Can Universal Health Coverage ensure Health?

1. Jagannath Chatterjee

2. What does it imply?
Objectives:
Spreading health all over the country
Country wide replication of a tried and successful
model (promotive, preventive, curative)
People do not suffer financially while paying for these
services
Goals are noble but..
Will health be achieved?
Is the model beyond reproach?
Is the model financially viable?
What is the alternative?

3. Can UHC achieve health?
HEALTH: “a complete state of physical, mental and
social well-being, and not merely the absence of
disease or infirmity.” – WHO definition
Does the dominant model intend to achieve health?
Has it achieved this so far?
Has the emphasis been on health and well being?
Has the emphasis been on cures?
Emphasis has been on;
Disease management
Growth/Profits of pharmaceutical industry
Monopoly of the dominant model
Germ/virus theory challenged by findings of Human
Microbiome Project

4. Intent of dominant model
History shows an interplay of various forces;
 Chemical industry (starting from dyes, and ending in chemical inputs
for wars) grew to immense proportions under the I G Farben cartel in
Hitler’s Germany.
 John D Rockefeller - the Petroleum Barron who had earned massive
wealth through various means - was looking for a change of image
 William Gates – a change agent – convinced Rockefeller who had
already tried his hand in synthetic drugs to form a charity, buy stake
in I G Farben and expand his empire while improving his image in
society
 Facing opposition from medical community, the Flexner Report of 1910
commissioned by Carnegie Foundation established the monopoly of
chemical drugs declaring all other forms of medicine to be illegal
 Of the around 600 medical institutions of the day only 43 were
allowed to continue; even in these, dissenting members were replaced
by Rockefeller’s trusted aids
Intent was therefore global business, profits and power –
concept of health and medicine was redefined to suit the
designs of the powers and research was redesigned by
Rockefeller Institute for Medical Research set up in 1901
Components of I G Farben cartel also entered agriculture and general
chemical industry promoting chemicals to be the next revolution ‘to
transform lives’

5. Has dominant model achieved health?
Global Burden of Disease (GBD) – studied 188 countries for
period 1990-2013 funded by BMGF- published in Lancet, June
2015;
More than 95% of the world’s population has health problems
Third of the world's population (2·3 billion individuals)
experiencing more than five ailments
Increases in rates of diabetes have been substantial, rising by
around 43% over the past 23 years
burden on health systems from 301 acute and chronic diseases and
injuries, as well as 2337 health consequences (sequelae) that result
from one or more of these disorders.
The main drivers were musculoskeletal, mental, and substance
abuse disorders, neurological disorders, and chronic respiratory
conditions.
Overuse of antibiotics have led to dangerous super bugs
Vaccines are leading to newer strains of pathogens taking over
Status indicates alarming trend of increasing disease burden
which, ironically, will fuel the growth of the system

6. Is the model being practiced efficiently?
In the land of the best medical care USA, “medicine
/procedure induced deaths in USA 784,000 per year! “
(Death by Medicine, Gary Null, 2011).
“It is evident that the American medical system is the
leading cause of death and injury in the United States
…” – Gary Null
In 2013, Leapfrog Study rated by Journal of Patient Safety-
“New research estimates up to 440,000 Americans are
dying annually from preventable hospital errors. This puts
medical errors as the third leading cause of death in the
United States”
The United States has a higher infant mortality rate than
any of the other 27 wealthy countries, according to a new
report from the Center for Disease Control.
A new (Save the Children) report reveals that the United
States has the highest first-day infant death rate out of all
the industrialized countries in the world.

