Supreme Court's orders in sex determination case

In the Writ Petition (Civil) No.341 of 2008, Supreme Court of India passed the following orders on the following dates:

1.  18/08/2015
2. 30/4/2015
3. 26/3/2015
4. 19/2/2015
5. 28/1/2015
6. 15/12/2014
7. 04/12/2014
8. 22/9/2014
9. 18/3/2013
10. 14/3/2013
11. 05/4/2010
12. 11/5/2009
13. 24/2/2009
14. 13/1/2009
15. 26/11/2008
16. 13/8/2008 

The notice in this case was issued on  13th August, 2008. Writ Petition (Civil) 349 of 2006 was attached with the original petition on 22nd September 2014. 

The first significant order in the case was passed on 4th December, 2014. The 6 page long order is as under:

"It is submitted by Mr. Sanjay Parikh, learned counsel appearing for the petitioner that despite the legal prohibition, the respondents, namely, Google India, Yahoo India and Mocrosoft Corporation (I) Pvt. Ltd., are still getting things advertised in violation of the legal provisions contained in the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994, as amended from time to time. Learned counsel would submit that the Department of Information Technology, Ministry of Communication and Information and the competent authority of Department of Health and Family Welfare are required to work harmoniously to see to it that the provisions of the 1994 Act are not violated, for that gravely affects the sex ratio in the country which has been seriously viewed by the legislature, as well as by this Court on the basis of legislation made by the Parliament. Mr. Shyam Divan, learned senior counsel appearing for the respondent No3, Mr. Anupam Lal Das, learned counsel appearing for the respondent No.4 and Mr. K.V. Vishwanathan, learned senior counsel appearing for the respondent No.5, pray for some time to file their respective replies to the rejoinder affidavit filed by the petitioner. Before we proceed to deal with the prayer for grant of time, we think it is obligatory to take note of one aspect. The Group Coordinator, Cyber Laws Formulation and Enforcement Division, Government of India, Department of Information Technology, had filed a counter affidavit on 16th August, 2010. We are compelled to reproduce a part of the said affidavit: “3(e) While submitting this, it is further to submit that technological limitations pose a difficult task for providers of search engines to filter out/block the information violating the law. It is important to distinguish between two types of results that show up on a search engine. (i) Organic Search results - When a user enters a query in the search box a list of results that are most relevant to the users query are shown. In generating these results the search engine nearly indexes the information that is publicly available and accessible on the Internet in a purely authomated manner. These search results are merely a list of third party independent website that are beyond the control and management of search engines themselves. (ii) Sponsored links - Sponsored links referred to the advertisements placed by advertisers after accepting the terms and conditions of use. These links advertise the goods and services offered by any advertiser and upon clicking on the URL, take the user to the parent website of the advertiser where the user can find more information on the particular product or service that he/she is interested in. (f) The service provider/search engines only provide the carriage, technology for indexing information. The content information is provided by others. Wherever the service provider is providing only the carriage and transmission mechanism and not the contents/information, it is necessary that the distinction needs to be made between a service provider and a content provider. The service provider can only be liable to the extent service provided by him. Wherever the service provider/search engines are providing both carriage as well as contents, it should be their absolute responsibility to filter out/block the violated information and sponsored links. X X X X X (s) The pre-natal sex determination is an offence in India under PC & PNDT Act. However, it may not be an offence in other countries. The information published on the websites is generally aimed at for wider, world wide dissemination and caters to the needs to many countries and may not be for the Indian citizens. Also, most of these websites are hosted outside the country. Blocking of such sites advertising pre-natal sex determinaton may not be feasible due to their hosting outside the country. Moreover, some of the websites provide good content for medical education and therefore blocking of such websites may not be desirable.” As we understand from the affidavit, it reflects a kind of helplessness by the said deponent. That apart, we do not appreciate the manner in which the stand has been expressed in paragraph (s) of the counter affidavit, that has been reproduced hereinabove. Mr. Parikh, learned counsel for the petitioner, in his turn, has submitted that other countries have been able to control such advertisements, which violate the laws of their countries by way of entering into certain kind of agreement, developing technical tools and issuing appropriate directions. In our considered opinion, an effort has to be made to see that nothing contrary to laws of this country are advertised or shown on these websites. However, for the said purpose, we would like to have the assistance from the competent authority from the Department of Information and Technology. We would request Mr. Ranjit Kumar, learned Solicitor General to assist us on the next date, being assisted by a competent officer, as it involves technical issues. Learned counsel for the respondent Nos.3 to 5 have submitted that the websites do not violate the laws of India, but as they provide a corridor, they do not have any control. Be that as it may, a legal solution has to be arrived at. List the matter on 15th December, 2014. As agreed to by the learned counsel appearing for the parties, let the matter be taken up at 2.00 p.m. Liberty to file reply, as prayed for by learned counsel appearing for the respondent Nos.3 to 5, within a week hence. Call on date fixed."

On 15th December, 2014, the Court passed the following order:

"Though a letter was circulated on behalf of the Respondent No.3 seeking three weeks time to seek instructions, yet we have thought it apt to take up the matter regard being had to the directions issued in the previous order. The respondent No.3 may file the additional affidavit within a period of three weeks and that shall be adverted to on the next date of hearing. At this juncture, on a query being made, whether the Central Government has any device to see that the Respondent Nos.3 to 5 or such entities can be controlled not to show anything on their website which would violate the Indian Law, Mr. Ranjit Kumar, learned Solicitor General, being instructed by Dr. Gulshan Rai, Director General, Ministry of Information and Technology, submitted that there are certain areas which can be controlled and there are certain areas which may not be possible to control by the Central Government. We would like the competent authority to file a comprehensive affidavit which can be of assistance to this Court. Needless to say, the affidavit that shall be filed by the competent authority should be in consonance with the provisions contained in the Information Technology Act, 2000. The affidavit shall be filed within three weeks from today. Let the matter be listed on 28.01.2015."

