Medical Research in Bhopal

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Medical Research in Bhopal
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1985

Medical Research in Bhopal
—Are we forgetting the people?

Concern for man himself and his safety must
always form the chief interest of all technical endea­
vours. Never forget this in the midst of your diagrams
and equations.

—Albert Einstein
Preamble
In a tribute to the medical relief workers
involved in service to the Bhopal disaster victims the
ICMR has noted (1) that a disaster of such magni­
tude, of such suddenness and caused by the release
of a highly toxic chemical methyl isocyanate (MIC)
into a densely populated habitat is unparallelled in
human history. The doctors, medical students, civil
servants, governmental, public sector and voluntary
bodies and the people themselves rose to the occasion
in a human gesture equally unparallelled*. . .

In the absence of authoritative information on
the released gas; the unwillingness of the company to
part with authentic information; the unpreparedness
of the local bodies and the government health autho­
rities to understand the consequences of the disaster;
and the absence of technical or toxicological exper­
tise on MIC among our scientific community, it was
imperative that a national body like the Indian
Council of Medical Research through its own initia­
tive would have to harness the scientific medical
expertise in the country including the local medical
college community to meet this challenge. Conside­
ring that the affected population was over 2 lakhs
and that the dead were over 6000 (though official
estimates are 2000!) this research initiative had to be
equally unparallelled in meeting the phenomenal
challenges of the world’s worst recorded ecological
disaster. Do the records of events in the past four
months since the disaster bear this out?
The Plan
A report on the first nine days of the Bhopal
disaster identified (1) three objectives for the ICMR’s
research programme:

1. To establish a clinical and patho-physiological profile of the hazard which would

also provide clues for improved patient
management and clinical outcome
2. To study the long term sequelae of toxin
exposure to lung, tissues, foetus, genes and
cancer induction
3. To obtain a basic understanding of the
biological alterations associated with MIC
exposure.

Strangely enough there is no mention in this
report of a strategy by which conclusive research
data as and when available would be transmittea to
the relief and rehabilitation effort in Bhopal, ie., to
the treating doctors and through a health education
effort to the affected public.
A report of projectization of ICMR supported
research effort (2) lists out 17 study projects which
covers acute and long term health effects, lung func­
tions, follow up of children aged 5-15 years, ocular
changes, pulmonary and neurological changes,
growth and development of new borns, clinical and
forensic toxicological studies, pathological and
microbiological investigations, radiological studies,
biochemical and immunological studies, carcino­
genicity, mutagenicity, teratogenicity and chromo­
somal changes, data management information system,
hospital based cancer register, cytofluorometric

INSIDE
The KEM Study

4

Women’s Health

4

The mfc Bhopal Study

5

Dear Friend

6

Scientific medicine

6

Introducing the Third Anthology

7

Consumer Alert — Action

7

I

Issues of concern

studies and blood gas analysis. The studies ranging
from a time span of 6 months to 5 years would incur
a total financial outlay of 1.07 crore rupees.

An mfc fact finding team which visited Bhopal
in mid February at the request of various non govern­
mental agencies and action groups published a report
on the realities of medical research and relief which
has been widely circulated and is now well known(9).
In mid March an mfc team of 16 members camped
in Bhopal and undertook an epidemiological survey
which included detailed history taking, physical exa­
mination, lung function tests, haemoglobin estimation
of a 10 percent sample of a severely affected area and
a control area(10).

Some surprising omissions in the list were the
assessment of psychological stress and its manifesta­
tions in the affected families, studies on health of
women (not obstetrical outcome but gynaecological
effects) and the assessment of medico social effects
like reduced earning capacity and functional disabi­
lity which would affect rehabilitation efforts. Though
there were references to an epidemiological and
community based outlook the research endeavour atleast as on paper did not seem to be a coordinated
holistic effort in understanding the total problem
but basically a series of vertical research programmes
initiated and funded according to the interests of the
professors involved in the exercise.

The team also met decision makers, relief and
service providers, medical teams of voluntary agencies
and others, apart from undertaking a survey of the
people’s perceptions of relief services and an overview
of the services itself. The findings of the team are
being analysed and will be reported shortly (a press
release is published in this issue) but the experience
of the third week of March in Bhopal strengthened
the findings of the earlier fact finding team and
identified a whole series of issues of concern in the
ways in which research efforts were becoming
exploitation of peoples’ suffering rather than expres­
sions of support to programmes of human welfare.

Results
It is four months since the tragedy and about
three months since many of the research programmes
got underway.
As far as a communication strategy goes three
press releases and two lectures by the director
generals and a minutes of the meeting on the thio­
sulphate controversy are the only freely available
literature on the research (3-8) efforts. . From these
all that any member of the scientific community or
the general public can gather1 are:-

i.

that there is no evidence of irreversible
eye damage or blindness

ii.

that the autopsy findings are indicative
of severe respiratory damage caused by
pulmonary odema and asphyxia

iii.

that studies of exposed persons with lung
symptoms/signs have shown obstructive
and or restrictive abnormalities

iv

that a double blind clinical study under­
taken using sodium thiosulphate and
a placebo has established that sodium
thiosulphate administration results in
symptomatic improvement and in increa­
sed excretion of thiocyanates in the
urine. On the basis of clear cut results,
the State government has been advised
to administer sodium thiosulphate to the
exposed population and detailed guide­
lines have been drawn up and circulated.

v.

