India Medical Tourism: Pakistanis Spend the Most Per Patient

As Indian medical visas granted to Pakistani patients regularly make headlines in India, it is hard not to conclude that it's all part of a PR campaign by the Hindu Nationalist Modi government in India.

What is often left out of the media stories is the minor detail that Pakistanis pay more to use services of for-profit Indian hospitals than do people of other nationalities for such "humanitarian gestures".

Pakistan is an important and lucrative source of medical tourism dollars in India.  The kind of facilities Pakistanis pay to use in India are not accessible to poor Indian masses who must rely on India's decrepit public health system.

A 2017 report by Indian ministry of commerce and industry says an average Pakistani spends Rs 187,000 on treatment in India. Those from Bangladesh spend Rs 134,000 on an average, followed by those from Commonwealth countries (Rs 125,000), Russia (Rs 104,000) and Iraq (Rs 98,554).

Times of India quoted Manish Chandra of Vaidam medical travel agency as saying: "This is because Pakistani patients mostly come for organ transplants and heart surgeries for children that are costly." In 2015-16, he said, nearly 166 Pakistanis received treatment in India every month. Top Delhi hospitals, which are frequented by foreign nationals, confirmed this.

Most of the Pakistani patients suffering from liver and heart ailments go to major for-profit hospitals in Delhi, Mumbai, Chennai and other cities, according to TOI. The number of Pakistani patients, however, has seen a sharp drop since February this year when the Indian government decided to stop granting medical visas to retaliate after Pakistan handed out a death sentence to Indian spy Kulbhushan Jadhav.  In other words, humanitarian concerns take a back seat to Modi government's policies to assert India's dominance in the region.

The Times of India sums up the situation as follows: India's imposition of restrictions on the issue of medical visas to Pakistanis has not just affected hundreds of patients from across the border but also dealt a body blow to medical tourism in India.

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Riaz Haq said…
Why India should issue more medical tourism visas to Pakistani nationals

The highest average earnings per patient through export of health services from India comes from Pakistan at $2,906, says survey

The highest average earnings per patient through export of health services from India comes from Pakistan at $2,906. Pakistan is followed by Bangladesh ($2,084), CIS (Commonwealth of Independent States) countries ($1,950), Russia ($1,618) and Iraq ($1,530), according to a first of its kind survey on export of health services by Directorate General of Commercial Intelligence and Statistics, under the commerce ministry. This means a patient from Pakistan visiting a hospital in India spends more than people from any other country, boosting India’s foreign exchange reserves.

However, the number of medical visas issued to Pakistani patients in 2015-16 stood at a measly 1,921 compared to 58,360 to patients from Bangladesh and 29,492 to patients from Afghanistan. Due to the low number of medical visas issued, Pakistan contributed only $6 million to India’s services exports compared to $343 million by Bangladesh in 2015-16.

India has emerged as a top-notch destination for medical value travel because of its world-class healthcare facilities and affordable price. India aims to significantly promote medical tourism and has recently liberalized its e-visa system for most of the countries except Pakistan.

In the health tourism portal maintained by the services export promotion council as a one-stop for overseas patients, there is no specific information on how patients from Pakistan can obtain a medical visa. The same information is available for patients from 16 countries, including Bangladesh and Afghanistan.

The tension between the two South Asian neighbours has risen after a Pakistan military court handed a death sentence to captured Indian national Kulbhushan Yadav who Pakistan alleges is an Indian spy. India has denied the charge and has repeatedly asked for consular access to Yadav that Pakistan has refused time and again. There are reports that India may further restrict visas to Pakistani nationals, though another report claims visas will be issued to Pakistan nationals only on medical ground.

Pakistani nationals can get visitor visa of six months to meet relatives or friends or any other legitimate purpose and the duration of stay in India at a time shall not exceed three months. “However, senior citizens (above 65 years of age) or a Pakistan national married to an Indian and their children below 12 years of age accompanying parents may be granted two years visit visa with multiple entries subject to certain conditions,” minister of state in the ministry of home affairs Kiren Rijiju said in response to a question in Rajya Sabha earlier this month.
Riaz Haq said…
Why do so many Indians travel abroad for medical treatment? Why did Sonia Gandhi go overseas for treatment in March 2017?

Why do Indians import almost all of their surgical instruments from Pakistan? Why do Indians depend heavily on Chinese imports for almost everything? Why don't they do it all themselves?

Or for that matter, why do nations trade? Why does't each nation make everything and provide all services within the country? Surely, a nation as large as India with over a billion strong consumer market should be able to do that?

Why does US depend so heavily on Chinese imports? Even for critical parts of their advanced fighter jets and other defense equipment? Surely, a nation as advanced as US should do it all themselves.
Riaz Haq said…
The umbrella term “surgical instruments” summarises the specific and mostly hand-held instruments used during an operation or a surgery (e.g. scalpels, clamps and forceps). Worldwide these instruments are mainly produced in two traditional clusters – in Sialkot, Pakistan and in Tuttlingen, Germany. Together, these clusters supply up to 75 % of the world demand of traditional hand-held stainless steel surgical instruments [1]. As Figure 1 illustrates, not all of the instruments made in Pakistan are directly sold to the end customer. Instead, many of the Pakistani instruments are first transported to Germany where they often get final finishing and quality control [2].
Riaz Haq said…
Home » OpinionLast Published: Tue, Sep 05 2017. 12 42 AM IST
Is India really cheaper than the US?

The Penn Effect is that prices of goods and services in developed countries (DCs) are, after using market exchange rates, substantially higher than those in less-developed countries (LDCs). The World Bank in 2015 estimated that prices are more than three times higher in the US than in India. This price differential is huge. This raises some interesting questions.

