The drugs don’t work, say back pain researchers

Commonly used non-steroidal anti-inflammatory drugs used to treat back pain provide little benefit, but cause side effects, according to new research from The George Institute for Global Health.

The findings of the systematic review, published in the Annals of the Rheumatic Diseases, reveal only one in six patients treated with the pills, also known as NSAIDs, achieve any significant reduction in pain.

The study is the latest work from The George Institute questioning the effectiveness of existing medicines for treating back pain. Earlier research has already demonstrated paracetamol is ineffective and opioids provide minimal benefit over placebo.

Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories. But our results show anti-inflammatory drugs actually only provide very limited short term pain relief. They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance.

When you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year.

The team at The George Institute, which examined 35 trials involving more than 6000 people, also found patients taking anti-inflammatories were 2.5 times more likely to suffer from gastro-intestinal problems such as stomach ulcers and bleeding.

— source georgeinstitute.org

Claims we buy

As Nandini Shah, a health-conscious young working mother in New Delhi, enters a supermarket, she knows exactly what to buy. She picks Bournvita for her 11-year-old son and Fortune VIVO Diabetes-Care Oil for her husband. “Bournvita will help build stamina in my son who has interest in sports, and the oil can help manage diabetes of my husband,” she says. Deepti Khanna, a college student from a posh South Delhi locality, carefully reads nutrition facts on the label before buying grocery items. “I prefer NutriChoice Essentials Oats cookies and Sunfeast Farmlite Digestive over other biscuits as they have a high fibre content, are made out of whole grains and have no added sugar,” says Khanna. She also buys ragi (finger millet) cookies for her diabetic father and Saffola Masala Oats for a healthy snack in the morning.

While Shah and Khanna are happy with their choices, the claims based on which they choose the products may not be entirely true. An analysis by Delhi-based Centre for Science and Environment (CSE) shows that several milk-food drinks come loaded with sugar. A serving of Bournvita contains enough sugar to exhaust 57 per cent of one’s daily quota as recommended by the National Institute of Nutrition (NIN) in Hyderabad.

CSE researchers also spoke to health and nutrition experts to understand the authenticity of claims by food manufactu rers, and the observations were startling.

The claims made by diabetes-friendly products like Fortune VIVO Diabetes-Care Oil are misleading. “Diabetics may assume that such products are especially made for them and end up consuming liberally, leading to excess calorie intake,” says V Mohan, Chairperson of Madras Diabetes Research Foundation, Chennai. In fact, nine cases have been registered against Fortune VIVO Diabetes-Care Oil at the Grievance Against Misleading Advertise ments (GAMA) portal of the Department of Consumer Affairs (DoCA) since it was launched in 2016. An evaluation of the product’s claim by DoCA showed it pertains to only type-2 diabetics and is based on a study conducted over a short period.

“Diabetes-friendly cookies are misleading as cookies usually contain a minimum of 15 per cent fat which may increase the total caloric intake,” says Mohan. A 150 g pack of NutriChoice Essentials Ragi cookies comes with six packets of three biscuits, which are usually consumed in one go. These three biscuits can provide 18-22.5 per cent of the daily fat allowance—this is significantly high given that biscuits are not meal. Though popular digestive biscuits are considered healthier alternatives due to no added sugar, the calorie content in 1 g of fat is double that of sugar, he adds.

Seema Gulati, Head of Nutrition Research Group at the Center for Nutrition and Metabolic Research, Delhi, points out a serious problem. Food items marketed under high fiber, multi-grain category often come loaded with saturated fats and trans-fats, which are implicated in heart diseases. “Whole grain cereals are healthy. But it is not appropriate to call whole grains healthy after they are coated with sugars and fats,” says Shweta Khandelwal, associate professor with the Public Health Foundation of India in Gurugram.

“Saffola Masala Oats are salty (or have high sodium content),” says Shalini Singhal, chief nutritionist at Dr Shalini’s Wellness in New Delhi. High-sodium foods can strain one’s heart and blood vessels. But the 40 g pack of Saffola Masala Oats does not mention sodium content on its label. Another brand, Quaker Oats, owned by Pepsico, mentions sodium content on the label of its sweet variety but not on the salted one. Nestle’s Maggi Veg Atta Noodles also does not declare sodium content on the pack, though Maggi Masala declares that it contains about 900 mg of sodium per serve. A 2012 study by CSE had found that instant noodles have highest salt content—4.2 g in Maggi Masala and 3.2g in Top Ramen noodles (per 100 g).

