Economy
Brexit not to have major impact on India: Moody's
The UK's decision to exit the European Union will not have any significant credit impact on India and other countries in the Asia Pacific region, Moody's Investors Service said on Monday.
 
However, in case of countries where fiscal and monetary policy space is constrained, a shift in portfolio and/or banking flows in some Asia Pacific markets might hurt growth, said the credit rating agency.
 
While the fiscal and monetary policy space is constrained in India its exposure to external financing is limited, it said in its latest report.
 
Moody's does not expect the UK's vote to leave the European Union to have a significant credit impact on Asia Pacific sovereigns.
 
"In particular, although lower GDP (gross domestic product) growth in the UK will dampen demand for products from the rest of the world, Asia Pacific's direct trade linkages with the country are generally limited," Moody's said.
 
"However, in the months to follow, announcements related to Brexit could trigger market volatility. While not our baseline expectation, a shift in portfolio and/or banking flows that resulted in tighter financing conditions in some Asia Pacific markets would hurt growth, especially in countries where fiscal and monetary policy space is constrained," Moody's said.
 
Moody's assume UK's GDP growth will slow to 1.2 per cent in 2017, from 1.6 per cent this year, as uncertainty over future trade relations with the European Union results in lower investment and potentially lower household consumption.
 
"In our base case scenario, we do not expect Brexit (Britain's exit of European Union) to have a significant impact on the EU economy as a whole. Also considering the limited exposure of Asia Pacific sovereigns to UK demand, we do not foresee a large impact on trade or GDP growth in the region," Moody's said.
 
"A prolonged period of lower portfolio or banking flows would imply tighter financing conditions and hurt GDP growth for the affected economies. Where monetary and/or fiscal room is available, policy easing could act as a buffer," Moody's said.
 
"In India and Pakistan, too, room for fiscal policy easing is constrained by a high debt burden, but the two sovereigns' exposure to external financing is limited," the credit rating agency said.
 
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.

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Fewer Pills for Better Health
Less Medicine, More Health is the title of a wonderful new book from Gilbert Welch which shows all that I was writing and saying for the past four decades is true. Decades ago, I espoused a new concept called ‘Step Down’ treatment of hypertension. This occurred to me when I first started work in an Indian government hospital in the 1960s after having been at the National Heart Hospital and The Middlesex Hospital (London) and the Peter Brent Brigham (Boston). I used to see lots of hypertensive patients. Almost all patients seemed to respond to the treatment, only beta-blockers and diuretics then, during the follow-up visit which was a week later. I used to encourage them as they had responded. 
 
One day, one patient had a sarcastic smile on his face when I told him “You have done well by taking medicines as advised correctly and your blood pressure (BP) has come down.” Government hospitals have a limited budget which gets exhausted by June and, then, until the next financial year, drugs are not available regularly. This patient did not get the drugs but did follow my advice on lifestyle changes. I was nonplussed! Then, more and more patients followed and I thought of doing a prospective study with controls. This confirmed my belief that, probably, mild-moderate hypertensives will do well on lifestyle modifications alone. Then, I started the step-down treatment where I used to taper off anti-hypertensive drugs in patients whose BP was normal, to see what happens. In more than 50% of them, BP remained normal without drugs. The rest needed drugs in smaller doses to keep BP under control. It was then that late professor Sir George Pickering’s wisdom dawned on me: “more people in this world make a living off hypertension than dying of it.”
 
I have described them more graphically in my own book What Doctors Don’t Get to Study in Medical School. Every doctor needs to give his/her patients just two bits of important information before they embark on any drug treatment. The drug’s NNT and ADR (adverse drug reaction) risk. None of the drugs that we prescribe helps every patient. It is a lottery. ‘number needed to treat’ (NNT) is a statistical term. Say, the NNT of drugs in mild-moderate hypertension in the MRC (Medical Research Council) study published in 1985 in the British Medical Journal (BMJ) puts the NNT at 850. To help one patient with an imaginary stroke in the next five years, one has to unnecessarily treat 850 healthy individuals with drugs that will not benefit them but will carry the ADR risk of 5%. If you inform the patient about these facts, most of them will opt for trying lifestyle modifications rather than take drugs. Their chance of getting benefit is one in 850 but their chance of getting side-effect is one in 45. Come to think of it, our drugs help one and harm 45!  The same for statins: NNT is 300 and side-effects 10%. Taking statins might help one in 300 but will make 30 of them diabetics in one year and it has many other dangerous side-effects!
 
Less medicine for the old elderly gives them better health to enjoy life. It will add life to their years while it might also add years to their life! These facts, added to the dangers of hospitalisation for no good reason and that too inside intensive-care units, is an invitation to undignified route to heaven. We make every human being who comes to us more and more anxious about his health and uncertain future, instead of giving him the much-needed reassurance that goes a long way to help. I couldn’t agree more with late Oliver Wendell Holmes, a Harvard-trained physician, poet and writer, when he wrote: “the two most powerful drugs that mankind has ever invented are the two kind words of a humane doctor.”
 
We need to think whether this medical and health scare system should be allowed to exploit sick human beings in this cruel way for the future. Recently, the FDA (Food and Drug Administration), US fined Genentech $70 million for selling a drug, Tarceva, an expensive one at that, for small cell cancer of the lung, knowing fully well that the drug is useless in that condition. They made tonnes of money between 2006 and 2011. “The company also promoted Tarceva, the lawsuit said, by giving doctors illegal kickbacks disguised as fees for making speeches or serving on Genentech’s advisory boards.” So, we also have blood on our hands as doctors! We are close associates of drug companies! 

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COMMENTS

Prasanna kumar

11 months ago

Dr. Hegde's comments are motivational. Listening to the body is the right way than looking for the checklist of lab tests to confirm our health. Thanks to Dr Hegde and Moneylife magazine.

Brajesh Kumar

11 months ago

Very well written article with lots of wisdom. Not many doctors in India believe in the principles of Dr Hegde. In India Tests and Drugs is like normal things these days. None things a moment before gobbling any drug.

We need more of these earthy wisdom, which serves humans.

Ashok Kumar Kannan

11 months ago

Well said, Doctor!

sundararaman gopalakrishnan

11 months ago

As always, in moneylife magazine, i look forward to Dr Hegde's columns..Wise and apt words for the medicine -obsessed world..

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