Why aren’t very many tourists from the US attracted to India, if the prices are very low in India? Also, the price differential can be attractive to migrants who had initially shifted from India. In their retirement years, the migrants could return home but this hardly happens.

Prices in the US are, as mentioned earlier, more than three times the prices in India. Let us consider this number in perspective. Pension funds in the US are, as discussed by Richard A. Marin, still going through a near-crisis as they have large unfunded liabilities. The size is still debated. If the shortfall is a quarter of the liabilities, then on one hand, a shortfall of 25% is viewed as a near-crisis. On the other hand, there is an opportunity to get 200% more by shifting to India! But we do not see this behaviour.

there is often a risk in purchases. For example, medical charges can be relatively low in India but there is a question mark about the competence of a medical practitioner (and even about the arrangements in many hospitals). So, the risk-adjusted price can be higher than the observed price.

quality is low in India. This is well known but not adequately appreciated. For example, while the cost of higher education in India is low, the quality too is typically quite low. So, the quality-adjusted price of education can be high in India.

It is true that the use of market exchange rates can underestimate the gross domestic product of a country like India relative to that of a DC. So many economists advocate the use of exchange rate based on PPP. However, this can overestimate the GDP in India. So, it may help to consider adjusted-PPP to get the correct picture.

Riaz Haq said…
India plans to lessen its drug reliance on China

Currently, India gets 70-80% of its medicines and medical devices supplies, including raw material for pharmaceuticals (Active Pharmaceutical Ingredient) from China. This poses a major risk of severe drug shortage if India's diplomatic relations with China worsen.

In fact, in 2014, National Security Adviser Ajit Doval had also warned the government about India's over-dependence on China for API and how the tension between the two countries can cause a crisis in the public health ..
Riaz Haq said…
Swiss tourist couple badly injured in youth assault at #Agra #India. #Tourism #TajMahal

Youths would later tell the police that the couple, both 24, had offended them by ignoring their greetings and kissing in front of them. Not so, Ms. Droz told The Times of India. They were trying to force her to take selfies with them, Mr. Clerc added. Eventually, they began beating the couple with sticks and rocks.

By the time a crowd had gathered and the youths had run away, he had a fractured skull and possibly permanent hearing damage and she had a fractured left arm. “The blood was flowing,” said Ram Kishor, a police constable in the area.

The assault late last month made headlines for several days in India. It was a fresh setback for tourism in this part of the country, which is home to some of the world’s most famous monuments but finds its status threatened by disputes about its Muslim heritage, amid reports of declining visitor numbers and of harassment of tourists.

Stops at Fatehpur Sikri and in the nearby city of Agra to see the Taj Mahal, all of which are in Uttar Pradesh State, are at the top of many itineraries for tourists in India. Built in the 17th century by the Muslim emperor Shah Jahan as a tomb for his wife, Mumtaz Mahal, the Taj Mahal attracts millions of visitors every year. Tour operators call it India’s monument to eternal love.

But Hindu nationalists, some of them aligned with the governing Bharatiya Janata Party, have taken aim at the Taj Mahal and its ties to a Muslim ruler.

During a trip to Agra in June, Yogi Adityanath, the chief minister of Uttar Pradesh, said at a rally that small replicas of the monument given to foreign dignitaries “did not reflect Indian culture.” Other far-right leaders went further, describing it as having been built by “traitors” who “wanted to wipe out Hindus.”

But Mr. Adityanath seems to be softening his stance, at least in public. When he visited Agra in late October, he called the Taj Mahal a “unique gem.” A tourism brochure published by the state government that initially omitted the Taj Mahal has been updated to include it.

Tour guides said the controversy had hurt their business.


On a recent day, a throng of tourists formed a line at the mouth of the Taj Mahal complex, pressing their bodies forward. Among them was Vital Labonte, 66, a French Canadian visitor in hiking boots, who said the occasional jostle or appeal for money did not bother him.

“The kids run at you, they want money to better their life,” he said. “Just say no. I’m not worried with it.”

Viktoria Simeoni, 23, an Austrian visitor who had booked a trip to India on a whim, said she sometimes felt unsafe when men stared at her or asked for pictures, a request often made to foreign tourists in India.

“One lady gave me her baby,” she said. “I was just holding the baby, and then she took pictures of me. I didn’t feel so comfortable.”

The police found it necessary to crack down. In the days after the attack, they arrested over 50 people they accused of being touts with reputations for hounding tourists.

In Fatehpur Sikri, officials emphasized that the severity of the attack against the Swiss couple was rare. The crime that tourists report most often is theft.

Riaz Haq said…
BBC News - Anger as #India doctor mistakenly declares newborn dead. #Health #MedicalTourism

A newborn baby, declared dead by a hospital in the Indian capital Delhi, was found to be alive while they were on their way to his funeral.
Doctors at the privately run Max Hospital had pronounced the baby dead hours after his twin who was stillborn.
The parents said they noticed one of the babies squirming inside the plastic bag that doctors placed the infants in.
The incident has sparked outrage and a debate over the quality of private healthcare which is often costly.

Delhi Chief Minister Arvind Kejriwal tweeted that he had ordered an inquiry into the matter. The state health minister has also described the incident as "shocking criminal negligence".

According to the twins' grandfather, the stunned family rushed the newborn to a nearby hospital where they were told that their baby was still alive, local media reported.

In a statement to reporters, Max hospital said they were "shaken" and "concerned" over the incident, and added that the doctor has been asked to go on leave, pending an inquiry.

