applause] [Applause] [Applause] [Applause] [Applause] good evening we we have a record of starting on time and we didn't want to deviate too much today so welcome to this program on healers or Predators healthcare corruption in India organized by the Hindu Center for politics and public policy we are waiting for one of our main speakers he his flight was delayed a flight from Delhi but he's very close by and should be here any minute dr. Sharma on Monday we have this panel discussion addresses a subject and a set of general as well as specific issues that are of critical importance there are vital importance to the people of our country and to India as a society as a political economy and as a self-proclaimed welfare state whose Constitution makes the improvement of public health among other goals caught a primary duty of the state I repeat the improvement of public health is a primary duty of the state this discussion organized by our Center arises out of the work done by more than 50 contributors to this well-researched splendid if depressing book to court from a Marquis of sense forward it was published recently by Oxford University Press New Delhi it's an authoritative and revealing collection of 41 essays or chapters drawing from research as well as reflection based on practice there's a very helpful introduction by the three editors of this work of many hands this book is the book is organized into eight sections by broad themes one background to corruption in practice three morals politics legal issues and consequences for we are not alone we are not alone they comprise four chapters global medical corruption and healthcare corruption in Bangladesh Sri Lanka and Pakistan just somewhat comforting I suppose five governance and health healthcare corruption six personal views seven major scandals and eight beacons of Hope and there's a very short conclusion offered by the three editors of the book now the contributors include a substantial number of medical practitioners including distinguished physicians and surgeons who are represented here teachers and researchers including journalists the main title healers or Predators captures the heart of the book the secondary title healthcare corruption in India suggests a large part of the diagnosis and when you finished the book all its 657 pages you will find the rhetorical question fully vindicated amartya sen states in his foreword that quote the lack of public discussion and exposure of the nature and extent of the debasement of health care corruption indian health care is a major cause of the persistence of the terrible deficiencies I agree with him that he loves or predators will significantly help to remedy this deadly neglect although some of our panelists may have questions about that a panel comprises four distinguished contributors to the book each one of them can speak from decades of experience in the field there dr. Shah Mira Nandi emeritus consultant Ganga the Gangaram hospital New Delhi a well known and well published surgeon who's waited it should be here any minute Keshav desi raju former union health secretary dr. MK money a pioneer in the study and treatment of diseases of the kidney and Akhter george thomas an orthopedic surgeon who worked for 25 years in the indian railways and now works at saint Isabel's chennai the first two that is docked that there he is welcome dr. Nandi no no you are on time consider it please come up I was providing some background which you can read so I won't repeat it the dr. Nandi and mr. deci Raju or editors are two or two or the three editors of this book the other editor being dr. Sanjay Nagar all who was invited but couldn't make it to this event dr. money has contributed a chapter title corruption in everyday medical practice and dr. Thomas a chapter title the consequences of corruption in health care the organization of this discussion will be as follows each panelist will make opening remarks for about eight minutes I was going to say seven but after a mild protest we've added one minute eight minutes each opening in a box that will be followed by my moderators questions to them and finally the panelists will take questions from the audience and may also make brief concluding remarks and we hope to conclude by 8 p.m. although we are slightly flexible we have this hall for a little longer now I'll just have a brief word with mr. deshee Raju to see whether he or dr. Nandi will open this discussion already he's eager to open dealings I'm very pleased to see so many people here ok and listening about healthcare corruption I must say it's a subject which is quite close to me because I am probably part of a long lost generation of Indians who were born into privileged families and who had education in the best schools and the best university in the world but we had because I think of Nehru a very strong patriotic zeal to come back and help India become a great nation and so after many years in England and America I tried to get a job in India and the chairman of surgery at the All India Institute came and he was fated regally and he said that he it'll give me a job needless to say there was no job the second time there was an advertisement my wife who was doing a PhD on an important subject like you know the change of family structure in west bengal at the turn of the century and she saw an advertisement that he told me and I was at Massachusetts General Hospital Harvard Medical School to apply i applied when i came i realized i came to see what india was like in fact and i stayed with a friend of mine who was press secretary to mrs. Indira Gandhi and he said have you come for the interview I hadn't got the I hadn't got message to come and when I came down the next morning he said the interviews the next day and he was ringing up every single person on the selection committee and he said a friend of mine has applied for this job and I am press secretary to mrs. Indira Gandhi and I would be grateful to see that justice is done to him so I duly got the job I said I don't want the job under these circumstances he said you never get the job unless you have to accept this so I started on the wrong foot I joined the All India Institute as an assistant professor we got my wife was a very strong patriotic person and we got 900 rupees a month we stayed in a very small flat of 700 square feet with an Indian style lavatory which took three months to change because of bureaucracy but I loved the job it was very interesting the patients were poor very interesting problems they had and they were inordinately grateful for little things you did for them there was of course a background of corruption the corruption was manifest as doctors running after politicians going to their houses and the one person who was on the selection committee told me who's my patient that 70 percent of the faculty used to come to his house to ask him for favors canvassing for promotion and really I thought well this is India I like the job and I don't want to give up and needless to say I didn't get promoted anyway I started I stuck at the system professor for 12 years what really key gradually gradually I crept up the ladder and I really loved the work in the old Indian stitute but what brought light into my life was an article by dr. David burger in who worked in the Himalayas in Londo and he said that corruption pervades Indian healthcare he said that while he was writing a prescription for an ECG a yawn you know doctor said I'll do it why because he will get a kickback from the ECG person and he said that this is a terrible thing and something should be done about it and I think that I wrote an editorial in our journal called current bets and research in practice this was taken out by the British Medical Journal and we dr. kamran Abbasi who was the deputy editor of the British Medical Journal and ether gen from Bombay and I wrote an editorial about corruption in Indian healthcare this was taken up by all the newspapers and the Health Minister said it is true that this corruption and Indian Health Care the mci is a den of vipers we should get rid of it and now the whole thing has snowballed into a big issue Oxford University Press then said why don't you edit a book on corruption and since I didn't know enough about healthcare I asked my friend case of desi Raju who had been an outstanding health secretary and a straightforward health secretary to join and Sanjay Darul from Bombay and we asked a large number of people and I don't think anyone refused we wanted to put corruption in health care in a kind of icky academic background as well as have personal stories and in the end we said that we should not end by being pessimistic we should also highlight what has been great in this country and I think that there are many institutions like the Banyan Christian Medical College below the water all these places have been outstanding beacons of hope and not only that I think that in the middle of healthcare corruption we have produced some great doctors of course they've been other people will say differently but I think in my experience the great per people I remember dr. akibo CEO of Calcutta dr. na John Tia of Mumbai and of course dr. PK city of Jaipur of the Jaipur foot I am really very pleased and grateful to the Hindu and mr. Raum for hosting this occasion because I think that the Hindu is one of the or the only newspaper in India that I admire and I read nearly from cover to cover every day thank you very much for coming thank you thank you everyone for coming to this evenings function I just like to say a little bit about the context dr. Nandi has explained that the idea for this book really came from a lived experience of corruption as it were at various levels but there are a couple of points which I would just like to flag now our book is called healers or predators and it somehow gives the impression that it is only doctors were responsible for corruption now this is not at all the case the fact is that the the public health ecosystem is it worse doctors do make up any very very important and essential component of that but it also includes health policy makers it includes regulators such as the drug Controller General of India or the Medical Council of India the Nursing Council of India it includes a range of miscellaneous providers without whom the health system itself would not function and very importantly it also includes the public in the sense that these are the public in the sense that this is screaming at me if I go any closer to it the public in the sense that is their expectations that is very important what is it that people want and is our system delivering what people want so I would not like this impression to say that it is actually there the whole problem is with doctors and settle the problem of corruption in the in the doctor establishment and you've done what needs to be done not at all health regulation on health policy making also very crucial and it is corruption in those sectors and we do have we do with the discussion on behalf on for instance is a very fine example of detailing of what happens when the entire system from within begins to rot several pieces pick up on the Medical Council and what the Medical Council is not done and all of you would know there has been a very recent development in the history of the Medical Council because yet again it has been suspended and we now have to wait and watch to see where this suspension is going to lead so that is one set of issues the others are the other point of flag is and this point has come up in earlier discussions around this book that well why are you only talking to doctors me it's not as though we're the only people in India who are corrupt this is of course true if you begin to go into the area of higher education if you go into school education if you know any sector you go into you will find any area where there is government expenditure you will find instances of reckless corruption even so we are not gonna be an audit or making the case that this that the Medical set of the healthcare sector is somehow uniquely susceptible to corruption or at all it's a sector that between us we felt we knew a little about and could therefore address more comprehensively the third set of issues which I do believe we should talk about which I think the book pushes us towards is so what happens because there many of the pieces in this book people speak from experience people have been actually extremely forthright even courageous in actually saying what happens and the kind of experiences they've been through and the way in which corruption and real life takes place in this sector so the