Further comments on the superbug controversy

Since I blogged about the superbug controversy in India, there have been a few other pieces on the issue. In particular there are two blogs that I would like to comment on.

Firstly, take this blog, part of the Indian National Interest community, which is apparently an attempt to refute my earlier post. I usually strongly endorse the opinions expressed in the INI domain, but I have to politely (not really, but I try to be nice) disagree with the viewpoints in the blog.

Before that, I must applaud the blogger for raising concerns about Indian health-care. I am in total agreement with the author about the need for India to employ stringent medical procedures to control the spread of this particular resistance and prevent future outbreaks.

What I disagree with and do not understand is the rest of his rather absurd arguments.

Especially, lines like:

…the exaggeration, the dramatization of the threat, the hyphenation with Pakistan, etc. (emphasis mine)

do not make sense. I hate as much as the next person, the collectivization of the subcontinental people under a single name. But I doubt bacterial organisms care much for geopolitical boundaries.

Anyway, the author goes on to say:

Scores of revelations (this blog has tried to document as many of them as it could) about the pharma industry in the last two decades literally implores us to treat any thing that they are behind, with scepticism first and acceptance later.

We need to adopt a two-pronged strategy going forward as these kinds of ‘attacks’ are bound to emerge. They are thinly-disguised protectionism from the economically beleaguered West, whether or not they are orchestrated at the sovereign level.

….

That does not mean I should accept this report with all its shades and hues.

The whole thrust of the blog’s argument – if one may accord that respect to the writings – is that pharmaceutical companies are not to be trusted. Ergo we shouldn’t trust this study and protest our heads off.

Firstly, the study was not a pharmaceutical company study. Yes, I am aware of the partial sponsorship by Wellcome and this ‘conflict of interest’ issue has already been explained in many places. [However, I do also ask how Wellcome gains anything from a paper that talks about superbugs in India when they (or any other pharmas really) do not have a drug to kill these organisms? But that is a separate matter]

Further, if we do extend this logic of the one bad apple, then, given the lack of stellar record of Indian scientists and doctors in the honesty department (let’s not even go into the politicians and the media), we should not really believe anything they say about the results in this particular journal paper!

What particularly bothers me about the post is that there’s hardly any attempt to directly engage the scientific merits of the article (other than use of quotes around the word ‘research’, which hardly justifies as a critique). Rather, the blog simply puts forward the nebulous idea of some Western extra-governmental entity insidiously planning to bring down the Indian health-care tourism industry one scientific journal publication at a time (why the same entities have not attacked other places such as Thailand, Singapore, Malaysia, Costa Rica etc which also has a thriving medical tourism industry, I do not know).

It is sad that a blog hosted by a portal that frames serious policy matters relating to India, deems fit to advance conspiracy theories on shaky grounds with zero evidence.

Note: I am not saying that India should sit back and not react at all to the publication. But doing so in the framework of ‘the west is out to get us’ media show is wrong.

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On the other end of the spectrum, Charakan, an MD from India, has written a very insightful post on this issue, which explains a lot of the science behind the bacterial resistance and tries to separate the facts from myths. I highly recommend reading the article in full.

I do however have a comment to make about this section:

The article in Lancet says
‘It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money. As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals’.
This is an unscientific comment not based on any data.The authors have not proved that NDM 1 enzyme producing bacteria in UK was imported from India. More than 50% of patients in UK detected to have NDM 1 has never traveled to South Asia.Also the comment is not taking into consideration other groups and sub groups of Carbapenemase enzyme producing bacteria which are more prevalent in UK than in India.

The author of the article in Lancet seems to show undue haste in blaming medical tourism for antibiotic resistance in UK.

It is a valid argument weather the authors have overreached in ascribing all the bacterial infection in UK cases to South Asia. It is an unfortunate tendency on the part of scientific authors to sometimes over-interpret their data, usually in the Discussions section of the paper. Reviewers often let this slide as well.

However, in this particular case, I don’t think it is a huge stretch. The authors are commenting within the framework of a particular question: does NHS’ plan to reduce cost by outsourcing surgeries to India make sense? They conclude that this may not be cost-effective in the long run due to the dangers of superbug infections. Given the data showing incidences of such bugs showing up in India, it is perhaps not a wholly unreasonable point to make.

Still, the authors of the paper could have phrased it differently.