According to ANI news agency, Delhi police have begun to investigate the case and have consulted legal experts.
This is the second instance in recent months where a private hospital in India has been called out for negligent care. Last month, a girl died of dengue fever in another hospital and the parents allege they were overcharged for her treatment.
Riaz Haq said…
August 16, 2018, 2:00 AM IST Rohit Saran in TOI Edit Page | Edit Page, India, World | TOI

It may have looked moth-eaten to its founder Mohammad Ali Jinnah, but Pakistan was anything but that at the time of Independence. An average Pakistani was richer, lived longer and lived more safely than an average Indian for almost two decades after 1947, which is roughly the time democracy was absent in Pakistan.


What can India offer to Prime Minister Khan that’s new, substantive and outside the immediate no-go areas of J&K and terror? We should first banish the thought that a weak Pakistan is good for us. A crippled Pakistan is only good for two things: 1. Shouting matches on TV where those criticising India are asked to migrate to Pakistan. 2. To give us a false sense of achievement in doing better than Pakistan when India’s potential-performance gap is much wider than Pakistan’s.

A less hostile public attitude toward our neighbour will allow government to take a few out-of-the box steps. For instance, Indian companies should be allowed and encouraged to hire from top Pakistan campuses, even if for one or two years. If only 30 Sensex companies hire 50 Pakistanis each, there will be 1,500 young and talented Pakistanis working and living in India benefiting, and benefiting from, the world’s 6th – and soon to be 5th – largest economy. Companies will get good talent at competitive salaries – Pakistani rupee is nearly half the value of Indian rupee. For those worrying about a job loss for Indians, 1,500 is only 0.0007% of Sensex companies’ workforce.

Imran Khan’s passport has more Indian visas than any prime minister of Pakistan. Unfortunately, India allows only the rich and powerful in Pakistan to benefit from India’s soft power. That’s counterproductive to our own interests. We should want average Pakistanis to see India as a source of good to them. They will then begin to resent whatever power comes between that ‘good’ and them – whether that power is in Rawalpindi or Islamabad or Beijing – or even Srinagar.

Aspiring cricketers in Pakistan will dream of playing in IPL if we unblocked their entry. A budding artist (actors, singers, comedians …) in that country will look forward to hitting the big stage in India, if we don’t hum and haw over granting him a visa. Pakistanis with a critical medical condition in the family should want to get treatment in India – without having to try their luck on Sushma Swaraj’s Twitter handle. Pakistan should be allowed to fill its quota of students at the South Asian University, something we committed to at the time of deciding to host this institution that could one day be the region’s most coveted.

Not one of these will be acts of charity or concession because India’s gains will be as much as Pakistan’s – if not more. This is exactly what we tell the US while arguing for easier immigration. In geopolitics there is no positive emotion as powerful as seeing your countrymen excel in another country. India has that power in its grasp today. Let’s use Imran’s prime ministership as an occasion to unleash that power.
Riaz Haq said…
#UAE to build first ever #medical mall in #Islamabad, #Pakistan. The project will include therapeutic and recreational areas, a regional #Cardiology center, an orthopedic centre and 400-bed #university #hospital.

A prominent UAE-based MBF Group has announced to establish an integrated medical city that will also feature a first-ever medical mall of the country in Islamabad.

The agreement of MBF with Ibchez Housing and Nixon, according to the report, will include the construction of a hospital that will provide medical services at international standards.

The founder and owner of MBF Group Shaikh Mohammad Bin Faisal Al Qasimi ,in an interview with the Gulf news said the project will include a 400-bed university hospital that will offer the most advanced levels of healthcare services.

The medical city will also feature the country’s first medical mall, therapeutic and recreational areas, a regional cardiology centre, and an orthopedic centre, he added.

He noted that the city will include a nursing college and is expected to serve some one million patients and clients on a monthly basis.

There is a need for such advanced hospitals to serve Pakistan’s growing population, he stressed.

Shaikh Mohammad pointed out that the investment provided for the medical city has reached US$970 million (Dh3.52 billion), while noting that its land has been purchased, as well as the desire of all parties to complete the project on time, in a bid to answer the growing demand for medical services in Islamabad and provide specialist health services that are in short supply.

He informed that the group will manage the city’s 1,000 medical, technical and administrative staff, who will all be Pakistanis, and is responsible for providing medical equipment and beds.
Riaz Haq said…
Not all is well with #India's corporate #hospital chains. The sharpest dip is witnessed in the National Capital Region (NCR), where operating margins have declined by 21 percentage points. #medical #health #tourism

Four of India’s large publicly traded hospital chains — ApolloNSE 4.37 %, Narayan Health, Fortis and Max IndiaNSE -1.34 % — have cumulatively lost `6,300 crore in market cap in the last two years, an analysis by ET Intelligence Group showed. A report by rating agency ICRA in July revealed that profitability of hospitals have touched a multi-year low.

“The health of the hospital sector has been deteriorating since early CY2017 due to several factors that have adversely affected its profi ..
Riaz Haq said…
#Indian woman undergoes successful weight loss #surgery in #Pakistan. Sources told media that Maali Saasan had come to Pakistan after a failed attempt in #Mumbai, #India.
ISLAMABAD: A Pakistani doctor has done a successful weight loss Bariatric surgery on 37-year old Maali Saasan, an Indian citizen in Pakistan.

Sources told media that Maali Saasan had come to Pakistan after a failed attempt in Mumbai, India.

She said that she had lost only 15 kg in her first surgery whereas Dr Maaz has removed more fat from her body as she had 150 kg weight which came down to 80kg.

Dr Maaz has set a remarkable example which is a good initiative to strengthen the image of Pakistan across the world, doctors said.
Riaz Haq said…
New Delhi killer superbug hits Tuscan tourist paradise

Authorities in Tuscany, home to some of Italy's most visited tourist attractions, have stepped up hospital controls after a deadly outbreak of the New Delhi superbug.