question is where do we go we can't just keep bemoaning the fact that there is widespread corruption where and how is this correction is this corruption to be to be stemmed and this is where I do believe health policy makers need to need need to play we need to actually think about it we hear a great deal these days from health policy makers about irishman pirates now I have no problems arise man Barrett it's a fairly well it's a fairly well conceived program but there are a very large number of unanswered questions and the way in which it has been structured Iceland borrowed that is there's nothing towards addressing the specific points at which corruption has been known to occur we have basically we we still have a system where everything depends on a limited number of people providing a scarce resource which is health care all the corruption that we see in health care comes from the fact that a limited number of people need to provide essential service to a very vast population and as long as this imbalance continues that we can that that situation will continue to the corruption situation will continue and Iceland baratie the way it is currently structured does nothing to redress the imbalance between a limited number of providers and the very large number of people who may need the service that they're providing and absolutely one last point I want to make which is again that in discussing the question of healthcare corruption we have to face I mean the one big question we have to address is is corruption more in the private healthcare sector or in the public healthcare sector there is no dispute the corruption exists in both sectors but where is it more and where is it more likely to be damaging is a question there's no easy answer to this one we are all familiar with instances in both the private and the public sector in healthcare and I think this is this question is going to be with us for some time we need to find ways that address because there are different factors that cause the corruption in the public in the private sectors and how best do we go about addressing actually ROM I don't mean to speak to that chapter how many other things I would like to speak about I have perhaps position of Vantage over here because at a glance I think I am the second oldest person in the room I'm aware of one person who is older than I am and what I would like to say that none of you could have reached your present age without having come into contact with the medical profession in some way or the other so what we're mentioning in this book is something that you would have come across anyhow you would be I would have met it somewhere or the other it's only put together and documented over here for you a couple of points that we should establish it's not our idea that we should give you the impression that except for the contributors to this book all the other doctors in the country are corrupt that's not true they have a large number of people who are doing an excellent job and working extremely hard on that the second point I'd like to say is which has already been mentioned his corruption does not exist only on our side a significant amount of the corruption comes from you and I find that many people are quite ready to go on and criticize the medical profession but they want certificates which may not be entirely true and they want insurance which very often most people in this country fall ill get an illness which requires a lot of expenditure then bluff the date on which they got the illness they take an insurance policy they come to the doctor and say now I got it from so many years ago but on your notes please make sure that I got it only two months ago and that's a very common thing I can tell you as a practicing doctor it is routinely done how are we going to rectify this that the major problem it's easy to point out the defects I don't know how we're going to rectify it and I'm rather pessimistic about all that we would like to do obviously you need a strong and straight regulator the Medical Council of India which was supposed to look after all that is actually a cesspool and I don't know what is going to come of the of the desire to or the intentions talked about of reforming all that basically we are other people who respect rules or laws you just have to think of all the V posters the placards which we have on the pavements the last two days there are rules which say you should not do it but what's the rule for just go down the road and see how many of the motorcyclists are very helmets most of the IC today I saw quite a few people who have a helmet but it is on the petrol tank so I presume the petrol tank of the motorbike will be well protected and is not going to have any problems I thought that the way that we should make a beginning is that we have to look after health care for the poor the rich somehow or the other will manage and they may be able to also take remedial action if they find somebody who is very corrupt dealing with them we must strengthen the public hospitals when I was a student and I admit that that was prehistoric days many of you may not be aware of those in those days the place to go when you were seriously ill was the government hospital you may go to a nursing home to have minor surgery and the comfortable conditions but if you had something seriously wrong you went to the government hospital government has abdicated its responsibility to maintain a center of excellence for looking after the care of people maybe the All India Institute is an exception it is why regarded as one of the best hospitals in the country but I can tell you definitely that at least as far as this state is concerned the government hospitals are no longer the leaders I don't find any sense in these government insurance schemes which are very good what caching schemes Andhra Pradesh started it all the southern states have taken it up now the central government has also taken it up so what are we going to do spend government money which will go to the private sector the private sector has enough money on its own there is no necessity for government money to be spent going to the private sector I don't understand why the money the government spends on the insurance cannot just be spent on improving the facilities in the government hospitals don't have this kind of an insurance system at all in my days people with an income below a certain level were treated free at the government hospital if their income was a little higher they were charged a little bit not too much if you are really wealthy you into the upper class wards and you paid a lot for the treatment over there what I feel is that the only way we can improve the government hospitals is if we insist that all those who get paid by government for their health care should get that health care at the government hospital and nowhere else everybody has the right everyone has a right to go to the doctor whom he chooses and to go to the hospital that he chooses but he should pay for it if he goes and this I apply particularly to the senior government officers and the ministers why should they get government money being spent at a private hospital for their care years ago I had a fairly famous government person who consulted me and the first thing I asked him is why are you coming to me I am at a private hospital you run a hospital yourself why don't go to that hospital and he told me other than a lie linger so I said why is that not good you're running it make it good and the only way that will get good is if you people all go there you all go to the private sector you don't bother about what is happening in the government hospital when I was a junior doctor but the aslam had a fracture he came to the government hospital but was chief minister of thumb are not at that time he had a fracture he came to the government hospital we had a lift which had not worked for one year and he got admitted in a ward which meant that the convenient way of going up was taking that lift overnight that lift worked this is what will happen if all ministers and all government servants go only to the government hospitals for three and that is what I think we should try to insist on I don't see how we are going to get people to do that it's a very ambitious idea but somehow or the other if we can exert pressure to see that at least for that government hospital should come up people and the only way that will come is if we can make sure that if these people go to any place other than the government hospital they should pay for it themselves and that is the way that I think hospitals will improve the only way we can get it is by public pressure all of you should exert that pressure on your leaders and your rulers to see that this is the thing that they should do the government hospital must improve and it can improve only if they go there and see what is actually happening over there not just go on an inspection when I was an assistant physician we used to be told we had 18 beds in the ward 50 odd patients lying on the floor and we used to be told health ministers inspecting tomorrow discharge all the patients so when the Health Minister came he saw a clean Hospital 18 beds one or two of them empty all doctors comfortably he didn't see us crawling under the bed to find the patient to examine him to administer a drip to him while he's on the floor I never seen by the minister's so this is what we should make sure the minister himself gets admitted there he will know what is actually going on thank you in a way I represent our collections common man because when I was still a student dr. Simon and Nancy and dr. MK money was already famous so I actually met dr. Simon and the in All India Institute when I was a postman as a student in Trivandrum Medical College when this topic of the of today's meeting has you know it's been sent around on whatsapp group and one common response among doctors is that we should go there and or rather we should boycott this meeting we should not have anything to do with this and I'm sure a lot of doctors are going to ask me why are you here okay because this posed in this binary fashion either you're a healer or you're a predator you can either be one or you can be the other and they will say that people like dr. Simon and Nandi he has pedigree what difficulty for him to be a healer what about a person like you who'd studied in the government Medical College came from a very reasonably reasonably okay family didn't have a lot of what they call in some on our background what are you doing in this company they are talking hot eh they don't know what the struggles of doctors are and how can they call us predators this is the common question that all doctors who hear this topic ask and I was rather sad I didn't know the title of this book before I contributed to it otherwise I would have objected to this title ok because there is a huge grey area between HeLa and predator lots of doctors may not be healers but not all of them are predators in fact as many of them have very gently remarked or I'm putting it very very mentally most doctors are not predators okay we have to think about but are a lot of doctors corrupt the answer is yes and is there the only corruption money corruption is only finance corruption I would beg to differ there are all kinds of corruption there is corruption for fame there is corruption for wanting to be up on the stage speaking with dr. Samir and Nandi there is a corruption of wanting to be selected in All India Institute without paying money for it there is all kinds of corruption and they will say they can easily speak they never had to struggle for anything we had to struggle so we have to understand the ecosystem of corruption you know when doctors asked some of them asked me you know doctors are not a happy lot you go to any conference they always complaining complaining complaining and ordinary people wonder what are they going to complain about they have a wonderful life but it's not really so it's because they also have this pain in their heart that they are not doing what they set out to do when they became students and that's because most of the students who were with me left the country you know when we were young we started a group called medical action forum which was for medical ethics we were only the 20s then one of them only surviving member of the group other than me is dr. Amador Pawan Aden was sitting there the second row all the rest of emigrated they are either in the US or the UK because they found it much easier to be ethical there than in India but we struggled on and somehow managed so the question is what is it that