India's unhealthy truths

Our healthcare is marred by poor infrastructure, negligence, and pharma-doctor collusion. Sumanth C Raman's book exposes all this and more, questioning why it doesn't evoke as much anger in Indians

Sick Business: The truth behind healthcare in India

Author: Dr Sumanth C Raman

Publisher: HarperCollins India

Pages: 336

Price: Rs 399

Blowing the lid off medical malpractices in India’s healthcare system, Sumanth C Raman’s exposé, Sick Business, packs solid arguments backed by facts and extensive research. “India’s healthcare system, in one word, is horror,” writes Dr Raman, who has over 25 years of experience in medicine. He intersperses every argument he makes with disclaimers that his aim is not to demean the country’s healthcare system but to “shake you [readers] out of complacency”. He argues that the survival of a patient in India often depends on God’s grace or luck.

In a way, the book is prescient. A week after it hit the shelves, the Supreme Court cracked down on Baba Ramdev’s Patanjali, asking for a public apology after the Indian Medical Association (IMA) accused Ramdev of a smear campaign against the Covid vaccination drive and modern medicine.

Dr Raman is aware that he is walking a slippery slope. At a time when any criticism of modern medicine can be misconstrued as an alignment with pseudoscientific approaches to healthcare — homeopathy, ayurveda, et al — he treads the path of exposing the flaws in India’s healthcare system with caution.

He begins by addressing India’s Covid vaccination drive, highlighting how Bharat Biotech received permission for emergency use of the vaccine Covaxin without putting out the trial data in the public domain. Subsequently, the World Health Organization (WHO) suspended the supply of Covaxin to United Nations (UN) agencies for “less-than-stringent manufacturing practices”.

A couple weeks after the book’s release, AstraZeneca admitted Covishield can cause a rare side effect leading to the formation of blood clots. This is another slippery slope to navigate for Dr Raman because any questions on the legitimacy and efficacy of vaccines can be misunderstood as an alignment with the anti-vaxxer agenda where conspiracy theories on side-effects run amok.

Beyond the vaccine controversy, Dr Raman details many horrifying accounts of medical negligence in his book — from an aspiring athlete dying during surgery to an aspiring badminton player losing his vision because of an error. These experiences highlight the abysmal state of healthcare in India, but I couldn’t help but worry that these might cause the unsuspecting reader to grow averse to seeking medical help in times of need.

It is possible, of course, to apply your judgement in distinguishing between the quacks and genuine practitioners but in a country like India, where fear mongering is rampant, such stories could well make people suspicious of modern medicine. So to give credit where due: Dr Raman clarifies his intentions frequently lest they be misread — he isn’t trying to dissuade readers from seeking help but rather opening their eyes to an institution that has become increasingly exploitative and corrupt.

Out of all the chapters in the book, perhaps the most compelling is the one titled “Is Big Pharma influencing your treatment?” Dr Raman offers a behind-the-scenes glimpse of the unholy nexus between doctors and the Big Pharma companies. He narrates a familiar story of a doctor accepting a business class ticket by a Big Pharma company for a sales event overseas. In exchange, the doctor is expected to prescribe their drug to most of his patients — except that this doctor now wants a business class seat for his wife, too. The ground-level sales reps of Big Pharma companies often struggle to meet these unreasonable demands.

Dr Raman explains Big Pharma companies recover their clinical trial costs by liaising with chemists and doctors, both of whom can boost the sales of their latest drug. The chemist boosts sales by saying “no other brand is available”, “the other drug isn’t effective” and “no stock” and the doctors over-prescribe these medicines. “Doctors often keep track of their prescriptions and have a good idea of the revenue they generate for the company,” Dr Raman observes.

As Big Pharma colludes with doctors and chemists, it also plays with the law by finding loopholes that strictly prohibit direct advertising of medicines to the public. Add to it the ethical violations during clinical trials — forcefully picking up volunteers, making them sign consent forms in a language they cannot read, lack of transparency around clinical data for drugs, and you have a recipe for disaster.

Though healthcare in India is marred by inequality both in terms of access and quality of treatment, the privileged are not spared either. “If you think only the government sector is apathetic, think again,” Dr Raman writes, detailing many instances of criminal negligence that shook up the private hospital chains. Many of the private hospitals built in large acres of land occupy space for medical equipment but are poorly staffed.

As Dr Raman glides from one traumatising and gut-wrenching anecdote to another, he asks a pertinent question: Why does a poor healthcare system not evoke as much anger in Indians? Why have we become so complacent? Why don’t we call out the medical malpractices we see around us? More importantly — how did a profession that was earlier considered a hallmark of compassion and altruism fall prey to greed and money-making motives?

He acknowledges that there are doctors, honest ones, who are swimming against the tide, trying to keep the system afloat. However, much reform is still needed for us to imagine a future where equitable and accessible healthcare is no longer a distant dream for Indians.

Sick Business will make you fearful of the next time you need an IV drip or an emergency room visit. It speaks volumes about the state of healthcare in our country.

The reviewer is a freelance film and book critic based in New Delhi. He is @Deepansh75 on X