The antibiotic-resistant killer has shown "significant diffusion in the northwestern area of Tuscany" since November 2018, infecting at least 75 people, local health authority ARS said.

The bacterial disease is believed to have killed at least 31 people in 17 different hospitals since then, Italian media reported Thursday.

More than 31 cases were reported in Pisa, home to the famous leaning tower.

Superbug NDM-1 (New Delhi metallo-beta-lactamase 1) sparked a global panic when it was found in the Indian capital in 2010 and showed resistance even to carbapenems, a group of antibiotics often reserved as a last line of defence.

The European Centre for Disease Prevention and Control in June issued a rapid risk assessment after a "large outbreak" of the New Delhi superbug in Tuscany.

It warned of possible cross-border infections, "especially since the affected area is a major tourist destination."

Tuscany's health authority said "the ability to resist antibiotics makes these bacteria dangerous, especially in vulnerable patients, already affected by serious pathologies or immunosuppressed."

As a result, hospitals in the region have "stepped up procedures for the prevention and control of infections in health facilities," it said.
Riaz Haq said…
What is superbug NDM-1’s India connection?
After a 70-year-old American woman died of the superbug NDM-1 (New Delhi Metallo-beta-lactamase-1) in November last year, health officials recently revealed that her infection was resistant to all the available antibiotics, raising major concerns in the health community.

Here’s all you need to know about the superbug, the infection it causes, where it’s found and its effects:

NDM-1 (New Delhi Metallo-beta-lactamase-1) is an enzyme that makes bacteria resistant to a wide range of powerful antibiotics, including the carbapenem class of antibiotics that are used to treat multidrug-resistant infections.

The gene for NDM-1 encodes beta-lactamase enzymes called carbapenemases, which makes bacteria resistant to antibiotics, including carbapenem, which is used to treat other superbugs such as methicillin-resistant Staphyloccus aureus (MRSA).

Bacteria that produce carbapenemases are popularly referred to as superbugs because they are difficult to treat and result in the infection spreading easily within the body, especially in people who are ill or recuperating from an illness or a surgery.

People die of septic shock after the infection enters the bloodstream and reached the heart, lungs, kidneys, bones or joints to cause multi-organ failure.

The enzyme that makes bacteria drug resistant got New Delhi in its name because it was first detected in 2008 in Swedish patient of Indian origin who had travelled to India.

NDM-1 has been detected in bacteria in the UK, US, India, Pakistan, Croatia, Canada and Japan.

The first death was recorded in Belgium, where a man who was treated in a hospital in Pakistan died in August 2010.

The most common bacteria that make this enzyme are E. Coli and K. pneumoniae, but the NDM-1 gene can spread to other bacterial strains.

Riaz Haq said…
The growing peril of drug-resistant superbugs
Many in India face a similar fate – they get admitted to hospitals with seemingly treatable illnesses, only to contract HAIs caused by superbugs.

Manoj Ghamandayan, 21, has little memory of the month he was hospitalised and nearly died.

It started out as a fever in the first week of October 2019. Then he began to have trouble breathing. Soon, Ghamandayan, an undergraduate Arts student from Haryana’s Jhajjar district, was admitted to Sunflag Global Hospital in Rohtak. He was diagnosed with dengue, a viral infection spread by the Aedes mosquito and scrub typhus, a bacterial infection. To help him recover, the hospital hooked him to multiple devices: a mechanical ventilator to aid breathing, a catheter for draining urine, and a central line to pump medicines into his body.

But Ghamandayan got sicker. During his two-week stay at the hospital, he caught three healthcare-associated infections (HAIs) or infections that patients catch at hospital. Invasive devices like ventilators, central lines and catheters pose the risk of HAIs because they breach the body’s protective barriers.

For example, a ventilator’s breathing tube could easily transfer bacteria from a nurse’s hands to the patient’s lungs, triggering pneumonia.

Ghamandayan came down with two bacterial infections, Escherichia coli and Acinetobacter baumanii, and a fungal species called Candida.

These pathogens were superbugs — i.e, resistant to multiple antimicrobial drugs — which make them hard to treat. His family moved him to New Delhi’s Sir Gangaram Hospital, where his doctor, Atul Gogia, deployed two last-line antibiotics called colistin and meropenem —both expensive, with toxic side effects. Yet these drugs are the only hope for patients when all else fails.

Ghamandayan eventually got better and was discharged nearly a month after he was first hospitalised. In all, he had spent Rs 6 lakh on his treatment.

Many in India face a similar fate – they get admitted to hospitals with seemingly treatable illnesses, only to contract HAIs caused by superbugs.

Few Indian hospitals track their HAI rates, which is why it is hard to get a countrywide picture of this problem.

But several stand-alone studies show that India has higher rates compared to richer countries like the US. For example, a study by the International Nosocomial Infection Control Consortium, which surveyed data from 40 hospitals in 20 cities in India, between 2004 and 2013, found that for every 1,000 days that patients were hooked to ventilators in Indian cardiac Intensive Care Units, there were around 11 times as many pneumonia cases as in American hospitals. “The rates of infections in Indian hospitals are just unacceptably high,” says Ramanan Laxminarayan, a public-health expert at Washington DC’s Center for Disease Dynamics, Economics & Policy (CDDEP).

But that’s just part of the problem. Many of the bugs that cause these infections have learnt to tolerate powerful antimicrobial drugs. Unpublished 2019 data from a 20-hospital surveillance network run by the Indian Council for Medical Research (ICMR) shows that key hospital bugs, like Acinetobacter baumanii and Klebsiella pneumoniae, have grown widely drug-resistant.

