Healthcare – China spends 10x and the developed world 100x of India

It is a pity that India spends so little on healthcare for its citizens.

For a country that ranks a low 130 on HDI but with superpower ambitions, it is a shame that we can’t spend enough to improve the healthcare available to our people.

The central government health budget is about ₹50K crores and the states three times that. The total healthcare spend by the centre and states put together is ₹200K crores, which is about 28 billion US dollars.  This translates to 21 US dollars per capita.

Another telling statistic is that most of the healthcare expense in India is in the private sector. Government spend of $21 is only 30 percent of the spend. Both rural and urban India depend primarily on the private sector for medical care.

As a comparison, spend by government in the US on healthcare is over 100 times more, at 2500 US dollars per capita. While total healthcare spends in the US are actually higher than 8000 dollars per capita, the share of government spend is about 2500 dollars.

In the UK, while total spend on healthcare per capita is lower than the US, the government spend on NHS is even higher than the US at above 3000 dollars per capita.

The Chinese government too, spends ten times as much as India does on healthcare per capita.

I am simply unable to understand India’s poor focus on healthcare.

True, the current government has come up with an ambitious healthcare policy but the proof of the pudding is in the budgets. What is the point of announcing a policy that needs ₹800K crores of funding but only ₹200K crores has been budgeted? Where is the balance money going to come from?

Is this then a policy or just a statement of desire?

I think it is clear and everybody understands now that our real capital is our human capital. But without prioritising health and education, the human capital will not be of good quality. Then of what use will that human capital be? Surely not capable of the productivity gains we need, if we are to become a middle income country in the next 15 years.

The biggest Indian natural disaster ever

India has faced many severe and huge natural disasters in the last 5 centuries.

The largest ones according to public memory and our history texts are the famines.

For example, the Bengal famine of 1943 was responsible for about 3 million deaths.

But what most people do not know and we are not taught in school is that the single biggest disaster was the 1918 flu.

The flu killed 5 percent of India’s population within a few months. About 18 million people.

A similar pandemic today with the same mortality rate would kill 70 million people.

The flu was caused by an H1N1 flu strain. Another strain of H1N1 causes what we all know now as the Swine Flu.

There are two theories about what caused such high mortality in the 1918 flu.

One is that it caused an extreme reaction of the immune system in young adults. If this was the case, a similar pandemic could cause equivalent rates of mortality today.

The second is that most of the deaths in 1918 happened as a result of a bacterial superinfection that followed the flu. The first antibiotics were not available until the 1930s! A similar occurence today would see most of those bacterial infections treated successfully.

It is surprising that the flu was not so devastating in the South and East of the country. Was it because of the high levels of coconut oil and coconut in the food? Monolaurin (Lauric Acid) in coconut oil is known to have antiviral properties. Did this protect them? Or was it something else?

 

 

 

90 percent of Indian parents suck at parenting

Here is a shocking statistic from the NFHS4 (National Family Health Survey) –

“Only 11.6% children (breastfeeding and non-breastfeeding) of 6-23 months of age receive an adequate diet.”

Going further

“The combination of high stunting, wasting and poor IYCF (Infant and young child feeding) stem from multiple deprivations and chronic malnutrition continues to be the dominant epidemiological concern”

Let’s rephrase the first sentence to say the truth plainly –

“India is a country where about 90 percent of the children under the age of 2 do not receive proper food or nourishment.” Jai Hind. Mera Bharat Mahaan. Bharat Mata Ki Jai.

Shameful! Chulloo bhar paani mein doob maro. That’s for the people whose chest swells with pride when we speak of our country.

For the others, there is no shame. It is sadness. It is helplessness. It’s a desire to set it right. And a sense of urgency to act.

Where are we going wrong? Why are we allowing this mammoth tragedy to continue? What needs to be done to solve this?

Conditions like stunting, if not checked and reversed by the time the child is about 2 years old, tend to be a lifelong, irreversible problem.

Why are we condemning an entire future generation this way? Where are our priorities? Why is not 20 percent of the union budget (and not less than 1%) allocated to child and maternal health? Is this not the single biggest issue that faces us?

Read more here – and cry – https://indianpediatrics.net/aug2018/653.pdf

 

Artificial Intelligence and cancer spotting

Going by first principles, any medical diagnosis is the interpretation of data based on known correlations. What disease or condition does that data correlate to?

The data could include stated symptoms, visual/touch/sound observations, ECG readings, ultrasound imaging, MRIs, X-Rays, CAT scans, blood reports, radiology reports, biopsy observations, reactions/cultures and more.

The correlations may not be simple or direct. Often the interpretation could simply throw up the need for more data. A different test perhaps.

