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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

5 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

5 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

5 months ago

Well said, Doctor!

sundararaman gopalakrishnan

5 months ago

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

Railways gouge money from taxpayers’ pocket even if MPs don’t travel on reserved ticket
Of the many perquisites given to Members of Parliaments (MPs), air, rail and road travel is one of them. Now consider this:  “every member has been given the facility of 32 air journeys during a year to be availed of during session/ inter-session period with the spouse or any number of companions or relatives. The spouse/ companion of a member may travel alone by air eight time to meet the member out of the 32 air journeys available to a member in a year.”
 
Now, with 32 free air rides at the expense of taxpayers’ money, would you think these netas would regularly travel by rail for which they are provided first class berth? Yet, most of the year, most of the 1st class quota in most of the trains, across India, reserved for MP quota, is consumed, apparently by these VIPs. Many a time, the MP reserves the berth; does not travel and yet; does not cancel his or her (free) ticket. Irrespective of this, the Railway Board sends the expenditure to the Parliament Administration, which blindly pays for it.
 
It took Right to Information (RTI) activist Subhash Chandra Agrawal’s for the Central Information Commission (CIC) to direct the Railway Board to probe into this irregularities and corruption, after he appealed to it as was denied information by the public information officer (PIO) and sought intervention of the Commission.
 
Mr Agarwal’s RTI application sought information on various aspects of such priority reservation for MPs such as:
  • Complete information on rules providing priority-reservation in railways for present/ former Parliamentarians and their families who are entitled for free rail-travel at cost of railways or any other public-authority
  • Complete information on priority-reservation for any other category of rail-passengers entitled for free rail-travel at cost of railways or any other public-authority other than Parliamentarians
  • Is it true that many Parliamentarians (and others entitled for priority-reservation and free rail-travel) do not travel on reserved rail-accommodations without informing Indian Railways?
  • Complete information on Parliamentarians (and others entitled for priority-reservation and free rail-travel)  not travelling on reserved rail-accommodations in last five years without informing Indian Railways separately for each year mentioning differently for Parliamentarians and non-Parliamentarians giving number of such cases for each of the rail-class
  • Complete information on loss occurred to railways or any other public-authority in respect of Parliamentarians (and others entitled for priority-reservation and free rail-travel) not travelling on reserved rail-accommodations in last five years without informing Indian Railways separately for each year
  • Complete information on steps taken to recover cost of unutilised rail-reservation from Parliamentarians (and others entitled for priority-reservation and free rail-travel) who do not travel on reserved accommodations without informing Indian Railways
  • Complete information on utilisation of unutilised reserved-accommodations by Parliamentarians (and others entitled for priority-reservation and free rail-travel) who do not travel on reserved accommodations without informing Indian Railways
  • Complete information on steps taken to inform concerned authorities about Parliamentarians entitled for priority-reservation and free rail-travel not utilising reserved rail-accommodation without informing Union Railway Ministry
  • Complete information on steps taken to abolish priority-reservation (VIP quota) in Indian Railways revealing also present percentage of seats/berths in each class reserved for VIP quota in Shatabdi, Rajdhani and Duranto trains
  • Are priority-reservation and/or VIP-quota also applicable in ‘Anubhuti-class’?
  • Is facility of free rail-travel at cost of railways or any other public-authority also available in ‘Anubhuti-class’ for Parliamentarians and/or others entitled for free rail-travel?   
  • Is Union Railway Ministry aware of black-marketing of rail-reservation caused by sudden cancellation by Parliamentarians (and others entitled for priority-reservation and free rail-travel)
  • Complete information on steps taken to check black-marketing of rail-reservation caused by sudden cancellation by Parliamentarians (and others entitled for priority-reservation and free rail-travel)
  • File-notings on movement of this RTI petition
 
The CIC, in its decision (appeal-number CIC/VS/A/2014/001250/BJ) on 6 July 2016, has recommended to the Railway Board to take steps to remove any malpractices existing in process of ticket booking and cancellation by the MPs and to ensure that the larger public interest is kept in mind. The CIC also directed the Board Chairman to consider institutionalising a mechanism so that the public is not put to any inconvenience by denial of first class reservation.
 
However, it has asked the PIO to curiously only give a reply on the question  “Complete information on priority-reservation for any other category of rail-passengers entitled for free rail-travel at cost of railways or any other public-authority other than Parliamentarians’’ which is far less in importance than other questions.
 