Patients infected with any of these bugs often have to be treated with last line drugs, which are both expensive and toxic. Many of them succumb: A 2018 study, carried out in 10 Fortis Group hospitals found that patients with multidrug resistant infections were almost thrice as likely to die as those with susceptible ones.
Riaz Haq said…
#Fake #vaccines administered in #India. #Medical scams are nothing new in India, where, during the country’s mammoth outbreak this spring, profiteers targeted vulnerable #COVID19 patients with fake drugs and oxygen. #Modi #BJP #fraud #pandemic

As India intensifies its vaccination effort amid fears of another wave of the coronavirus, officials are investigating allegations that perhaps thousands of people were injected with fake vaccines in the financial capital, Mumbai.

The police have arrested 14 people on suspicion of involvement in a scheme that administered injections of salt water instead of vaccine doses at nearly a dozen private vaccination sites in Mumbai over the past two months. The organizers, including medical professionals, allegedly charged between $10 and $17 per dose, according to the authorities, who said they had confiscated more than $20,000 from the suspects.

“Those arrested are charged under criminal conspiracy, cheating and forgery,” said Vishal Thakur, a police officer in Mumbai.

More than 2,600 people came to the camps to receive shots of the Oxford-AstraZeneca vaccine, manufactured and marketed in India as Covishield. Some said that they became suspicious when their shots did not show up in the Indian government’s online portal tracking vaccinations, and when the hospitals that the organizers had claimed to be affiliated with did not match the names on the vaccination certificates they received.

“There are doubts about whether we were actually given Covishield or was it just glucose or expired/waste vaccines,” Neha Alshi, who said she was a victim of the scam, wrote on Twitter.

Siddharth Chandrashekhar, a lawyer who has filed a public interest lawsuit in Mumbai’s high court, described the scenario as “heartbreaking.” The court said it was “really shocking that incidents of fake vaccination are on the rise.”

Medical scams are nothing new in India, where, during the country’s mammoth outbreak this spring, profiteers targeted vulnerable Covid patients with fake drugs and oxygen. The police in West Bengal state are also investigating whether hundreds of people, including a local lawmaker, received fake vaccines there.

India has administered more than 340 million vaccine doses, but less than 5 percent of the population is fully vaccinated, according to the Our World in Data project at the University of Oxford. The country is reporting nearly 50,000 new cases daily and nearly 1,000 Covid deaths, numbers that are far lower than two months ago, although experts have always believed India’s official tallies to be vastly undercounted.

On Saturday, the pharmaceutical company Bharat Biotech reported that its Covaxin shot — the other vaccine in wide use in India — was 77.8 percent effective in preventing symptomatic illness, according to the results of a late-stage trial. Those results were published online but have not been peer-reviewed.
Riaz Haq said…
Patients are flocking to #India for surgery but "Indian #medical #tourism lacks effective regulations to govern the sector, which leaves it unorganized and lacking in monitoring". The quality of the services provided by these agents is not regulated.

"India has the largest pool of clinicians in South Asia," explains Dinesh Madhavan, President of Group Oncology at International Apollo Hospital Enterprises.

"We are uniquely positioned thanks to our hospitality and rich culture, combined with modern as well as traditional medicine and therapy," he says.

And it's not just treatment for medical conditions like cancer. There has also been a sharp rise in patients arriving in India for cosmetic surgery procedures such as liposuction (removal of body fat) or hair grafts for baldness.

"We get patients from the US, Africa and Gulf regions," says Dr Satish Bhatia, a dermatologist and cutaneous surgeon in Mumbai. Dr Bhatia says he sees many flight attendants, looking for quick, non-invasive cosmetic procedures such as dermal fillers or Botox.

Dr Bhatia says that, on average, the price of most cosmetic procedures in the US, Europe and the Middle East are at least 50% higher than if done in India.

Like much travel, medical tourism ground to a halt during the pandemic, but Dr Bhatia says business is picking up again and he is confident it will continue to grow.

However, this boom in overseas patients has its downsides.

"There is a mushrooming of new aesthetic clinics all around India. Sadly, this also attracts unqualified and untrained doctors wanting to make easy money," says Dr Bhatia.

Always research your doctor's credentials and experience before fixing an appointment, he advises.

Patients should also make sure there are adequate arrangements in place for aftercare, says Dr Shankar Vangipuram, senior consultant, radiation oncology at the Apollo Cancer Centre in Chennai.

"Post-treatment in India - sometimes due to lack of qualified clinicians and diagnostic tools - we do face difficulty in tracking the responses and toxicities," he says.

The government meanwhile, acknowledges that the sector needs tighter regulation.
Riaz Haq said…
#India’s drug regulator has ignored red alerts on #COVAXIN, imperiling millions of lives. World #Health Organization warned #UN agencies against procuring Covaxin, India’s indigenously developed & manufactured #COVID19 #vaccine. #Modi #Hindutva #Bharat

Why are CDSCO and others treating Bharat Biotech with kid gloves?

The simple answer is that virtually all of India has thrown its weight behind Bharat Biotech because of Prime Minister Narendra Modi’s AatmaNirbhar policy, which broadly translates into a policy of economic self-reliance. This has meant special regulatory privileges for Covaxin, given its status as a made-in-India vaccine that was developed with the support of the Indian Council of Medical Research (ICMR).


In a shocking turn of events, the World Health Organization warned United Nations agencies against procuring Covaxin, India’s indigenously developed and manufactured Covid-19 vaccine, just five months after granting approval to the made-in-India vaccine. The warning came after a WHO inspection of a manufacturing facility owned by Bharat Biotech International Ltd. revealed “deficiencies in good manufacturing practices.”

