(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
We just missed it last week, by a whisker. As the newsletter left our outbox, the news of the Indian Council for Medical Research distancing itself from a Banaras Hindu University study acknowledging it in a safety study on Covaxin landed in the inbox. By no means is this usual, even in the highly fractious world of scientific research.
The ICMR, after the article was published, issued a letter to the researchers, which naturally found its way into social media, casting doubts about the BHU study, denying its own involvement in any form, but also calling for its retraction. While pointing out the limitations of any study is par for the course in research, and justifiable as they were, the original study did also mention as limitation the fact that the observational study went ahead without a control group. The absence of data on background rates of adverse events assessed as part of the study makes it clear that further investigation into its conclusions is necessary, as R. Prasad explains here.
Nevertheless, the ICMR’s action found detractors as well. Foremost among them was the Universal Health Organisation (UHO), a group of researchers, doctors, and public health experts, who echoed the research ecosystem’s shock at the belated denial. The UHO wrote an open letter to the ICMR stating the BHU study filled a key gap in terms of field data, analysing the safety of Covaxin, and took strong objection to the Institute not declaring its vested interest - the ICMR’s National Institute of Virology co-developed the vaccine along with Bharat Biotech. Also, they wondered why the ICMR, which had access to data from the control group, had not published the long-term safety trials. No doubt, the hurry during the COVID-19 pandemic necessitated the rapid tracking of scientific processes, to do great good, but post facto, it is important to conduct regular research to understand how these interventions have worked on the human body. Keeping track of the safety and efficacy of vaccines is a lifelong process, and the country’s top research institute inhibiting such activity does not bode well for the scientific community.
Another crazy health story we had to bring to you is the chilling expose of the U.K.’s infected blood scandal. Did you know? Between the 1970s and 1990s, more than 30,000 people were infected with HIV, Hepatitis C and Hepatitis B after receiving contaminated blood and blood products imported from the U.S. — making it the “worst treatment disaster” in the history of Britain’s state-funded National Health Service (NHS). Saumya Kalia explains what the enquiry report revealed last week, and the ‘chilling cover-up’ of the U.K.’s infected blood scandal. The six-year-long inquiry uncovers a coverup that was “more subtle, more pervasive, and more chilling in its implications” than an orchestrated conspiracy. It was undertaken “to save face and to save expense”. The calamity was made more catastrophic by the “defensiveness of government...and its refusal over decades to hold a public inquiry.”
Why did it happen? Haemophilia is a rare genetic condition where the blood does not clot properly. Up until the 1970s, treatment options included administering the frozen blood product cryoprecipitate. It carried a low risk of passing on an infection since it was formulated from a single blood donation, but cryo was hard to store and harder to administer to patients. Enter Factor VIII, a revolutionary ‘wonder treatment’ made using concentrating pooled plasma from tens of thousands of donors. It was deemed to be a medical breakthrough. The caveat: Factor VIII had a high risk of infection. This is where ‘chilling’ enters the picture: Despite the warning by the WHO and awareness about the terrible consequences of using contaminated blood, the evidence was ignored. How does any one who has sworn to the Hippocratic oath to ‘do no harm’ go ahead and do just the opposite of that. Literally and figuratively, the history of medicine is steeped in blood.
Setting again on the gender perspective, Sridhar Sivasubbu and Vinod Scaria write how the X chromosome revival in older women increases autoimmune disease risk. Recent genomic studies have shed light on the fundamental biological processes the X chromosome modulates and the genes it encodes. The gathering evidence suggests in fact that it plays a part in a variety of biological functions as well as controls the sex-specific susceptibility to certain diseases. The human X chromosome encodes around 800 genes, which in turn code for proteins. A loss of function of these genes could thus lead to a variety of genetic diseases. In humans, the Y chromosome has been shrinking over time, so the X chromosome is possibly evolution’s best-bet and thus plays a pivotal role in human health and disease. Its evolutionary genomics and emerging insights into its participation in biological processes illuminate the complex interplay between genetic inheritance, epigenetic modifications, and disease manifestation. Cracking all this to get the full picture could also lead us to new drugs and therapies.