While Shah and Khanna may feel duped after knowing these information (see ‘Hidden facts’), making misleading claims by manufacturers through labels and advertisements is a common practice in the country. And at the root of this is a weak regulatory framework governing labels and advertisements.

Gross omissions on labels “Food labels are essential source of infor mation and potentially powerful tools of communication to discourage consump tion of unhealthy packed foods,” says SubbaRao M Gavaravarapu, Deputy Director at NIN.

Nutrition and health claims made on labels are governed under the Food Safety and Standards (Packaging and Labelling) Regulations, 2011. But all that the regulations do is briefly define nutrition and health claims. While the market is flooded with multitude of claims, the regulations have set standards for only three nutrition claims—trans-fats, saturated fats, and dietary fibres, which was added almost as an afterthought in mid-2016. Worse, the standard set for the claim “trans-fats free” is vague—it is based on serving size whereas India does not have a standard serving size.

While food manufacturers often use nutritional facts to make health claims, such as “diabetic-friendly” and “whole at its heart”, the regulations do not have a list of authorised or unauthorised health claims. “All health claims are misleading as health depends on the total diet and lifestyle, not just on one product,” says Marion Nestle, professor of nutrition, food studies and public health with New York University.

Though the regulations say such claims should be scientifically substantiated, they do not mention the kind of substantiation required. They also have no provision requiring manufacturers to seek approval for such claims. “The approval procedure is mostly about self declaration,” says Ashok Kanchan, chief advisor at Consumer Voice, voluntary action group in Delhi. Companies share details about the claims upon being questioned, and this leaves a room to cheat consumers by not selling the same product batch that has been tested, he says.

The regulations also do not provide reference values for popular claims, such as low sugar, low sodium, light or lite, diet.

The scenario in India appears chaotic when compared with developed countries. The EU maintains a list of permitted nutrition claims and authorised and unauthorised health claims; has a detailed approval process; and prescribes reference values for terms such as high, low, extra, rich, more and less, which are used to describe the amount of nutrients.

Similarly, in the US, standards are available for almost all nutrients of concern and details on the kind of health claims that can be made along with approval process. “It is important to regulate claims to ensure that food labels are truthful and not misleading. This way, consumers can have confidence in the label,” says Anne Norris, Health Communications Specialist, US Food and Drug Administration (FDA), adding that FDA has the authority to take action in case the information on labels are false and misleading.

Even the Codex Alimentarius, whose set of standards and guidelines are recognised by several countries across the globe, lays out standards for nutrients, such as salt, sugar and fat.

A lax regulation means several claims that are considered invalid or unlawful in developed countries, are freely used to push products in India. For instance, Kellogg’s Special K makes the claim of being 98 per cent fat-free. No food product can make such “x per cent fat-free” claims in the EU. Health claims linking dietary fibre to a lower risk of heart diseases are not authorised in the US, whereas such claims are liberally made in India. In Canada, claims, such as “DHA helps in cognitive performance”, are considered vague. But in India, Bournvita Lil Champs claims: “contains DHA helps brain development”.

Censored ad regulations

Advertisements are another powerful tool to push food products. Though they come under the purview of several departments and government agencies, including the Food Safety and Standards Authority of India (FSSAI), they are largely self-regulated through the Advertising Standards Council of India (ASCI), an industry association.

For instance, FSSAI can penalise those involved in misleading advertisements under the Food Safety and Standards Act, 2006. But it does not directly monitor advertisements and has a Memorandum of Understanding with ASCI for doing so. Similarly, DoCA directs all complaints registered on its grievance portal GAMA to ASCI.

“We are not a pre-approving body, so there is no pre-censorship of advertisements,” says Shweta Purandre, Secretary General of ASCI. “We are a self-regulatory body and our role is to sensitise advertiser,” she adds. Based on complaints, ASCI has withheld a few advertisements in the past. A few recent ones are the claims made by Fortune Rice Bran Health Oil, which says the product contains “antioxidant power”. But antioxidants do not necessarily correspond to “power”. Another such claim is by Kellogg’s K, which mentions, “2 week challenge and eating 2 bowls everyday: 1 for breakfast, 1 for lunch/dinner for only 2 weeks”. The advertisement was found to be misleading as it does not mention specific conditions of the diet plan.