The WHO has not revealed the extent or nature of the deficiencies at Bharat Biotech’s facility; but given its recent instructions to U.N. agencies, the deficiency must have been significant from a public health perspective. Violations of current good manufacturing processes is nothing new to the Indian pharmaceutical industry. There is a sordid history of warning letters from the U.S. Food and Drug Administration documenting systematic compliance issues over the last decade. Foreign inspections all but ceased during the pandemic. Agencies such as the WHO rely on national regulatory agencies like the Central Drugs Standard Control Organisation (CDSCO), which regulates the pharmaceutical industry in India, to assess compliance before granting approval for commercial use of a drug.

This is not the first time that a foreign regulator has found problems with the manufacturing facility at Bharat Biotech that produces Covaxin. Exactly one year ago, the Agência Nacional de Vigilância Sanitária (ANVISA), Brazil’s drug regulator, pointed out serious lapses at Bharat Biotech’s manufacturing facility in India that makes this vaccine. ANVISA inspectors discovered issues with quality control at the facility that are meant to confirm that the live virus at the core of this vaccine has been inactivated.

At the time, the CDSCO remained a mute spectator to the affair and gave no assurances to the Indian public on measures it was taking to ensure that Bharat Biotech fixed these issues. It has followed the same path of silence since the WHO’s recent suspension of Covaxin’s procurement by the United Nations.

As I write this, not a single newspaper in India has been able to identify the exact nature of the deficiency the WHO raised, and few in India seem to be concerned about the implications of the WHO’s action, despite the fact that Covaxin is being administered to children in India.
Riaz Haq said…
India-made cough syrups may be tied to 66 deaths in Gambia: WHO | Business and Economy News | Al Jazeera

The WHO also issued a medical product alert asking regulators to remove Maiden Pharma goods from the market.

The deaths of dozens of children in The Gambia from kidney injuries may be linked to contaminated cough and cold syrups made by an Indian drug manufacturer, the World Health Organization said on Wednesday.

WHO Director-General Tedros Adhanom Ghebreyesus told reporters that the UN agency was conducting an investigation along with Indian regulators and the drugmaker, New Delhi-based Maiden Pharmaceuticals Ltd.

Maiden Pharma declined to comment on the alert, while calls and Reuters messages to the Drugs Controller General of India went unanswered. The Gambia and India’s health ministry also did not immediately respond to a request for comment.

The WHO also issued a medical product alert asking regulators to remove Maiden Pharma goods from the market.

The products may have been distributed elsewhere through informal markets, but had so far only been identified in The Gambia, the WHO said in its alert.

The alert covers four products – Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup.

Lab analysis confirmed “unacceptable” amounts of diethylene glycol and ethylene glycol, which can be toxic when consumed, the WHO said. The Gambia’s government said last month it has also been investigating the deaths, as a spike in cases of acute kidney injury among children under the age of five was detected in late July.

Medical officers in The Gambia raised the alarm in July, after several children began falling ill with kidney problems three to five days after taking a locally sold paracetamol syrup. By August, 28 had died, but health authorities said the toll would likely rise. Now 66 are dead, WHO said on Wednesday.

The deaths have shaken the tiny West African nation, which is already dealing with multiple health emergencies including measles and malaria.

Maiden Pharmaceuticals manufactures medicines at its facilities in India, which it then sells domestically, as well as exporting it to countries in Asia, Africa and Latin America, according to its website.
Riaz Haq said…
#India facing a #pandemic of #antibiotics-resistant superbugs. It is worst hit by what doctors call "antimicrobial resistance" - #antibiotic-resistant neonatal #infections alone are responsible for the deaths of nearly 60,000 newborns each year. #health

Things are so worrying that only 43% of the pneumonia infections caused by one pathogen in India could be treated with first line of antibiotics in 2021, down from 65% in 2016, the ICMR report says.

Saswati Sinha, a critical care specialist in AMRI Hospital in the eastern city of Kolkata, says things are so bad that "six out of 10" patients in her ICU have drug-resistant infections. "The situation is truly alarming. We have come to a stage where you are not left with too many options to treat some of these patients."


At the 1,000-bed not-for-profit Kasturba Hospital in the western Indian state of Maharashtra, doctors are grappling with a rash of antibiotic-resistant "superbug infections".

This happens when bacteria change over time and become resistant to drugs that are supposed to defeat them and cure the infections they cause.

Such resistance directly caused 1.27 million deaths worldwide in 2019, according to the Lancet medical journal. Antibiotics - which are considered to be the first line of defence against severe infections - did not work on most of these cases.

Millions are dying from drug-resistant infections
India is one of the countries worst hit by what doctors call "antimicrobial resistance" - antibiotic-resistant neonatal infections alone are responsible for the deaths of nearly 60,000 newborns each year. A new government report paints a startling picture of how things are getting worse.

Tests carried out at Kasturba Hospital to find out which antibiotic would be be most effective in tackling five main bacterial pathogens have found that a number of key drugs were barely effective.

These pathogens include E.coli (Escherichia coli), commonly found in the intestines of humans and animals after consumption of contaminated food; Klebsiella pneumoniae, which can infect the lungs to cause pneumonia, and the blood, cuts in the skin and the lining of the brain to cause meningitis; and the deadly Staphylococcus aureus, a food-borne bacteria that can be transmitted through air droplets or aerosols.

Doctors found that some of the main antibiotics were less than 15% effective in treating infections caused by these pathogens. Most concerning was the emergence of the multidrug-resistant pathogen called Acinetobacter baumannii, which attacks the lungs of patients on life support in critical care units.

