Universal Health Coverage

Jagannath Chatterjee

What does it imply?Objectives: Spreading health all over the countryCountry wide replication of a tried and

successful model (promotive, preventive, curative)

People do not suffer financially while paying for these services

Goals are noble but..Will health be achieved?Is the model beyond reproach?Is the model financially viable?What is the alternative?

Can UHC achieve health?HEALTH: “a complete state of physical, mental

and social well-being, and not merely the absence of disease or infirmity.” – WHO definition

Does the dominant model intend to achieve health?

Has it achieved this so far?Has the emphasis been on health and well being?Has the emphasis been on cures?Emphasis has been on;

Disease managementGrowth/Profits of pharmaceutical industryMonopoly of the dominant model

Germ/virus theory challenged by findings of Human Microbiome Project

Intent of dominant modelHistory shows an interplay of various forces;

Chemical industry (starting from dyes, and ending in chemical inputs for wars) grew to immense proportions under the I G Farben cartel in Hitler’s Germany.

John D Rockefeller - the Petroleum Barron who had earned massive wealth through various means - was looking for a change of image

William Gates – a change agent – convinced Rockefeller who had already tried his hand in synthetic drugs to form a charity, buy stake in I G Farben and expand his empire while improving his image in society

Facing opposition from medical community, the Flexner Report of 1910 commissioned by Carnegie Foundation established the monopoly of chemical drugs declaring all other forms of medicine to be illegal

Of the around 600 medical institutions of the day only 43 were allowed to continue; even in these, dissenting members were replaced by Rockefeller’s trusted aids

Intent was therefore global business, profits and power – concept of health and medicine was redefined to suit the designs of the powers and research was redesigned by Rockefeller Institute for Medical Research set up in 1901

Components of I G Farben cartel also entered agriculture and general chemical industry promoting chemicals to be the next revolution ‘to transform lives’

Has dominant model achieved health?Global Burden of Disease (GBD) – studied 188 countries

for period 1990-2013 funded by BMGF- published in Lancet, June 2015;More than 95% of the world’s population has health problemsThird of the world's population (2·3 billion individuals)

experiencing more than five ailments Increases in rates of diabetes have been substantial, rising by

around 43% over the past 23 yearsburden on health systems from 301 acute and chronic

diseases and injuries, as well as 2337 health consequences (sequelae) that result from one or more of these disorders.

The main drivers were musculoskeletal, mental, and substance abuse disorders, neurological disorders, and chronic respiratory conditions.

Overuse of antibiotics have led to dangerous super bugsVaccines are leading to newer strains of pathogens taking

overStatus indicates alarming trend of increasing disease

burden which, ironically, will fuel the growth of the system

Is the model being practiced efficiently?In the land of the best medical care USA, “medicine

/procedure induced deaths in USA 784,000 per year! “ (Death by Medicine, Gary Null, 2011).

“It is evident that the American medical system is the leading cause of death and injury in the United States …” – Gary Null

In 2013, Leapfrog Study rated by Journal of Patient Safety- “New research estimates up to 440,000 Americans are dying annually from preventable hospital errors. This puts medical errors as the third leading cause of death in the United States”

The United States has a higher infant mortality rate than any of the other 27 wealthy countries, according to a new report from the Center for Disease Control. 

A new (Save the Children) report reveals that the United States has the highest first-day infant death rate out of all the industrialized countries in the world.

Is the model financially viable?Medical expenses push 38 million Indians into

poverty every year, expert says – Times of India quoting Dr Sumanth Raman, 7th Aug 2014

The analysis of nationally representative data from India shows that 3.5% of the population fall below the poverty line and 5% households suffer catastrophic health expenditures. Medicines constitute the main share (72%) of total OOP payments. This share reaches 82% for outpatient care, compared with 42% for inpatient care – Sharawat & Rao, PHFI, Oxford Journal, 18th April 2012

Is the model scientific?Much of medical research is false – Prof Iaonnodis, PLoS Med,

Aug 30, 2005 Much of the scientific literature, perhaps half, may simply be

untrue.– Richard Horton, Editor in Chief, Lancet, 2015 It is simply no longer possible to believe much of the clinical

research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. – Marcia Angel, Editor in Chief, NEJM, 2009

Main allegations: Industry sponsored studies ‘fit into established ideas’Conflict of interest, bias, desire to get publishedData manipulation (cherry picking)Suppression of negative trial data

Example: Trial data of Indian Rotavirus vaccine was suppressed. In court case lawyers pleaded, “Revealing trial data will alarm public!”. Still court decided in their favour. Vaccine to be included in UIP - Minister

Does it promote health?Nutrition and exercise not key subjects in medical

educationPublic health efforts focused only on vaccinationClean water, sanitation, hygiene, housing, - factors

that led to sharp decline in mortality rates from infectious diseases (JAMA, 1999) – not prerogative of doctors but are political tools

Doctors often speak about promoting health, but they end with advocating new medicines or procedures they are paid to promote

Workshops ostensibly to promote healthy practices feature advertisements and hoardings of drug companies

Health check ups by hospitals encourage unnecessary medication and procedures

Is it preventive medicine?

200 adverse effects compiled from published research papers in PubMed http://www.greenmedinfo.com/blog/200-evidence-based-reasons-not-vaccinate-free-research-pdf-download

“Childhood illnesses have beneficial effects”In early 1997, a team of British physicians writing in Science

noted : "Childhood infections may, therefore, paradoxically protect against asthma.“ These infections have a purpose in building general immunity.

Danish physician Tove Ronne in The Lancet in 1985:"Measles virus infection in childhood can prevent disease in adult life." Among these, Dr. Ronne listed skin disease, immune dysfunctions, degenerative diseases of bone and cartilage, and certain cancers.

Measles can cure eczema. Induced measles can cause cancer to reduce (remission). Having measles, mumps, rubella in early childhood can prevent against allergies, eczema, asthma , heart attack, stroke (Atheroscleorosis Journal, June 2015)cardiovascular disease mortality and cancer. Polio virus used for cancer remission

Association of measles and mumps with cardiovascular disease: The Japan Collaborative Cohort (JACC) study.

Kubota Y, et al. Atherosclerosis. 2015. http://www.ncbi.nlm.nih.gov/m/pubmed/26122188/

Is it Curative Medicine?Focus on disease management, not curesThe word cure is hated, “punishable under Magic

Remedies Act!”UNLESS THE SYSTEM AIMS AT CURES IT CAN

NEVER UNDERSTAND HEALTH, LET ALONE LEAD TO IT

Very important to understand this.No long term vision of healthNo emphasis on toxicity as basis of diseaseDoctors who digress from traditional medicine to

effect cures are pulled up and persecutedDoctors have lost degrees simply writing about real

health options (Medical Mafia, Dr Carolyn Nash, MD)

Who will benefit from UHC?Pharmaceutical companiesLobbyistsPoliticiansBureaucratsInsurance companiesHospitals, patho labsUnethical DoctorsSub staff

Patients may not benefit; may suffer in health, happiness and finance

What is the way out?An integrated approach (AYUSH + Allopathy)Dr B M Hegde (noted medical author,

Padmabhusan, Cardiologist) suggests having ayurveda as base, other AYUSH modalities with the current system as emergency back up

NOT ACCEPTABLE TO THE MEDICAL COMMUNITY

“Bina Juddhe nahi deba suchagra medini”Other medical systems being houndedConfrontation is a must which is very unfortunateThe aim of the medical profession should be to heal

the sick, by all means possible; not pursue a faulty but profitable system

It is up to the civil society to ensure

justice