But since ASCI does not have the power to impose punitive measures, violators often repeat offences. In fact, companies are lately changing their campaigns, moving from nutrition and health claims to emotional tags to avoid scientific scrutiny.

In 2011, Bournvita’s tag line was “Badhaye doodh ki shakti” (increases power of milk), where the advertisement focussed on the presence of Vitamin D in the drink, which can help absorption of calcium in milk. In 2013, the focus shifted to emotion. In the ad-campaign “Tayari jeet ki—Adatein”, a mother and son can be seen racing. The voice-over says, “Toh jis din woh mujhe harayega, main jeet jaoongi” (I will win the day he defeats me). Finally, one day, the son defeats the mother in their race.

“Present situation can encourage purposeful misleading advertisement as advertiser can go scot free. Consumers usually do not pursue action against misleading advertisements. So the role of government is important,” says Kirti Bhatt, former head of the legal division at Consumer Education Research Centre, Ahmedabad.

Endorsements of foods high in salt, sugar and fat by celebrities, such as prominent sports icons, actors and TV personalities, is also a huge concern worldwide. Their impact is not limited to the buying behaviour of children. The situation is damaging in India where most popular packaged foods, especially sweetened beverages, are endorsed by film celebrities. These include Kellogg’s K Special by Deepika Padukone, Thums Up by Salman Khan, Ching’s Secret and Kellogg’s Oat Masst Masala by Ranveer Singh.

The Consumer Protection Bill, 2015, which aims to replace the archaic Consu mer Protection Act, 1986, recommends stringent measures to tackle misleading advertisements and fix liability on endorsers or celebrities. The draft Bill has provisions for imposing a penalty of Rs 10 lakh and imprisonment of up to two years or both for the first offence; and a fine of Rs 50 lakh and imprisonment of five years for the second offence. For subsequent offences, the penalty will increase proportionally based on the sales volume of the product.

But this may not be sufficient. Harish Bijoor, Chief Executive Officer at private-label consulting firm Harish Bijoor Consults Inc, says celebrities should not endorse food and beverage brands at all. “I blame us for tolerating brand endorsements. When you advertise something you put personal liability,” he says.

Words of advice

MAKE FOOD LABELLING AND CLAIMS FOOL-PROOF

Ascertain the nutrients for which claims can be made. The kind of nutrition claims along with limits suitable in the Indian context should be finalised. All other nutrition claims should be prohibited.
Only authorised health claims should be allowed. A procedure to approve health claims should be developed. A well-defined criterion for requirement and evaluation of scientific substantiation of claims needs to be worked upon. A detailed list of health claims, which are unacceptable, should be formalised.
An online system for all information related to claims should be set and made available to all stakeholders, including the public. It should include an updated repository of approved and unapproved nutrition and health claims.
Public health campaign on nutrition, food labelling and misleading claims should be initiated at all levels, starting from schools to mass media campaigns.
The current nutrition labelling needs to strengthen. It should include mandatory labelling of salt/sodium, added sugar, and immediate implementation of saturated fats and trans-fats labelling. Serving size must be standardised to help per serve information disclosure; nutrient declaration as per serve should be mandatory. Accordingly, serving size and number of servings in a pack must be mentioned wherever applicable. Per serve nutrient information should be mentioned along with percentage contribution to the recommended dietary allowance. The reference value used for calculating percentage should also be mentioned.
An easy-to-understand front-of-pack labelling system, provisions for warning labels and specified format for nutrition labelling should be developed.

MAKE ADVERTISEMENTS TRUTHFUL

Advertisements of food, particularly those high in salt, sugar or fat, should be approved prior to screening. They should be based on approved and unapproved claims finalised by Food Safety and Standards Authority of India. The evaluation should include the design and target group of the advertisement. An integrated advertisement approval and monitoring team should be set up by roping in different stakeholder ministries, such as the Ministry of Consumer Affairs, Information Broadcasting and Health and Family Welfare. Advertising Standards Council of India should also be involved in this.
With an aim to limit the power and exposure of advertisements to children and adolescents, celebrities should not be allowed to endorse foods high in salt, sugar or fat. No advertisement should be allowed for categories such as soft drinks on the lines of tobacco-based products.
There should be stringent legal and financial penalties for misleading claims. Liabi- lity should be aligned with the scale of damage. Penal provisions should be directed towards food manufactures and/or marketers.