Hidden pandemic of antibiotic-resistant infections
"As almost all our patients cannot afford the higher antibiotics, they run the real risk of dying when they develop ventilator-associated pneumonia in the ICU," Dr SP Kalantri, medical superintendent of the hospital, says.

A new report by Indian Council of Medical Research (ICMR) says that resistance to a powerful class of antibiotics called carbapenems - it defeats a number of pathogens - had risen by up to 10% in just one year alone. The report collects data on antibiotic resistance from up to 30 public and private hospitals every year.

"The reason why this is alarming is that it is a great drug to treat sepsis [a life-threatening condition] and sometimes used as a first line of treatment in hospitals for very sick patients in ICUs," says Dr Kamini Walia, a scientist at Indian Council of Medical Research (ICMR) and lead author of the study.

Riaz Haq said…
Necessary #Indian Drugs Prove Deadly For Dozens of Children. Deaths believed to be linked to contaminated #cough syrups in #Gambia have brought attention to loose #regulations in #India and a lack of testing capacity in poor importing nations. #health

“What happened in Gambia is happening in other African countries without us even knowing,” said Michel Sidibé, the African Union special envoy for the African Medicines Agency, a new body aimed at harmonizing drug regulation across the continent.

“Most African countries don’t have testing capacities nor well-trained regulatory bodies,” Mr. Sidibé said. “The African market is very fragmented, but because of poor regulations, drugs move from one country to another.”


They had fevers, aches, runny noses, the normal stuff of childhood. The kind of illnesses for which a doctor would prescribe cough syrup.

But the children’s condition only worsened. They developed persistent diarrhea, then could no longer urinate, as their kidneys failed. The very medicines that were supposed to make them better, simple cough syrups imported from India, were instead killing them, because they turned out to be poison.

In all, 70 children in the tiny West African nation of Gambia are suspected to have died in recent months from contaminated Indian-made cough syrups. Among them was 2-year-old Muhammad Lamin Kijera, who died on Aug. 4.

“He was lively and likable — he was everybody’s friend,” said his father, Alieu Kijera, who works as a nurse at an eye clinic in Banjul, the Gambian capital. “How can they allow something like this into the country, destroying lives?”

India has taken to calling itself “the world’s pharmacy” as its drug industry has expanded rapidly, providing a lifeline to the developing world by selling medicines, many of them generics, for an array of illnesses like malaria and AIDS at prices lower than those of American or European drugs.

But the deaths in Gambia have raised alarm over what one expert called a “dangerous cocktail”: on one side, a $50 billion Indian pharmaceutical industry whose regulation has remained loose and chaotic despite repeated calamities, and on the other, poor nations with little or no way to test the quality of the medicines they import.

India’s drug industry, experts say, is rife with data fraud, inadequate testing and substandard manufacturing practices. While people around the world take Indian medicines every day without incident, the regulatory weaknesses give the country’s drug makers openings to cut corners and increase profits, experts say.

That has created a hazardous reality far more widespread than the occasional tragic cases of mass poisonings, and could shake faith in Indian medicines in the places that need them most.


India is the world’s third-largest drug manufacturer by volume, producing 60 percent of global vaccines and 20 percent of generic medicines. In a sign of the world’s reliance on Indian drugs, the country’s pharmaceutical exports increased nearly 20 percent during the first year of the pandemic, reaching $24 billion, despite lockdowns that disrupted global supply chains.

As a stamp of approval for the quality of Indian medicines, officials point out that more than half of the drugs manufactured in India go to highly regulated markets — “every third pill in the U.S. and every fourth pill in Europe is sold from India,” according to the Indian Pharmaceutical Alliance.
Riaz Haq said…
As the Covid-19 pandemic spread across the world two years ago, one of India’s leading biotech companies was racing to develop a vaccine with crucial backing from the Indian government. The shot engineered by Bharat Biotech was, in part, an important effort to create a home-grown product that could bolster the fortunes of the Indian pharmaceutical industry.

However, a STAT review of documents detailing the steps taken toward government approval found that regulators endorsed the vaccine, called Covaxin, despite discrepancies in the number of clinical trial participants. Moreover, questionable changes were made to the trial protocols — which are established procedures for testing a vaccine or medicine — to expedite the approval process.

For instance, the number of people enrolled in the Phase 1 portion of the trial differed from what was later published in a medical journal. There were also important changes made to the protocol for Phase 2 testing, when immunogenicity data from the previous Phase 1 stage were not yet available.

In addition, the protocol for Phase 3 was approved while Phase 2 was still underway and the final vaccine candidate was selected without Phase 2 data, according to protocol documents and minutes of meetings held by an expert committee that reported to India’s Central Drugs Standard Control Organization (CDSCO), the national regulator responsible for approving medicines. This was the agency that authorized the vaccine for emergency use in January 2021, two months before Phase 3 results were known.


More controversy erupted last spring. Brazilian authorities raised concerns about Bharat Biotech manufacturing. Then, the WHO, which listed the vaccine for emergency use in November 2021, suspended supplies after an inspection of the facilities found unspecified problems. The decision meant United Nations procurement agencies, such as UNICEF, would no longer be able to supply the shot to other countries. A WHO spokesperson declined to offer an update on the findings.

For now, it remains unclear whether the newly disclosed issues surrounding the clinical trial will trigger still more questions about the willingness of the Indian government to boost its oversight. The CDSCO and the Drugs Controller General of India, which oversees the CDSCO, did not respond to emails seeking comment about the changes made to the Covaxin trial protocols and subsequent government approval.