removes this fair amount of desire to be of use to this society when they're students and it changes when you come out of the college if you study in a normal college not in All India Institute only Institute seventy percent they emic they export them they go of some other country they don't stay in India if you study in Kilpauk medical college like I did do post resolution 200 medical courses like I did what makes the change and I would humbly suggest that the change is the fact that we have two systems of medical care in India we have the private system for those who can afford it probably not a single one of you has ever gone to a medical college for treatment and then you have the medical colleges which are ever since the 80s it's only for the poor and this new scheme ayushman bharat which is supposed to be for the below poverty line medicine for poor people will be poor medicine take it from me it cannot be otherwise the doctors who sit in such things will be the ones who are despised which are the doctors who are looked up to in society the ones who wear the white coat and come on TV programs all from Apollo Hospital they have the brand little do you know that they are slaves to a corporate they are not freemen men either they are not happy people either they pretend to be happy among the doctors they may sit there and ok we get social prestige what happens when you go home and you have to sleep at night that's the question we have to ask and that's the question which I say will this book is not a depressing book actually because if you can face the fact then that's when you can begin to change and if we know that the system in India is bad it's corrupt sure corruption in health care exists in India and do we expect we cannot say that it exists in every field why should it exist in why cannot it exist in medicine we can't say that because from doctors we have a right as society has a right to ask for more to demand a higher standard of excellence because every day you give to us your body personally it's a one-to-one interaction it's not a public health intervention if you come to me as your doctor you have to have faith in me that I will do what is right so I have to live to a higher standard of excellence than any other person an engineer who builds a bridge which collapses sure but it's far removed so you don't have that personal touch and the personal touch is what makes medicine exciting it also what makes you expect more from the doctor and it's also what makes necessary for society to protect the doctor make sure it can be done right and present Indian society doesn't permit that corruption is inset when you have to a private system for the well-off and one for the poor the poor doctors who look after the poor will be treated poorly will be looked down upon and every doctor who is there will try to be in Apollo and that's the root of it you have one system like the National Health System there are different types of corruption all of the world but you won't have the type of corruption that you're having in India David brother could say what he did because he was he always had the comfort that he's going back to the UK he doesn't have to live and work here that's what makes a difference so it's up to the society make it possible for us doctors to treat you as the way you should be treated now that we have finished the opening statements and before we start the interaction among the panelists as moderated by me I want to make an argument in support of the title of the book and people might want to respond to that because publishers want provocative titles and they it's not out of line with the content of the book but but the book does I read the book quite carefully a large part of it anyway and there is an acknowledgement that a very large and I quote a very large number of doctors and government hospitals and health centers in private hospitals and clinics and in public and private medical colleges code remain true to their calling and yet the central issue for dealt with in the book is corruption has broadly understood and also also very specifically understood there's a great deal of detail and specific insights in this book which I recommend to people who may wonder whether it's just hot air but having said that may I turn to the editors first of the book the issues the book touches upon dr. Nandi low allocation of resources Martius n has something to say that it is an important factor but it's only one of the relevant factors Kavita Narayan characterizes our healthcare system as a broken system and Martius n refers to a comprehensive healthcare SCI crisis of course we can say this about other sectors like the public school system the justice system and so on and then about the everyday corruption doctor money in his chapter as many examples of it so do some others so you can say that there's everyday corruption what is often called by corruption research as petty corruption it's not really petty it adds up but every day transactional petty corruption and at the other end grand corruption and then you have a lack of trust and also dr. Thomas has dealt among others with the outcomes why did you focus on corruption as the central issue to be tackled and that in a faker ODEs the whole health care system is that is that accurate or would that be considered an exaggeration given all the other problems of the system I'd like to preface my answer with a statement I made to the British Medical Journal where in an interview they asked me what has been your most far-reaching choice of career and I said that coming back to India was a wonderful experience for me it made me because of my refined background I could try and iris didn't succeed give the best treatment in the world to the poorest of the poor the poor were very grateful for whatever you did for them the problems in India are huge but the solutions are at hand the problem is that we don't attack the solution attack the problem in a very kind of intellectual way and the reason that I thought the probable contraption was mean and because I read a lot about it and it suggests that 25 percent of healthcare expenses could be lowered by eliminating corruption for instance the MRI person in Pusa Road which is near Gangaram Hospital where I work gives a three thousand rupee kickback to doctors who refer patients for MRI the cost to the patient is either 6000 or 7000 rupees now people say that well society is corrupt why shouldn't doctors be the same the problem with the medical profession is that we are there's a huge difference of knowledge between birth amano-san says in his brilliant forward that when you go to buy a toothbrush you know as much about the toothbrush as the seller of the toothbrush but medical care you depend on a doctor and the doctor you must trust and I think that we mustn't underestimate the number of doctors who are corrupt because I went to km hospital in Bombay but to do exams and they were telling me about corruption Bombay and kickbacks and all that and they said that 90% of GPS in Bombay give kickbacks but I asked a friend of mine dr. Ajay Desai who's not there anymore is it true he said that this is an incorrect figure it's 99 percent and I think that we are in a privileged position we have a country which needs us and I think all this universal healthcare stuff is impossible in India because we just don't have the money we can have basic health care for the poor but I think that what has happened with with the corporate hospitals and private hospitals since my time here is that Indian healthcare has reached the highest levels for instance I mean in the field in which I'm interested they were transplant the most complicated operations are done here and the results in the best centers are equal to the best in the world unfortunately 98% of these operations are done in the private sector I may ask doctor money a similar question pointing out that you you you you have a sort of historical timeline going back to your early days as in the profession and you remark there you observe that these malpractice ISM corruption may have been the the exception in those days today they become the rule so how has this normalization of deviance happened and when did I think one of the first things was the the influx of high cost equipment when people started having CT scans and MRIs and things like that it was a large capital inlay and people wanted to get something back so that's where the kickback system started and I believe it has existed in dominar for a long time but in the early days when we were early days of our practice and working in the hospitals whatever it was the expense was not that high so a kickback would not be all that much even then as I pointed out in my chapter people had some people some surgeons would insist on a patient coming to the house and consulting them before equals get operated in the government hospital so that was in existence even in those days but all that was small change in comparison with big things now like all these little trips CT scan and so on so that is when it became large scale and the second thing of course was capitation fee medical colleges when people spend colossal sums of money to get a degree they expect a return the people who put it in ER obviously have to be business people or to have that kind of money and they want to return from it so that is what I think led to the onset and of the corruption and now there is no limit it goes on you talk about the business of admission to medical colleges advertising in medicine corruption and government hospitals inducements given to and received by medical practitioners on which you have commented abetting the patient in crime you said that issuing false certificates to avail of or to avoid the tendons and law-courts or to avoid going to prison cells insurance fraud transplantation and organ commerce would you like to comment on that part the last one I'm afraid if I get to start talking about the problems in transplantation we won't finish the meeting today the largest amount of corruption is I'm sorry to say in the field of transplantation starting from the exploitation of the poor who are as unrelated donors and one of the things that you would have to think even though there are strict laws which say that unrelated transplantation should only be altruistic this altruism comes from the slums of Chennai to the millionaire's from different parts of the country and that is where the altruism goes it is obvious that the only reason why a slum dweller in Chennai would give a kidney to somebody who's a millionaire from Kanpur shall we say it's because of money but somehow the authorization committee appointed by our government has never been able to see that they simply this is one of the authorization committee members some years ago told me he says that or she says that he she loves him Who am I to say that it is not true this is the answer which I got I don't know what else we can do this this is massive corruption and even in terms of the deceased donor program now we do have corruption coming in in different ways in that some people get may get the kidney in advance of someone else that they can move up and a waiting list and the other thing is obviously that people from overseas are getting transplants quite freely over here somehow the impression that there is no Indian who can receive because no no foreigner should get an organ from India unless there is no Indian who can take that particular organ and yet we find that a large number of the transplants are being done for people from overseas that is really a big can of worms and I think we should get to the bottom of it sometime but I don't know how it can be done okay so now that you are free from the fetters governments plays on senior civil servants and you were Union health secretary do you think now weighing the various factors that have been mentioned in this book inadequate spending on health care weak infrastructure that you mentioned in the introduction lack of research and lack of you know standards maintenance of standards and corruption how would you in a hierarchy or inveighing those different factors what's your sense yeah these are all important I think first things undeniable we do not spend enough between central and state governments we certainly spend and we must give credit where it is due 2005 when the National Rural Health Mission was introduced it was for the first time possibly such a huge influx of public money into into primary health care so that and that continues to date that that what goes into what is now called the National Health Mission it's still a sizeable amount but if