— source downtoearth.org.in By Ananya Tewari, Amit Khurana

Global economic downturn linked with at least 260,000 excess cancer deaths

The economic crisis of 2008-10, and the rise in unemployment that accompanied it, was associated with more than 260,000 excess cancer-related deaths–including many considered treatable–within the Organization for Economic Development (OECD), according to a study from Harvard T.H. Chan School of Public Health, Imperial College London, and Oxford University. The researchers found that excess cancer burden was mitigated in countries that had universal health coverage (UHC) and in those that increased public spending on health care during the study period.

The study will be published May 25, 2016 in The Lancet. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2900577-8/abstract

— source eurekalert.org

Yearly Cost of U.S. Premature Births Linked to Air Pollution: $4.33 Billion

The annual economic cost of the nearly 16,000 premature births linked to air pollution in the United States has reached $4.33 billion, according to a report by scientists at NYU Langone Medical Center. The sum includes $760 million spent on prolonged hospital stays and long-term use of medications, as well as $3.57 billion in lost economic productivity due to physical and mental disabilities associated with preterm birth.

The new analysis, published online March 29 in Environmental Health Perspectives, is the first to examine the costs of premature births due to air pollution in the U.S., according to the study’s authors. Researchers say air pollution is known to increase toxic chemicals in the blood and cause immune system stress, which can weaken the placenta surrounding the fetus and lead to preterm birth.

“Air pollution comes with a tremendous cost, not only in terms of human life, but also in terms of the associated economic burden to society,” says lead study investigator Leonardo Trasande, MD, MPP, a professor at NYU Langone. “It is also important to note that this burden is preventable, and can be reduced by limiting emissions from automobiles and coal-fired power plants.”

For the study, Trasande and his colleagues examined data from the Environmental Protection Agency, the U.S. Centers for Disease Control and Prevention, and the Institute of Medicine. The investigators calculated average air pollution exposure and the number of premature births per county. They then tabulated estimates of the long-term health implications of premature birth as detailed in more than six previous investigations and computer models that focused on early death, decreased IQ, work absences due to frequent hospitalizations, and overall poor health.

Trasande says the research team plans to share their findings with policymakers in an effort to help shape regulations and laws designed to reduce air pollution and protect public health.

According to Trasande, the national percentage of premature births in the U.S. has declined from a peak of 12.8 percent in 2006 to 11.4 percent in 2013, but the number remains well above those of other developed countries.

Moreover, he says, the decline is insufficient to meet the goal of 8.1 percent by 2020 set by the March of Dimes, a voluntary health organization dedicated to reducing premature births and infant mortality.

Statistical estimates developed by his team as part of their analysis attribute slightly more than 3 percent of premature births to air pollution.

Among the report’s other key findings was that the number of premature births linked to air pollution was highest in urban counties, primarily in Southern California and the Eastern U.S., with peak numbers in the Ohio River Valley.

Trasande says his team plans to conduct further research into the role of specific outdoor air pollutants, especially particulate matter, and whether any stages of pregnancy are more susceptible to their negative effects, including increased risk of heart and lung diseases. Trasande also plans to expand the analysis to a global level.

Funding support for the study was provided by the KiDS of NYU Langone Foundation. Besides Trasande, other researchers involved in the study were Patrick Malecha, BS, and Teresa Attina, MD, PhD, MPH, both of NYU Langone Medical Center.

— source nyulangone.org By David March

The US Health System Is an “International Scandal”

Changes are coming to America’s health care system. Not long from now, the Affordable Care Act could be history. President-elect Donald Trump wants to repeal so-called Obamacare, although he is now urging Republicans to repeal and replace it at the same time. But replace it with what?

The political culture of the most powerful nation in the world is such that it vehemently defends the right of people to buy guns but opposes the right to free and decent health care for all its citizens. In all likelihood, the Trump health care plan will be one based on “free market principles.” Under such a plan, as Noam Chomsky notes in the exclusive interview for Truthout that follows, poor people are likely to suffer most. In other words, the scandalous nature of the US health care system is bound to become even more scandalous in the Trump era. Welcome back to the future.

