The editorial in the November 19th issue of the BMJ is a caustic take on the lopsided growth of the health sector in India. As usual, truth is strange but worth knowing. In 1947, 5-10% of health care was provided by the private sector while today, 82% of out patient visits, 58% of inpatients and 40% of institutional deliveries are done in the private health institutions. While 40% of all patients admitted to hospital have to borrow money or sell assets, including inherited property and farmland, to cover expenses, and 25% of farmers are driven below the poverty line by the costs of their medical care; medical tourism in India is likely to become a billion dollar business by 2012 and patients from Europe, USA and South East Asia have been steadily streaming into India for various surgeries. While government spending on health care is 0.9% of GDP which is among the lowest 5 in the world, private spending on health is 4.2% of GDP which is the top 20 in the world. Why does tuberculosis kill half a million people annually in India while top line work like liver transplants and complex pediatric cardiac surgery is also possible in this same country? Does anyone know where we are going and how to go there? (BMJ 19 November 2005;331:1157-8).

India is being flooded by a deluge of international clinical trials. We have drug naïve patients, who are also illiterate besides being conveniently poor. A perfect recipe for exploitation. Tired of the various controversies on unethical and illegal trials, the Indian Council of Medical Research has decided to establish a registry of clinical trials conducted in the country, and drug regulators will scrutinize trials to ensure compliance with ethical guidelines and good clinical practice. Around 100 international multicentric trials are on in India currently and the industry has earned close to $17 million since 2003. Ethical guidelines have been drafted by the ICMR 5 years ago but need legislation to ensure it is being followed. Auditing clinical trials in India was long overdue (BMJ 5 November 2005; 331: 1044).

Bill Gates donation of $ 107 million for the development of a vaccine against malaria has borne fruit. Trials in African children published recently showed that it reduced the risk of malarial episodes by 35%. It was protective for 18 months and was also effective in significantly reducing severe malaria. Pierre Druilhe of the Pasteur Institute in Paris developed this vaccine which induces antibodies against merozoite surface protein. In vitro studies have also shown promising results (Scientific American 9 November 2005).

Gouri Rao Passi,
Consultant,
Department of Pediatrics,
Choithram Hospital & Research Center,
Indore -452001, Madhya Pradesh,
 India.
E-mail: [email protected]