On 28th January, 2015, the Court passed the following 3 page long order:

:"Heard Mr. Sanjay Parikh, learned counsel for thepetitioenr, Mr. Ranjit Kumar, learned Solicitor General of India, Mr. Shyam Divan, learned senior counsel for Respondent No.3, Mr. Anupam Das Gupta, learned counsel for Respondent No.4 and Mr. Vishwanathan, learned senior counsel for Respondent No.5. All the affidavits are taken on record. It is submitted by Mr. Ranjit Kumar, learned Solicitor General of India, relying on the additional affidavit filed by the Union of India, that it can stop the presentation of any kind of thing that relates to sex selection and eventual abortion, if the URL and the I.P. addresses are given along with other information by the respondents, regard being had to the key words, namely, “pre-natal diagnostic tests for selection of sex before or after conception, pre-natal conception test, pre-natal diagnostic, pre-natal foetoscopy for sex selection, pre-natal ultrasonography for sex selection, sex selection procedure, sex selection technique, sex selection test, sex selection administration, sex selection prescription, sex selection services, sex selection management, sex selection process, sex selection conduct, pre-natal image scanning for sex selection, pre-natal diagnostic procedure for sex selection, sex determination using scanner, sex determination using machines, sex determination using equipment, scientific sex determination and sex selection” It is his submission that such blocking/filtering on key-words advertisements links can be effectively or regularly done by the respondents as they have access to their respective mathematical algorithms all the time. In essence, either the respondents can block themselves or on certain details being provided the Union of India can block it. Learned counsel for the respondents have referred to Section 22 of the PCPNDT Act 1994 and Section 69A of the Information Technology Act, 2000, apart from other provisions. Mr. Sanjay Parikh, learned counsel appearing for the petitioners has submitted that throughout the world, the search 3 engines have been directed to block certain service/giving of information which are not permissible to be shown in that country despite the issues of jurisdiction and technical problems being raised. He undertakes to file a convenience volume of judgments by the next date. Having heard the learned counsel for the petitioner, as an interim measure, it is directed, the respondents, namely, Google, yahoo and Micro Soft shall not advertise or sponsor any advertisement which would violate Section 22 of the PCPNDT Act, 1994. If any advertise is there on any search engine, the same shall be withdrawn forthwith by the respondents. At this juncture, Mr. Parikh, learned counsel appearing for the petitioner submitted that the order passed today shall be put on the policy page as also on the page containing 'terms and conditions of service' by respondent Nos. 4 to 6. The prayer is accepted and accordingly so directed. The matters relating to total blocking of the items that have been suggested by the Union of India and providing the URL and IP addresses by Google, Yahoo and Micro Soft shall be taken up on 11.02.2015 when the matter shall be taken up for further hearing."

On 26th March, 2015, the Court passed the following 2 page long order:

"It is submitted by Mr. Sanjay Parekh, learned counsel appearing for the petitioner that, the order passed on 28.01.2015 is not followed by the respondent nos.3, 4 and 5, namely, Yahoo, Google and Micro Soft inasmuch such advertisements which were prohibited by virtue of that order are still being depicted. Mr. Parekh has filed a compilation indicating that till 19.02.2015, advertisements were shown by the search engines. Let the same be served on the learned counsel for the said respondents within three days from today. Response thereto be filed within a week therefrom. Be it noted, learned counsel appearing for the said respondents seriously disputed the allegations made by Mr. Sanjay Parekh. Be that as it may, the said aspect shall be adverted to after the copy of the compilation is served on the learned counsel for the respondents and response thereto is filed after a week therefrom as fixed hereinabove. Let the matter be listed in the last week of April, 2015."

On 28th August,2015, the Court passed the following 3 page long order:

"It is submitted by Mr. Sanjay Parikh, learned counsel appearing for the petitioner that he has filed an affidavit on 14th August, 2015, ascertaining that despite the interim order passed by this Court that there should not be any advertisement by the respondent Nos.3 to 5, the advertisement is still carried on. Mr. Shyam Divan and Mr. K.V. Vishwanathan, learned senior counsel appearing for the respondents, pray for two weeks' time to file response to the said affidavit. Prayer stands allowed. At this stage, Mr. Sanjay Parikh has drawn our attention to a part of the order dated 12th May, 2015, which reads as follows: “Mr. Sanjay Parikh, learned counsel appearing for the petitioners submitted that vide order dated 28th January, 2015, this Court had directed to reflect the said order on the “policy page” as also on the page containing “terms and conditions of service”, but the “policy page” does not sub-serve the purpose and, therefore, it should be put on the “Home page”. Learned counsel for the respondents pray for some time to file response to the same. Be it noted, Mr. Sanjay Parikh, learned counsel, has submitted with immense concern that when it is reflected in the “Home page”, there is a real warning, but when it is mentioned in the “policy page”, it does not really come within the public domain as is expected.” Mr. Ranjit Kumar, learned Solicitor General appearing for the Union of India, shall file an affidavit of the competent authority in that regard, in addition to the substantive affidavit that is required to be filed by the Union of India with regard to the affidavit filed on 14th August, 2015, by the petitioner. The contesting respondent Nos.2 to 5 shall also file their respective affidavits in that regard. Let the matter be listed after four weeks. Liberty to mention."

These orders are an outcome of PIL filed by Sabu Mathew George through well known public interest lawyer, Sanjay Parikh. It is unpeeling many dubious layers of illegal sex determination tests underway in the country with the complicity of almost all the concerned public and private institutions. It appears that Court alone can set matters right if progressive state governments can intervene creatively. 

Major Initiatives Undertaken by the DGFASLI during the XIth 5 year plan

DGFASLI is operating following two plan schemes under the XI^th 5 year plan:

 

1.     Establishment of New Regional Labour Institute at Faridabad

2.  Strengthening of DGFASLI Organisation and Occupational Safety & Health in Factories, Ports and Docks.

 

One more plan scheme with the following title has been proposed DGFASLI which is under consideration with planning commission for approval:

        Identification & Elimination of Silicosis in India

The objectives and the initiatives being pursue under each of the schemes are presented below scheme wise:

 

ESTABLISHMENT OF REGIONAL LABOUR INSTITUTE AT FARIDABAD

Objective:    

1.  To cater to the Occupational Safety and Health (OSH) needs of the factories in North Western States of India (i.e. Haryana, Punjab, Himachal Pradesh, Jammu & Kashmir, National Capital Delhi & UT Chandigarh) effectively as a Centre of Excellence in OSH.