C.J. Polychroniou: Trump and the Republicans are bent on doing away with Obamacare. Doesn’t the 2010 Patient Protection and Affordable Care Act (ACA) represent an improvement over what existed before? And, what would the Republicans replace it with?

Noam Chomsky: I perhaps should say, to begin, that I have always felt a little uncomfortable about the term “Obamacare.” Did anyone call Medicare “Johnsoncare?” Maybe wrongly, but it has seemed to me to have a tinge of Republican-style vulgar disparagement, maybe even of racism. But put that aside…. Yes, the ACA is a definite improvement over what came before — which is not a great compliment. The US health care system has long been an international scandal, with about twice the per capita expenses of other wealthy (OECD) countries and relatively poor outcomes. The ACA did, however, bring improvements, including insurance for tens of millions of people who lacked it, banning of refusal of insurance for people with prior disabilities, and other gains — and also, it appears to have led to a reduction in the increase of health care costs, though that is hard to determine precisely.

The House of Representatives, dominated by Republicans (with a minority of voters), has voted over 50 times in the past six years to repeal or weaken Obamacare, but they have yet to come up with anything like a coherent alternative. That is not too surprising. Since Obama’s election, the Republicans have been pretty much the party of NO. Chances are that they will now adopt a cynical [Paul] Ryan-style evasion, repeal and delay, to pretend to be honoring their fervent pledges while avoiding at least for a time the consequences of a possible major collapse of the health system and ballooning costs. It’s far from certain. It’s conceivable that they might patch together some kind of plan, or that the ultra-right and quite passionate “Freedom Caucus” may insist on instant repeal without a plan, damn the consequence for the budget, or, of course, for people.

One part of the health system that is likely to suffer is Medicaid, probably through block grants to states, which gives the Republican-run states opportunities to gut it. Medicaid only helps poor people who “don’t matter” and don’t vote Republican anyway. So [according to Republican logic], why should the rich pay taxes to maintain it?

Article 25 of the UN Universal Declaration on Human Rights (UDHR) states that the right to health care is indeed a human right. Yet, it is estimated that close to 30 million Americans remain uninsured even with the ACA in place. What are some of the key cultural, economic and political factors that make the US an outlier in the provision of free health care?

First, it is important to remember that the US does not accept the Universal Declaration of Human Rights — though in fact the UDHR was largely the initiative of Eleanor Roosevelt, who chaired the commission that drafted its articles, with quite broad international participation.

The UDHR has three components, which are of equal status: civil-political, socioeconomic and cultural rights. The US formally accepts the first of the three, though it has often violated its provisions. The US pretty much disregards the third. And to the point here, the US has officially and strongly condemned the second component, socioeconomic rights, including Article 25.

Opposition to Article 25 was particularly vehement in the Reagan and Bush 1 years. Paula Dobriansky, deputy assistant secretary of state for human rights and humanitarian affairs in these administrations, dismissed the “myth” that “‘economic and social rights constitute human rights,” as the UDHR declares. She was following the lead of Reagan’s UN Ambassador Jeane Kirkpatrick, who ridiculed the myth as “little more than an empty vessel into which vague hopes and inchoate expectations can be poured.” Kirkpatrick thus joined Soviet Ambassador Andrei Vyshinsky, who agreed that it was a mere “collection of pious phrases.” The concepts of Article 25 are “preposterous” and even a “dangerous incitement,” according to Ambassador Morris Abram, the distinguished civil rights attorney who was US Representative to the UN Commission on Human Rights under Bush I, casting the sole veto of the UN Right to Development, which closely paraphrased Article 25 of the UDHR.The Bush 2 administration maintained the tradition by voting alone to reject a UN resolution on the right to food and the right to the highest attainable standard of physical and mental health (the resolution passed 52-1).

Rejection of Article 25, then, is a matter of principle. And also a matter of practice. In the OECD [Organization for Economic Cooperation and Development] ranking of social justice, the US is in 27th place out of 31, right above Greece, Chile, Mexico and Turkey. This is happening in the richest country in world history, with incomparable advantages. It was quite possibly already the richest region in the world in the 18th century.

In extenuation of the Reagan-Bush-Vyshinsky alliance on this matter, we should recognize that formal support for the UDHR is all too often divorced from practice.

