DECCAN HERALD 11

Tuesday, July 5, 2016

Panorama

North, east India bathe

in monsoon. P12

Drop in stent prices has not benefited patients

By Dr Sanjay Mehrotra

verthelastfewdecades,newmedical
technologies and devices have revolutionisedhealthcare,enablingdoctors to treat potentially fatal heart diseases:
coronary stents have halved the number of
patients dying from heart attacks and implantablecardiacdefibrillatorshavepushed
up the survival rate from sudden cardiac
arrest from 5% to 98%. Minimally invasive
technology and advanced surgical equipmentusedtoconductheart,spineandneuro-surgerieshaveshortenedrecoverytimes,
improvingtheoutcomesofthesepreviously
life threatening procedures.
Medicaltechnologyisespeciallyrelevant
in a country like India, which is struggling
to provide healthcare to its 1.4 billion people. Non-communicable diseases (NCDs)
such as cancer, heart disease, pulmonary
disorders and diabetes now add to the burden posed by infectious diseases, leading
tooverhalfofthetotaldeathsinthecountry.
Experts say that over 60 million Indians
will succumb to these by 2020.
This is especially relevant considering
the condition of the public health system

which is characterised by insufficient resources, doctor shortages and crumbling

infrastructure. Despite a rapidly growing
economy, India spends a mere 1% of its
GDP on public health, far less than China,
Nigeria and the United States.
So far, only 3% of the total health budget
hasbeenallottedtoNCDprogrammes;the
remainder goes to maternal and child
health, and communicable disease programmes.Despitethelifesavingroleplayed
by medical devices, less than 2% of those in
need have access to them. In fact, medical
facilities and treatments are still a dream
for 70% of peoplewho livein remote areas.
The absence of robust public hospitals
leads three-fourths of the population to
seek private medical treatment, at their
ownexpense.AccordingtothelatestWHO
Global Health Expenditure database,
85.9% of total private health expenditure
in India was paid out-of-pocket by individuals in 2013. Nearly half of hospital admissions were financed by loans and sales of
assets. The NCDs are only compounding
the huge economic loss incurred by families, and an impetus must be given to national efforts to stall the public health crisis

we have today, innovation which would

havebeenimpossiblewithoutfunds.While
price regulation on established but still
useful technologies may promote the provision of low cost health care to the needy,
it will be detrimental to the development
of new technologies.
Nodoubt,MakeinIndiaisagoodslogan.
ButMadeinIndianeedstoearncredibility
when it comes to medical devices. Quality
control standards are a must for all indigenous devices. Yet, so far, locally made devices have not been subjected to the rigorous research required to ensure they meet
globalstandardsofquality.Tillthishappens,
we must ensure that tried and tested delooming on the horizon.
vices already in the market reach those
The national mission of providing most in need.
health for all can only be realised once
both rural and urban populations have ac- Price regulation
cesstoqualityhealthcarethatincludesmed- Medical technology plays a critical role in
icaldevicesandtechnologies.Technological improving patient outcomes, including
innovation is the hallmark of medical tech- quality of life, and policy makers must renology and the governments move to cap alise that the policies that encourage rethe prices of critical medical devices will search and innovation are essential. Relimit the evolution of devices.
strictive policies prevent companies
Take the progress of stents from basic from introducing newer life saving techmetal devices to the bio-absorbable ones nologies and we, as doctors and patients,

will lose out on newer therapies.

Priceregulationcannotserveitspurpose
because newer technology does not fall in
its ambit. It may be possible to control the
pricesofoldorobsoletestentsbutnotstents
thatareconstantlybeingupgradedthrough
researchanddevelopment.Lowqualitydevices can lead to repeat procedures, prolonging time spent in hospitals, increasing
medical expenses over the long term, and
ultimately shortening life spans.
In any case, the price of a medical device
is just a fraction of the total cost paid by a
patient for implantation, in a hospital. So
thereisnoguaranteewhatsoeverthatalower priced device will cost the patient less.
During 2011-14, stent prices fell steeply
ascomparedtodrugandprocedureprices.
But patients havent derived the benefit of
this price drop. The cost of an angioplasty
procedure has risen in every hospital. The
only way to ensure benefits of price reduction are conferred to patients is to regulate
the hospital mark up of procedures.
Ultimately, the need of the hour is to ensure that every Indian who needs a stent or
pacemakerhasaffordable,highquality optionsathisreach.AsIndiastrivestoprovide

