Beyond the name

The medical bureaucracy in India had jumped in record time to make a high-pitched protest against a study,published in British medical journal The Lancet last August,that named a new bacterium with a drug-resistant gene New Delhi metallo-beta-lactamase or NDM-1,after some Europeans returning from South Asia were found infected with it. In the first month of the new year,Lancets editor,Richard Horton,launching The Lancet: India Series,apologised for naming the superbug after the Indian capital. While it may be standard practice to name bacteria after cities,the medical bureaucracy as well as the Indian public should not bask in that apology. There are,instead,things of far greater and real import of a medical and public health nature to fix. And India hasnt made much headway.

NDM-1 by any other name would still offer the same lesson in the dangers of profligate prescription and use of antibiotics. NDM-1 itself made bacteria resistant to most commonly used antibiotics. The development of this drug-resistant superbug,found in patients who had come here for surgery and transplant,was almost certainly impelled by antibiotic overuse or misuse. Just as the Indian medical fraternity missed the wood for the trees last August because of that name,now that an apology has been pronounced,it shouldnt be blinded by it. Antibiotic overuse is an entrenched and pervasive problem in India,as it is in Kenya,South Africa,Vietnam and China,according to a WHO study. We can no longer entertain a medical culture in which doctors indiscriminately prescribe antibiotics keeping in mind only their own patients,who might themselves complain their ailments are being ignored otherwise; or under incentives from pharmaceutical firms,forgetting the larger public health picture.

Nor can we tolerate chemists supplying them over the counter and without prescriptions. Post-NDM-1 last year,a guideline was issued by a group of public health experts for state-run hospitals on antibiotic use; it didnt,however,cover private hospitals.

The case remains for tackling antibiotic misuse comprehensively,with foolproof regulations and punishments for violation. At the same time,Indias deplorable public health awareness and hygiene standards need an immediate and far-reaching uplift. A surveillance system must be evolved for antimicrobial resistance and hospitals must do more in infection control,cleanliness,hand washing,etc. These details must be attended to,every day,even as awareness is raised about the urgent need for macro health infrastructure or even a fractionally adequate public health policy.