7. Is the model financially viable?
Medical expenses push 38 million Indians into
poverty every year, expert says – Times of India
quoting Dr Sumanth Raman, 7th
Aug 2014
The analysis of nationally representative data from
India shows that 3.5% of the population fall below the
poverty line and 5% households suffer catastrophic
health expenditures. Medicines constitute the main
share (72%) of total OOP payments. This share
reaches 82% for outpatient care, compared with 42%
for inpatient care – Sharawat & Rao, PHFI, Oxford
Journal, 18th
April 2012

8. Is the model scientific?
Much of medical research is false – Prof Iaonnodis, PLoS Med, Aug 30,
2005
Much of the scientific literature, perhaps half, may simply be untrue.–
Richard Horton, Editor in Chief, Lancet, 2015
It is simply no longer possible to believe much of the clinical research
that is published, or to rely on the judgment of trusted physicians or
authoritative medical guidelines. – Marcia Angel, Editor in Chief,
NEJM, 2009
Main allegations:
Industry sponsored studies ‘fit into established ideas’
Conflict of interest, bias, desire to get published
Data manipulation (cherry picking)
Suppression of negative trial data
Example: Trial data of Indian Rotavirus vaccine was suppressed. In
court case lawyers pleaded, “Revealing trial data will alarm public!”.
Still court decided in their favour. Vaccine to be included in UIP -
Minister

9. Does it promote health?
Nutrition and exercise not key subjects in medical
education
Public health efforts focused only on vaccination
Clean water, sanitation, hygiene, housing, - factors that
led to sharp decline in mortality rates from infectious
diseases (JAMA, 1999) – not prerogative of doctors but
are political tools
Doctors often speak about promoting health, but they
end with advocating new medicines or procedures they
are paid to promote
Workshops ostensibly to promote healthy practices
feature advertisements and hoardings of drug companies
Health check ups by hospitals encourage unnecessary
medication and procedures

10. Is it preventive medicine?

11. 200 adverse effects compiled from
published research papers in PubMed
http://www.greenmedinfo.com/blog/200-evidence-based-reasons-not-vaccinate-free-research-pdf-download

12. “Childhood illnesses have beneficial effects”
In early 1997, a team of British physicians writing in Science
noted : "Childhood infections may, therefore, paradoxically protect
against asthma.“ These infections have a purpose in building
general immunity.
Danish physician Tove Ronne in The Lancet in 1985:
"Measles virus infection in childhood can prevent disease in adult
life." Among these, Dr. Ronne listed skin disease, immune
dysfunctions, degenerative diseases of bone and cartilage, and
certain cancers.
Measles can cure eczema. Induced measles can cause cancer to
reduce (remission). Having measles, mumps, rubella in early
childhood can prevent against allergies, eczema, asthma , heart
attack, stroke (Atheroscleorosis Journal, June
2015)cardiovascular disease mortality and cancer. Polio virus
used for cancer remission
Association of measles and mumps with cardiovascular
disease: The Japan Collaborative Cohort (JACC) study.
Kubota Y, et al. Atherosclerosis. 2015.

13. Is it Curative Medicine?
Focus on disease management, not cures
The word cure is hated, “punishable under Magic
Remedies Act!”
UNLESS THE SYSTEM AIMS AT CURES IT CAN
NEVER UNDERSTAND HEALTH, LET ALONE LEAD
TO IT
Very important to understand this.
No long term vision of health
No emphasis on toxicity as basis of disease
Doctors who digress from traditional medicine to
effect cures are pulled up and persecuted
Doctors have lost degrees simply writing about real
health options (Medical Mafia, Dr Carolyn Nash, MD)

14. Who will benefit from UHC?
Pharmaceutical companies
Lobbyists
Politicians
Bureaucrats
Insurance companies
Hospitals, patho labs
Unethical Doctors
Sub staff
Patients may not benefit; may suffer in health,
happiness and finance

15. What is the way out?
An integrated approach (AYUSH + Allopathy)
Dr B M Hegde (noted medical author, Padmabhusan,
Cardiologist) suggests having ayurveda as base, other
AYUSH modalities with the current system as
emergency back up
NOT ACCEPTABLE TO THE MEDICAL
COMMUNITY
“Bina Juddhe nahi deba suchagra medini”
Other medical systems being hounded
Confrontation is a must which is very unfortunate
The aim of the medical profession should be to heal
the sick, by all means possible; not pursue a faulty but
profitable system

16. It is up to the civil
society to ensure
justice