Medical developments from around the world
Exercise after Age 40 May Increase Life Expectancy
A study published recently in the journal PLOS Medicine sounds a loud wake-up call to ‘healthy weight’ couch potatoes who believe their good BMI (body mass index) will ensure them a long life. “Even from among people with a BMI of between 20 and 25, those who told researchers that they were physically inactive were far more likely to die in the next decade or so than those who were overweight or obese exercisers. Among the 431,479 study
participants over the age of 40, the sedentary were almost twice as likely to die during the course of the study than were participants who were highly active,” the study said. Other studies also show that a little bit of activity helps the human body, irrespective of the body size and weight. Walking for an hour daily has been shown elsewhere to reduce the risk of premature death by as much as 80%! Drug interventions in other risk factor management therapies might reduce the risk by hardly 1%-2%. The MRFIT study (multiple risk factor interventional trial) did show, at the end of 25 years of observation, that risk factor control with drugs and/or surgery would definitely alter the risk factor but NOT the final risk (premature death). Writing his opinion on the trial, one of the trialists, Roger W Sherwin opined that, as far as the MRFIT trial was concerned, there was nothing called risk factor controlling with which the risk gets altered. He labelled the study a boondoggle.
Patients with Diabetes
A recent five-year follow-up study of diabetic patients who received cardiac interventions showed clearly that bypass surgery was better and safer compared to the fashionable angioplasties especially in multi-vessel disease syndromes. The guidelines will have to be changed accordingly. This research data was presented at the American Heart Association meeting in September 2012.
Excessive Sitting Linked to Unhealthy Fat around the Heart
A new study, presented at the annual meeting of the American Heart Association, states that “all those hours Americans spend in their office chairs or on their sofas may be packing on a particularly unhealthy form of fat around the heart,” and “what’s more, the fat stayed in place even when people undertook regular exercise.” Interestingly, there have been many studies recently that showed that “when it comes to its deleterious health effects, sitting is not just the absence of physical activity—it has effects on the body that go beyond lack of exercise.”
Heart Failure and Cancer
“Heart failure patients face an increased risk of cancer along with an increased risk of death.” These preliminary findings were presented at the recent American Heart Association meeting. Investigators found that a cohort of patients diagnosed with heart failure at baseline were significantly more likely to develop cancer than participants in a control population without heart failure; cancer in those patients was the cause of death in almost half of them.
Sulfonylureas Linked to Increased Risk for CVD
A study published in the Annals of Internal Medicine, a journal, showed that “using sulfonylurea as a first-line treatment for diabetes is associated with increased risk for cardiovascular disease compared to other drugs. How that happens is not known. They felt that metformin is better. But common sense says that metformin is a not a safe drug.”
Alternative to Statins To Lower Cholesterol
An alternative to statins that lowers levels of ‘bad cholesterol’ by up to two-thirds is being developed. The drug, called AMG 145, is currently only being tested in an injectable form but scientists hope to be able to make it available as a pill in the future. This study was published in The Lancet (Early Online Publication, 6 November 2012).
Hospitals often diagnose fake critical illness or serious injuries just to loot hapless patients
Gopal (not his real name) is a young techie working for a big software company in Chennai. One day, he was a bit late to office and was in a hurry. He was trying to park his two-wheeler with his helmet on which was not securely tied as usual. He slipped and fell on his face with the helmet strap cutting his upper lip. His friends got frightened on seeing blood gushing from the mouth and rushed him walking to a nearby five-star hi-tech hospital.
When they reached the hospital, Gopal was rushed into the intensive care unit (ICU) in a wheelchair, although he preferred to walk. No one was allowed inside the ICU for the whole day. Gopal was brainwashed that he had 'serious' head injury. Apparently, everything was normal—including the results of a battery of blood and urine tests. Despite all that, even his three-month-pregnant wife was not allowed to see him. They were told that Gopal was seriously ill and could become unconscious any minute and might throw a violent fit at any time. His life, they said, hangs by a thin thread! The anxious wife almost collapsed and became unconscious herself.
By then, it was late evening and his other relatives got scent of the incident: one of them was an influential man who works with hospitals in Chennai. He insisted on seeing the patient at any cost or else he would get the patient discharged against medical advice. The nursing staff relented and allowed him inside. Incidentally, no medical staff, above the rank of a duty doctor, had seen this ‘seriously’ ill patient whose life was said to be hanging by a thin thread (!) all day, as most of them were in Deepavali mood. What the relative saw there shook him up. It was a large A/C room. One side of the room was separated by a plastic sheet to keep contagious patients being quarantined and the other half was used for such 'fake' serious patients. The nurses refused to show him the CAT-scan and blood reports. Blood was still oozing from the wound and they had not stitched the torn lip wound yet, as they were waiting for their facio-maxillary surgeon who was out for Deepavali holidays. In these hi-tech hospitals, even minor surgery had to be done by a sub-specialist!