2.   To liaison with the Chief Inspectors of Factories of the North Western States of India for effective implementation of the statutes.

3.   To liaison with the Ministry of Labour & Employment, Government of India, on behalf of the DGFASLI on urgent matters related to policy planning and administration.

 

Initiatives :

1.      Establishment of infrastructure, human resources and procedures for initializing the technical
        activities such as:
          a.      Consultancy, Research and Training in the field of:

•  Industrial Safety
• Industrial Hygiene
• Industrial Medicine
• Workplace Environment Engineering
• Industrial Physiology & Ergonomics

b.      Personal Protective Equipment Testing

c.      Industrial Safety, Health and Welfare Centre (Exhibition)

d.      Mobile Safety Exhibition Van

2.      Establishment of liaison with the Chief Inspectors of Factories of North Western States.

3.      Initializing the educational/vocational programmes on:

       a.      One year - Post Diploma in Industrial Safety.

       b.      Two weeks - Refresher course on Occupational Health for Medical Officers.

 c.      Six weeks - certificate course on Industrial Hygiene

 d.      Others - as per the arising training needs.

4.      Initializing the package programme on, 'Higher Productivity and Better Place at Work' for
   Small Scale Industries.

5.      Initializing the technical advice services on risk assessment for safe site selection, risk
   reduction and emergency preparedness in process plants and MAH installations.

6.      Initializing research studies, technical guidance, specialized training programmes in the
   field of 'Psychological well-being of industrial workers'

7.      To establish a link between the Ministry of Labour & Employment, Government of India,
   and DGFASLI on urgent matters related to policy planning and administration.  

STRENGTHENING OF DGFASLI ORGANISATION AND OSH IN FACTORIES, PORTS & DOCKS

Objective:

To strengthen the infrastructure facilities at DGFASLI, CLI and RLIs for improving occupational safety and health in factories, ports and docks thereby contributing in prevention of occupational injuries and diseases. 

Initiative:

1.   1.      Development of occupational safety and health national inventory and connectivity between
       State Factory Inspectorate and DGFASLI.

2.      2.  Creation of occupational safety and health information action resource centers at five labour    
      institutes.

3.      3.   Dissemination of OSH information through electronic media.

4.   Dissemination of information through conventional media through newsletter and technical
       reports, safety cards etc.

5    5.    Creation of databases on handling of  containers and dangerous goods, hazardous
       installations, inland container depots, minor and intermediate ports, competent persons,
       panel of doctors in ports etc.

6.      6.   Promotion of E- Governance.

7.   To amend the Statute and Regulations connected with dock work.

8.   To establish enforcement and advisory system in the Inland Container Depots and ship
       breaking units in the country.  

9.      9.    Establishment of an accreditation system for experts and facilities in the field of Occupational
       Safety & Health

10. 10.  Formulation of policies and programmes for improving productivity in industries, ports, mines,
        construction and unorganized sectors in consistence with Occupational Safety & Health.

11. 11.  Development and adopting of comprehensive OSH standards for industries, ports, mines,
       construction and unorganized sectors.

12.12.   Up gradation of different laboratories of CLI & RLIs by acquisition of high precision and
        state-of -the art instruments and equipments to act as National Referral Laboratories on
        occupational safety and health.

13. 13.  Monitoring of Occupational Safety, Health and Work environment in factories, ports and
       docks

14. 14.  Strengthening of enforcing systems in the major ports

15. 15.   Enhancement of technical capabilities of officers of DGFASLI & State Factory Inspectorates.

16. 16.   Creating awareness on occupational safety and health in various sectors of the economy
         through training.  

     

IDENTIFICATION & ELIMINATION OF SILICOSIS IN INDIA (PROPOSED)

 

OBJECTIVES:

       To assess the prevalence of Silicosis in India.

       To Create and update a data base.

       To suggest appropriate preventive and control measures.

       To generate awareness.

         Rehabilitation of the afflicted workers when incapacitated.

 

Initiatives

              1.      Identification of the cases of silicosis among the workmen with the help of ESI, Medical
       College of the State & Inspectorate.

       2.      Creation of Database on Silicosis.

       3.      Conduct of training programmes on Silicosis & ILO Radiographs on Pneumoconiosis for
        ESIS/IMA Doctors/Factory Medical Officers/Certifying Surgeons/Medical Inspectors of
        Factories/Govt. Hospital doctors etc. is proposed to create awareness.

       4.      Conduct of training programmes on Silicosis for Nurses/ Medical Assistants.   

DTAB Urged to Deny Permission to Injectible Contraceptives DMPA

PRESS RELEASE

DTAB Urged to Deny Permission to Injectible Contraceptives DMPA

Women’s organizations and leading health experts including Member Population Commission urge the Drug Technical Advisory Board [DTAB] to deny permission to use DMPA in the mass family planning programme



DMPA, Depo medroxy progesterone acetate, a three monthly progestogen only contraceptive injection was licenced for use by the Drugs Controller in the nineties. An intervention petition filed in the matter had led to DTAB restricting its use to private market. The approval itself was based on the manufacturer Max Pharma carrying out post marketing studies as this injection was not properly researched into in India. Even at that time women’s groups had objected to the licencing because of the many contraindications and unmanageable side effects already known.

Since then more data has become available and now its use is linked with loss of bone density and increasing the susceptibility of the user to HIV. In more than fifteen years since the licence was granted there is no reliable treatment for heavy bleeding suffered by a substantial proportion of women administered DMPA.

DTAB at the time had refused to revoke the licence but had restrained the government from using it in the family planning programme as the members had felt that the almost superstitious belief of women in the power of injections would render them to misuse of the injections. The health of the user has to be monitored to watch for the array of disturbing side effects of DMPA. The Indian public health system is too inadequate, inefficient and indifferent to do this work properly. Up to two-thirds of the women on DMPA suffer menstrual chaos which may be culturally unacceptable to women.

Women’s organizations have asserted that contrary to the claims of the health secretary nothing has improved in the public health system. Though the UPA government had promised to increase proportionate expenditure on health this has not materialized. The only personnel that have been added are ill trained ASHAs in the rural areas who have no relevance for delivery of injectable contraceptive.