it's nowhere near enough but a second point which I think is more important is that we like very much building hospitals we like buying equipment because at one level these are easier to do also it's easier to make money on these things this additional investment that we need from the public sector really needs to go into medical education this doctor money mentioned there's this huge influx of private medical colleges charging capitation fees which came about because of a decision of government in the early 90s when the in the Medical Council Act of 1956 was amended to permit the setting up of medical colleges by private parties that is completely I mean imbalance the situation so drastically what we need is state governments putting money into state government medical and nursing colleges if you can have medical and nursing colleges that charge a normal kind of fee then there is some expectation a that those students will have a sizable patient volume to look at or in the course of their studies and be that they will be able to afford to come into public service when they are finished with their education if they have paid three and four and five crores to acquire a degree they're not going to come to a government job tamil nadu is unique amongst Indian states and that they recognize this a long time ago there are possibly one government medical college in every every district all of you P has eight medical colleges in the government sector so you see there is something grotesquely wrong and that that space is being taken by private private colleges so that's so not it's not just that we need more public investment we need public investment in health human resource training doctors nurses more postgraduate C's because you do need a certain number of specialists and in this whole huge area of allied health care which is completely unregulated I can start high in my house I can start an ICU technician course and I will produce ICU technicians who will get jobs because there are ICUs and every private hospital who they want somebody with a piece of paper saying I am a trained ICU technician laboratory technician x-ray technician Kavita Narayan is one of our contributors has done absolutely stupendous work in this area there is now and is now government has a list of something like 113 allied health professions and curricula and syllabi are being framed for each of these now these need to be regulation right the process has not come to an end but this is the kind of stuff we need to do and then then we will be in a position to create these wellness centers arrivin Bharath is promising I can't have a Wellness Center unless there are qualified people to do something there tamil nadu we may still because of the reasons i mentioned you may still have MBBS doctors you know in every primary health center in large tracts of the north you don't have any doctors at all in the private health center unless you produce these people we are not going to have any kind of primary care and that's where the money should go yeah on the subject of limited funds and what you can do with it I should like to comment on the work of the kidney health trust in Chennai which has a simple program very cheap by means of which by home domiciliary testing for diabetes and hypertension with an annual survey we have been able to pick up a large number of people with diabetes and hypertension and treat them with cheap drugs keep their blood pressure and diabetes under reasonable control and have lowered the incidence of chronic kidney disease in that population from 28 per thousand to 11 per thousand this is possible and that cost was 33 rupees per capita of population not per patient per capita of population per year well within the budget of the government this is the sort of thing that we really need to do we need to try to keep people healthy and we need to spend a lot more time and effort on that and if we can keep people healthy we will prevent a whole lot of other diseases which anyhow we don't have money treat I just add one little thing here when this trust won an award we dr. money forbade us from even mail publishing it in the press I remember that very well saying I don't want that kind of recognition anyone is that true or not that's the kind of physician we have here all physicians and surgeons we have I just want to say that one of the major deficiencies Indian health care is a lack of research and dr. monies research is something that dr. money has done for instance you see what the prevalence of hypertension and diabetes or kidney failure is in a population then you intervene you do a simple intervention or you do no intervention or you do a complex intervention and you see what the result is and we did a study of the publication's from Indian Medical Colleges Indian institutions there were 570 between 2005 and 2014 57% of them had not published a single indexed paper research paper such is the quality of our medical training and people say that the quality of research output from a medical college reflects the standard of the medical college and this paper was quoted by 50 papers and medical journals and the Washington Post had a headline which said that if you think Indian Medical Education is bad it is very so I think that it's time that not only should we give good patient care we should look at research in India which is relevant to our nation's needs on this question of this money allocation I think if as doctors we are too willing and eat too easily except that there are no resources this would make sense if we don't see the humongous amounts you know like mind-boggling amounts 1 lakh crores written-off 1 lakh crores given to some corporate it would make sense I mean I would believe dr. Nandi if I her if I never saw these things every day in the newspaper we cannot accept this we do not elect governments to say things as they are we elect them to change the things and we need if we do not demand if you are so easily accepting that's not enough money there's not enough money therefore there will be private it's a wrong philosophy I have a fundamental difference in philosophy from many of the people right now on the panel because I do not believe this and I do not think that we should be you know and Danny Daniel Kahneman and Amos Tversky in Thinking Fast and Slow they say unfortunately human beings they grab on to these things you know like liver transplant oh it is the most magical thing actually it has a very very very small impact on health outcomes if you but who wants to read what the World Health Organization says about health outcomes who wants to read what where the money should really be going we are all after this doctor oh he can do liver transplant he can do it the fastest he can do it the best that doesn't really affect anything minuscule number of people need liver transplants for this we are spending huge amounts of money and why are we looking at parameters from the West Washington Post says that Indian Medical Colleges are bad do we need that not me I am an Indian and I know why medical colleges do not produce research Indian Medical Colleges if you work there you have no time for research you see hundred patients in an hour if you live if you are living in the glorified ivory tower of games you get protected time for research or your living I am the institutional review board chairperson for the Christian Medical College very long so I'm very well aware of what I'm speaking about Christian Medical College is after Ames the second most highly publishing medical college in India Ames is first CMC second I am the IRB chairperson for ten years they get protected time is Christian Medical College a scalable model it isn't what we really are scalable models are all these government medical colleges of which some in and only thinks so little please go there between 7:45 and 1:00 p.m. you may have to see 300 patients at the end of it what you'll do is lie down flat like I used to and my dear wife used to every day of her life I'll have to wake her up because she's tired to do anything else that's the reality of medical care in India and unless we know that stop looking at this research stuff right now what we need is patient care for that what do we need we need more money and what do we need we need not focus on liver transplant I believe that if we are a proud country every person in the country should get the same level of treatment if the Prime Minister of India can get a liver transplant munuswamy from guru depandi also should get if Munusamy from woman if we can't get a liver transplant nobody should get unless we have that philosophy we're getting nowhere let's not believe universal health care is a myth every no country can afford health care that's what the statistics say but they all do it now I would like to question one of your assertions in this in your chapter what you're saying now is rather different from what I read in your chapter it's totally because I read that quite carefully question your the chapter comprises hidden fees unnecessary investigations unnecessary procedures errors of omission poor standards tendering process medical education and then court in summary the consequences of corruption in health care denying medical care to many impoverishing they already poor and an assault on the patient's body if he or she has to undergo an unnecessary procedure it causes a trust deficit in society between the patient and the doctor it damages one of the vital institutions of modern society it causes conflict in the doctors mind between what should be done scientifically and the patient's best interest and what's actually done in the doctors interests so you talk about confused thinking for the doctor and I and I think the tone there is and the content is rather different from what you said yeah but before but I just wanted a question one session you make or invite you to explain it or this defend it code practicing scientific medicine will automatically mean practicing ethical medicine I recall that so scientific medicine can be interpreted in many ways but if it's largely professional evidence-based medicine I don't see how it'll automatically mean practicing ethical medicine because I recall a parallel from with journalism a long time ago walter Lippmann one of the great thinkers on journalism and on writing was bothered about the problem of the propaganda role that debased the performance of the media and he considered professionalization whether it could be an answer and came to the conclusion professionalization is no antidote to to the you know mal practices in journalism including the propaganda role but how would you defend it this particular statement first of all I like being challenged so thank you the first thing is that first of all I must define what did I mean by scientific medicine I am a hardcore believer of the pop Aryan view that in science you make a proposition which can which is subject to falsification if the proposition is not subject to falsification it's not a subject for science so that's this method which I mean is a scientific method as defined by Karl Popper maybe others said it before him but popper wrote about this therefore I believe that if you get a patient who does not require an MRI you won't send for the MRI so you won't get the kickback so that if you are only defined they're going to practice scientific medicine and you know that this patient needs an MRI and therefore I'm going to send him for an MRI and if I am affected by the fact that I'm going to get 3,000 rupees for that mr then my brain is already altered so I'm not following scientific medicine therefore I will be sign I will be at the girl that's in simple words what I meant how was it automatic if you are if you are always scientific then the kick in that thought comes in when I offer you as the surgical procedure is it because it's the right thing to do or because I'm going to make money out of it if it's the right thing to do it's because I'm scientific if I'm going to make money out of it then it may be scientific but it's also because I'm going to make money on it it's just taught it yes Oh tautology okay I want to defend here the practice of liver transplantation in India I've given a lecture in fact in Chennai about three months ago on the history of liver transplant it started really when Rajiv Gandhi came back from one of the tours abroad and he said why aren't we doing heart and liver transplants in India and the Health Minister set up a small committee health secretary I was one of the four and we defined that there were four things that we needed one was change in the law because people were selling