This is with reference to your Cover Story, Doctors and their Devices (June 19). It is shocking to note that patients in this country are exploited to the brim by multi-speciality hospitals and doctors at every step of their treatment. Medical devices such as replacement kits and implants are priced about 300 to 1,000 per cent more than the ex-factory prices or import prices. This has been happening for a long time, with the government knowing all of it but choosing to look the other way. India is known to have some of the best doctors in the world. One also hears that India has made major improvements in manufacturing medicines, yet it is not known why doctors and hospitals insist on selling imported drugs and medical kits, when cheaper Indian alternatives are available. The government’s move to promote generic drugs and kits manufactured in India, and making available cheaper drugs to poor people is appreciable, but what is needed is a vigorous and sustained push for the same. A relentless fight against the unscrupulous practices of big pharma companies is the need of the hour. But this can happen only when the concerned government agencies are willing to act. ‘Organised loot’ is the correct term to describe the practices of the medical sector.
M.Y. Shariff, Chennai
Imported medical devices are not cheap per se, but what is the justification of the mindboggling profit margin set by hospitals and doctors, who are hand-in-glove with big pharma companies, at the expense of clueless patients? A knee replacement implant kit imported at Rs. 10,159 is sold between Rs. 95,478 to 1, 47,628, with a maximum trade margin of more than 1,450 per cent! This is just a straightforward practice of looting a distressed patient, who has very little choice in the matter. The government may well take note of these unfair price hikes and intervene to put a cap on prices, as it did in the case of the cardiac stents a few months back. But how much will that really help? The Government slashed the prices of cardiac stents by over 75 per cent, but, as another of your stories on the subject revealed (Cheaper Stents Make No Hearty Dent June 19)—hospitals are still finding ways to fleece patients and ‘compensate’ for the price cap, for example, by hiking the hospitalisation charges as this doesn’t come under the National Pharmaceutical Pricing Authority (NPPA)’s portfolio. In this situation, a National Healthcare Pricing Authority needs to be created in place of the NPPA to control the prices of not only medical devices but also of each and every test and procedure involved in medical healthcare.
M.C. Joshi, Lucknow
After reading the article on medical devices with interest, I checked the website it quoted from and found out how misinformed it was. The knee replacement kit price you mention, Rs 10,159, is the price of just the stem extension and not the total knee kit. A basic knee replacement kit has three components—stem extension, femur and tibial liner, and in the same list they are priced at (Rs 18,404+Rs 12,515+ Rs 7,730) Rs 38,649. On this there is a custom’s duty of, I suppose, 7.73 per cent. So, before manufacturing sensation, the magazine should dig the data responsibly. I am sure there are company margins, dealer margins, central and state taxes etc, on this landing price. Having said that, I agree that implants are overpriced in India, and need an active government intervention.
Aman, New Delhi
Your story shows how doctors, who are expected to save lives, have become profit-crazed, unscrupulous businessmen, caring little for their patients. The reason behind it is the role abdicated by the Indian state to provide quality health and education to all. India spends just 1.4 per cent of GDP on its health sector. That makes health a highly privatised service, where private hospitals and care-givers can make up more than 80 per cent of an average household’s expenditure, whereas even in the US—the Mecca of privatised health-care—only 50 per cent of such expenditures are on private hospitals. Unless and until the Indian state takes the basic responsibility of meeting the health-care of its citizens, these businessmen in white coats will keep on looting hapless citizens.
Rakesh Agrawal, On E-Mail
Being a hapless victim of a multi-specialty hospital’s swindle, in the case of my mother who passed away, I strongly oppose this kind of a trend in our hospitals. The practice of extracting ridiculous amounts, even when the patient is incurable, is plain unethical. This routine is prevalent in almost all hospitals, small or large. Doctors refer patients to multi-specialty hospitals to extract commissions and exploit the helplessness of family members, who have to shell out huge sums of money. The medical council should debar such corrupt doctors who fleece money in the name of treatment.
K. Chidanand Kumar, Bangalore
This refers to Popping the Right Pill? Therapeutic substitution (using generic drugs from the same class as a brand-name drug) can help patient and large institutions save money. But medicines for chronic ailments like diabetes and blood pressure are usually prescribed as fixed dose combinations and prescribing generic drugs is not practical here. On issues of quality, doctors go by the name and reputation of the manufacturer. One cannot expect doctors to judge the quality of all the medicines prescribed by them. State & Central drug control authorities should ensure that only quality drugs reach the prescriber. Sadly, even established companies have been found to be short on quality parameters. Today, ‘affordable health care’ has proved to be a mirage for even the middle class.
H.N.Ramakrishna, Bangalore
People have no option but to believe in whatever doctors say. It’s no secret that doctors take commission from pharma companies. Can we have the medical association look into this and stop this open loot? And we must remember that at the end of the day, private hospitals are also corporates subject to quarterly reports and under pressure to perform as well. Therefore, one must not make the mistake of viewing them as charitable institutions.
Kamal Kapadia, On E-Mail
It’s about time the halo around the heads of docs was replaced with some accountability.
N. Srivatsa, On E-Mail
This refers to Are We Going to War? (June 12). Today, an all-out war between nations would lead to total destruction with the kind of nuclear weapons at the disposal of armies. Post-Hiroshima, the purpose of nuclear bombs has been to only demonstrate military might and compete with ‘enemy’ nations. The Chinese nuke test in October 1964 hurt Homi Bhabha’s pride as much as his patriotism. He said we were still 18 months away from exploding either a bomb or a nuclear device for ‘peaceful’ purposes. The then PM Lal Bahadur Shastri gave the go-ahead to prepare a test site. Around the same time, Pakistan was found to be covertly buying parts for a uranium-enrichment plant. The then Pakistan PM Zulfikar Ali Bhutto said, “If India builds the bomb, we will eat grass or leaves, even go hungry, but we will get one of our own.” Can we say that this is perhaps how even the thought of war impoverishes nations? The Kargil war was a disaster for both India and Pak. No sir, we should not go to war with Pakistan.