It was too much for the relatives to keep him there, under the circumstances. They got the patient discharged against medical advice. The hospital insisted that they pay Rs25,000 on the spot as it is the minimum charge for any patient admitted to their intensive-care unit. The hospital refused to give any certificate or discharge summary for insurance purposes, as patients discharged against advice were not entitled to such luxuries!
This is the new ‘fakery’ syndrome that I am describing. Anyone who goes to the hospital becomes a patient. Most of them have minor ailments; the problems get exaggerated in these hospitals to fake into serious maladies to net a bigger booty from them.
What worries me more is the way the hapless and anxious patients are further pushed into the bottomless pit of anxiety by labelling them as serious, where life hangs by a thin thread. Many a time, they even predict when the patient is going to die without a shred of scientific evidence to predict the unpredictable future of their patients. The last usually happens to cancer patients. The ‘wise’ doctors tell the patient that s/he has a only certain number of months to live and so on! Such scare generation is one of the novel methods of disease mongering. This fakery is the height of ‘health-scare system’ that prevails today. Would the powers that be take a call? Incidentally, our friend Gopal is fine on his own, a bit shaken, though, by the new experience.
“To fake it is to stand guard over emptiness.”— Arthur Herzog.
Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He can be reached at [email protected]
In the 21st December meeting, the first row around the large conference table was packed with SEBI officials and stock exchange reps, while investor associations were relegated to the second and third rows. And the chairman announced that he would leave in 10-15 minutes…
The Securities & Exchange Board of India’s (SEBI) attitude to investors is best reflected in the shoddy manner in which it conducted a meeting with representatives of accredited investor associations (IAs) on 21st December 2012. These meetings, which used to be conducted every quarter under previous SEBI chairmen have already been reduced to an exercise that is reluctantly undertaken only when there is pressure over issues such as redress of investor complaints.
The recent meeting with IAs on 21st December has left us surprised and confused about SEBI’s attitude to any meaningful engagement with retail investors or their representatives in the form of SEBI-accredited associations from all over the country. This was evident from the seating arrangement around the large conference table in SEBI’s meeting room. We found that the first row around the large conference table was packed with SEBI officials and representatives of stock exchanges, while we were relegated to the second and third row. This was strange, but it is not the first time this has happened. The last time this happened was during chairman M Damodaran’s tenure and this was corrected only when the representative from the Consumer Education & Research Centre objected. Mr Damodaran was gracious enough to reprimand his officers for the arrangements, nothing of that sort happened this time. Instead, sparks flew from the very beginning, not only because investor representatives (IRs) were offended by the seating but the SEBI chairman compounded it by saying, “I will leave in 10-15 minutes. Senior officials will interact with you and apprise me of the deliberations later”. Naturally sparks flew at the very outset, but what followed was unusual in every way.
Ms Mala Bannerjee, who heads the Federation of Consumer Associations of Bengal, was the first speaker. She took a strong exception to the fact that the chairman planned to leave meeting in 10 minutes and castigated the cavalier manner in which the meeting had been arranged. She spoke about the poor response of SEBI’s officials to IAs and also mentioned that her organization was ignored when investor programmes were conducted in West Bengal. Ms Banerjee was especially scathing about the seating arrangement which belittled IAs by relegating them to the back-benches. “The stock exchanges talk with you daily throughout the year. You should interact with us and not push the non-profit organisations back”, said Ms Bannerjee.
When it was my turn to speak, I said that the chairman’s decision to leave so early is a clear indication that he and SEBI do not consider retail investors and their associations important enough to spend even half a day with them to understand ground realities. I apprised him of the fact that since 2000, IAs meetings used to be full-day affairs; in recent years, in line with the changing attitude to retail investors, they have been curtailed to half-a-day, but successive SEBI chairmen made it a point to be present for the entire period. After all, the preamble to the SEBI Act places primary emphasis on investor protection—a job where IAs play and important role.
I pointed out that I had made the effort to be in Mumbai only on the specific understanding that it would be an opportunity to interact with the chairman. I made it clear that in future, I would not like to attend these meetings unless the chairman intended to be present.
I apprised the chairman of Midas Touch Investors Association’s contribution to investor protection over the past 16 years. We have been invited to depose before the Joint Parliamentary Committee and before the Parliamentary Standing Committee on Finance. Our eight public interest litigations (PILs) include the one which forced Canara Bank to pay Rs975 crore to investor during the 1992 scam. We also took the ministry of corporate affairs to court on the “Vanishing Companies” scam which was a hard battle to convince the government about how poor supervision had allowed fly-by-night operators to raise public funds and vanish with the money. The lawsuit ultimately led to the creation of joint coordination committee in 1999, is still struggling to initiate credible action.