Further the data from post marketing study done by the Population Council is rather discouraging. Despite training, MBBS doctors had poor recall of contraindications, indications, side effects and management of side effects. Doctors specialising in obsterics and gynaecology [OB/GYNs] were better and the study recommended that these specialists are suitable for delivery of injectables. If the government does not have enough specialists to deal with serious health problems of women, can they be deployed to improve the basket of choices of contraceptives, ask womens’s groups.

They have demanded that in the light of the data thrown up by post marketing studies the DTAB should restrict the use of DMPA to OB/GYNs and extend this restriction for NGOs as well who are using this injection in their programme.

Women’s organizations have consistently opposed the introduction of all long-acting hormonal injectables, including Net-En, and implants such as Norplant, due to their hazardous side effects, potential of abuse and inability of the health system to deliver them safely and they are appalled by repeated attempts of the government to introduce them in the family planning programme in total disregard of the health of women.

Dr. Mohan Rao, Member, Population Commission of India
Dr. Betsy Hartmann, Director, Population and Development Program, Hampshire College, USA
Dr.Veena Poonacha, director, Research Centre for Women' s Studies, SNDT University, Mumbai,
Dr. Nalini Vishvanathan, USA
Anveshi Research Centre for Women's Studies, Hyderabad
Centre for Women’s Development Studies, Delhi
Global Sisterhood Network, Australia
Majlis, Mumbai
Sama Resource Group for Women and Health, Delhi
Saheli women’s Resource Centre, Delhi

November 25,2010, Delhi

Contact saheliwomen@gmail.com, Saheli Women’s Resource Centre, Under Defence Colony Flyover, New Delhi 110024

Experts Question Approval of Bt Brinjal

Press Release
Experts Question Approval of Bt Brinjal

Violates Cartagena Protocol & Precautionary Principle

New Delhi 28/1/2010: THE claimed benefits and the apparent risks emerging from inadequate regulatory and monitoring systems of the proposed introduction of Bt Brinjal, a transgenic variety of brinjal were rigorously examined at a Colloquium organised by the Centre of Social Medicine and Community Health (CSMCH), School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi, in collaboration with Hazards Centre, New Delhi on the 27th of January.

Taking cognisance of the valid questions raised about the conflict of interest ridden Genetic Engineering Approval Committee, the experts recommended adoption of precautionary principles and adherence to Cartagena protocol of which India is a party. The experts at the Colloquium felt that Bt Brinjal requires to be further studied by a trans-disciplinary, independent and impartial team of scientists keeping in mind the short-term and long-term consequences of genetic pollution linked acute and chronic toxicity of food chain.

The Colloquium adopted the following Resolution.

RESOLUTION
The Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi, in collaboration with Hazards Centre, New Delhi, organised a Colloquium on Bt Brinjals on the 27th of January 2010. Attended by students and faculty, the house resolved as follows.

Various issues are unresolved about the problematic nature of transgenic technologies in general and Bt in particular. One core issue was the competence, the transparency and the conflict of interest in the regulatory process prior to the grant of licence to market Bt brinjal.
Safety issues have not been adequately dealt with both in terms of food safety and environmental safety. Long-term studies on allergicity and toxicity have not been carried out prior to approval.

We are also concerned about the implications for food security for the country. It is not desirable to hand over the control of seeds to transnational monopolies. To ensure that access to seed is ensured, the Intellectual Property Rights (IPR) regime must retain farmer’s rights and must not reduce flexibilities in Indian law.

As per the Cartagena protocol, to which India is a signatory, transgenic versions of crops for which we are the country of origin should not be permitted. Mexico, China and Peru follow this protocol. Thus transgenic varieties of Bt brinjal cannot be permitted in India.

A system of post-release monitoring must be put in place before commercial release is allowed into the environment to assess the performance and impact. Exhaustive socio-economic studies are necessary to assess the impact of transgenic crops on traditional agricultural systems and indigenous crops.

A proper system of labelling of GM crops must be put in place with public awareness to enable informed choices.

A system of public participation in decision- making and in regulatory bodies must be put in place. All regulatory data and bio-safety data should be available to the public.

A law of liability must also be in place before commercial release is permitted so that companies are liable to health and environmental damage that might ensue.

Till such systems are in place, this house calls for a moratorium on all transgenic crops.

The herbicide tolerant trait should not be permitted in India as this will displace agricultural labour and destroy valuable plants used as food, fodder and medicines.

There is indeed an acute agrarian crisis in the country. The solution to this does not lie in GM technologies. There are cheaper, safer, healthier options that must be explored and supported.
-----------------------------------------------------------------------------------------------------------------
The participants included eminent experts like Dr Pushpa Bhargava, Founder Director, Centre for Cellular and Molecular Biology, Prof. Mohan Rao, Professor, CSMCH, JNU, Prof. Deepak Pental, Vice Chancellor, University of Delhi, Dr. Suman Sahai, Convener, Gene Campaign, Dr. Rama Baru, Professor, CSMCH, JNU, Dr N. Raghuram, School of Biotech, Guru Gobind Singh Indraprastha University, Dr K.C. Bansal, Professor, National Research Centre on Plant Biotech, IARI, Prof. K.J. Mukherjee, School of Biotechnology, JNU and Dunu Roy, Director, Hazards Centre.

The Colloquium was preceded by a letter sent by CSMCH to the Union Ministry of Environment and Forests. The resolution of the Colloquium would be sent to the Union Agriculture Ministry and Union Health Ministry shortly besides the Union Ministry of Environment and Forests. The program of the Colloquium is attached.