Quite a few of these diagnostics involve the interpretation of images. This could be an MRI report, an Ultrasound test, an X-Ray, a photograph…

There are reports that despite spending billions of dollars, IBM Watson has not lived up to its promise in cancer detection.

However, I will argue that irrespective of whether some AI experiment succeeds or fails, machines are better than human experts already in interpreting images for applications like tumor detection. The only caveat is that this statement will be true only in those cases where there is a large enough existing dataset to learn from.

I am not saying that doctors will get replaced. On the contrary, doctors will have tools with diagnostic capabilities that have not existed so far.

People will want a human doctor to exercise independent judgement and accept or reject what a machine finds. People will want a doctor to explain the diagnosis to them, to recommend a course of action and to tell them why such an action is being recommended.

But doctors must be prepared for a world that is coming very soon, where diagnostic tests and their interpretation will by machines. They must adopt and embrace these technologies sooner rather than later. These are the tools that will enable them to greatly enhance outcomes for their patients.

here is an article on a technology that detects lung cancer tumors with 95 percent accuracy, when human experts are at 65 percent-
https://news.cgtn.com/news/3d3d674d78677a4e79457a6333566d54/share.html

Open offices drain your energy and spirit

The scientific evidence that demonstrates the stupidity of open offices continues to pour in.

Open offices do not enable collaboration. On the contrary you collaborate and interact more in the cubicle and cabin type offices.

Workers in an open office are not more productive. How can you be? With the drumbeat of constantly changing visual, auditory and olfactory inputs all around you, you are being distracted and interrupted hundreds of times every day.

An open office is an environment that tells you that it is not important to focus or to get the job done well. It forces you to struggle against totally avoidable obstacles and yet expects you to get the job done.

It’s like forcing you to sit at someone elses untidy desk with blaring music, bling and disco lights added and still expecting you to get your best work done.

You might as well put your employees in a crowded public space and expect them to work from there 8 hours a day, 5 days a week.

Guess what you would want to do if you were made to work in a crowded public space all the time? You will crave privacy. You will eagerly wait for weekends and after office hours, when you can disappear into a private and quiet place where you can get some work done.

And that’s how people end up working all the time – in office and outside. Personal time and family time goes out of the window. So does curling up on the sofa to spend two hours reading a book.

Open offices create an attention deficit hyperactivity culture that spills over to addictive, obsessive compulsive, social media use. And then blank out zombie like in front of dumb television.

People need privacy. People need silence. People need to be left alone. That’s when they get good work done. Whether it’s problem solving, coding, writing, reading, analysis, research or decision making.

They will collaborate, reach out, talk and meet when they must. These can not be impositions. These are choices.

Here is an article in the Economist with some science and opinions on open offices – https://www.economist.com/business/2018/07/28/open-offices-can-lead-to-closed-minds

 

Extinction of a Species – By Design

I am not sure if we should be troubled about the work being done to eliminate mosquito species that are vectors for diseases.

This is no longer science fiction. There are multiple initiatives which follow variants of a basic approach : “Make males whose offspring will only be males. Then release a few of these engineered males into the wild”

This approach, as some experiments have shown, have the potential to rapidly eliminate the species within a few generations in that area. This can be a very short period. Less than a couple of years.

There is no way that this can be isolated to a particular area. Any such initiative will soon spread worldwide and make the species extinct.

These “blood suckers” which cause malaria, dengue, chikungunya are not just disease carriers. They are also food for other animals. They are a part of the food chain. 

Only the females feed on blood. Both male and female mosquitoes primarily feed on nectar. The same thing that honey bees feed on. They also perform the same function that bees do – they pollinate the flowers (Some have argued that mosquitoes are not the great pollinators they are suspected to be).

We are entering an era of genetically engineered plant and animal species of all kinds. These mosquitoes are merely the beginning. Many of these species will get into the wild without any controls because the species are created by individuals or small groups of people in DIY labs.

Somehow, the thought of man made genetic solutions that eliminate or replace an entire existing species troubles me.

What about you?

Here is the mosquito article – https://www.business-standard.com/article/opinion/the-bite-that-can-wait-118082500638_1.html

Criminal or Needs Help? How Do We Know?

Someone told me the other day that the reason why we send people to jail is not to punish them. That’s not the reason at all.

The reason is protection. And it works both ways. Protecting society from criminals and protecting criminals from vigilante justice. One keeps society safe and the second keeps it sane.

That brings me to the topic of mental illness. It is possible to argue in the following manner :  Almost all criminal behaviour is deviant from what we consider “normal”.  Criminal behaviour born of thought patterns that are deviant from the normal is what we may call mental illness. And so a person who has exhibited criminal behaviour is to be treated as a victim of mental illness.