their organs and we wanted to stop second was recognition of brain death the third was expertise and the fourth was sensitization of the public and in 1994 the transplantation of human organs Act was passed and today we have 98 liver transplant centers in the country and why should we have liver transplants to black patients died of liver failure every year the rich used to go abroad and get a liver transplant for 2 to 3 crores you can get a liver transplant in India now between for between 20 and 30 lakhs second liver disease affects the young people thirdly if you have liver transplant you immediately the quality of service both of the doctor and all the ancillary departments is improved and fourthly there is a national pride in that we can achieve what other people have achieved I disagree with this idea that we should go down to the lowest common denominator and spend money on only providing clean drinking water and no high-class health care I just like to say one thing when you have a limited amount of money you're not talking about people who can spend their own money and have liver transplants but if you have a limited amount of money which you're going to spend it would be much better to prevent the disease at lower cost than to treat it after it comes so I believe therefore that we should do far more on primary care and prevention and try to keep people from getting all these terminal stages so may ask what is the state of preventive medicine in India in some of the areas you are familiar with I won't say to non-existent definitely there is a significant amount of work which is being done we have it is public health which has eliminated a small pox from the country which has eliminated leprosy to a large extent maybe some degree of control of tuberculosis all these have been based and these are based on domiciliary programs I believe that when you got a man working on daily wages in a in a village and you expect him to travel 10 kilometers to a primary health center and stand in a queue for four hours to get a medicine for one week it's never going to work we have to do a lot more at home the answer to these things really is that much of our work will have to be done at home it does not require very highly qualified people it doesn't mean I want the doctor to go to every house but a sort of screening program can be established and then we can have those people brought to the doctor the doctor can go to a village and see them as we have established in the work of the kidney health trust so I believe that we should spend whatever money we have first thing is we certainly need to spend more that I have no doubt at all we are as Tomas pointed out that we are spending a lot of money on many big things which are not really showing any kind of return so we need to spend more rationally the money has to go to the health budget as a whole and it has to be spent properly without being lost on the way and but with that money whatever we have we have to budget it that said I believe that we should offer facilities for liver transplantation kidney transplantation at least in some hospitals because we have to teach people people the younger doctors will have to learn how to do this ER time may come when the cost will come down and we should have the expertise in the country to do it but it should not be that the government spends all the money on that at the expense of looking after the health of the common man should not have by the way this is being live-streamed on at the hindu centers website the hindus website and also on our facebook page so welcome to the people who have tuned into this but Quecha is why if I may ask you how does policy relate to preventive medicine preventive strategies public health interventions and in particularly we heard that Tamil Nadu is ahead of many states in this respect is that true what that is true certainly in that Tamil Nadu is possibly the only state which for many decades now certainly from before independence has had wooden the Health Department of Public Health Department and the clinical faculties that the people who run the hospitals and not really the biggest policy problem is the lack of appreciation in within government governments tend to be very Covington's governments tend to work in silos so there's a lack of appreciation of the fact that a good robust nutrition policy is an essential feature of a good robust public health policy that ICDs or the system that runs the onion bodies it's not a standalone program where children under the age of six come get something to eat and that it there's a reason why children under the age of six need to be fed appropriately nutritious food at the right time which they may not be getting in their own homes that also likewise that the importance of safe drinking water sanitation household ventilation for instance the I remember seeing written somewhere that indoor choose the single largest killer in India are domestic Appl indoor air pollution caused by bad cooking stuffs now that all these things government knows about all these things but does not see the connection between them that if you if you want to have a healthy population you need to address these not as in standalone programs but as part of our overall health policy and that these will contribute towards having a healthier population the second thing governments need to understand is that you are not going to see results before the next election investing in healthy nutritious food for children below six the impact of this you will see one generation from now mr. Boddy needs to understand that everybody is your understand that you are not which is why I was saying earlier all governments like to build hospitals because you can do that all governments like to say that I have installed some cancer equipment in this or an x-ray machine you know this under the scheme of MP MPs have the Local Area Development money a lot of MPs and a lot of M&A is like buying expensive equipment for the hospital in their constituency respective the fact I mean are there people who know how to use this what is going to happen who is going to maintain this do you have money on a recurring basis to keep this equipment functioning but then that produces an immediate splash that you know this has been donated but you we need to invest in things we are not going to see the results a very important example that everyone in public health could know is how did in the United Kingdom how did they draw a drastically reduced into the incidence of tuberculosis because their national housing policy changed ro housings was given up and you know that the everyone recognized that houses need windows it will and it's a clearly documented properly evidence-based results that kind of stuff we don't have the patience for we will be better also possibly because the size of the problem is so V there are people all around us with horrible diseases dying in great pain distress you want to do something but always looking at the immediate and urgent doesn't mean that you shouldn't be looking at what is may not be you may not be immediately obvious to you it's also hugely important some ten years ago a former student of mine who's a nephrologist in a neighboring state and knew the Health Minister he went to him and suggested that they take up the prevention program of the kidney help trust there the minister said if I do one transplant free I will get headlines for three days I may prevent thousand people from getting kidney failure nobody will talk about it actually you know whenever we say a problem is large we have to remember that in 1947 when at the time of Independence all problems were large and PC Mahalanobis who started the Indian Statistical Institute he was tasked by Nehru you know this whole question of hunger in India we had famines regularly and it's been eliminated we don't have famines anymore that was a huge problem and India solved it so if we cannot solve the health problems the major health problems of India it's simply because we lack the political will people are not asking for it there are no such big problems you solve famine how can you not solve this I think before I invite questions from the audience since most of us haven't read the book I just want to briefly stay flag the conclusions or the lessons broad lessons learnt so that you can question the panelists more specifically one lesson is a public health or conclusion the most important they say is that public health must remain a public responsibility and neither the lack of financial resources the inability to manage systems the unwillingness to govern responsibly nor an unfamiliarity with technology should become an argument or excuse for outsourcing health care to private enterprise public health must remain a public responsibility and no excuses for outsourcing healthcare to private providers secondly the history or the current implementation of health insurance schemes that's already been discussed at least briefly or mentioned three governments at both center and state levels must continue to be the primary player in health care and certainly in primary health care the specious difference between providing and purchasing health care must be called out that's the conclusion in the book for there's a great deal in it's the private or non-governmental sector can and must do and examples are given in this book the great great healing traditions of institutions such as the Christian Medical Center CMC mg I am IMS and st. John's and the highly professional health care delivery through organizations such as the JSS in Chattisgarh or the Banyan in Chennai we have here Vandana Gopi Kumar a co-founder of the Banyan and the books goes on to say that they this delivers a powerful message that non-governmental civil society activism based on platform on a platform of hard professionalism not those phrases civil society actors ISM built on a platform of hard professionalism that will be signed scientific medicine have a role to play in health care delivery etcetera and moreover it's been pointed out that they are substantially free of any taint of corruption they are substantially free of any taint of corruption because these organizations draw on the strength of individual commitment and dedication to a superior cause I think nobody is going to challenge that I think these institutions are highly respected and esteemed and relied upon five a third broad lesson is that information is power we have already discussed it access to information determines the quality of treatment the patient receives access to technologies is limited in India then no system of health care delivery whether public or private can function in the absence of enlightened regulation and that's the elephant in the room the Medical Council of India and but lesser known body is also like the nursing and dental councils and the I don't know about the regulatory agencies in the IO sector but there's [Laughter] then a need for a comprehensive overview of the medical curriculum and syllabus very little research of any standards that's been mentioned so these are teams that are conclusions that figure in the book and and I repeat they pay tribute to code very la dr. Thomas took umbrage at people questioning the the commitment and integrity and so on of doctors although they coexist with corruption he said or indicated but the book does acknowledge a very large number of doctors and government hospitals and health centers in private hospitals and clinics and in public and private medical colleges who caught remained true to their calling and everyone here is true to his calling this and we also have many in the audience who come from the medical profession I think they are true to their calling I would expect the question the question is corruption in health in the health care system is not a pathological is it a pathological condition or is has it become normalized and the book tends to lean to the view that it has become normalized it has become systematized and it's no longer the exception it's the rule it's largely the rule although the extent to which it is a rule can be questioned or criticized and so on so these are these are the themes of the book the conclusions in the book and I think I would recommend that everyone who can afford it buy a copy of this book it's already doing extremely well a lot of people are interested in it among other things thanks to the title which which attracts I think you need titles like that to provoke thought but now I would invite questions from the audience please keep them brief to the point we don't want long statements unless somebody has some new