For Details: Dr. Mohan Rao, Professor, Centre of Social Medicine and Community Health, JNU
Phone: 26704490, E-mail: mohanrao2008@gmail.com

Programme Schedule

0930 : Registration
10 00 : Inaugural Session

Welcome Address:
Prof. Mohan Rao, Professor, CSMCH, JNU
10 30 : Tea

10 45 – 12 00 hrs : Session I:
Benefits Claimed and Apparent Risks
Prof. Deepak Pental, Vice Chancellor, University of Delhi
Dr.Suman Sahai, Convener, Gene Campaign
12 00 – 13 30 : Session II :
Regulatory System and Concerns
Chair: Dr. Rama Baru, Professor, CSMCH, JNU.
Dr. K.Satyanarayana, Member of Exp Comm II, Genetic Engineering Approval Committee.
Dr. Pushpa Bhargava, Founder Director, Centre for Cellular and Molecular Biology
13 30- 14 30 : Lunch

14 30 – 16 00- Session III :
Need for Bt Brinjal
Chair : Dr. N.Raghuram, School of Biotech, Guru Gobind Singh Indraprasth University.
Dr. K.C. Bansal, Professor, National Research Centre on Plant Biotech, IARI.
Dr. G.V Ramanjaneyulu, Executive Director, Centre for Sustainable Agriculture
16 00- 16 30 – Tea
16 30- 17 30-

Concluding Session
Prof. K.J.Mukherjee, School of Biotechnology, JNU
Dunu Roy, Directror Hazards Centre
Vote of Thanks by Dr. Ramila Bisht, CSMCH, JNU

Note: Dr. G.V Ramanjaneyulu and Dr. K.Satyanarayana could not come for the program.

Bt Brinjal & Food Security

Center for Social Medicine & Community Health of JNU and Hazard Center organized a Colloquium on "Bt. Brinjal & Food Security" today at Jawaharlal Nehru University (JNU), New Delhi. Speakers underlined the inter linkage between food safety and security. Proceedings of the Colloquium would be shared in due course.

Earlier, responding to the introduction of Bt Brinjal in the country for public discussion by Jairam Ramesh, the Union Environment Minister, the Centre of Social Medicine and Community Health (CSMCH), Jawaharlal Nehru University had sent a letter to the Union Minister saying, “We believe that there are serious issues of safety that are not yet addressed through long term studies. There is some data that these crops could be allergy- inducing, and indeed that they might be mutagenic. It is for these reasons that in the European Union but major countries have a restrictive regulatory regime. Countries in EU have a precautionary approach towards GM crops and major countries like Germany, France, Hungary, Greece etc has a ban on their cultivation.”

CSMCH took cognizance of the reports suggesting that the Genetic Engineering Approval Committee (GEAC) has decided to approve the environmental release of Bt Brinjal from Monsanto/Mahyco in India which would for all purposes permit the use of transgenic and Genetically Modified Organisms (GMOs) and products for edible purposes.

The letter notes that CSMCH is seriously troubled with this move. The letter says, “ First of all, this is entirely unnecessary from a public health perspective, indeed undesirable. The argument that Bt brinjal would not require pesticides is dissembling. There are other, better, pest management methods like non pesticidal management that we need to utilize.”

It refers to “serious methodological flaws in the studies that have been carried out, not to mention ethical ones.”

It takes note of the “profound conflict of interest issues involved in the studies carried out in India. The companies that stand to gain by the introduction of these crops into the market were the sponsors of the studies. This is entirely unacceptable.”

The Prof Mohan Rao, Chairperson, CSMCH says, “There has not been adequate assessment of the ecological consequences of the introduction of this food crop. These concerns regarding the health and environmental risks associated with GM crops are too serious to be disregarded. Given our retailing structure, labeling is impossible in India and contamination is inevitable. Introduction of GM crops would kill the choice of the consumer."

The letter concludes saying that “this policy move is entirely unnecessary, has not been transparent and is potentially injurious to public health. We believe there should be a moratorium on such technologies till their safety both to human beings and the environment is proven.”

ENVIRONMENTAL POLLUTION IN 11TH PLAN

Serious environmental health problems affect millions of people who suffer from respiratory and
other diseases caused or exacerbated by biological and chemical agents, both indoors and outdoors. Millions are exposed to unnecessary chemical and physical hazards in their home, workplace, or wider environment.

Concern about the health effects of the high levels of air pollution observed in many mega cities is growing; moreover, it is likely that this problem will continue to grow because countries are trapped in the trade-offs of economic growth and environmental protection. Population in urban areas are at risk of suffering adverse health effects due to rising problems of severe air and water pollution.

Cooking and heating with solid fuels on open fires or traditional stoves results in high levels of indoor air pollution. Indoor smoke contains a range of health-damaging pollutants, such as small particles and carbon monoxide.

Indian women spend nearly 60% of their reproductive life in either pregnancy or breast-feeding.
Most of the women keep their children in the kitchen when they are cooking, thereby exposing the children to the pollutants too. This, combined with malnutrition may retard growth and lead to smaller lungs and a greater prevalence of chronic bronchitis. There is an urgent need for the implementation of control programs to reduce levels of particulate and other pollutant emissions. To be effective, these programs should include the participation of the different stakeholders
and initiate activities to identify and characterize air pollution problems, as well to estimate
potential health impacts. A full understanding of the problem and its potential consequences for the local setting is essential for effectively targeting interventions to reduce the harmful impacts of air pollution.

Monitoring of air and water quality is crucial for devising programmes and policies related to pollution management. Establishing a reasonably adequate monitoring network with contemporary technology will be given priority. Ways of linking treatment of sewage and industrial effluents to the urban and industrial development planning need to be worked out. The goal should be to ensure that by the end of the Eleventh Plan no untreated sewage or effluent flows into rivers from cities and towns.

OCCUPATIONAL HEALTH IN 11TH PLAN

Exposure to chemicals, biological agents, physical factors and adverse ergonomic conditions,
allergens, safety risks, and psychological factors often afflict working population of all ages. People also suffer from injuries, hearing loss, respiratory, musculoskeletal, cardiovascular, reproductive, neurotoxic, dermatological, and psychological effects. Such risks are often preventable. The illness resulting from such exposures is not identified properly due to lack of
adequate expertise. The work up of the cases by physicians lacking skills to identify such illness leads to unnecessary use and waste of scarce medical resources as well as their own time. Freedom from occupational illness is essential in today’s competitive world where workers’ productivity is an important determinant of growth and development.

The objectives of occupational health initiative during the Eleventh Five Year Plan will be to promote and maintain highest degree of physical, mental, and social well-being of workers in all occupations; identify and prevent occupational risks of old as well as newer technologies such as Information and Nano technology; build capacity for prevention, that is, early identification of occupational illness; create an occupational health cell under NRHM in each district headquarter, well-equipped to be able to promote primary, secondary, as well as tertiary prevention; and establish occupational health services in agriculture, health and other key sectors for placement of workers in suitable work and propagating adaptation of work to humans.