It was during the CIC hearing that the malpractices came to light. Agrawal says, “Presently, booking is always shown full especially in first-class air-conditioned coaches because Parliamentarians usually make prior multiple reservations without caring to cancel these in case of non-travel. Officials of Railways, Rajya Sabha and Lok Sabha secretariats also admitted that payment for reserved rail berths of Parliamentarians was made from public-exchequer even in cases of Parliamentarians not actually travelling.
 
Agrawal says it is something akin to the fake airfare scam termed as leave travel concession (LTC) scam. Elaborating more on the CIC-hearing, he says, “The railway officials made a shocking revelation of some mischievous elements make multiple bookings in the name of Parliamentarians at times even without the direct knowledge of concerned Parliamentarians, reminding of infamous LTC scam involving the air facility provided to Parliamentarians. Railway Board must incorporate proper system ensuring that only the Parliamentarians may be able to make online railway reservations so as to avoid mischievous elements making multiple or fraud bookings in the name of MPs.”
 
Agrawal has made the following recommendation during his submission at the CIC hearing: “Railway Board should adopt a system whereby a travelling Parliamentarian may be required to submit his/ her identity proof apart from filling a form confirming his/ her actual travel at the reserved accommodation. These forms may be submitted to Lok Sabha and Rajya Sabha Secretariats while claiming reimbursement. A copy of such a travel-certificate may also be provided to travelling Parliamentarians for their submitting directly to Lok Sabha/ Rajya Sabha Secretariats, in case of need when railway authorities may somehow not be able to send these to Lok Sabha/ Rajya Sabha Secretariats. Lok Sabha and Rajya Sabha Secretariats may be required to deduct cost of amounts paid to railway authorities from pay/ pensions of concern parliamentarian(s), and ex-parliamentarian(s) for their not travelling on reserved accommodations. Such a system can only make Parliamentarians feel responsibility for cancelling rail-reservations in case of change in travel-plan.”
 
 
Rail Travel Facilities Every member is provided with—
 

(a) One free non-transferable first class air-conditioned or executive class of any train pass which entitled him to travel at any time by any railway in India;
 

(b) One free non-transferable air-conditioned two-tier railway pass for one person to accompany the member when he travels by rail; The spouse of every member is entitled to-
 

(a) One free non-transferable railway pass to travel in first class air conditioned or executive class in any train, and if travelled by air, an amount equal to the air fare, from the usual place of residence of a member to Delhi and back once during every session and twice in Budget Session but not exceeding eight single journeys in a year. The spouse can travel from the usual place of residence of the member to Delhi at any time after the issue of Summons and can return back any day before the commencement of the next session.
 

(b) The spouse is also  entitled to travel in first class air conditioned or executive class in all the trains with the Member from any place in India to any other place in India. A member having no spouse is entitled to accompany with any other person in lieu of spouse in any train in first class AC or executive class from any place in India to any other place in India in addition to the facility available to him in respect of one companion in AC-II tier. The spouse of the Member is allowed road mileage for the journey or part thereof performed by road, if unaccompanied by the Member. Where during any part of a year the usual place of residence is inaccessible by rail, steamer or road, due to climatic conditions and where air service is available, a member is entitled to travel by air to and from his usual place of residence upto the nearest airport outside his constituency having rail service.
 

Steamer Pass
 

Every member representing the Union Territory of Andaman and Nicobar Islands and the Union Territory of Lakshadweep Islands is provided with one free non-transferable pass to travel in the highest class of Steamer (excluding diet charges) to and from any part of his constituency and any other part of his constituency or the nearest port in the mainland of India. Such pass is valid for the term of his/her office and on the expiration of the term, the pass is required to be surrendered to the Lok Sabha Secretariat.
 

Members representing these Islands can also use the pass before taking their seat in the House, to utilise the same for the purpose of attending a session of the House for taking his/her seat therein.

 
 
 
(Vinita Deshmukh is consulting editor of Moneylife, an RTI activist and convener of the Pune Metro Jagruti Abhiyaan. She is the recipient of prestigious awards like the Statesman Award for Rural Reporting which she won twice in 1998 and 2005 and the Chameli Devi Jain award for outstanding media person for her investigation series on Dow Chemicals. She co-authored the book “To The Last Bullet – The Inspiring Story of A Braveheart - Ashok Kamte” with Vinita Kamte and is the author of “The Mighty Fall”.)

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COMMENTS

Saumil Mehta

5 months ago

Is this freebie (partly or wholly) life long even after the person is an ex MP?

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