Health Matters

Heat of the moment

Image for representational purpose only. File | Photo Credit: G.N. Rao

This week in health: why heat is a hot-button issue this election season, Indian spices’ quality crisis and inside the world of bio-hacking.

We end April by circling back to a conundrum we raised at the start of this month. The Election Commission of India suspects heatwaves are contributing to lower voter turnouts in the first two phases of the General Election. Kerala, which had a relatively low voter turnout on April 26, recorded its second-highest temperature since 1901. Elsewhere too, the IMD predicts temperatures can soar up to 46°C, including many regions scheduled to vote in the upcoming phases.

The turnout is not the only casualty. We emphasised earlier how heat exposure is the least kind to people, giving way to a cascade of health impacts and diseases. The retelling of the 2024 elections must also document the remarkable contest that is sizzling on the side. In the fray are political parties and people both fighting an unbending and uncompromising opponent: the Indian summer. Union Minister Nitin Gadkari fainted recently after feeling dizzy due to the heat at a rally in Maharashtra’s Pusad region. Doctors are cautioning — repeatedly and resoundingly — that the unrelenting heat is likely to impact the health of children, pregnant women, the elderly and people with co-morbidities. States like Telangana have issued heatwave advisories; others including Tamil Nadu have erected 1,000 rehydration points offering water and Oral Rehydration Solution (ORS) across the city. Heat exposure is a hot-button issue this time, and the ECI should implement measures to minimise the health impact, we pointed out in our recent editorial. Increasing voters’ awareness of managing heatwaves, along with collecting robust data on heat-related morbidity and mortality, could institute a long-term defence.

It’s worth probing if the heat action plans are realistic, evidence-based, and most importantly, inclusive. The heat and health relationship also nurtures collective neglect at times. Suggestions on avoiding outdoor activities, drinking lassi or staying hydrated may be impractical prescriptions for people like gig workers who travel miles and miles every day to deliver goods for a living. Occupation, gender or caste places communities at the heart of heat exposure. Here, C. Palanivel Rajan argues for a need for inclusive health and heat action plans that address the intricacies of local challenges. What makes a heat action plan successful? Liffy Thomas traces the lessons learned from plans implemented by Ahmedabad and Odisha. 

Speaking of plans and probing, we follow up on IRDAI’s move from last week to remove the 65-year age limit for purchasing health insurance. The fine print troubled many: the premiums for this demographic might be higher priced. And if the only effect is to provide many more unaffordable health insurance policies, well, “it would be equivalent to admiring the icing on an inedible cake”. Click on this link to read our editorial on why the reforms are being met with a reluctant embrace. For a refresher on IRDAI’s new rules and their relevance, do read N. Ravi Kumar’s detailed explainer on this. 

Bindu Shajan Perapaddan reports on an escalating concern among druggists’ associations. The Union Government recently allowed the retail sale of over-the-counter (OTC) drugs, for common medical problems, like flu and allergies, without license. The All India Organization of Chemists and Druggists flagged that this change contravenes existing drug laws, pharmacy regulations, and legal frameworks, including directives from the Supreme Court. Unregulated OTC drugs may spell graver health consequences – including drug abuse, increased risk of adverse drug reactions, delayed access to healthcare and possible compromise in storage of medicines. 

These, by no means, are hypothetical scenarios. You’ve heard our alarm bells and read our warning signs about the threat antimicrobial resistance poses to public health. A key driver of AMR? Misuse and overuse of antibiotics, which are often sold OTC. New evidence from the World Health Organisation shows the same antibiotics that were sold and used indiscriminately during the COVID-19 pandemic may have exacerbated the “silent” spread of AMR (they also did nothing to improve clinical outcomes for patients). The new data called “for improvements in the rational use of antibiotics to minimise unnecessary negative consequences for patients and populations,” said Dr. Silvia Bertagnolio, WHO Unit Head for Surveillance, Evidence and Laboratory Strengthening, Division for AMR. Restraint, at times, is the best self-medication for pharma and the patients it caters to. 

Staying on infections, the Union Health Ministry yesterday said it is monitoring the avian influenza situation and keeping a close watch on seasonal influenzas too. The nudge came from avian influenza virus cases being detected among cattle and in milk in the U.S. For now, it has advised hygienic practices such as boiling milk and cooking meat at adequate temperatures would help prevent transmission of the virus from an infected product to human beings. It is also carrying out real-time surveillance of Influenza-like Illness and Severe Acute Respiratory Infections in OPDs and IPDs of health facilities, the Ministry said.

In an earlier communique, the Health Ministry also passed new orders to address the risk of hospital-associated resistant infections (HARI). It recently directed health workers to remove jewellery (bangles, rings, religious threads, etc.) below the elbows, and restricted the use of mobile phones, to “ensure infection control practices”. India is among the countries bearing the highest burden of HARI globally.  