information to provide please make them in the form of just questions yes please introduce yourself freelance journalist and an author this question is to dr. money I would like to know how many doctors in April Oh belong to the Consensus tribe many scientific studies but I'm afraid that is not one studied well let me say one thing every doctor even a corrupt doctor wants his patient to do well because he wants the reputation to come whatever the methods that he uses and whatever the money that he tries to get he wants to he wants to get a good reputation so every doctor is trying to do the best for the patient largely largely through scientific medicine but there is a maybe a little bit of an excuse also for a patient who over for a doctor who over investigates a patient and this is the litigation which has come in now if somebody does not do a particular test and the the patient may then go to court and say or the patient's relations if the outcome is bad say if only this test had been done it would have been there's a little bit of a breakdown in the doctor-patient relationship and the trust that is become a little bit of an adversary effect and that certainly applies much more in private hospitals than it would in the public sector so it works both ways and somewhere or the other we have to break it I don't know how we are going to get that done introduce yourself npf Govind then nan Marwan surgeon Stanley Myrtle Manor Hill he's a surgeon pani i three were patrolling he's retired after working and Stanley Medical College he was in the waiver that hit Paraguay nam en todo not a very chaotic iboga Rob Kelly won my first question after this is what are we going to do after this discussion of this reflection what are we going to do next yes next the piecemeal attempted to attempt at peace mail-in reformations will it be will it work are happy to consider about total Reformation in with reference to corruption you heard that the situation in India is similar to the situation in the United States in the beginning of the last century the Carnegie Foundation sent Simon Flexner from I think he was at Harvard or Yale to suggest how American health care could be changed Flexner traveled to Europe mainly to Germany which was the leader of medical care in the world then he came back and transformed American healthcare heat there were 300 medical colleges he reduced it 230 he said that he laid down standards for medical education and he said one of the primary purposes of a medical college is to do research and to do research into American medical problems I think that we should have another Flexner here dr. money you'd love to add anything piecemeal or wholesale please restructuring I think we can talk about it but the way to get it done I I don't see a solution we cannot get a Flexner to do things like that over here because nobody will listen to him he'll always say that I'll get more headlines if you do one transplant man if I prevent a thousand piecemeal is the Indian Way please I'm sorry my I apologize Korona and if you have a physician thanks thanks for coming to Chennai the health secretary and the people and we have it's nice to our or my health secretary lives in Chennai oh I didn't realize how nice but okay you are the one looking from the sea again to that extreme person that Joseph view that the role of non-governmental in our organization is the safety net for the for the society the government's role and how do you survive with this I mean with this corrupted environment people you try well so we can't do it you expand the government does it help you or who can help you – so you I think the for the solution is only from the non-governmental organization nobody trusts the government hospital none can go to doctor many and I'm not talking about his his hypertension prevention but I can't go and get to transplant and by him so either so I think is from the non-governmental sector could you please highlight your future plans actually I unfortunately I feel that even though I'm not working in Chris American College I work in Saint Isabel Hospital I was a student of Kilpauk Medical College Trivandrum Medical College I worked in railways before railways government of Kerala so I have an ordinary very very ordinary man okay so I unfortunately I don't believe that models like Christine Medical College any of them they are not scalable models like guarda the only organization which can do this on a large scale is the government there are only people so we must have universal health care we must demand it from them see dr. Nandi was a little unfair to me I didn't say that real liver transfer not important what I said is if the Prime Minister gets it Munusamy and goobidy party should also get it so every every intervention available in India should be available to everybody else that's a fair Society this is a democratic country we are not in a dictatorship or in a kingdom even the Queen of England goes to the National Health Service that's all I'm asking and I believe because dr. money said it unless they go to that same Hospital it won't improve so you must have only one kind of hospital in Germany there's insurance I went to Germany many times for getting training everybody gets similar care similar may not may be slightly different but similar unless we get that with nothing is going to change you know how you move towards that and you said piecemeal okay so George's really said what I wanted to say which is that we are blessed and that we have in the non-governmental sector extraordinary women and many now country not just in healthcare but in other sectors some of them of contributors to our book but he's absolutely correct when he says that how just because government is failing we cannot say that let other people take over this job it is government's job to do it we should be grateful for the remarkable people there are in the non-government especially working mean mr. Tom mentioned London I know work yoga Jane is a contributor we have Poonam estrogen and rather from Vidya Sagar here these are outstanding examples of civil society work working in areas where government 3 doesn't know too much Vidya Sagar FinCEN's works in the care of children with disabilities which a great deal of what is now good practice in India comes from organisations like this but that does not mean there it becomes their work full-time because these are jobs that government needs to do and that's what we've tried to say in this book that's any other questions yeah okay many hands up my name is dr. Ganesh I am working in ESA hospital as a senior medical specialist the title we are focusing on something which is negative we always should talk about light and the absence of light is darkness this the the corollary is we should be talking about honest persons and a set of honest persons should be supported a set of dishonest persons they are thriving because you are not supporting the the crux of the the doctors who are doing good work like I can claim I can vouch that in my hospital you anybody can come and without my without my knowledge go see for yourself ask for yourself you will get the picture what I am trying to tell you the ESA hospital he has a cooperation has given enough powers for us to do all the things including the liver transplant and other things and these patients these paint this employees they are getting the best of the treatment and the standard of care which these people are getting from my side from as a physician and from all the departments of our Hospital is so noteworthy that why people like you from the pub the journalists group have not even touched such wonderful examples there's people tend to vote with their feet and 75 percent of Indians pay out of pocket for health care and only 25 percent of them go to government hospitals and I have experience of ESI hospitals in Delhi and elsewhere and I'm sorry to say that they are not a patch on the best hospitals in India one issue here is I think there are plenty of stories in the media not enough maybe not cover the hospital they should about good work being done but if you only talk about it that will amount to propaganda it is and you will miss the big picture of what is happening please read the book to see whether you agree with the evidence provided there the story is provided there the insights provided no no no don't interrupt me okay please we heard you without interruption so give us that courtesy so yes I recognize it is quite possible it looks highly likely that there are these commendable areas but I in my observation newspapers as well as news television they cover this to a significant extent as the Banyan for example asked CMC not is it enough no but if you have left out is a interesting work it must surely be covered people should know but we are not in the business of raising morale or make or feel good journalism so far as journalism is concerned and we are very happy that people here who have much more experience in this area than any of us can have speak to these issues in a bold and honest way honesty is the key here if you merely talk about good things you're not being true to what is happening out there you're letting down people and so on that that's my uncertain or your comment on the media not covering this not now yes you will next we can have this conversation after thank you so I'm unsure I've profiled many like with celebrated doctors but I attend the government hospitals in the villages and I'm doing my doctoral studies on foreign policy my question said I would like to say when you say doctor studies on foreign policy so I would like to say when you say about health care this is a very much inclusive industry there are many of many things are getting included inside for example AI is coming big data is coming health informatics all these things are coming my question is all these things are coming from the US anyway when you talk about the health care we only say about the basically the allopathic treatments and all do you all of us haven't talked about here the homeopathic and the other kind of and the forms of treatments which are much more affordable much more cheaper and which are practiced largely in the in the countries of South Asia the scaley in Bangladesh and eastern portion of West Bengal so are we anyway celebrating the triumphs of cold where when you mention about the Rockefeller and Carnegie Foundation you mentions are just a few gotta go anyway is it a subsequent of the Cold War this is they anyway this is winning this cold weather question is clear I think we are dealing largely we are not dealing with indigenous systems or medicines whatever the claims are and I don't think that's really relevant to the book but dr. Gandhi wants to say something I just want to say something on homeopathy and there have been many studies which have shown the homeopathy is completely useless and it is time now that we should get rid of it from this country there are there's a log in squeaky and charlatans ISM ketchup it was since the question of what in government are called the IU systems has come up I think two very quick points our government recognizes the I've read yoga Unani Siddha homeopathy and there's a sixth form of Tibetan medicine which is also which is recognized by government and so at this point of time that is that is our policy my understanding is that corruption in the regulation of the sector whether through the Central Council of homeopathy or a central council Indian medicine it's far worse than in the mems here it's a it's a it's a whole the whole new story which we have not addressed but the only important thing I would like I believe about the Irish sector is that Irish hospitals and I use doctor should certainly be encouraged to work within their own discipline got a break every so often you see someone in government saying that I use doctors will be given a rich course and be made to work in practice Western medicine this is something that we should prevent against Iowa the hospital you nannies and hospitals should certainly be encouraged from that and properly qualified Iranian a nice introductory working in in those hospitals but let us not pretend that they can they're equivalent to somebody who has been trained in western medicine the temptation for this is because there are huge numbers of these people poor all over the place in Germany if you're just talking about numbers it's quite easy to say whether all these trained doctors are there let them come and staff the PhDs let them come and staff so District Hospital it can't happen they can practice what they have been taught to practice so there are a few few issues I would