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Tuesday, June 19, 2012

We, The Condemned. - Reply to SMJ

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We, The Condemned.

Dear Aamir Khan,

I saw your show on the status of medical
healthcare in India today. It highlighted to society the concern that it should
have about the healthcare that it receives at the hands of brutally dishonest
and unethical doctors a.k.a ‘maut ke saudaagar’.

I understand
that there are sections of the medical fraternity that behave in ways that do
not bring glory to the profession. I understand that your aim in this episode,
and on the show, as a whole, is to make society aware of the issues that plague
India, and help it to move towards a better place.

I also
understand that you may have, unfortunately, done the exact opposite, at least
with this episode.

tell you why.

You started
the show with the story of a diabetic losing his toe.(You did not tell us that
he is diabetic, but the footwear he was wearing hinted at that.) This gentleman
was retrospectively told about the
possibility of medical management of his toe infection. I will present to you a
few statistics about diabetic foot disease (yes, Indian doctors also are aware
of research methodology, like your famed “research” team). The foot ulcer
incidence rates range between 2% and 10% among patients with diabetes mellitus.
The age adjusted annual incidence for non traumatic lower limb amputations in
diabetic persons ranges from 2.1 to 13.7 per 1000 persons (as per a study
published in the Journal of American College of Surgeons in 1996). India has
approximately 50.8 diabetic patients, according to the world diabetes
foundation. Assuming that Indian doctors are competent enough to treat diabetes
as well as their counterparts in the US, (where, presumably, you will be going
for your medical treatment, as you proudly proclaimed that you will not undergo
any medical treatment in India) that translates to about 5 million Indians
having a chance of developing a foot ulcer, and about 500 thousand Indians needing
lower limb amputation. Each of those 5 million people who develop the foot
ulcer, will remember your episode, and will opt for medical treatment, which,
if it fails to work (which it will, Mr. Khan, in a more than a few cases), will
convert a toe amputation into a below knee or above knee amputation, or even
death, depending upon how long the patient chooses to be on medical therapy.

have just condemned 5 million Indians to uncertainty, loss of limb more than
what would have been, or even death.

there was a chat about “unnecessary” Kidney transplants. Here are a few facts,
Aamir. In the United States, the general
hemodialysis and peritoneal dialysis populations have 2 hospital admissions per
patient per year; patients who have a renal transplant have an average of 1
hospital admission per year. Additionally, patients with ESRD( End Stage Renal Disease) who undergo renal
transplantation survive longer than those on chronic dialysis. The
mortality rates associated with hemodialysis are striking and indicate that the
life expectancy of patients entering into hemodialysis is markedly shortened.
In 2003, over 69,000 dialysis patients enrolled in the ESRD program died
(annual adjusted mortality rate of 210.7 per 1000 patient-years at risk for the
dialysis population, which represents a 14% decrease since peaking at 244.5 per
1000 patient-years in 1988). The highest mortality rate is within the first 6
months of initiating dialysis. Mortality then tends to improve over the next 6
months, before increasing gradually over the next 4 years. The 5-year survival rate for a patient undergoing chronic dialysis in
the United States is approximately 35%, and approximately 25% in patients with
diabetes. Though there are no nationwide records to calculate the incidence
of ESRD in India, a population based study done in Bhopal showed the average annual crude and age-adjusted
incidence rates for the period were 151 and 229 per million population, respectively.
Extrapolating this data to the population of India, we have 200 thousand Indians
with ESRD. Again, if you are willing to believe that Indian doctors are
as competent as their western counterparts, only 25 percent of these will live
beyond 5 years without a transplant.

You have
just condemned 150 thousand Indians to uncertainty, indignity and death.

you spoke about doctors asking for “unnecessary” tests, and even went to the
extent of describing a “basin” test in jest.

In doing so, you condemned every
clinical practitioner in the country to a lifetime of uncertainty about how his
patients will react to his demand for justified investigations which will
undoubtedly save the patient’s life.

You spoke about doctors buying
medical degrees for 40-50 lakh rupees. Here are some figures for you. In 2011,
2,21,867 students appeared for an entrance examination into medicine called the
All India Pre Medical Test (AIPMT). They were competing for 1887 medical seats
in government colleges. After listening to your show, every doctor who has
worked tirelessly and endlessly to get into the profession, and inspite of ALL
odds, qualify as a doctor, will be viewed with suspicion by his society, as
someone who may have “bought” his degree.

You have condemned me, and
thousands, perhaps lakhs of young and upcoming doctors like me, who struggled
among 2,21,867 people to get those 1887 seats, to a lifetime of suspicion and ignominy.

You then went on to chat with a
gentleman from Wales about how he had to flee India due to rampant malpractice.
In doing so, you have encouraged thousands of young Indian minds into falsely
believing that the west is the destination where they will have a clean,
ethical and well paying job. You have just doubled the brain-drain
singlehandedly, Mr. Khan. And you have condemned every Indian to losing the
best minds they could have had treating them in India.

I could go on with this
dissection of your well researched show Aamir, but I just want to end this
letter with a story. There is a man, who was educated in rural India, came to a
city with next to nothing, practiced as an honest doctor there for 30 odd
years, refused to give or accept commissions or cuts, stayed simple, worked
hard, gave his family a decent life.

Today, you have condemned him to
being seen as a criminal in the eyes of the same people he served.


The Condemned.

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