US dismissal of the UDHR in principle and practice extends to other areas. Take labor rights. The US has failed to ratify the first principle of the International Labour Organization Convention, which endorses “Freedom of Association and Protection of the Right to Organise.” An editorial comment in the American Journal of International Law refers to this provision of the International Labour Organization Convention as “the untouchable treaty in American politics.” US rejection is guarded with such fervor, the report continues, that there has never even been any debate about the matter. The rejection of International Labour Organization Conventions contrasts dramatically with the fervor of Washington’s dedication to the highly protectionist elements of the misnamed “free trade agreements,” designed to guarantee monopoly pricing rights for corporations (“intellectual property rights”), on spurious grounds. In general, it would be more accurate to call these “investor rights agreements.”

Comparison of the attitude toward elementary rights of labor and extraordinary rights of private power tells us a good deal about the nature of American society.

Furthermore, US labor history is unusually violent. Hundreds of US workers were being killed by private and state security forces in strike actions, practices unknown in similar countries. In her history of American labor, Patricia Sexton — noting that there are no serious studies — reports an estimate of 700 strikers killed and thousands injured from 1877 to 1968, a figure which, she concludes, may “grossly understate the total casualties.” In comparison, one British striker was killed since 1911.

As struggles for freedom gained victories and violent means became less available, business turned to softer measures, such as the “scientific methods of strike breaking” that have become a leading industry. In much the same way, the overthrow of reformist governments by violence, once routine, has been displaced by “soft coups” such as the recent coup in Brazil, though the former options are still pursued when possible, as in Obama’s support for the Honduran military coup in 2009, in near isolation. Labor remains relatively weak in the US in comparison to similar societies. It is constantly battling even for survival as a significant organized force in the society, under particularly harsh attack since the Reagan years.

All of this is part of the background for the US departure in health care from the norm of the OECD, and even less privileged societies. But there are deeper reasons why the US is an “outlier” in health care and social justice generally. These trace back to unusual features of American history. Unlike other developed state capitalist industrial democracies, the political economy and social structure of the United States developed in a kind of tabula rasa. The expulsion or mass killing of Indigenous nations cleared the ground for the invading settlers, who had enormous resources and ample fertile lands at their disposal, and extraordinary security for reasons of geography and power. That led to the rise of a society of individual farmers, and also, thanks to slavery, substantial control of the product that fueled the industrial revolution: cotton, the foundation of manufacturing, banking, commerce, retail for both the US and Britain, and less directly, other European societies. Also relevant is the fact that the country has actually been at war for 500 years with little respite, a history that has created “the richest, most powerful¸ and ultimately most militarized nation in world history,” as scholar Walter Hixson has documented.

For similar reasons, American society lacked the traditional social stratification and autocratic political structure of Europe, and the various measures of social support that developed unevenly and erratically. There has been ample state intervention in the economy from the outset — dramatically in recent years — but without general support systems.

As a result, US society is, to an unusual extent, business-run, with a highly class-conscious business community dedicated to “the everlasting battle for the minds of men.” The business community is also set on containing or demolishing the “political power of the masses,” which it deems as a serious “hazard to industrialists” (to sample some of the rhetoric of the business press during the New Deal years, when the threat to the overwhelming dominance of business power seemed real).

Here is yet another anomaly about US health care: According to data by the Organization for Economic Cooperation and Development, the US spends far more on health care than most other advanced nations, yet Americans have poor health outcomes and are plagued by chronic illnesses at higher rates than the citizens of other advanced nations. Why is that?

US health care costs are estimated to be about twice the OECD average, with rather poor outcomes by comparative standards. Infant mortality, for example, is higher in the US than in Cuba, Greece and the EU generally, according to CIA figures.

As for reasons, we can return to the more general question of social justice comparisons, but there are special reasons in the health care domain. To an unusual extent, the US health care system is privatized and unregulated. Insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs are far greater in the private component of the health care system than in Medicare, which itself suffers by having to work through the private system.

