Health Matters | Health and tech, when the twain meet…

This week in health: the Aadhaar data breach, QR codes on food products, India’s worrying salt intake and a surrogacy verdict that sets right a wrinkle in the rules.

Updated - November 01, 2023 09:52 am IST

Published - October 31, 2023 02:12 pm IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: Vijay Soneji

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We are at that juncture again where we have come face to face with the twin sides of technology in health care, and are forced to, once again, reassess the employment of technology, from an ethical and secure point of view. Data security is one of the key areas that have been a source of concern for the advocates for a robust utilisation of technology in the health sector, and a technophobic nightmare. The news this week - the long and short of it being that a data breach had been effected on ICMR and the COVID-19 test details of citizens had been stolen. Bindu Shajan Perappadan and Aroon Deep say ICMR has faced multiple cyber-attack attempts since February, and the latest alleged breach also involves a ‘threat actor’ with a handle on X advertising the database for sale on the dark web, claiming that this COVID-19 test details of citizens have been sourced from ICMR. 

The data lead was flagged by Resecurity, a U.S. data security firm, but the company did not speculate on how the Aadhaar numbers, addresses and other such personal information found their way into the dark web in such numbers in this specific instance. But this is not the first time a breach has surfaced on large databases with the personal information of Indians out in the open. In June, a Telegram chat allowed people to fetch any entries from the CoWIN vaccination portal’s database, potentially allowing the Aadhaar or passport numbers of vaccinated beneficiaries to leak. 

“A threat actor going by the alias ‘pwn0001’ posted a thread on Breach Forums on October 9, brokering access to Indian Citizen Aadhaar & Passport records,” according to media reports on the leak. It is also being reported that the data involves the personal details, including Aadhar numbers, passport numbers, addresses and mobile numbers of over 81 crore people in the country. The availability of that kind of data in the public realm, open for misuse, is actually a staggering thought. No doubt the use of mobile apps to streamline vaccination at a time of lockdowns and complete shutdowns did prove to sort out a number of hassles, but the inability of the ICMR to set a lock on this, keeping the data safe, is worrying to say the least. 

Clearly, hackers are on the top of their game and have the best tools to overcome security measures. It is the state actors that will have to be more on the ball to ensure that their security systems are regularly upgrades, and bug fixes installed periodically. 

And then, there is the primary question of whether we need technology at all. For instance, it is pertinent to ask: Will QR codes improve access to food labels? The Food Safety and Standards Authority of India (FSSAI) has recommended the inclusion of a QR (quick response) code on food products for accessibility by visually impaired individuals stating that this will ensure access to safe food for all.

Experts argue that the move is vital as India is one of the largest markets of packaged foods in the world and is currently witnessing a growing burden of non-communicable diseases (NCDs) which have seen an abrupt rise globally since the last two decades, according to the World Health Organisation. Besides other factors, this trend is attributed to aggressively marketed, cheaper, and more easily available pre-packaged foods which is finding a growing preference among consumers.

The FSSAI has advised that these new QR codes should encompass comprehensive details about the product, including, but not limited to, ingredients, nutritional information, allergens, manufacturing date, best before/expiry/use by date, allergen warning, and contact information for customer enquiries. It adds that the inclusion of a QR code for the accessibility of information does not replace or negate the requirement to provide mandatory information on the product label, as prescribed by relevant regulations. 

The advisory caters to two important regulations — the FSSAI’s Food Safety and Standards (Labelling and Display) Regulations, 2020 which outlines the information to be included on labels of food products and the Rights of Persons with Disabilities Act, 2016 which recognises the rights of individuals with disabilities and emphasises accessibility to information that will impact on health, for persons with disabilities.

COVID-19 keeps giving up gentle reminders from time to time, that it has not vanished yet, and that the threats from it are still to be considered seriously. Apart from the deluge on social media itself, there are studies, and genetic analyses that we have access to now, which help mark the impact of COVID-19 infections in the past, or the possible impact of new strains and variants in the future. In a recent study, researchers at the University of Southern California and Stanford University in the U.S. said children infected with the Omicron COVID variant remain infectious for three days, therefore concluded that school policies can restrict themselves to mandate children with COVID-19 stay out of class for five days.