Meanwhile, retail investors have lost faith in the capital market and its regulatory system and the investor population has shrunk from two crore in 1992 when the SEBI Act was enacted to half the number after two decades. In the corresponding period, the deployment of financial household savings into the securities market has dropped from over 10% to around 2% while household savings have galloped from Rs100,000 crore to Rs15 lakh crore. This fall is all the more glaring in the face of economic growth numbers. It reflects the failure of SEBI to attract and channel investment in the securities market and reflects an emphatic vote of no confidence in its policies. I then said that it was incomprehensible that SEBI made no effort to see engagement or brain-storming with IAs. A few other IAs also spoke.
Later, chairman UK Sinha tried to explain the situation by saying, “Perhaps some of you are not aware of the way SEBI works and its structure. We consciously took a decision that the chairman would not be a member of the various ‘advisory’ committees set up by SEBI.” This is absolutely incorrect. First, the structure of advisory committees has been followed by several of Mr Sinha’s predecessors, yet they have treated their meetings with IAs very differently because the two simply cannot be equated. Also Mr Sinha suggested that IAs will be overawed to speak frankly in the presence of the chairman although there was no evidence of this at the meeting.
The logic of facilitating a frank discussion in absence of SEBI chairman shows the astounding disconnect between politicians, bureaucracy and the citizens, all too familiar in last two years. The fact is that officials should have the gumption and guts to face questions from the public in open forums.
Among the issues discussed was the proposed “safety net” for investors. IAs made it clear that this seems more like a red-herring since only a small extent of the loss would be covered and allow investment bankers to lure investors by creating the impression among retail investors that their money was 100% safe. We made it clear that we are opposed to any sops, discounts or inducements for enticing retail investors. What we require is reasonable IPO pricing.
Multi-level marketing (MLM) schemes & collective investment schemes (CIS): Mr Sinha in his opening remarks had stated that SEBI was facing great difficulty is dealing with CIS schemes, particularly in West Bengal since the lower courts had a issued stay order on SEBI action when they had no jurisdiction under SEBI Act. He pointed out that SEBI had been forced to go into appeals in the high court; however, they did not provide any details or number of such instances. (However, Moneylife has written about MPS Greenery; ).
Almost all IAs were concerned about MLM companies and some suggested that SEBI should regulate them. I brought up the case of Stockguru India, which collected nearly Rs1,000 crore by promising hefty stock market returns.
Moneylife (and other media organizations as well) had reported this in December 2010 and again in April 2011. SEBI should have acted on these reports. I pointed out that it was obligatory for SEBI to initiate action and impose a penalty u/s 23(g) and 23(h) of the Securities Contracts Regulation Act (SCRA). I pointedly asked: “Does SEBI have any mechanism in place to identify such cheating and take early preventive action?” To the best of my knowledge, it has no such mechanism and structure in place. Chairman Sinha merely replied that SEBI has taken action without providing any specific details.
* Yet another issue that came up for discussion was the non-utilisation of “Investor Protection Funds” by SEBI and “Investors Services Fund” by stock exchanges. The Bombay stock exchange (BSE) and National Stock Exchange (NSE) together have anywhere between Rs300-Rs500 crore in their investor services funds. Regional exchanges also have some funds. IAs pointed out that these should be effectively deployed for capacity building of investor associations. The chairman said that, in this, they have to keep CAG’s (Comptroller and Auditor General) objections in mind!
IAs formally registered our strong reservation regarding the arbitrary and non-transparent manner in which various committees (and sub-committees) are constituted by SEBI and their functioning. These committees are packed with the corporate sector representatives, industry bodies, market intermediaries and some academics pointedly leaving retail investors associations, especially the more active ones. There is no criteria for selecting representatives of IAs even after two decades of SEBI’s existence.
In response, Mr Sinha said that they will nominate IAs by rotation so that all the associations get representation. But if SEBI wants meaningful participation of IAs, it needs to combine merit with a policy of rotation. Mr Sinha left soon after the brief interaction with IAs.
A key part of the agenda was a presentation on SCORES, SEBI’s online grievance redress mechanism. We were informed that pending grievances in November 2012 has dropped to around 13,000 from 24,000 on 31st March 2012. Data of grievances received, redressed and other details were not provided. SCORES efficiency was self-appreciated. The data presented for ‘pending’ grievances is simply not credible and demonstrates an obfuscation of facts.
As per SEBI’s own report the unresolved grievances on 31 March 2010 & 2011 were 1,60,593 and 1,50,711 respectively. On 31 March 2012 unresolved grievances were 1,44,439. The reason for the discrepancy is that SEBI has quietly started excluding those pending grievances against whom “regulatory action viz. adjudication, direction or prosecution has been initiated”. On 31 March 2012, regulatory action was in progress with respect to 1,20,714 grievances.
AK Bakliwal of The Bombay Shareholders’ Association drew the attention of SEBI to the fact that companies are not annexing important schedules in their annual/abridged reports.
The tenor and mode of IAs meeting have undergone a significant change. Interaction by senior officials has reduced. They merely note the issues raised and say they will get back in due course. Earlier, they would engage in discussions, express their views and the chairman would, in principle at least, agree on certain matters.
(The author is the president of the Midas Touch Investors Association).