Health Matters | Back to basics — defining life and health

This week in health: India’s hunger index ranking, the state of mental health and the mysterious cancer cells that survive chemotherapy.

October 17, 2023 03:18 pm | Updated October 18, 2023 11:36 pm IST

The Supreme Court this week passed a judgement denying a two-time mother her petition to terminate her pregnancy at 26 weeks.

The Supreme Court this week passed a judgement denying a two-time mother her petition to terminate her pregnancy at 26 weeks. | Photo Credit: The Hindu

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Oftentimes, the resolution of an intensely medical matter happens outside of medicine, with ethical considerations always queering the pitch. It was one of those occasions. The last few days of this health week were dominated by hectic parleys, not in hospital corridors, but in the courtroom. The Supreme Court finally passed a judgement denying a two-time mother, undergoing postpartum psychosis, her petition to terminate her pregnancy at 26 weeks. She had petitioned the court to terminate on the grounds of her mental health, but also economic and emotional hardships. The court sent her to the All India Institute of Medical Sciences on October 13 to check if her foetus was suffering from anomalies. 

Throughout the entire course of this trial, which ended in the Court deciding to deny her petition for medical termination of pregnancy, it was clear that it had dragged the country through questions not only of science, but also philosophically delving into long-drawn debates on what constitutes life, living and death.

Arguments oscillated between the rights of a living woman and those of her unborn child, as the prosecution pitted the 26-week-old foetus, declared as having no abnormalities, against its 27-year-old mother. A Division Bench of two women judges of the Supreme Court was split in their opinions about the decision of a married woman to abort her 26-week pregnancy and the Centre’s resolve to save the “unborn child”. Unable to reach common ground, Justices Hima Kohli and B.V. Nagarathna finally referred the case to the Chief Justice of India to form a three-judge Bench.

The petitioner’s counsel submitted in court that she was “physically, emotionally, mentally, financially and medically unable to carry, deliver or raise a child”. Additional Solicitor General Aishwarya Bhati who seemed to take this case up like a crusade, argued that while Indian Medical Termination of Pregnancy law was “pro-life” for sure, but stopped short of deliberately extinguishing life. She argued: “This is no longer a case of pro-life [life of the child] or pro-choice [reproductive autonomy of the woman]. This is actually Hobson’s choice for her. She cannot medically terminate the child now. The choice is now between a pre-term or a full-term delivery. Chances of a healthy child reduces with a pre-term delivery. A full-term delivery gives the child a healthy chance to survive.” 

As per the Rules of the amended Medical Termination of Pregnancy Act, (as explained by Sreeparna Chakrabarty), the opinion of a medical board had to be sought before termination of pregnancy beyond 24 weeks. K. Aparna Sharma, a member of the Board, and a doctor at AIIMS, wrote back informing the court that the foetus was ‘viable’ and terminating the pregnancy at this stage would amount to foeticide, seeking the permission of the court to do so. The mother herself came to a rather belated realisation of her pregnancy, as she was still lactating (since her second child in September last) and not menstruating at the time, and sought the intervention of the court as she felt unable to carry this baby to term. 

Though the doctors certified that she indeed had psychosis and was under treatment, their statement that the medicines had not affected the foetus seemed to weigh the scales in favour of the little one. The court did itself between a rock and a hard place, and chose to go with the statute. A three-judge Bench headed by Chief Justice of India D.Y. Chandrachud urged her to reconsider her decision. In the final judgement, Krishnadas Rajagopal reported that the judges made it clear that the woman cannot claim an “absolute, overriding right” to abort, especially when multiple reports from the AIIMS medical board have confirmed that the pregnancy was neither a cause of immediate danger to her life or that of the foetus. The Bench, in this significant judgement, also recorded the willingness of the Centre to undertake the expenses of the delivery, and later arrange for the adoption of the child after it was born. 

Much of this case hinged on the mental health status of the petitioner, the young mother. With Mental Health Day falling in October, it was perhaps a seasonal high for articles emphasising a number of aspects of mental health care, including at the regional levels. Most significant was this stunning indictment from the National Human Rights Commission that most mental health establishments were stuck in the past, and its recommendation to restructure them as per contemporary requirementsBindu Shajan Perappadan further writes that the NHRC wrote to the Health Ministry and appropriate State authorities, also seeking measures to boost accessibility to treatments for mental disorders for financially disadvantaged populations, and listing out an “advisory on mental health containing a set of recommendations.”

Sumeda writes on how accessible and affordable mental healthcare is in the country. While globally there is a significant number of individuals who need mental healthcare, far fewer actually receive treatment, even if effective treatments are available at a low cost. Most don’t have access to care services, adding to the widening gap between those who need care and those with access to such care. Last year, the National Tele-Mental Health Programme (NTMHP) was launched under the NMHP to use digital technology to address growing mental health challenges and improve access to quality mental health counselling and care services in the country.