During the Eleventh Five Year Plan, following strategies will be implemented to reduce occupational health problems:

• Creating awareness among policymakers on the cost of occupational ill health including injuries
• Ensuring use of technologies that are safe and free from risks to health of the workers
• Sensitizing employers as well as workers’ organizations for their right to safety and the implication of injuries in their lives
• Instituting legislation and ensuring proper enforcement for prevention and control of occupational ill health and compensating those who suffer intractable illness due to work
• Building a national data base of occupational illness and injuries
• Monitoring and evaluating programmes and policies related to pollution prevention and control
• Establishing surveillance and research on occupational injuries and building capacity in health
sector to be able to participate in preventing work related illness and injuries
• Enforcing safety regulations and standards
• Introducing no-fault insurance schemes for all workers in the formal and informal sectors

Cancer & Public Sector Spending: 11th Plan

Cancer has become an important public health problem in India with an estimated 7 to 9 lakh cases
occurring every year. At any point of time, it is estimated that there are nearly 25 lakh cases in the country. The strategy under the National Cancer Control Programme (NCCP) was revised in 1984–85 and further in 2004 with stress on primary prevention and early detection of cancer cases. In India, tobacco related cancers account for about half the total cancers among men and 20% among women. About one million tobacco related deaths occur each year, making tobacco related health issues a major public health concern.

NATIONAL CANCER CONTROL PROGRAMME (NCCP)

During the Tenth Five Year Plan, a taskforce comprising experts from across the country was
constituted. Based on recommendations from the national taskforce a comprehensive NCCP will be
implemented during the Plan. The main activities during the Plan will be:
• Establishing new Regional Cancer Centres
• Upgradation of the existing Regional Cancer Centres based on their performance and linkages with
other cancer organizations in the region.
• Creating skilled human resources for quality cancer care services
• Training health care providers for early detection of cancers at primary and secondary level
• Increasing accessibility and availability of cancer care services
• Providing behavioural change communication along with provision of cost effective screening
techniques and early detection services at the door step of community
• Propagating self-screening of common cancers (oral, breast)
• Upgrading Oncology Wings in government medical colleges
• Creating and upgrading Cancer detection and Surgical and Medical Treatment facilities in District Hospitals/Charitable/NGO/Private Hospitals
• Promoting research on effective strategies of prevention, community-based screening, early
diagnosis, environmental, and behavioural factors associated with cancers and development of cost
effective vaccines
• Creating Palliative Care and Rehabilitation Centres
• Monitoring, Evaluation, and Surveillance

As per NSSO 60th Round, during 2004, 24% of the episodes of ailments among the poor were
untreated in rural areas and 22% in urban areas. Lack of finances was cited as a reason by 28% of persons with untreated episodes in rural areas and 20% in urban areas. It is also notable that 12% cited lack of medical facility as the cause of not receiving treatment in rural areas.

Public spending on health in India is amongst the lowest in the world (about 1% of GDP), whereas
its proportion of private spending on health is one of the highest. Households in India spend about 5–6% of their consumption expenditure on health (NSSO). The cost of services in the private sector makes it unaffordable for the poor and the underprivileged.

The cost of health care in the private sector is much higher than the public sector. Many small
providers have poor knowledge base and tend to follow irrational, ineffective, and sometimes even harmful practices for treating minor ailments. Bulk of the qualified medical practitioners and nurses are subject to self-regulation by their respective State Medical Councils under central legislation. In practice, however, regulation of these professionals is weak and close
to non-existent.

We have a huge working population of about 400 million. Almost 93% of this work force is in the
unorganized sector. There are numerous occupational groups in economic activities, passed on from generation to generation, scattered all over the country with differing employer–employee relationship. Those in the organized sector of the economy, whether in the public or private sector, have access to some form of health service coverage. The unorganized sector workers have no access. The National Commission for Enterprises in the Unorganized Sector (NCEUS) has recommended a specific scheme for health in incidences of illness and hospitalization for workers
and their families.

The Eleventh Five Year Plan will introduce a new scheme based on cashless transaction with the
objective of improving access to health care and protecting the individual and her family from exorbitant out-of-pocket expenses. Under the scheme, coverage will be given to the beneficiary and her family of five members. Providers will be both public and private.

Time-Bound Goals for the Eleventh Five Year Plan

• Reducing Maternal Mortality Ratio (MMR) to 1 per 1000 live births.

• Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births.

• Reducing Total Fertility Rate (TFR) to 2.1.

• Providing clean drinking water for all by 2009 and ensuring no slip-backs.

• Reducing malnutrition among children of age group 0–3 to half its present level.

• Reducing anaemia among women and girls by 50%.

• Raising the sex ratio for age group 0–6 to 935 by 2011–12 and 950 by 2016–17.

Eleventh Plan and health care

Eleventh Five-Year Plan: There is a shortage of 5,801 doctors in PHCs and a shortfall of 4,681 specialists in Community Health Centres (CHCs).

Rashtriya Swasthya Bima Yojana: I have serious doubts about the benefits that will actually accrue to the rural poor from health insurance and the option to go to private hospitals.

The Eleventh Plan, whose central theme is ‘Inclusive Growth,’ has substantially stepped up the allocation for health. The public health care system in many States is in [a] shambles. Extreme inequalities and disparities persist both in terms of access to health care as well as health outcome, bemoans the Plan document.

The role of health care in economic development has received increasing attention in recent years. There is a general agreement that economic growth is not merely a function of incremental capital-output ratio. Investment in man -- enhanced allocation for education, imparting skills and health care -- plays a significant role in fostering economic growth. It is, therefore, in the fitness of things that the Eleventh Five-Year Plan, whose central theme is ‘Inclusive Growth,’ has substantially stepped up the allocation for health. The Plan document presents a well-conceived, comprehensive programme for the sector. According to the Prime Minister, the aim is to provide broad-based health care in rural areas through the National Rural Health Mission (NRHM).