A.S. Raj, Mumbai
Apropos Scripting a Good Ending (June 19), I would like to thank the government and especially the home minister for at least taking the lead to settle the Kashmir imbroglio. In fact, it is now amply clear that the Kashmir tangle can unravel if that’s what both Indian and Pakistani politicians desire and if they are flexible enough for political settlement. It is sad that the two neighbours never see eye to eye and always try to bleed each other. We should learn from countries like Korea, Vietnam, Germany and Russia who have long settled their border disputes. The Berlin wall had to fall and Germany became one country once again. It is time India and Pakistan shunned hatred towards each other, settled their border dispute and learned to live in harmony so that people of both countries could prosper.
Lt Col Ranjit Sinha, New Delhi
This is with reference to Flash Bangs from the Star Stable (June 19). Star kids have a limited advantage over outsiders. They are launched with much fanfare, without having to struggle for their first break. But to be successful in tinsel town, pedigree is not all. The star kids get a readymade platform, but they still have to prove their worth. The box office does not distinguish between them and others. Moreover, they carry the baggage of extra expectations and are measured against the success of their parents. This quite often stifles their histrionic skills and weighs against them.
Vijai Pant, On E-Mail
This is about the editor’s leader comment on the media (Notwithstanding NDTV, Jun 19). In this fairly reasonable piece, the author has let the cat out of the bag by saying, “If it is about the 2002 riots, NDTV’s coverage wasn’t any different from any English newspaper’s”. This means the coverage was different from the vernacular media/press. While most of the vernacular press gave equal coverage to Godhra & post Godhra riots, the English media highlighted only the latter, as if the carnage in Godhra itself didn’t matter. Communal riots have happened before 2002 too, but the Gujarat riots will always be played over and over again in the English media, and used against the BJP and Modi. As the point has been frequently made, Modi is pilloried for 2002, but Congress leaders got a clean chit after the 1984 anti-Sikh riots. At least for the Gujarat riots an SIT under the Supreme Court did hand out punishment to some people, including ruling party leaders. But what happened in 1984 was scarcely probed; victims still wait for justice. In fact, the double standards of the media are glaring. Take the recent comments of Mani Shankar Aiyar, Salman Khurshid and Omar Abdullah in the English media, accusing Indian security forces of all sorts of crimes against human rights in Kashmir, while keeping silent about stone-pelters who destroy lives as well as jehadi militants and separatist politicians. Not a single English editorial took a contrary line. Take also Sandeep Dikshit’s views accusing the army chief as a ‘sadak ka gunda’. It would be like music to the ears of our foes across the border.
Hemanth D. Pai, Bangalore
No one is surprised at the wages of sin Air India is now required to reap for the profligacies of people like Praful Patel, who was the aviation minister in UPA-1 (A Bird’s Past, and Future, June 19 ). Reckless purchase of aircraft, that too after merger with its junior loss-making partner Indian Airlines, almost sank the maharaja of Indian skies. Another hard-to-explain folly of the management was to surrender the full occupancy flights, like the Amritsar—Birmingham—Amritsar, which were introduced with great fanfare in 2005 to favour the hub-and-spokes ‘innovation’ under which all such flights were made to originate from Delhi and benefit the airport operator GMR, even if this caused avoidable inconvenience and hardship to Punjab passengers bound for long-distance destinations. More skeletons are tumbling out as Air India is dragged in to face one controversy after another. What a sad spectacle for the dream airline of the late J.R.D. Tata.
Mohan Singh, Amritsar
Niti Aayog’s proposal to privatise Air India is most welcome, given the airline is now surviving on regular infusion of government funds. Yet, there is another salvage formula: find a strategic investor whose demands could be embarrassing (such as monetising its assets, compensating its services like evacuating Indian citizens during a crisis and conveying security personal during elections). AI has huge assets that are not yet computed. Also, it owns facilities that are highly profitable. If these are monetised, the revenue will be enough to take care of a large part of its debts.
C. Koshy John, Pune
There is no other option but to privatise AI, more so when it is weighed down by a huge debt and the unproductive merger with Indian Airlines a decade ago. It has become inevitable for the government to exit the airlines business. Considering that Indian aviation sector is expected to become the world’s third-largest in the market in the next three years, the government needs to lay a proper roadmap for not only AI’s privatisation but the sector as a whole. AI employees should not feel insecure, as there is no dearth of opportunities in the aviation sector for them.
Bal Govind, Noida
The extract from Ruskin Bond’s autobiography, Lone Fox Dancing (Trysts Under The Deodars, Jun 19), makes for pleasant reading. His frank manner and lucid style of expression is perfect for narrating his parents’ courtship and his granny’s discomfort about his legitimacy. His affection for the hills of north India is also infectious.
M.N. Bhartiya, Goa
This is about the interview with Shyam Saran (‘Trump relishes making deals and bargains’, June 19), about India’s diplomatic way forward with the Trump administration. Having failed in all his strange ideas about taming terror, Trump has now targeted the Paris Agreement on climate change, walking out of it with a barrage of lies about other major countries. The absurdity of his decision is all the more apparent given the status of fossil fuels in the US, with most Americans, and most Republican leaders, supporters and corporate leaders solidly behind renewable energy, rubbishing Trump’s dubious reasons. Far from being a credible world leader, Trump might just help create a climate crisis. What a legacy to leave!
L.J. Sing, Amritsar