In the last century, we have recognised and accepted some forms of deviant behaviour as born of mental illnesses and recognised that some others (like homosexuality) are not illnesses at all and are perfectly normal. 

But many other behaviours are yet to be recognised and formally classified as mental illness by the criminal justice system. Even perfectly normal behaviours like homosexuality continue to be criminalized in less developed legal systems and unfortunately in India as well.

Just as in other areas of life, I expect technology to play a major role in the coming two decades in this area. So far, psychiatry has not had the technology to look at things like genetic profiles or body chemistry at hormonal and other levels. The causal relationships or correlation between these and mental illnesses is neither visible nor well understood. I think that very strong relationships most likely exist and they will be found.

This opens up the possibility of cures or methods of containment. 

Maybe in future, we will be able to treat these people as victims and help them to reverse the condition or contain it. Maybe many of the people who go to jail today, don’t really belong there.

Alok Sarin makes an interesting case here on an associated topic –

https://www.livemint.com/Leisure/5OJMgBRNZshpufNJdgTf2O/Alok-Sarin-dreams-of-relevant-conversations-on-mental-health.html

 

WhatsApp, Government, Traceability – Who is lying?

In a country like India, people easily believe malicious rumours. Often, these rumours whip up mob hysteria and we have mobs doing all kinds of things- lynching someone, parading someone naked, rioting, arson, destroying property and more.

Whatsapp is not only increasing the number of such rumours but also accelerating their spread and a hydra headed monster of mob violence is making itself felt all over the country. People are getting killed.

The solution obviously is not to ban WhatsApp. The solution is to create a mechanism to identify the originators of these rumours and make an example of them. Arrest them and ensure justice.

Every society has a written law and the law acts as a deterrent to crime. However, the law is emasculated and rendered ineffective by WhatsApp’s refusal to share the identity of the originator of the rumour with the enforcers of the law – the police, the courts, the government.

Minister Ravi Shankar Prasad recently said that he was successful in getting WhatsApp to agree to implement traceability. He confirmed to me on a LinkedIn message exchange that this is the case. The picture on this page is a screenshot of the exchange.

Today, I read news reports that this is not true. And that WhatsApp has REFUSED the Indian Government’s request to implement traceability.  A couple of news report examples are here and here.

Now who has got it wrong? Minister Ravi Shankar Prasad or the Press?

I would like to see a formal announcement by the minister or his ministry telling us what exactly WhatsApp has agreed to.

Portable Medical Imaging and Communicating Thought

I was reading this extraordinary set of claims for a new technology at this link – https://medium.com/s/where-is-the-future/telepathy-could-be-real-are-we-ready-2750f11ddfbd

Coming from Mary Lou Jepsen, you have no option but to take the claims seriously.

Imagine looking into your body at resolutions that are even better than MRIs or CAT Scans. Imagine being able to do that over extended periods of time and not just looking at organs but also movements and flows! And all this as a wearable and not while lying inside a huge machine in a hospital.

The telepathy piece is something I have difficulty believing in. I think the jump from imaging, to interpretation and then communication of complex thought patterns is not feasible using any current technology.

Speech to text is complex enough. Interpretation of the nuances of language is still a work in progress.

Here we are talking of interpreting thought, or rather the visual expression of it as seen on an imaging machine. I suppose that will work  for basic commands that you would use for playing a video game for example. It may also work for communicating simple phrases or feelings or direction etc.

I can’t see how complex, structured (or monkey brain) thinking can be interpreted or communicated.

Maybe I am reading this wrong. I am assuming that a machine is interpreting and then communicating the interpreted thought patterns to humans. On the contrary, here it is humans who interpret the raw expression of thought?  And this is easy for us because it is not much different from what we “see” in our own heads?

I would so love to be a part of this team! This work seems to be really exciting.

Hazardous work and no protection in New Delhi

This is a photo I took today in New Delhi. In the heart of Lutyens Delhi, where our ministers and senior bureaucrats live.

These are sanitation workers cleaning the underground sewers.

The men you see are wearing no protection. 

No gloves. No boots. They are bare bodied. They also do not wear any masks before opening the manholes and descending into the sewers.

Who are the people who employ them? Why does the New Delhi city government allow this? Is this not illegal? 

These workers could fall victim to an accident. They may contract illness due to exposure to pathogens or toxins. And given India’s fairly dysfunctional justice system, they will have no recourse. Nobody will pay for illegal worker treatment like this and nobody will pay for the damage that will happen to their health and well-being.

This is in Delhi. Less than 4 kilometers from the seat of our government. Just imagine what the situation is, in other parts of India…