And it was clearly a felt need. In the last year or so since it was launched, Tele MANAS Seva has counselled more than 3,50,000 people, the Union Health Minister Mansukh Mandaviya claimed, on the occasion of World Mental Health Day. “Ayushman Bharat health and wellness centres have facilitated the integration of mental health services with primary health services as priority services for mental health, neurological disorders and substance use disorders. Now to improve coverage and access to mental health care, district-level activities have been supported under the National Mental Health Programme in 743 districts across all 36 States/union territories,” he added. If you wish to understand the role of Tele MANAS further, do read this piece by Saumya Kalia: One year of Tele-MANAS: The wins, the concerns.

One way to destigmatise mental illness would be to share freely the experiences of persons with such conditions across the world. In telling their stories, there is a sense of shared responsibility and the feeling that however difficult it might seem now, others have done it. Which makes this story very important: at an event held to observe Mental Health Day, people shared their lived experiences on how being diagnosed with mental illness changed their lives, of how they coped with the symptoms and overcame barriers in the form of stigma through treatment and support.

The impact of mental health on growing children has always been a concern, particularly with device use becoming prominent and even inevitable. We had a couple of stories analysing these important angles last week: Suchitra Karthikeyan writes on how India tackles mental health among school children and S. Murali writes precisely about the phenomenon of mobile phone addiction among youth, and how to counter it. A.S. Jayanth writes about a place to get redemption from internet addiction, here, while his colleagues in Kerala record experts as saying higher expectations are undermining people’s health. 

Did you know that the second week of October is set aside to raise awareness and promote understanding of OCD? Sruthi Darbhamulla looks at some of the dimensions of OCD and how it may affect individual existence.

And thus we fulfil the promise we made, to keep eyes on the case of the Court deactivating the social media account of @theliverdoc the herpetologist Cyriac Abby Philips. Now, the Karnataka HC has allowed the reactivation of his X (formerly Twitter) account of Dr. Philips after he agreed to hide defamatory posts against Himalaya Wellness Company. That’s a strike for freedom of expression, and allowing for the exchange of information by doctors and scientists online. If we shut everyone we didn’t agree with online down, there’d hardly be anyone to converse with. 

Which is why it is important to discuss traditional medicine too, but with evidence. George Thomas and G.L. Krishna write: It is a fact that irrespective of the advances of modern medicine, several systems which lay claim to healing, and which fall under the broad category of alternative medicine exist. Certain systems such as Ayurveda, Unani and Siddha have their own pharmacopoeia. The physiological basis of Ayurveda is not sound, they argue, but that does not, ipso facto mean that its therapies are not sound either, and call for an evidence-based appraisal of traditional systems of medicine, without being sullied by ideas of nationalism. The Centre would do well to bear this in mind, even as it seeks the inclusion of traditional medicine on WHO’s list. 

Mini Tejaswi reports on a study on how blindness causes an economic loss of $27 billion in India. The comparative loss in China was the highest at $96 billion while the loss in the U.S. is estimated at $50 billion, implied the study by the International Agency for the Prevention of Blindness, a London-based global alliance of organisations working towards the elimination of avoidable blindness and vision impairment. Better eye health will boost the economy, naturally, and governments must get on the bandwagon to plan for and prevent blindness.

Yet another ranking for India that indicates a huge role for the government. Jagriti Chandra writes that India ranks 111 out of a total of 125 countries in the Global Hunger Index (GHI) 2023, with its progress against hunger nearly halted since 2015, reflecting a global trend. However, the Union Government has once again contested the measure of India’s performance, for the third year in a row, citing flawed methodology. Thankfully, the Centre is also launching its own programme to address a certain aspect at least, in the meantime. It launched a protocol to manage malnutrition in children at Anganwadis last week. The ‘Protocol for Management of Malnutrition in Children’ was launched by Union Minister for Women and Child Development Smriti Irani.

Another aspect of childhood health is addressing the gap in vaccinating eligible children. Aimed at ensuring that routine immunisation services reach children who have missed vaccine doses or who have dropped out of their vaccination schedule, as well as pregnant women across the country, the Intensified Mission Indradhanush is scheduled to conclude all three rounds on October 14. As on September 30, over 34,69,705 children and 6,55,480 pregnant women had been administered vaccine doses during the first two rounds of the campaign.

