The Nobel Prize in Medicine
Englishman John Gurdon who won the 2012 Nobel Prize
for Medicine and Physiology has a framed picture of a school report on
his desk. The report from his teacher says "I believe he has ideas about
becoming a scientist….this is quite ridiculous…it would be a sheer waste
of time, both on his part and those who have to teach him." His teacher
also wrote that young John "will not listen, but will insist on doing
work in his own way". Great minds probably all have this all
encompassing passion and indomitable spirit to swim fearlessly through
ridicule and failure.
Gurdon challenged the dogma that the specialized cell
is irreversibly committed to its fate. He hypothesized that this cell
may still contain all the information required to drive its development
into different cell types. In 1962 he replaced the nucleus of a frog
embryo with the nucleus of a mature frog intestinal cell. The embryo
developed into a mature frog. His work was received with intense
skepticism. However, replication of results in different labs finally
convinced the scientific community. What followed was a worldwide
outburst of research which finally culminated in the cloning of animals.
He shares the prize with Shinya Yamanaka, a Japanese
scientist, who was studying embryonic stem cells. These are pluripotent
cells that are isolated from the embryo and cultured in the laboratory.
He decided to find the genes which are responsible for keeping these
cells immature. Of the several candidate genes discovered, when he
inserted 4 of them into mature cells, they transformed them into
pluripotent cells. These induced pluripotent stem cells (iPSC) have
major implications in medicine. The most important and immediate
application is to study disease mechanisms. Pharmaceutical companies use
iPSC to screen candidate drugs for toxicity and efficacy. The future
goal is to replace damaged tissues with iPSC from the same individual
with no fear of rejection (http://www.nobelprize.org, The Hindu 9
October 2012).
The 3 ½ Year Medical Degree
In 1952, Sir JW Bhore, chairman of India’s first
health survey, abolished the Licentiate in Medical Practice (LMP) to
establish a single medical qualification – the MBBS degree – to become a
doctor in India. However, a lopsided distribution of doctors has
resulted in only 26% of them currently serving in rural areas which
account for about 72% of India’s population. In 2010, proposal was made
for a 3½ year long Bachelor in Rural Medicine and Surgery (BRMS) course.
There have been many doubts and worries about the course. Will they not
be tempted into private practice? Won’t they migrate to urban areas?
Will working for the government be a requirement for admission? Who will
maintain quality control of their education? Will the rural areas have
substandard medical care?
The MCI has finally given a green signal to this
course under a new name – B.Sc. in Community Health. They cannot affix
the prefix Dr to their name. They will serve government health
institutions under a bond. They will have clear career progression as
"health officers" up to the district level. The decision to accept and
implement the course is now with the State Governments. Chhattisgarh
where this model was adopted in 2001 has shown fair results. Assam has
replicated the model and probably the rest of the country will slowly
follow (The Hindu, 8 October 2012, http://nhsrcindia.org).
Her Lost Childhood
More than 40% of child marriages round the world
occur in India. And in 8 states of India 50% of girls are married before
they reach their 18th birthday. The United Nations Population Fund
(UNPF) report also shows that girls from rural areas were twice more
likely to be married as their urban compatriots. Those with no education
were thrice more likely to become married underage. In the poorest
families 75% girls had underage marriages as compared to 16% of girls
from rich household. The consequences of these dry statistics are
horrifying to imagine. An abrupt termination of education, lack of
awareness of contraceptives, a lack of bargaining power to use them,
teenage pregnancies and the associated life threatening health problems
that invariably accompany them. The International Day of the Girl Child
was celebrated for the first time on 11th October, though the girl child
herself had nothing to celebrate (The Hindu 22 October 2012).
Raising A Stink
When Union Rural Development Minister Jairam Ramesh
said that India needed toilets more than temples he stirred up a
political hornets nest. People have forgotten Gandhi’s famous quotation
"Sanitation is more important than independence". It is a perverse
paradox that while 63.2% of households in India have a telephone
connection and almost half have a television, 49.8% have no toilet
facilities and defecate in the open. A World Bank study conducted some
years ago pegged the economic impact of lack of toilets and sanitation
at a staggering Rs. 24,000 crore annually. That comes to 6.4 % of
India’s GDP. The loss is due to deaths often of children by diarrheal
diseases, reduced productivity and tourism revenues. One hopes that Mr
Ramesh’s "Nirmal Bharat Yatra" from Sevagram to Bettiah in Bihar which
is a campaign to make the country open defecation free will yield good
results (The Hindu 12 October 2012).