Revelation on attackers
shocks Bangladesh
Themen,allintheirlateteensorearly20s,wereproductsofBangladeshs elite,includingaformerleaders son
By Julfikar Ali Manik and Geeta Anand

angladeshs capital city reeled in shock

on Sunday as clues began to flood social
mediaabouttheprivilegedbackgrounds
of the half dozen attackers believed to have
butchered 20 patrons of a restaurant during a
bloody siege in Dhaka late last week.
The six attackers were killed when the army
stormed the Holey Artisan Bakery to end an 11hour siege early Saturday. The police declined
to name the young men because nobody had
shown up as of Sunday night to identify their
bodies, but friends and relatives recognised
photographs that were posted on a messaging
app by the Islamic State (IS) group, along with
praise for the violence.
The men, all in their late teens or early 20s,
were products of Bangladeshs elite, several
having attended one of the countrys top English-medium private schools as well as universities both in the country and abroad. Among
them was the son of a former city leader in the
prime ministers own Awami League, the governing party.
Thatswhatwereabsolutelyrivetedby,said
KaziAnisAhmed, awriterandpublisherofthe
daily newspaper, The Dhaka Tribune, That
these kids from very affluent families with no
material want can still be turned to this kind of
ideology, motivated not just to the point of
killing but also want to be killed.
That children of the countrys upper classes
appear to have joined militant Islamists in an
act of such brutality highlighted the radicalisation among the largely moderate Muslim population here, a process that has accelerated in
recent years. The attackers intended to kill foreigners, whom they shot and then hacked with
sharp weapons, blaming them for hampering
the progress of Islam, a hostage later said.
For more than three years now, Islamist militantshavemurderedatheistbloggers,members
of religious minorities and others. The IS and a
regional branch of al-Qaeda have claimed responsibilityforthekillings,althoughtheBangladeshi government continues to insist that local
groups were responsible. The involvement of
ISappearedincreasinglymorelikelyduringthe
latest attack, with the organisation not only
claimingresponsibilitybutlaterpostingthephotographs of men believed to have carried it out.
Some of the rescued hostages remained in
police custody Sunday evening, including a
Bangladeshi couple and their two school-aged
childrenwhowitnessedthemassacre,theirrelatives said. The country was in the midst of a
two-day mourning period declared by Prime
Minister Sheikh Hasina, but in the homes of
the young men who had been identified as the
attackers on social media, families struggled
with grief, shame and disbelief.
On Sunday, police telephoned Meer Hayet
Kabir, an executive with a foreign company in
Dhaka,askinghimtogotothemilitaryhospital
morguetoidentifyabodythatwaspossiblythat
ofhis18-year-oldson,MeerSaamehMubasher.
He said he just could not bear to make the trip.

OUTPOURING OF ANGUISH: Local residents pay their respects to the victims of the attack at the Holey Artisan Bakery at a stadium in Dhaka. The children of Bangaldeshs upper classes joining militant Islamists in an act of such brutality highlights the radicalisation there. AP

How will we arrange a funeral for him in

these circumstances?heaskedinaninterview
in his familys apartment in a wealthy neighbourhoodclosetothediplomaticdistrict.Who
willcome?Iwillhavetoapologisetothewhole
world on behalf of my son,he said.
Kabir had already been in close touch with
the police since Mubasher disappeared on Feb
29.TheyoungmanwasastudentatScholastica
School, one of the top private schools in Dhaka.
He left home for a tutorial class, which he did
not attend, and never returned. Kabir said he
hadmadetheroundsofpoliceandsecurityofficials in the capital since then, seeking help. He
gave them a picture of his son, describing him
as quiet and pious, someone who prayed five
times a day and frequented the local mosque.
Kabirs close relatives believe Mubasher was
radicalisedeitherbypeoplehemetatamosque
or in school. I believe some Islamist group recruited my boy and brainwashed him, Kabir
said. At least two other young men who appear
in the photographs posted by the IS had also
attended the Scholastica School, a senior government official said. The official spoke on the
condition of anonymity because he was not authorised to speak about the investigation.
That official said that several of the men pic-

tured had studied in Malaysia, at least one at

Monash University, and that at least one other
hadstudiedatNorthSouthUniversity,aprivate
collegeinDhakawhereseveralothersconvicted
in the hacking death of a blogger in 2013 were
students. The families of other attackers had
also reported them missing, the official said.
Party leaders son
Among them was a son of a former city Awami
League official who disappeared at the end of
December, said Biplob Kumar Das, Deputy Commissioner at the Dhaka Metropolitan Police.
Das said police officers searching for the young
man, who was in his early 20s, had linked him
with militant groups but had not been able to
apprehend him. He confirmed that one of the
photographs posted by the IS resembled him.
Kabir said the family was unaware that
Mubasherwasbeingradicalised,except,inretrospect, for one clue. The young man had liked
to play the guitar, his father said, but about
three months before his disappearance, he
stopped.WhenKabiraskedwhy,hissonreplied,
Music is not good, reflecting an Islamist believethatmusicanddancingarebadinfluences.
Until now, he had hoped that Mubasher
would reappear one day soon, like some others