In reviewing the documents, there was a clear discrepancy in the number of enrollees. In reporting the Phase 1/2 data, the protocol stated 402 participants were given the first dose and 394 got the second dose. But results published in Lancet Infectious Diseases in January 2021 stated 375 people were given a first dose and 368 received a second dose. (See Figure 1 on page 640.)
Riaz Haq said…
#India still uses #asbestos. Poor #Indians use it for roofing. WHO says all asbestos types cause “lung cancer, mesothelioma, cancer of the larynx and ovary, and asbestosis [fibrosis of the lungs]”. Exposure, handling or inhaling it results in death.

Asbestos – a cheap, heat-resistant mineral – was once used widely in building materials all around the world. Today, it is banned in 70 countries which have deemed that this construction material is a “silent killer” since its fibres are carcinogenic.

While there are six types of asbestos, chrysotile – white asbestos – is the most common form, used especially in roofing houses.

According to the World Health Organization, all types of asbestos cause “lung cancer, mesothelioma, cancer of the larynx and ovary, and asbestosis [fibrosis of the lungs]”.

Exposure to the fibres and handling or inhaling them could also result in death.

Yet some countries like India continue trading it.

In 2011, India banned asbestos mining and asbestos waste used in ships. But it continues to trade in raw asbestos and asbestos-based products, commonly found in the roofs of houses, especially in poorer regions of the country.

According to a November 2021 report by the Indian government, between 2019 and 2020, India imported 361,164 tonnes of asbestos, a 1 percent decrease compared with 364,105 tonnes in the previous year.

The report noted that almost the entire import was chrysotile asbestos, with 85 percent of these fibres coming from Russia. About 3 percent also came from Brazil, Kazakhstan and Hungary each, and 2 percent came from Poland and South Africa respectively.

Aaron Cosbey, a development economist and head of Small World Sustainability, a consultancy, told Al Jazeera that trade goes on because commercial interests have been prioritised over human welfare.

“India’s biggest source of chrysotile asbestos – Russia – has not banned it nationally. So there is no hypocrisy; it is just bad policy, given that the WHO and 70 states worldwide have agreed that there are no safe uses for the substance,” he said.

India also exports asbestos, but its sales have decreased substantially to 1,001 tonnes between 2019 and 2020, compared with 1,112 tonnes in the previous year.

The Indian government’s November 2021 report noted that most of the exports went to Bangladesh, and 7 percent to Sri Lanka.

Gopal Krishna, an environmental lawyer and co-founder of the Ban Asbestos Network of India, said despite countries like Brazil ruling that asbestos use was unconstitutional – and Hungary, Poland and South Africa banning asbestos – India continues with its import and export.

“The trade continues because nobody in India has time to deal with health complaints when money is involved and there is a lewd relationship between the Indian government and the asbestos manufacturers in the country,” he told Al Jazeera.

“A 2012 study (PDF) was conducted by the National Institute of Occupational Health in Ahmedabad, India, surveying 1,248 workers exposed to the substance. Noting that the fibres affected only three workers, the study concluded that asbestos and its derivatives are not harmful to human health. But this study by a government body was co-sponsored by the Asbestos Cement Products Manufacturers’ Association, which lobbies for the industry, making it a conflict of interest,” he added.

Krishna said the study contradicts the UN Rotterdam Convention, which was adopted in 2004 and reviews the harmful effects of a wide range of chemicals and pesticides.

Riaz Haq said…
#Indian #pharma company used toxic industrial-grade ingredient in #cough syrup – #Noida #UP-based Marion Biotech linked to the deaths of 19 children due to poisoning in Uzbekistan. Marion sold the syrups without testing the ingredient used in its syrups

An Indian pharma company whose cough syrups were linked to the deaths of 19 children due to poisoning in Uzbekistan allegedly used industrial-grade ingredients, according to a report.

Reuters reported quoting sources that Marion Biotech, a company based in the township of Noida in the northern Indian state of Uttar Pradesh, bought the ingredient propylene glycol (PG) from trader Maya Chemtech India, which only sold industrial-grade materials and not pharmaceutical-grade ingredients.

Last year, India launched an investigation against Marian Biotech and suspended its license after WHO issued a global medical alert for two cough syrups produced by the company.

The firm’s Dok-1 Max and Ambronol cough syrups were linked to the deaths of 19 children in Uzbekistan last year.

A person who refused to be identified said Maya Chemtech did not have a licence to sell pharmaceutical-grade materials.

Two sources told Reuters that the syrup was made using PG which is a toxic material used in liquid detergents, antifreeze, paints or coatings, as well as pesticides.

"We did not know Marion was going to use it to make cough syrups," said the person, who declined to be identified while the case was being investigated. "We are not told where our material is used."

Another person, who is involved in the official investigation into the case, said Marion bought commercial-grade propylene glycol.

"They were supposed to take Indian Pharmacopoeia-grade," the person said referring to national standards for the composition of pharmaceutical products.

The source who is involved in the investigation told Reuters that Marion sold the syrups to a Uzbekistan company without testing the ingredient used in its syrups.

India, the world’s largest exporter of generic drugs, has come under scrutiny over the quality of the exported drugs that have been linked to deaths and hospitalisations in almost half a dozens countries.

Last week, the WHO flagged seven India-made syrups that were linked to over 300 deaths globally.

Around 20 syrups manufactured by companies in India and Indonesia were also flagged by the health agency, according to NDTV.

Marion Biotech denied allegations of wrong doing in previous statements. It previously said that it "did not agree" with the WHO’s findings and said the company was cooperating with investigation.

The WHO said that Uzbekistan’s health ministry found "unacceptable amounts" of diethylene glycol and ethylene glycol in the drugs.

Apart from Uzbekistan, at least 70 children were reported dead in Gambia after consuming cough syrups made by Maiden Pharmaceuticals.

Maiden Pharmaceuticals denied the allegations in previous comments.

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