Here’s another developing story, one that hinges on the quality of pharmaceutical products made in India. In a surprising move, India allows cough syrup firm linked to Uzbek deaths to re-open factory, documents show. The Marion factory in Uttar Pradesh was closed in March, after an analysis last year by Uzbekistan’s Health Ministry of two cough syrups made by Marion, Ambronol and DOK-1 Max.

On the same line, we learnt that the Zydus unit recalled 7,248 bottles of Oxybutynin Chloride tablets in the U.S. The New Jersey-based Zydus Pharmaceuticals (USA) Inc. recalled the affected lot due to ‘Failed Dissolution Specifications’, the U.S. FDA stated. The lot was produced at Ahmedabad and distributed in the U.S. by Zydus Pharmaceuticals (USA) Inc, the U.S. health regulator stated.

Something for the government to ponder about, given that in economic terms, the robust pharma market in India might be affected soon, if quality concerns continue to affect exports. India is the world’s third largest maker of drugs by volume after the U.S. and China. According to experts in the field, India’s pharma exports are set to rise to over $20 billion this fiscal year. Additionally, India’s cough syrup exports stand at $15 million a year. After the WHO issued a product alert on cough syrup being exported from India, the Directorate General of Foreign Trade issued a notification early this year for amendment in the export policy for cough syrups, making it compulsory from June 1 for cough syrup manufacturers to secure a certificate of analysis from a government-approved laboratory before exporting their products. Apparently, two labs in India take on the bulk of testing for cough syrup samples for export.

For our tailpiece offering this we, do read about this fascinating aspect of research, shedding more insights into what may be called the final barrier - understanding cancer better. P. Kasbekar writes on how some cancer cells survive chemotherapy. In a new study, published in Cell Reports on September 20, researchers from the Netherlands Cancer Institute investigated the resistance of some cancer cells to a drug called Taxol. They have reported that the culprit could be the location of a particular gene inside the cancer cells’ nucleus. A small subset of cancer cells can still escape confrontation with the anti-cancer drug. This happens when these cells express elevated levels of a protein called P-gp – short for permeability glycoprotein. Researchers found that a cell’s sensitivity to the drug Taxol, including its ability to resist Taxol’s anti-cancer effects, was related to the location of the ABCB1 gene inside the cell’s nucleus.

From the Health page

Those extra moments that you might have today, they will be well spent on the following health stories, that give you a glimpse of everything that happened in the health world this past week:

Continuing to cover the largest humanitarian crisis in the world today: The morgue at Gaza’s biggest hospital is overflowing as Israeli attacks intensify.

Watch | What does the Hamas attack mean for Israel, Palestine and West Asia?

Why I’m still masked up, explains Dr. Rajeev Jayadevan.

Ritual to reality: Unmasking the evolution of hand hygiene post-covid-19, writes Siddharth Kumar Singh.

NHRC seeks detailed report on snakebite deaths and preventive measures in India.

R. Prasad explains how Egypt is racing to eliminate hepatitis C.

Number of medical colleges doubled in India in 9 years, says Health Minister Mandaviya.

Since we do an exhaustive job, here’s another article from A.S. Jayanth on Nipah: Nipah infection possible in more places in Southeast Asia, says Nature article.

The world needs to stop taking water for granted, explain Takayuki Hagiwara, Ulac Demirag and Elisabeth Faure, as they make a pitch for sustainable water management.

A lot more variety frames our regional health news offering here, this week:

Andhra Pradesh

NABARD to provide ₹49 crore for super-speciality hospital in Parvatipuram.

Set up a kidney research centre in Prakasam, children’s hospitals in Vijayawada, Guntur, Vizag, Jagan tells officials.

Haryana

ASHA workers to camp outside houses of Haryana ministers for 24 hours.

Jammu

With a record number of calls, the J&K programme for mental health was declared top-ranking initiative among UTs, reports Peerzada Aashiq.

Karnataka

Bengaluru’s St. John’s Research Institute is part of a global collaborative effort to develop point-of-care diagnostic technologies.

Bengaluru start-up’s exposure visits to IITs aims to prevent student suicides.

AI-based lung cancer screening in 19 district hospitals in Karnataka to benefit over 1.4 lakh patients.

Centre of Excellence in Antimicrobial Resistance set up in Bengaluru.

Kerala

Health Minister promises action to augment healthcare facilities in Kottayam.

Master plan for Kozhikode mental health centre awaits government nod.

Teachers in Kozhikode schools get training on Type 1 diabetes.

Puducherry

Jipmer launches ‘Tele-MANAS’ mental health helpline.

Tamil Nadu

Chennai hospital to use AI to screen for glaucoma and diabetic retinopathy.

Foreign medical graduates face a long wait to internship in Tamil Nadu.

Efforts will be made to make India healthier, says Soumya Swaminathan.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.

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