who disappear into Islamic groups for a time

and then come back. How can I believe my
kinwhohashumanitarian qualitiescanbepart
of these brutal killings?he asked.
Gowher Rizvi, an adviser on foreign affairs
to Hasina, said police continued to believe that
local groups were behind the militant attacks,
and initial indications are that the restaurant
siegewasalsoorchestratedbyhomegrownmilitants.YetRizvisaidBangladeshwasalsowilling
toconsiderwhetherinternationalgroupsmight
beinvolved,althoughinvestigatorshadnotseen
evidenceofexternalcoordinationintheFriday
attack or the others of the past three years.
Kabirwassteelinghimselftomakethedreaded trip to the morgue on Monday morning to
confirm whether his son was among the dead
attackers. He had been staring at the pictures
ofthefiveyoungmeninred-and-white-checked
kaffiyehs, trying to convince himself that
Mubasher was not among them.
Whileherecognisedthechubbycheeks,wide
nose and big smile in the picture, Kabir said,
there was also something unfamiliar about it.
I can tell you my boy was really a good humanitarian soul, he said. Such a soul cannot
do something cruel like this.
International New York Times

universalhealthcaretoitscitizens,medical
technology that diagnoses and treats complex NCDs is even more critical.
Weneedtobreachthehugegapbetween
the numbers of devices used and those required, to address public health needs.
Heartdisease,diabetesandcancersarejust
someoftheNCDsthatremainundiagnosed
and untreated, primarily because medical
devices dont reach everyone.
Solving our enormous public health
dilemmas demands a broader, multi-sectoral approach. We need to spend at least
5-6%ofourGDPonhealth,basedonglobal
evidence that this amount is essential to
meet the basic health needs of populations.
Reducing the urban-rural disparity and inequitiesinhealthcareiscrucialtoo.Ultimately,alargernumberofdoctorstoservethe
medical needs of underprivileged communities, and a stronger public health infrastructurewillpavewayforastrongerIndia.
(The writer is Senior Consultant Cardiologist at the Narayana Institute of Cardiac
Sciences, Bengaluru, a visiting fellow at the
Texas Heart Institute, Houston and Senior
Registrar at the Western General Hospital,
Edinburgh, UK)

Campus politics
nurtures democracy
By P U Antony

uring the student

protests in Jawaharlal
Nehru University and
Hyderabad Central University,
Union Minister M Venkaiah
Naidu had objected to campus
politics. Months after that, a
government panel headed by
former cabinet secretary T S R
Subramanian who earlier
headed even the new environment policy working group
has recommended restrictions
on political activities in universities and colleges across the
country.
A few days back, in the wake
of criticisms, the Human Resource Development (HRD)
Ministry had rejected the committees recommendation banning student politics and proposed to conduct a study on
how to prevent outsidersand
those who have ceased to be
students from playing an active rolein student politics, disrupting the academic activities.
The ministry also recognised
the positive role played by student unions in furthering the
interests of democracy.
In India, the trend of students actively participating in
politics began in the early 20th
century, when the country was
fighting for its freedom. Political parties, at that time, started
soliciting the support of the
young students who organised
themselves to help one party
or the other. This trend continues till date.
While a majority of the public argue that students should
be kept away from politics, confining them to their study
schedules only, the politicians
took the younger generation as
their labour force. The present
scenario is thus a keen struggle
of political parties engaged in
enlisting support of students.
There are both disadvantages and advantages of students being on the centre stage
of politics. There have been incidences of violence, strikes,
and protest movements in our
educational institutions for different reasons. We have to realise that our economic development industries, social
welfare schemes, health, education, and infrastructure development is guided by political policies and practices.
Politics controls the creativity of our artists and writers
what they can or cannot speak.
Political backing is required for
even religious communities. It
also impacts and often controls
our personal lives the number
of children that we can have,
the food that we can eat, the
dress we can wear etc. Political
philosophers have extolled