like to flag I am doctor Manjula data I retired as professor of Epidemiology in the university I left a good career in the ICMR to take up this job in the university because I felt that we need to do something about improving medical education and I felt it felt very strongly that we needed to do I created two departments a Department of Epidemiology and a department of curriculum development and at that time this was in 1998 nobody knew what was the amount of burden of illness in this country nobody knew what types of illness what what is there this in spite of two or three surveys three National Health Service that had been carried out by the government the central government nobody had access to those data even though it was on a website it was so confused that we could not draw anything from that what is important I feel is I mean there are two things our we don't know what illnesses are people suffer from we need to know that immediately and our medical curriculum is imported from the US or UK we teach our medical students everything that are there in Harrison or some other exulted book but not what is there in our country these are two points that we need to really improve and talking about primary health care there is another issue that primary health care is confused with public health interventions primary health care is what the patient needs at the first point of care are we providing anything at the first point of care namely the pH C's nothing and are the PX is accessible to the patient so that they can get care when they need it that also we don't have and therefore if we think of restructuring medical education or medical care in this country these are points that need consideration and one question I have for dr. Nandi some since am artisan has given and given a forward to this book I can talk a little bit about health economics we have done several liver transplants I don't know the number we have done several transplants of lung heart etc have we done any follow-up studies on these patients to see whether they are a healthy and be productive and how many years of productive life they give to the country there are many studies on this and the best centers in a person who's dying of chronic liver failure and some who have acute liver failure if they have liver transplant in the best centers they have a 90 percent survival and about eighty four percent of them live five years and about 75 percent go on to normal life in the liver is particularly gifted in that it does not tend to get rejected and once a person gets used to the liver then he can live a nearly normal life there are thousands of studies on this all over the world including India in monetary terms money contributed have these people made good the amount of my shall be monetary just living isn't that enough so no if when you look at it from the government perspective so much money has been spent on them have they given that much back to the country that's my question yeah no no behind it I'm dr. Chandra Shekar I am a dental surgeon by profession I had two unique jobs one I worked 20 years in Cancer Institute and directly opposite I worked in a private dental college when they started a college now because we are talking about healthcare healthcare I think it is totally different from medical care now when I was working in a private medical dental college as a professor and a chori the amount of corruption in a private dental college I don't know they say it is a surprise inspection and that surprise inspection we know one big before I don't understand how so is it the DCI concerned gives us the time and all the microscopes from an engineering college is moved to the dental college all the engineering students wearing a port are sent to the Dental College and all the register over right are written for funded number of patients and this is the state of affairs now who is responsible for this it is the government whether it is a state government or the central government I do not know and what is the outcome of this I used to joke if the Polish you wanna get sick for me probably if a college owner of my college owner has a toothache he will not be prepared to have it done by his own stool and dentistry's is flying high now it is out of reach of poor yes thank you sir you know I think you've answered your own question it's yes government has regulatory oversight but everything you've said is absolutely true this is true all private medical and dental and nursing colleges everyone is complicit no no please let me finish we heard you out please let me finish everyone is complicit whether it is the management the senior features professors you may say that look they're under pressure they are protecting their jobs whatever the reason may be everyone participates in this Sharad of a DCI or an MCI inspection so while it's easy to say no no no government is responsible government first do something about it I think that's not forget that we have all participated in keeping the system active and flourishing and lt and I think therefore it has to come from within the the entire community of senior medical educators and professors and doctors who work in the sector must say enough is enough we will not tolerate this sort of demand from the councils we have an one of our contributors on this operative chairman of the charter ROG Mendelian Gujarat the long-term CMD Wendy DB she writes very openly and courageously about the hellish problems that they have had in coping with the MCI and what they have suffered as a result of not yielding and they have still not got many things that they are supposed to get but because they have said we will not take now you need more people like this and this surrogate Angela body is addressed to mr. Daisy Rajjo can you say something about the pharmaceutical industry and how what role it plays in this whole murky business operation professor Lee this this requires a whole separate but very simply I think the point is that now we are talking about the billion billion dollar industry and India represents both a huge manufacturing base as well as a huge demand for medicine drugs and pharmaceutical preparations how we a victim of the pharma multinational that promotes an aggressive Hospital based treatments that requires high intensity medication at all times this has been often discussed certainly if you if you read yoga Jane's chapter in this book he will tell you exactly why that is not necessary you need not it is true that is certainly happening it's possible that our large Hospital chains are driven our drug based drug driven but it need not be true also as in not just primary our centers but fairly well well equipped hospitals need not be driven by the compulsions of having to pander to the pharmaceutical industry the other very big question is this whole question of regulation the DC the drug Controller General of India the DC GI and many of you will be familiar with the OU Ranbaxy story where the nest hacker was the whistleblower and we just revealed how sloppy regulation is in India and how we can inadequate and underfunded our regulatory systems are so very quickly to sum up the discussion I think we will be much better equipped to take on the might of the pharma multinational if our domestic regulatory systems both the central level and the state levels much better equipped better trained than they are now yeah thank you yeah I'm Faisal Rehman I'm Indian research and also the secretary-general of Islamic forum for the promotion of moderate thought but of course since I am also interested in these subjects I really thank you for the underfill talks at all that have already been given here by the book yeah by the book yeah of course I'll be buying it yes in fact I was going to ask the question which dr. English club they asked about the pharmaceutical industry it is said that they create the disease for which the manufacturer direct later so that's what is said about the pharmaceutical industry and connected to that I would like to ask anybody here who can answer it now I listened to dr. azim Malhotra he gave a talk recently to the European Parliament where he talks about evidence-based medicine and in fact any questions that you know it all depends upon he says the people who are funding it so therefore have you listened to the talk of dr. C Malhotra the cardiologist from UK and what do you think about the kind of corruption that goes on in evidence-based research at so-called evidence-based medicine in fact I agree with you entirely dr. George Thomas we need to spoke about purpose theory of falsification I entire likely with it I've read both his books especially that strict open so I think you can touch upon this topic sir oh who would you like maybe dr. George you know see scientific medicine what I like about scientific medicine is that is open to question and that's a fun for me that as a human being that's the fundamental need for any science I don't like iron Veda I don't like C by the way the person who asked for me but he is not Indian okay honey man German let it go but when you have something which you are supposed to take like the Bible I'm a non practicing Christian science cannot be unquestioned so evidence-based medicine that what is good about it is it's open to question every day what it means is we are using the best available evidence at the present time so whatever you say you know I have not heard mal but you know this Cochrane Collaboration there's lots of question about this evidence-based medicine but the misunderstanding of evidence-based medicine is that it gives you a cookbook you know on the other side people will ask why are you allopathic doctors changing your opinion every day one day you say cholesterol is good another day you say cholesterol is bad that's good science that's what science is we have to change you know like Maynard John Maynard Keynes he said when the facts change I change what do you do so that's me if the facts change I will change so I will keep on reading the thing and again I remember Voltaire vigilance is the keystone of democracy so you have to read the evidence with care the problem is that somebody has to make the evidence now the recent past funding for independent scientists from universities is drastically dropped all over the world so you even though FDA the US FDA it's no holy cow anymore because it's largely funded by pharmaceutical companies in the US the job of pharmaceutical companies to make profit if you think otherwise we're stupid yeah obviously so we know that caveat emptor we know that so we have to look at the evidence carefully but that's the best evidence we have and so we have to keep on refining that but there's no better way if you can suggest a better way I'm ready to go with you five minutes more to questions activist yeah you can ask the final question yeah good evening sir I am Ramesh I'm having an rich experience of how my industry working as a sales and marketing manager for 25 years I have worked in Ranbaxy as well as in Wind Medicare bentrim see I have seen many doctors and most of the doctors all over India have visited all the corporate hospitals and by the what I'd say is that the government hospital is the best Hospital because many of the senior consultants who are working in hospitals also from the government hospital today the corporate hospitals are buying the doctors a team of doctors goes to the corporate door by paying more money in Delhi it has happened in Chennai it is happening so the diagnosis is the basic problem because those who have taken training in the government hospital they need not depend on the diagnostic facilities – that an extent because they experience what they get in the government hospital is much more than the government of private hospitals in private hospital so you will get the treatment for diabetes which diseases this is a general comment ya know from your own experience my own experience I am Telling You the corruption level is very high in this this is the second book which I am going to buy an first book was dissenting diagnosis written by dr. Ajay Gergely I show claw Arun this is the second one so what I feel is that the doctors themselves have to educate themselves not to come back to China I am a massage on my professional and I have been working on national healthcare policy for the past eight years I'm sure the interesting topic which has attracted every one of us is going to be changed in another 20 years are we being treated by the qualified doctors ah what is up how they are being product produced that's going to be the situation and I'm happy it's not going to be a question to the