Comparisons with other countries reveal much more bureaucracy and higher administrative costs in the US privatized system than elsewhere. One study of the US and Canada a decade ago, by medical researcher Steffie Woolhandler and associates, found enormous disparities, and concluded that “Reducing U.S. administrative costs to Canadian levels would save at least $209 billion annually, enough to fund universal coverage.” Another anomalous feature of the US system is the law banning the government from negotiating drug prices, which leads to highly inflated prices in the US as compared with other countries. That effect is magnified considerably by the extreme patent rights accorded to the pharmaceutical industry in “trade agreements,” enabling monopoly profits. In a profit-driven system, there are also incentives for expensive treatments rather than preventive care, as strikingly in Cuba, with remarkably efficient and effective health care.

Why aren’t Americans demanding — not simply expressing a preference for in survey polls — access to a universal health care system?

They are indeed expressing a preference, over a long period. Just to give one telling illustration, in the late Reagan years 70 percent of the adult population thought that health care should be a constitutional guarantee, and 40 percent thought it already was in the Constitution since it is such an obviously legitimate right. Poll results depend on wording and nuance, but they have quite consistently, over the years, shown strong and often large majority support for universal health care — often called “Canadian-style,” not because Canada necessarily has the best system, but because it is close by and observable. The early ACA proposals called for a “public option.” It was supported by almost two-thirds of the population, but was dropped without serious consideration, presumably as part of a compact with financial institutions. The legislative bar to government negotiation of drug prices was opposed by 85 percent, also disregarded — again, presumably, to prevent opposition by the pharmaceutical giants. The preference for universal health care is particularly remarkable in light of the fact that there is almost no support or advocacy in sources that reach the general public and virtually no discussion in the public domain.

The facts about public support for universal health care receive occasional comment, in an interesting way. When running for president in 2004, Democrat John Kerry, The New York Times reported, “took pains .. to say that his plan for expanding access to health insurance would not create a new government program,” because “there is so little political support for government intervention in the health care market in the United States.” At the same time, polls in The Wall Street Journal, Businessweek, The Washington Post and other media found overwhelming public support for government guarantees to everyone of “the best and most advanced health care that technology can supply.”

But that is only public support. The press reported correctly that there was little “political support” and that what the public wants is “politically impossible” — a polite way of saying that the financial and pharmaceutical industries will not tolerate it, and in American democracy, that’s what counts.

Returning to your question, it raises a crucial question about American democracy: why isn’t the population “demanding” what it strongly prefers? Why is it allowing concentrated private capital to undermine necessities of life in the interests of profit and power? The “demands” are hardly utopian. They are commonly satisfied elsewhere, even in sectors of the US system. Furthermore, the demands could readily be implemented even without significant legislative breakthroughs. For example, by steadily reducing the age for entry to Medicare.

The question directs our attention to a profound democratic deficit in an atomized society, lacking the kind of popular associations and organizations that enable the public to participate in a meaningful way in determining the course of political, social and economic affairs. These would crucially include a strong and participatory labor movement and actual political parties growing from public deliberation and participation instead of the elite-run candidate-producing groups that pass for political parties. What remains is a depoliticized society in which a majority of voters (barely half the population even in the super-hyped presidential elections, much less in others) are literally disenfranchised, in that their representatives disregard their preferences while effective decision-making lies largely in the hands of tiny concentrations of wealth and corporate power, as study after study reveals.

The prevailing situation reminds us of the words of America’s leading 20th-century social philosopher, John Dewey, much of whose work focused on democracy and its failures and promise. Dewey deplored the domination by “business for private profit through private control of banking, land, industry, reinforced by command of the press, press agents and other means of publicity and propaganda” and recognized that “Power today resides in control of the means of production, exchange, publicity, transportation and communication. Whoever owns them rules the life of the country,” even if democratic forms remain. Until those institutions are in the hands of the public, he continued, politics will remain “the shadow cast on society by big business.”

This was not a voice from the marginalized far left, but from the mainstream of liberal thought.

Turning finally to your question again, a rather general answer, which applies in its specific way to contemporary western democracies, was provided by David Hume over 250 years ago, in his classic study of the First Principles of Government. Hume found “nothing more surprising than to see the easiness with which the many are governed by the few; and to observe the implicit submission with which men resign their own sentiments and passions to those of their rulers. When we enquire by what means this wonder is brought about, we shall find, that as Force is always on the side of the governed, the governors have nothing to support them but opinion. `Tis therefore, on opinion only that government is founded; and this maxim extends to the most despotic and most military governments, as well as to the most free and most popular.”