popular participation as a
source of vitality, creative energy, as a defence against
tyranny, and as a means of enacting the collective wisdom.
The realities of the society
we live in should be understood
to value the need for politics in
our institutions, Politics today,
whether desirable or not, has
become totalitarian in nature
all around the world, varying
only in terms of degree. It has
become so pervasive that there
exists no social institution that
is not affected by politics or is
devoid of internal politics.
Deeply entrenched
If politics is so deeply entrenched in our system, how
can universities display apathy
to it? If the goal of education is
not myopically defined to train
students only in knowledge acquisition, but is to prepare students for unanticipated and
unimagined things that life has
to offer, then politics is imperative as a part and parcel of
campus activities.
Character building is the
first step to nation building.
Since campus politics is linked
to national and state level
politics, it becomes a good
springboard for youngsters to
enter the political pitch. Student politics institutionalises
the merit-based search for future leaders.
It is disheartening to note
that premier institutions of our
country do not allow student
politics. Consequently, some of
the best minds in India do not
get to enter the political arena.
Those who dispute against
the politicisation of institutions
give innumerable examples of
the entire academic sessions
going to waste. They condemn
political violence entering the
templesof learning. Handling
this issue by disallowing politics
in campuses is a myopic view.
May be, a change in the kind
of the politics they practice can
be thought of.
Democratic politics is not
only about the ritual of political canvassing, elections,
protests etc, but also refers to
the dialectical environment of
debate, discussion, dialogue
and dissent in a peaceful setting. The intention is not to
bulldoze opposing ideas but to
recognise the right of others
to have differing thoughts or
ideologies.
In a country with the worlds
largest youth population, it is
no doubt that the voice of students matters. For the future
leaders, student unions are the
first step to understand how a
democracy works.
(The writer teaches at Christ
University, Bengaluru)

WHATS THE BUZZ

Exercise bands err by

over 40% on fitness
Popular wrist-worn
tracking bands may
underestimate exercise levels by up to
40%, says a new study
by researchers from
Australia who determined the accuracy of several
popular wrist-worn fitness monitors.
None of the devices proved to be consistently
more accurate overall and the percentage error
for energy expenditure was between 9% and
43%. Measurement of heart rate was more accurate, with only minor variances, said Matthew
Wallen from University of Queenslands School of

Human Movement and Nutrition Sciences.

The study involved 22 healthy volunteers (11
males and 11 females) completing a variety of activities from running, cycling and walking, to seated and laying rest for approximately one hour.
The measurements of the wrist-worn devices
were compared to ECG readings every 15 seconds
and against a portable gas analysis system which
measured the number of calories burnt. Wristworn fitness monitors underestimated energy expenditure with variances of more than 40%.

Marijuana compound can help

treat Alzheimers disease
Scientists have found preliminary evidence that
compounds such as tetrahydrocannabinol (THC)
present in marijuana may promote the cellular

removal of amyloid beta, a toxic protein associated with Alzheimers disease, a finding that could
help treat the brain disorder, a study has claimed.
Researchers studied nerve cells altered to produce high levels of amyloid beta to mimic aspects
of Alzheimers disease. They found that high levels of amyloid beta were associated with cellular
inflammation and higher rates of neuron death.
The team demonstrated that exposing the cells
to THC reduced amyloid beta protein levels and
eliminated the inflammatory response, thereby
allowing the nerve cells to survive.
The psychoactive effects of marijuana are
caused by THC, a molecule similar in activity to
endocannabinoids, both of which can activate
same brain receptors, they said. Physical activity
results in the production of endocannabinoids
and studies have shown that exercise may slow
the progression of Alzheimers, researchers said.

Children of single mothers

are well-adjusted: UK study
Children born to single
mothers are generally
well adjusted, with positive feelings about family life, although they do
raise questions about
the absence of a father, a new study has found.
The study was an evaluation of 51 solo mother
families who were compared with 52 heterosexual two-parent families with at least one donorconceived child aged 4-9 years.
Mothers in both groups answered questionnaires of child adjustment and parenting stress. In
addition, the solo mothers completed an interview
on their childrens feelings about a father, and

whether this was a topic of family discussion. A total of 47 children of solo mother families agreed to
be interviewed about family life and friendships.
Mothers mostly reported that their children
had neutral (39%) or mixed (28%) feelings about
the absence of a father, although qualitative analysis of mothersreports showed that conversations
about fathers were a prominent feature in family.
Most children (89%) who answered a question
about changing their family circumstances either
expressed a desire for just trivial changes (38%)
or no change (51%). They mostly reported high
(19%) or very high (40%) levels of enjoyment of
school. All reported having at least one friend,
and most (51%) named five or more friends.
Indeed, at the age at which children begin to
understand their family circumstances, they continue to function well, said Sophie Zadeh from
University of Cambridge in the UK.