panelists but question to everyone I have been attempting to pull that public to support the health care policy for the political will to get in the political will for the common man but I am happy to see people have realized staying together for the better car in the name of blaming the doctors yes that's the corruption I had been running lab for the past 25 years one of the first lab in South India to had so many things but we are the only person who didn't give Commission and Commission was introduced in this country and without Commission nobody can practice nobody can no lab can train and even then it's going on but I I accepted that topic but be my topic must bring together the journalists and the public to bring quality products not only the doctors everything one small thing three things I would like to say the medicine is a dynamic imperfect science that's what you are selling number one another is it is social infrastructure you cannot expect return on investment it is the people which gives the production he goes with the public age is a school education results in that better economics so people must join together to gain the political will to produce better medical personnel's along with elite and qual supportive medical shop and pharmaceutical industry and diagnosis one single thing I would like to ask everyone now fee increase of journalists two years back know it's important thing you you when you introduced you told one is questioning another suggestion so I was I got nearing the end so I pushed myself I'm asking you every one of you you are lying and wait for word two years back we had rain for three our 333 times twenty-five days and fled India Chennai Varda and one week almost all the places no power and you are there are so many medicines which are supposed to be kept in the fridge cold storage and stock in the warehouses how well do you have record is there any medicines were discarded but there were cold storage really or those medicines which were the core supposed to be in the cold storage making crease vaccines well they discarded or they were separated among the people we have taken so what I am trying to tell you the question will end on that note we must do some research on this yeah thank you thank you what we do is let us rise to support for I have a better health care thank you thank you yesterday gentlemen there has been hand up please introduce yourself nothing in there thank you I thought you are known as the leftist but all the questions you are turning to a right anyway thank you wrong thank you for a chance yeah I saw you were coming on in citrus institutionalization of corruption I'm more worried as a journalist about institutionalization of cartelization I give a small example of what is happening for example in regard to ear HC hearing aids I just filled with I'm 80 plus now so I can talk with some experience of my this thing a little one I want a solution from you people for this because it was a very serious issue a conciliation you know I've had a fairly senior doctor recommend me to a hearing aid center in Coram baucom we went there they tested freely it took quite some time at the end of it they said there very nice-looking girls they said about 55,000 for a year luckily for my my both my children from wealth were there by my side they immediately took the photograph returned a checker with Amazon it showed it as eighteen thousand five hundred rupees the same brand the price so it took it up in the doctor and also with them again what is the problem they say this is a price I took the name and the address of the person in Delhi I checked with five different audiologists they all said this is the practice they can't do anything about it is a cartel there are only five manufacturers across the world two German one sees one American owned elsewhere and they are all catalyzed so beautifully they are not able to reduce the price they said what people happen if I order for Amazon will ticket they said nobody will I tune it for your requirement can something be done about this thank you would anyone like to answer that question no the activist has been waiting please introduce yourself and that's the last question hello sir extreme panel and over here my name is Chandra Mohan from Morocco Rijeka I'm a social activist or otherwise known as a aunty national urban excel so hi okay so I do understand there's a lot of doctors over here one kind relates to doctors is this when you are talking about these kind of issues please don't get defensive don't get your knickers in a twist we are not demonizing your entire profession introspection is the foundation of change please understand that we do think of you like gods so when there is an issue when we are talking about it please do not get defensive you're not demonizing you I just want to place that on record first now since a lot of been talking about liver transplants and everything the question that I want to ask is about accountability but I want to come up with an example I don't want to name the name of the hospital but the hospital is supposed to give a liver to a particular patient they paid the 25 lakhs full and amount and in fact that person is a doctor himself but anyways for about a year and a half no transplant was done and every month is stung I don't know what the medical condition is probably you guys know aborted the stomach bloats a big so every month they have to remove the you know drain the liquid and every month it cost about eighty thousand for that person to do that procedure so they literally kept him in cold storage for a year and a half trying to extract as much money as they can that this is what the hospital was doing now that that particular problem came to my attention so I have to go and intervene and what we found out is that he has a B+ which is a very common that group and we took a sample of the list of people who were on the donors list and whoever in the top and he was actually in the top and people after him we're getting these organs and getting treated so what we did a during of researches we found that a lot of government also results where the patients are brain dead or those transplants are going to these private hospitals now these private hospitals pay a huge amount of bribe to the people in the government hospital to get priority over these organs that is one thing that we also found during the investigation of this particular case now after exhausting all kinds of solutions finally I had no other option than to get the owner of the hospital the number of the owner of the hospital and then I had no other option than to threaten of I threatened them saying that I will demo leash your hospitals name from social media to everywhere else I will bring in the media I will bring in people and we will pick it in front of her hospital and demand justice till it gets done now he was giving me all kinds of excuse saying that you know that liver is probably not fit for this patient there you know the blood group might not be disaffiliate or whatever all kinds of reasons but after all the threatening happen within a week wala the operation is done they found the donor somehow now the question is who keeps these people responsible in your profession where is the accountability in this profession if an doctor does a mistake he screws things up right I understand they are not gods everybody can make mistakes but the entire Hospital comes in difference of the doctor doesn't matter whether he made a mistake or not whether he killed the patient or not the hospital comes in defense of the doctor there is no accountability zilch zero it's not even like us we can't even go to the courts two and another question one of the question I get asked is how many CEOs do I have to threaten to get things straightened out here and one of the things this in government hospitals Stanley in hospital a classic example of how bad the system is one patient came for kidney dialysis over there and he had hepatitis C virus in him they didn't do the tests properly and even after that one of the biggest thing that they did is problem that they did is this the filters that they use in the dialysis they reused it without properly sterilizing it so that patients happened it is C virus got spread to about 20 other patients and within a day the nephrologist the Dean of Nephrology immediately sent all the patients out of the hospital threatening them telling them that if they even stand there other patients will get happy to see virus and these poor people they don't know medically even at we don't know what Sciences so this is what happened so we have to go do investigative journalism literally inside the hospital get inside the hospital and fight them and of course we went to the court and in record time in eight months for all those 16 patients we got the ruling in their favor fil X was given as interim compensation for them but that is not enough the question is about accountability well on that note we'll stop but what's your name Chandra Mohan mr. Chandra Mohan we invite you to write to the Hindus and we like to meet you to get more details and then we will process it and pass it on to those who can look and look into this but I thank you for this these insights and information that we like to be in touch on these issues dr. Nandi suggests there's one person here who can speak to this dr. Amin or pivara on his head of was excellent distributor of organs of brain-dead patients in Tamil Nadu and set the example for the whole country thank you thank you very much sir I just want to respond to you in a very very simple way I headed that department for eight years the two things worked well one is we must ensure absolute transparency in an organ tradition we must know the public have a right to know where each organ course this is tantamount paramount importance and that worked very well number two is constant interaction with stakeholders this is a fast developing subject we might also do mistakes for the only way to reduce errors is a participatory democracy you interact with stakeholders very frequently so we used to have an advisory committee consisting of people like are no current many ethicists and many journalists were also there so advisory committee participate in democracy absolute transparency they ensured a good working transplant system which began became one of the best in the country but having that said whether that is scalable to the entire country for example MCI was thinking what would be the good model of MCA we can have in this country why is that we are not able to have something like British Medical Council in India what prevents us and what he was talking about medical research but if your unit Cities Vice Chancellors themselves are raided and they continue to be vice-chancellor and what kind of research you expect so unless you tackle the problems at the top unless you ensure a governance which is transparent answerable to people and participatory democracies there at that level I don't think you can tackle all these peripheral problems thank you thank you very much and I think on that note it has to be inconclusive but I think this has been a very good meeting for us for everybody I thank the panelists who represents some of the many contributors or this book I thank dr. Nandi especially for coming from Delhi dr. money has been here before and this auditorium we the Hindu launched participated in the launch of his two of his books kara has been very much with us and dr. Thomas is a new participant in this we thank our finalists and above all we thank people like we we were not surprised by the level of interest but the fact that so many of you registered for invitations some some were invited we really appreciate that but I am NOT surprised because the subject is of great importance it's closely connected to the lives of people some of you have experiences we can learn from but I think this has been one of our best meetings in recent times I won't bother to presume to conclude on any note please buy the book read the book you got a sense of the book you've got a sense of the differences at the book some newly emergent here which we need to be followed up this debate has to be continued but I commend the editors of this book for getting to getting so many people together to present a comprehensive view of what can we only be called that's that's a quote from the book a broken system maybe not completely broken but a broken system nevertheless few can dispute that and I think we and the question is what do we do about it thank you [Applause] [Applause] [Applause] you you

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