Meanwhile, do read this as well: How investing in breastfeeding efforts can help save the environment. Everything in the world is now, it seems, linked to climate change, and thereby positive action and changing lifestyles can logically help save the environment. Global health researchers propose to recognise the simple fact that women contribute to sustainable food production, and breastfeeding infrastructures deserve to be invested in as ‘carbon offsets’.The report is part of a special issue of the Bulletin of the WHO. The contention is two-fold. One, commercial milk formulas are a maladaptive practice in the context of emerging population and environmental crises. In contrast, breastfeeding is a renewable, economical and an environmentally-friendly natural resource. Two, adequate recognition and resources through international climate change financing “can support new public investments in breastfeeding as a carbon offset, with significant gains and co-benefits for women’s, children’s and planetary health”.
While you are at it, do read Kavita Aneja’s article spotlighting pre-eclampsia, to ensure safe motherhood. Pre-eclampsia is a hypertensive disorder of pregnancy leading to multiorgan dysfunction in the mother. Besides high blood pressure, usually commencing after 20 weeks of gestation, these mothers could present with swelling of the face, hands, and feet, severe headaches, changes in vision, upper abdominal pain, and difficulty in breathing. Nevertheless, it is unfortunate that post-partum maternal cardiovascular health after pre-eclampsia is a largely neglected area of research, she says.
Here’s keeping a promise. We did say we would stay on this developing story and, we are. Remember how several nations found toxic chemicals in Indian spice packets? The development is that India’s FSSAI finds no ethylene oxide traces in MDH and Everest spices. India’s food regulator said it had not found any trace of ethylene oxide in samples of spices of two major brands MDH and Everest that were tested in 28 accredited laboratories, sources said. According to them, reports from six other laboratories are still pending. Last month, the Food Safety and Standards Authority of India (FSSAI) started taking samples of spices in powder form of all brands, including MDH and Everest, from across the country in view of quality concerns flagged by Hong Kong and Singapore. The samples of Everest spices were picked up from their two manufacturing facilities. As many as 25 samples from MDH have been lifted by FSSAI from their 11 manufacturing facilities. Each sample was analysed for compliance with various quality and safety parameters including pesticide residues. These samples were also analysed for Ethylene Oxide (ETO) at NABL-accredited laboratories notified by FSSAI.
After the infection spread from the animal kingdom to humans in the U.S., last week, the first human case of ‘bird flu’ was reported in Australia in a child who acquired it while in India.
The Central Government has been emphasising on getting on the Indian Systems of Medicine bandwagon. A further strike in this angle is its plan to empanel public and private Ayush hospitals for insurance coverage, reports Bindu Shajan Perappadan. With an increase in demand for Ayush treatment, the Insurance Regulatory and Development Authority of India (IRDAI) has recently advised all insurers to provide Ayush coverage, which inter alia, shall include their approach towards placing Ayush treatment at par with other treatments for the purpose of health insurance so as to provide an option for the policyholders to choose treatment at their choice. So far, insurance does not cover ISM treatments.
The mantle of the tail piece of this week naturally falls on this story by Adam D. Hines: After 180 years, clues reveal how general anaesthesia works in the brain. Another weird but true moment this week: How it works has largely remained a mystery since general anaesthesia was introduced into medicine over 180 years ago. While we knew that general anaesthetics may act by binding themselves to a small number of targets in the Central Nervous System. In a study using fruit flies, Hines et al found a potential way that allows anaesthetic drugs to interact with specific types of neurons (brain cells), and it’s all to do with proteins. Broadly speaking, there are two main categories of neurons in the brain. The first are what we call “excitatory” neurons, generally responsible for keeping us alert and awake. The second are “inhibitory” neurons – their job is to regulate and control the excitatory ones. When we fall asleep, there are inhibitory neurons in the brain that “silence” the excitatory ones keeping us awake. This happens gradually over time, which is why you may feel progressively more tired through the day. General anaesthetics speed up this process by directly silencing these excitatory neurons without any action from the inhibitory ones.
Explainers
M. Soundariya Preetha brings us up to date on what is the current status with respect to spice exports in India.
Aroon Deep looks at recent developments and brings in experts who argue: Should doctors be kept out of the Consumer Protection Act? in the Parley podcast.
From the Health page
World Health Assembly to prepare a global toolkit for future pandemics.
Afshan Yasmeen writes on how a small error cast the cat among the pigeons: Human drug with vet label puts government body in the soup.
And, updates on intense heat sweeping the subcontinent. Let us be mindful of the deleterious impact such heat can have on health:
Jaipur weather office issues red alert; stresses need for “extreme care for vulnerable people”.
Two die of heatstroke in Ahmedabad, over a dozen across Gujarat.
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