“We are basically saying five days is more than sufficient; public health and education leaders may consider shorter durations,” said study co-author Neeraj Sood, Director of the COVID-19 Initiative and a senior fellow at the USC Schaeffer Center. The study, published in the journal JAMA Pediatrics, found that the median time of infectivity was three days, with 18.4% and 3.9% of children still infectious on day five and day 10, respectively.

Yet another study indicates findings that say Long COVID may not be linked to brain damage.  In a paper published in the Journal of Infectious Diseases, authors say in their study no significant differences between the participant groups were seen when analysing blood and cerebrospinal fluid for immune activation or brain injury markers. The findings suggest that post-COVID condition, or long COVID, is not the result of ongoing infection, immune activation, or brain damage, the researchers said. “The findings enhance our understanding of post-COVID condition,” said Nelly Kanberg, a doctoral student in infectious diseases at the University of Gothenburg.

Another significant court judgement to impinge on healthcare deliveries was delivered last week. Krishnadas Rajagopal reports that the Supreme Court sets right a wrinkle in the rules, allowing surrogacy, and striking down the rule banning the use of donor gametes. A two-judge Bench of Justices B.V. Nagarathna and Ujjal Bhuyan came to the rescue of a woman suffering from the rare medical condition of Mayer Rokitansky Kuster Hauser syndrome, which left her without a uterus or ovaries, by staying the operation of a law which threatened to wreck her hopes of becoming a mother. The couple had begun the process of gestational surrogacy, through a donor, on December 7 last year. But, a government notification on March 14 this year amended the law, banning the use of donor gametes. It said “intending couples” must use their own gametes for surrogacy. 

“The amendment which is now coming in the way of the intending couple and preventing them from achieving parenthood through surrogacy, we find, is, prima facie contrary to what is intended under the main provisions of the Surrogacy Act both in form as well as in substance,” the judges held, striking down the rule.

Another important legal case that in some way reaches into health care, and was in the works for sometime, is the United States suing Meta for harming young people’s mental health and collecting data on children. A group of 33 States including California and New York are suing Meta Platforms Inc. for harming young people’s mental health and contributing to the youth mental health crisis by knowingly designing features on Instagram and Facebook that addict children to its platforms. 

The broad-ranging suit is the result of an investigation led by a bipartisan coalition of attorneys general from California, Florida, Kentucky, Massachusetts, Nebraska, New Jersey, Tennessee, and Vermont. It follows damning newspaper reports, first by The Wall Street Journal in 2021, based on the Meta’s own research that found that the company knew about the harms Instagram can cause teenagers — especially teen girls — when it comes to mental health and body image issues. One internal study cited 13.5% of teen girls saying Instagram makes thoughts of suicide worse and 17% of teen girls saying it makes eating disorders worse.

Given that the use of social media is universal nearly, among children, the need to put in robust systems of control and a certain measure of protection from predators and unstable, age-inappropriate content is a no brainer. 

In other news, we hear that a comprehensive heart and lung transplant registry has been developed. An initiative of The Indian Society for Heart and Lung Transplantation (INSHLT), the registry will serve as a national database on the number of transplants being done, and will soon expand to include post-transplant outcome data as well. With an increasing number of centres registering for transplantation, this kind of database will only enhance easy access to the available organs, and also serve to share best practices in organ harvesting and post-transplant recoveries.

A recent report released by the NGO SaveLife Foundation highlights the lack of unified federal legislation in India on emergency careSiddharth Kumar Singh reports. It also recommends several actions, including the implementation of a Good Samaritan law for all medical emergencies, citizen training programmes, a dedicated universal emergency number and the development of national pre-hospital emergency personnel training standards.       