Health care in a shambles

While the proposed structure for providing health care is adequate and commendable, what is in place at present is thoroughly disappointing. The Plan document itself bemoans: “The public health care system in many States is in [a] shambles. Extreme inequalities and disparities persist both in terms of access to health care as well as health outcome.” (The Eleventh Plan: Vol. II, page 61, para 3.1.16.) The Plan deplores the critical shortage of health personnel, particularly doctors and nurses, poor working conditions and inadequate incentives, and the low utilisation of the meagre facilities in government hospitals. Government hospitals at all levels present a picture of neglect and decline.

I shall deal with two major problems: shortage of doctors for rural service; and the desperate state of medical education.

Health care after independence

Before independence, medical facilities in rural India were rudimentary. The Community Development Block pattern of rural development launched in the 1950s was the harbinger of modern health care in rural areas. According to the approved model, every block was to have a Primary Health Centre (PHC) with 10 beds at the block headquarters and three sub-centres at carefully selected locations. The sanctioned staff for a PHC consisted of two doctors, one Lady Health Visitor and two Sanitary Inspectors. One post of Auxiliary Health Worker and two posts of Auxiliary Nurse-Midwives were sanctioned for each sub-centre. A doctor was required to visit each sub-centre twice a week. I was the Collector of Darbhanga in north Bihar from mid-1958 to the end of 1960. During my tenure, out of the 44 blocks sanctioned for the district, only 37 had become operational. Some 25 blocks had one doctor each and the rest none. Most posts of Lady Health Visitors and Auxiliary Nurse Midwives were vacant.

As chance would have it, I became Bihar’s Health Secretary in July 1962 and stayed on in the post for nearly five years. The total number of blocks in Bihar was about 600. In spite of my best efforts, very few blocks had the full complement of doctors and paramedical staff. During the severe drought of 1965-66, it was only by resorting to draconian measures that we could ensure that all blocks had at least one doctor. Most doctors had an urban background and were reluctant to go to rural areas lacking in modern amenities. There has been no significant improvement in the situation during the last four decades. According to the data given in the Eleventh Plan, there is a shortage of 5,801 doctors in PHCs and a shortfall of 4,681 specialists in Community Health Centres (CHCs).

The Eleventh Plan presents a well thought-out and comprehensive structure for health care in rural areas. The important features of the set-up are:

— 1.75 lakh sub-centres each with two Auxiliary Nurse Midwives at one sub-centre for each panchayat (five or six villages).

— 30,000 PHCs at one for a group of four or five sub-centres. Each PHC will have one Lady Health Visitor and three staff nurses. There will also be an AYUSH physician. (AYUSH is acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy).

— 6500 CHCs each with 30-50 beds. The staff will include seven specialists and nine staff nurses.

— 1800 taluk or sub-divisional hospitals and 600 district hospitals will be fully equipped to provide quality health service.

When this structure is in position, and if it functions reasonably well, we can expect a significant improvement in the quality of medical care in rural India. There will, of course, be an enormous increase in the number of medical graduates, postgraduates and nurses needed to operate the system. The baffling question is how to find the number of personnel needed to fill the vacancies and new posts.

It should be possible to recruit adequate number of doctors and persuade them to stay in the field if the three suggestions given below are adopted and strictly enforced.

— After internship, every medical graduate should be required to work for a minimum of two years in rural areas before he is granted the MBBS degree.

— Only those who have completed three years of rural service should be admitted to any postgraduate course, including the Diplomate of the National Board.

— Every postgraduate student should serve for one year as a specialist in a CHC or sub-divisional hospital before he is awarded the degree or a diploma.

These proposals are not entirely new. Assam has already made rural service compulsory for medical graduates. Some medical colleges have been encouraging fresh graduates to opt for rural service for short periods. The implementation of the proposals, of course, calls for resolute political will. The rationale for making these seemingly harsh suggestions is this. Despite the recent increase in fee, medical education is heavily subsidised by the state. It is manifestly just and fair to stipulate that those who receive medical education should serve the rural society for a short period. Incidentally, the young graduates will benefit a great deal by getting an opportunity to improve their clinical skill. There should, of course, be substantial improvement in the salary of doctors and the amenities available to them.

Shameful state

The proliferation of sub-standard, under-staffed and ill-equipped private medical colleges in recent years is an unmitigated menace. A few institutions like the CMC, Vellore; St. John’s, Bangalore; and the Kasturba Medical College, Manipal, are among the country’s best. But many private colleges lack basic facilities and are run as profit centres for garnering huge amounts as capitation fee. I hear that the present capitation fee for an MBBS seat is Rs. 35 lakh-50 lakh and for a postgraduate seat above Rs.60 lakh. For a discipline like Radiology, the amount could exceed Rs. 1 crore!

Some 15 years ago, a relative of mine had to pay only Rs. 2 lakh through a bank draft and Rs. 2 lakh in cash to get his son admitted to a postgraduate course. The Indian Medical Council has laid down arduous norms in respect of faculty, hospital beds, equipment and so on. Apparently, there is some laxity in the enforcement of the norms. I have heard that while a well-equipped college may run into difficulties, substandard institutions manage to pass muster. I have also heard of cases in which retired teachers and other doctors with postgraduate qualification are shown as visiting faculty for short periods during an inspection by Medical Council teams. No civilised country, not even a soft state like India, can allow such a scandalous state of affairs to continue. It is time the government took resolute action to stem the rot.

Some reservations

The Prime Minister in the Foreword and the Deputy Chairman of the Planning Commission in the Preface have highlighted the positive role the Rashtriya Swasthya Bima Yojana will play in providing health care to the population below the poverty line. I have serious doubts about the benefits that will actually accrue to the rural poor from health insurance and the option to go to private hospitals. As I have not personally observed the working of the scheme, I would leave it to experts familiar with field conditions to evaluate the Yojana.

Another controversial matter is Public Private Partnership (PPP) in providing health care. I do not share the optimism expressed in the Plan document about the role of private institutions in providing health care in rural India. Nor do I agree with the Commission’s enthusiasm about the role of corporate health care and the benefits flowing from the expansion of medical tourism. These issues deserve to be dealt with by more knowledgeable persons.

I shall conclude reiterating that health care in rural India and school education throughout the country should squarely be the concern of the government. Private initiative can certainly supplement the government’s efforts in these fields, but that will benefit only the affluent.