Infections tend to raise parallel threats of infodemics. Only four years ago COVID-19 showed the perilous nature of health mis- and disinformation: the surfeit of information looked like science, moved to misdirect and preyed on people, which in turn affected health behaviours and outcomes. Can misinformation — about pathogens, transmission, vaccines — be prevented, as the world readies armours against future pandemics? I report on a new Lancet paper offers a cocktail of real-world strategies to immunise communities from infodemics. 

WHO expert Dr. Soumya Swaminathan also recollected the flurry of misinformation and disinformation around COVID-19 in a recent panel, assembled to discuss the launch of the book ‘At The Wheel of Research - An Exclusive Biography of Dr. Soumya Swaminathan’. She noted thatonly data and scientific evidence can make the scaffolding of public health sound and sturdy.

The D-word is a sore subject in health, if you remember the Lancet warning from some weeks ago. The delay in conducting the 2021 census seems to have sparked a data crisis; this, along with a delay in putting data out in the public domain, leaves the public health sector in dire straits. G. Sampath asked Prof. T. Sundararaman how policy-makers and social scientists are managing with 2011 census data in 2024, and why the calls for transparency and autonomy need to pierce through the data barriers. Listen in.

Nestle’s moment in the sharp spotlight of scrutiny hasn’t ended yet. In an update from last week, the Swiss food giant has reportedly denied applying any “double standard” after an NGO accused the company of selling baby food with high levels of added sugar in low-income countries but not in wealthier nations. The report has stirred the Food Safety and Standards Authority of India (FSSAI) to action, who is now reportedly collecting pan-India samples of Nestle’s Cerelac baby cereals. Public health expert Arun Gupta tells Zubeda Hamid more about the Indian lens to the Nesle crisis, exploring the legal regulations and safety standards in place. Tune in to know more. 

The FSSAI has other fires to put out this week: it is checking the quality of Indian spices sold in India. The push came after Singapore and Hong Kong banned the sale of four spices by Indian brands MDH and Everest; their curry powder, sambhar mixed masala and fish curry masalas allegedly contain high levels of cancer-causing pesticides. The U.S. Food and Drug Administration has also said it is gathering “additional information”.; Hong Kong has urged consumers not to buy these products, and Singapore has directed a recall of the four spices in question. MDH and Everest spices are staples in Indian homes; their quality, if found wanting, raises challenges new and old for the food regulator. We’ll stay on this and bring you more inputs in the coming weeks.

From food to drugs, regulation seems to be in a pickle all around. Dr. Reddy’s Laboratories on April 24 voluntarily recalled its Sapropterin Dihyldrochlroid oral resolution powder in the U.S. due to ‘sub potency’. 

Coming up for breath, to take note of the sights and sounds of innovation buzzing around.

A team of Indian scientists recently designed a potent antidote to cobra and krait venom toxins – leaping forward in the stagnant field of anti-venom research. Snake bites have the unfortunate fate of holding the distinction of a “poor man’s disease”; the mortality burden is especially higher in low and middle-income countries in Africa and Asia, with India alone at a staggering average of 58,000 deaths in a year. The researchers used human antibodies instead research is a promising answer that offers an antivenom that might work across regions and across species.” Rohini Subrahmanyamwrites about this ‘impossible find’ and the way forward.

2024 is also the year when two revolutionary malaria vaccines are being rolled out across Africa. Here, scientist Jaishree Raman explains if 2024 will be the year the continent takes a significant leap towards beating the vector-borne disease. Hope is perhaps the best antidote to health calamities and crises. 

Our tail piece this week is about science, biology, DIY experiments and the storied pursuit of longevity. Ever heard of bio-hacking, an elite race to become superhuman? The frontrunners are your typical Silicon Valley execs and tech-bros; the Jack Dorseys, Mark Zuckerbergs and Bryan Johnsons’ of the world. Research remains shoddy, but the appeal of nutraceuticals shines too bright for the bandwagon to slow down. In millionaire Johnson’s arsenal: a team of 30 scientists, 111 nutritional supplements, a penile device that measures night-time erections, and blood transfusions from his 17-year-old son — adding up to a cumulative expenditure of $2 million annually. Neha Vineet Mehrotra writes about this opioid to optimise cellular nutrition: “At its best, biohacking is about taking control of your own health, but at its worst, it can veer into pseudo-scientific peddling that does more harm than good.” 

From the Health page

C. Maya writes about the unsuspected, curious link between skin-lightening creams and kidney health. 

Why experts are concerned about the growing incidence of Inflammatory Bowel Disease (IBD) globally, reports Serena Josephine M. 

Here, public health experts Ananya Awasthi and Apoorva Kalra make a case for tossing out junk food and bringing back health food to the plate. 

Where shall the poor go for a kidney transplant in Kerala, asks K.G. Prem Chandra. 

Health Ministry constitutes task force on brain healthcare. 

That’s all for your weekly health bulletin. Before you go, did you know coconuts may be a fount of health benefits? If all else fails in this sultry and stifling weather, maybe the answer lies in cooler, calmer things. 

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