In other research news, Indian Institute of Science researchers, last week, uncovered the link between cell biomechanics and wound healing. An interdisciplinary team from IISc uncovered how the stiffness of a cell’s microenvironment influences its form and function. Inefficient wound healing results in tissue fibrosis, a process that can cause scar formation and may even lead to conditions like cardiac arrest. Changes in the mechanical properties of tissues like stiffness also happen in diseases like cancer, they said. The findings are expected to provide a better understanding of what happens to tissues during healing of wounds.

With the non-communicable diseases pandemic pushing more Indians into ill health, Sanjay Rajagopalan argues that unhealthy urban India must get into street fight mode. Unhealthy diets, reduced physical activity and air pollution are posing a greater risk to morbidity and mortality than most other risk factors combined. In this context, read what D. Balasubramaniyan has to say about how much salt should you take every day?  

Continuing in the final week of observing breast cancer awareness month, we reemphasise this aspect: Self-examination is the best way to aid early detection of breast cancer. Here is a self-examination chart and an animated video that were recently launched by the Apollo Proton Cancer Centre (APCC), along with the Department of Social Welfare and Women Empowerment, to create awareness about the importance of early detection in breast cancer treatment. We also discovered that Mizoram has the highest rate of cancer in India. Despite being the country’s second least populated State, Mizoram exhibits the highest incidence rate of cancer. The latest evidence from an 18-year trend study notes a consistent uptick in cancer incidence and mortality in the State, with stomach cancer emerging as the primary cause of cancer-related deaths among men, while lung cancer plays a parallel role among women. 

As long as we are talking about women, it is impossible to miss the need for awareness of osteoporosis, particularly among women in the peri- and post-menopausal periods. Dr. Christianez Ratna Kiruba writes that the issue is not simple, and is made tougher at the ground level with a lack of expertise and equipment to diagnose properly. Here, she unmasks India’s osteoporosis care crisis.

This week’s tailpiece has wormed itself into the column. Here is fascinating news that redefines our understanding of how the human body works: haemoglobin isn’t used only in blood, scientists find in a major discovery. Rohini Subrahmanyam writing on a study published in Nature, says scientists have reported that cells that make cartilage also make haemoglobin.

From the Health page

If you have a few extra moments, do also read: 

A follow-up from last week: WHO Southeast Asia members to meet to nominate its regional director, to discuss health issues.    

Daily walks can help reduce risk of cardiovascular diseases, say specialists.

Call to create Ayurveda start-ups to combine traditional wisdom and new approaches.

90% of paint samples tested contain lead above permissible limits in India, finds study.            

Here’s a smattering of health news from across our regional bureaus:

Andhra Pradesh

Andhra Pradesh Government to introduce thrombolytic therapy in all public health centres.

Delhi

Integrated nursing education, service model to be implemented at AIIMS Delhi.   

Karnataka

Jayanth R. writes that the Karnataka Government objects to NMC guidelines on capping medical seats.

Medical Education Minister takes exception to population-based cap for medical seats for states.

Kerala

Nipah virus antibodies detected in bats in Wayanad.

Health official assuages fears of leprosy in Kerala’s Malappuram.  

Nipah research centre to function from Kozhikode medical college in first phase.

AIIMS proposal assumes political colours in Kerala ahead of LS polls, notes A.S. Jayanth.

Special medical board to supervise treatment of those injured in Kalamassery explosions.

Puducherry

Dinesh Verma on: MBBS admissions made after NMC deadline kick up a row in Puducherry.    

Tamil Nadu

Centre’s share in maternity benefit scheme is pending for nearly two lakh women, says Health Minister.

108 ambulance workers in Madurai to go on strike from January 8.

Government hospital offers day-care procedure for patients with Trigeminal Neuralgia.         

Telangana

Hyderabad doctors save 18-month-old suffering from severe pneumonia, perform ECMO in flight from Goa, recounts Siddharth Kumar Singh.  

Uttar Pradesh

Amid political fallout, medical college rejects report of botched blood transfusions.

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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