Implicit submission is not imposed by laws of nature or political theory. It is a choice, at least in societies such as ours, which enjoys the legacy provided by the struggles of those who came before us. Here power is indeed “on the side of the governed,” if they organize and act to gain and exercise it. That holds for health care and for much else.

— source chomsky.info

Troubled by illness, 385,000 people committed suicide between 2001 and 2015

Bad health is turning out to be a big trigger for suicides in India. Between 2001 and 2015, about 385,000 people committed suicide because they were troubled by illnesses. At least 21,178 disease-stricken people in India committed suicide in 2015 alone. Going by the annual reports prepared the National Crime Records Bureau (NCRB), at least 1.84 million people committed suicide between 2001 and 2015. About 21 per cent (385,000) of them committed suicide because of their illness.

It clearly indicates that every hour, four people in India are driven to commit suicide because of their ailments. One out of every five suicide is committed by those who are troubled by illness.

It is worth noting that 118,000 people ended their lives as they were suffering from mental disorders, including depression, bipolar disorder, dementia and schizophrenia. Moreover, 237,000 people committed suicide because they were suffering from chronic illnesses.

Maharashtra has seen highest number of suicides (63,013) in that 15-year-period, followed by Tamil Nadu (50,178), Andhra Pradesh (48376), Karnataka (48,053) and Kerala (37,465).

This takes the total number of suicides in five states to 247,085 or 64 per cent of all suicides. People suffering from paralysis (9,036), cancer (11,099) and HIV-AIDS (9,415) also committed suicide during this 15-year-period.

Burden of healthcare expenditure

In India, common people have to bear at least 80 per cent of the total expenditure incurred for healthcare, while the government contributes only 20 per cent.

It is also a proven fact that every year, at least four per cent of India’s population suffers from poverty because they have to spend a huge amount of money for treating their illness. While between 10 and 20 million people in India suffer from mental illness and about 50 million of them are a victim of depression, only 0.06 per cent of the total health budget is allocated for treating such illnesses.

The country has only three psychiatrists per one million people, while the global standard is to have at least 56 psychiatrists. India is in urgent need of 66,200 psychiatrists. Our current healthcare system forces common people to seek help from costly private clinics and hospitals, which further leads to high expenditure and thus, triggering poverty.

Privatisation of medical studies has made it even more unaffordable. It costs around Rs 1 crore to finish graduation in medicine. Attaining a post-graduate degree in the subject will cost up to Rs 2 crore.

Healthcare costs linked to growing poverty

The Centre for Insurance and Risk Management and International Food Policy Research conducted a joint survey in two districts of Madhya Pradesh. It was observed that in rural areas, household income is severely affected in least 40 per cent of the families if any member falls ill.

As per the study, every family in the village is burdened with an average debt of Rs 78,828. Around 17-18 per cent of the loan has been taken for medical treatment at a high interest rate of 29 per cent.

India already has the dubious distinction of witnessing high maternal mortality and infant mortality rate. India is home to half of the leprosy patients (13 million) in the world and about 21 per cent of world’s total TB patients (1.9 million). It is unfortunate that when it comes to primary health care, the Indian government’s approach is extremely irresponsible.

According to 2011’s estimate, the average spending on healthcare in India is around Rs 2,500. The government contributes a meagre Rs 675 to it and the rest (Rs 1,825) comes from the individual’s pocket. Healthcare expense plays a crucial role in making people debt-ridden.

In 2014, Down To Erath had reported how people with hepatitis C in an extremely backward Haryana town were forced to buy expensive injections from a private pharmaceutical firm in the absence of a government-run treatment centre for the liver disease. In fact, health expenditure has long been established as one of the main drivers of chronic poverty.

It is disheartening that India spent only Rs 43 per person for medicine supply and only 5.4 per cent of its population can access medicines free of cost. It seems that a strong case is being built in favour of privatising healthcare by ignoring the poor state of public health sector.

In a report compiled for the 12th Five Year Plan, India needs 626,000 doctors and 4.96 million healthcare workers. Apart from this, we also need 187 medical colleges, 383 nursing schools and 232 ANM schools. Indian government is not equipped to fulfill these needs. In the past 35 years, health has been gradually pushed out from the government’s priority list.

— source downtoearth.org.in By Sachin Kumar Jain