(P.S. Appu is a former Chief Secretary of Bihar and former Director of the Lal Bahadur Shastri National Academy of Administration, Mussoorie. He can be reached at: psappu@hotmail.com)

The Hindu, 23 Nov. 2009

JNU’s Centre for Community Health Warns Against Bt Brinjal Hazards

Press Release

New Delhi, 20/11/2009: Responding to the introduction of Bt Brinjal in the country for public discussion by Jairam Ramesh, the Union Environment Minister, the Centre of Social Medicine and Community Health (CSMCH), Jawaharlal Nehru University has sent a letter to the Union Minister saying, “We believe that there are serious issues of safety that are not yet addressed through long term studies. There is some data that these crops could be allergy- inducing, and indeed that they might be mutagenic. It is for these reasons that in the European Union but major countries have a restrictive regulatory regime. Countries in EU have a precautionary approach towards GM crops and major countries like Germany, France, Hungary, Greece etc has a ban on their cultivation.”

CSMCH took cognizance of the reports suggesting that the Genetic Engineering Approval Committee (GEAC) has decided to approve the environmental release of Bt Brinjal from Monsanto/Mahyco in India which would for all purposes permit the use of transgenic and Genetically Modified Organisms (GMOs) and products for edible purposes.

The letter notes that CSMCH is seriously troubled with this move. The letter says, “ First of all, this is entirely unnecessary from a public health perspective, indeed undesirable. The argument that Bt brinjal would not require pesticides is dissembling. There are other, better, pest management methods like non pesticidal management that we need to utilize.”

It refers to “serious methodological flaws in the studies that have been carried out, not to mention ethical ones.”

It takes note of the “profound conflict of interest issues involved in the studies carried out in India. The companies that stand to gain by the introduction of these crops into the market were the sponsors of the studies. This is entirely unacceptable.”

The Prof Mohan Rao, Chairperson, CSMCH says, “There has not been adequate assessment of the ecological consequences of the introduction of this food crop. These concerns regarding the health and environmental risks associated with GM crops are too serious to be disregarded. Given our retailing structure, labeling is impossible in India and contamination is inevitable. Introduction of GM crops would kill the choice of the consumer."

The letter concludes saying that “this policy move is entirely unnecessary, has not been transparent and is potentially injurious to public health. We believe there should be a moratorium on such technologies till their safety both to human beings and the environment is proven.”

PublichealthWatch is a collective of public health researchers.

For Details Contact: Prof. Mohan Rao, Chairperson, CSMCH, JNU Ph: 26704420, 26717676, E-mail: mohanrao2008@gmail.com

Management of A(H1N1) epidemic: greater clarity needed

*Dr. Mohan Rao, Prof. Rama Baru, Dr. Rajib Dasgupta, Prof. Sanghmitra Acharya, Prof. K.R. Nayar, Prof. Ramila Bisht, and Dr. Ritu Priya of the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi write: *

As public health workers, we are concerned with the reaction in various quarters to the A(H1N1) (swine flu) epidemic. The hysteria created by the media and the knee-jerk reaction from the Ministry of Health and Family Welfare, are not conducive to rational and well-informed management of the situation.

Swine flu is not more lethal, for instance, than ordinary flu and dengue. There is thus no need for the panic response. It can be treated like any ordinary flu unless there are complications that require hospitalisation. There needs to be greater clarity in the management and treatment of A(H1N1) so that the public is informed regarding the aetiology, treatment and management of swine flu.

Secondary and tertiary levels should be used for confirmation and treatment alone and not for screening, as is being done at present. Screening should be done at the primary level — whether public or private. These have to be given guidelines for screening and testing. The Indian Medical Association will need to play a proactive role in professionally and ethically sensitising its members. Treatment should, at least in the current phase, be limited to designated public hospitals. The government needs to explicitly come out with guidelines regarding the stage of the epidemic at which presumptive cases and not just (laboratory) confirmed cases will be treated with specific antivirals.

Equally, there is no need for the government to open up testing and treatment in the private sector. As public health workers, we know that the private sector is diverse in quality and competence. The situation therefore is ripe for unnecessary — and expensive — testing for swine flu and unnecessary over-diagnosis and treatment. This will not only lead to resistance to the only drugs we have but widespread exploitation of people wrongly diagnosed to have swine flu. The response to this epidemic must be coordinated by institutions such as the National Institute of Communicable Diseases, Indian Council for Medical Research and the National Institute of Virology and not be guided by clinicians alone.

The swine flu epidemic must not be used as an opportunity for quick money making but must be used to strengthen the capacities of the public health infrastructure, including systems for surveillance and monitoring.

Tamiflu & H1N1 flu (Swine flu)

The US Centers for Disease Control and Prevention (CDC) recommends Tamiflu for prevention and treatment of swine flu. Tamiflu is the first neuraminidase inhibitor tablet for the treatment and prevention of influenza A and B. Tamiflu was approved by the US FDA for the treatment of influenza in October 1999 and for influenza prevention in November 2000.

The product, which was developed by Gilead Sciences, a US biopharmaceutical company (that discovers, develops and manufactures therapies for viral diseases and infectious diseases) is commercialized globally by Hoffmann-La Roche, a Swiss global health-care company that operates worldwide.

Notably, Donald Rumsfeld was chairman of the board of directors of Gilead company from 1997 until 2001, when he was appointed U.S. Secretary of Defense but he retained a huge shareholding.

The CDC website states, "CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses."

Researchers conducted a review of numerous studies of of anti-viral medications, which was then published in the prestigious medical journal Lancet on Jan. 19, 2006. As per this review of 51 randomized controlled trials, Tamiflu was useless against the avian flu and many other flus. Contrary to the CDC, their recommendation was not to use Tamiflu.

According to Roche Laboratories, the pharmaceutical company which owns exclusive distribution rights to the drug, Tamiflu has a shelf life of 48 months.

Stock prices of both the companies Roche and Gilead Sciences soared once the drug was recommended by the government as the best treatment. Gilead earns healthy royalties on every pack of Tamiflu.

Indeed what is lacking in the overall discussion about pandemic flu is disagreement, criticism, and skepticism from researchers willing to question and test the data on the efficacy of Tamiflu.