The government’s response to this new “superbug” controversy (NDTV report here) has been awkward and uncertain from the get go. Antibiotic resistance in bacteria, as the government itself admits, is very well known and the findings of the study published in Lancet (For those interested, the full study is available online on the Lancet website) which set off this debate are not surprising either. If there is anything new, it is the sense of alarm it raises by highlighting the pervasiveness of the problem in India.
So, with all the brouhaha in the media, the government probably felt compelled to issue a clarification to calm public fears. Besides that, not much of a purpose is served as anyone who has read a research paper in any field ought to be able to recognize some of the obvious facts it states. On the contrary, it is a little disturbing to see officials reluctant to confront the problem instead making feeble attempts to downplay it. The statement thus obscures more than it reveals and does little to alleviate the impact the report’s findings.
Firstly, with respect to the last paragraph of the report, the clarification says,”Concluding sentence presents a frightening picture which is not supported by any scientific data.” Sure, but discussions often involve presenting new theories that can account for all known facts and possibly predicts new ones. Once the results have been presented accurately, thoughtful but speculative ideas about concepts to explain them are entirely in order.
It further states, “It should have been highlighted that getting infection by such drug resistant bacteria is a matter of chance, is a global phenomenon and is preventable by sound infection prevention strategies which are followed in any good hospital.” Again, very true but not all folks take antibiotics based on prescriptions, not all regimens are duly followed or completed, not all prescriptions are filled by practitioners, not all practitioners work in hospitals, not all hospitals qualify as good and people move from one clinic/nursing home/hospital to another carrying the infections with them. All of this makes that ‘chance’ the government is referring to closer to 1 than 0.
Thirdly, it reads “While such organisms may be circulating more commonly in the world due to international travel but to link this with the safety of surgery hospitals in India and citing isolated examples to show that due to presence of such organism in Indian environment, India is not a safe place to visit is wrong.” The study cites that 3,521 bacterial isolates were analyzed through 2009 in Chennai, 198 in Haryana and isolates were referred from 25 laboratories across England in 2008-9. All of this suggests that the sample size is substantial and cannot be called ‘isolated’.
Finally, it throws dark hints of the “conspiracy”: “It also needs to be highlighted that several of the authors have declared conflict of interest in the publication. The study was funded by European Union & 2 pharmaceutical company namely Wellcome Trust & Wyeth who produce antibiotics for treatment of such cases. DGHS in consultation with Secretary DHR & DGICMR strongly refute the naming of this enzyme as New Delhi metallo beta lactamase & also refute that hospitals in India are not safe for treatment including medical tourism.”
Only two individuals including the lead author have declared conflicts of interest. The project has however involved numerous individuals and has been a collaborative effort with multiple institutions and grants involved part of which came from the EU. The report also states categorically that the study sponsor had “had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.” So the government’s allegation does not sound credible.
I understand the government’s concern that medical tourism could be adversely affected by this paper but this kind of knee jerk response is hardly going to improve matters or be taken seriously by those concerned. Facts are facts and findings of a study must be critiqued academically or be rebutted by new findings from another study. They cannot be ‘refuted’ like this with political statements. Trying to do so only invites ridicule. It is not that there have not been such instances earlier. In the US, the Indiana State House of Representatives in 1897 passed a bill defining the value of the mathematical constant pi (link to Wikipedia entry is here). The State Senate wisely did not follow up on that measure and allowed it to die. More recently, some years ago, the US Congress passed a resolution condemning the unpopular findings of a child abuse study which has nevertheless managed to withstand academic criticism. Thankfully, the government’s statement does not rise to that level of stupidity.
Impact of this study on medical tourism is only one part of the story. The other side of the question is what this means to the large number of people living in India who confront the impact of antibiotic resistance, a phenomenon which is not at all new and cannot be wished away through denials. The problem is a difficult one which requires concerted, long term, system wide efforts with the involvement of a large number of groups in order to be addressed. Hopefully, this will serve as a wake up call to the government and organizations such as the IMA to start looking for solutions.
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