1.

Lack of dissemination of technical guidelines

The medical relief services continue to be
starved of authentic and authoritative scientific
medical information to support clinical judgment and
patient management. In the absence of clear cut
guidelines from the seniors in the profession treat­
ment continues to be adhoc, symptomatic and
unstandardised. Findings of autopsies, lab investi­
gations and x-rays and other tests are not available to
the treating doctors. Doctors have not been alerted
to the fact that a wide range of symptomatology like
fatigability, weakness, memory problems are all part
of the MIC syndrome. In the absence of such
information peoples’ sufferings have often been passed
off as malingering or compensation neurosis.
2.

Pill distribution

The treatment basically consists of a whole
series of pills which are efficiently and actively
prescribed to the people in a sort of conditioned
reflex. In the absence of proper record linkages each
patient is collecting large amounts of pills and not
feeling the better for it. apart from the dangers of
over drugging. Other forms of care, counselling and
non-drug therapies have not been thought of.

that two visiting psychiatrists have
found that 10—12% of the affected indi­
viduals attending the medical clinics in
Bhopal are presenting with psychiatric
manifestations — symptoms of anxiety
and depression are foremost.

3.

The Thiosulphate controversy:

Even after the ICMR studies establishing the
validity of thiosulphate administration and the pre­
paration of clear cut guidelines for its administration,
(6,8) this specific antidote is not being used as
effectively as it should be. It has become a casualty
in a medical controversy between cyanogen and
carbon monoxide lobbies and the victims rather than
being informed and helped are being confused and
neglected.

Why this secrecy? or is it administrative over caution?

A more updated report prepared in mid March
collating all data as of that date has again become a
casualty in the commitment to secrecy (caution!) and
no press release has followed.

2

4.

Women’s health

IMA, voluntary agencies, action groups that there
are urgent needs to be actively met :

The mfc fact finding team had highlighted the
problems of women who have suffered abortions, still
births, diminished foetal movements, suppression of
lactation, abnormal vaginal discharges and menstrual
disturbances. The studies undertaken by two doctors
of mfc reported in this bulletin (11) establish the mag­
nitude and severity of the problem. It, however,
continues to be neglected by the concerned authorities.
5.

* Need to evolve a bold, imaginative and open
communication strategy to all the doctors and health
workers (treating the disaster victims) who are present­
ly starved of authentic technical/medical information
hampering clinical judgment.

* Need to evolve a creative, relevant health
education and awareness building public education
strategy to meet the expectations of the disaster
victims and to help and reassure them through the
crisis and prepare them for the eventualities.

Absence of Health Education efforts

. Whatever the other validity of the research efforts,
in the ultimate analysis it should get translated into a
strategy of health education and awareness building
of the affected people. As of date there are no
official guidelines or efforts in this direction. The
range of areas is phenomenal—advice to mothers of
the risk to the foetus and preparation for conse­
quences including options for MTP, advice to couples
on contraception till detoxification is over, breathing
exercises and antismoking advice to those with
fibrosis of lungs, avoidance of overdrugging of
pregnant mothers, advice to mothers regarding feeding
of infants/children as lactation suppression has taken
place, availability of thiosulphate and other medical
relief measures. None of this has even been recogni­
sed as being necessary.
6.

* Need to ensure that research efforts are geared
to supporting relief and rehabilitation efforts and
not become esoteric exercises for institutional deve­
lopment and career advancement.
* Need to make the commitment to patient care
and human welfare primary and to ensure that it does
not get bogged down by professional rivalries, inter
departmental incoordination, procedural constraints
and administrative protocols.

* Need for closer coordination between voluntary
agencies, action groups, citizen committees, medical
and health workers and the people oriented and
socially sensitive sections of the medical profession
and government authorities to ensure that the peoples’
suffering are not exploited and made pawns in the
games played by politicians, multinational compa­
nies, and misinformed professionals—all symptomatic
of an exploitative social system.

Poor epidemiological and medico social orien­
tation of problem assessment

The general impression is that research and
relief efforts are suffering from an acute clinical and
institution based orientation rather than a community
based epidemiological orientation.

An authoritative Lancet editorial (12) had
mentioned that ‘In a year’s time we will have learned
a lot more about methyl isocyanate at an appalling
price’. With the prevalent medical anarchy in Bhopal
in relief and research, this price may be immeasurable.
—mfc team, Bangalore

Only if all data is field based and is related to
known available morbidity patterns (or comparison
with controls) can early problems and special trends
be identified and urgently acted upon. The danger
of getting into the pursuit of a very neat and fool
proof epidemiological planning exercise can be equally
counter productive.
7.

References

Lack of informed consent

ICMR, The Bhopal disaster — current status (the first nine
days) and programme of research
2. ICMR. Projectization of ICMR supported Research
3. ICMR, Medical Research problems in Bhopal (V Ramalingaswami)
4. ICMR, Pathology and clinical toxicology of the Bhopal
disaster (S Sriramachari)
5. ICMR, Medical research on Bhopal Gas Tragedy — press
release 31st Jan 1985
6. ICMR, ibid, press release, 12 Feb 1985
7. ICMR, ibid, press release, 27th Feb 1985
8. ICMR, Thiosulphate therapy in MIC exposed — minutes of
meeting at ICMR, 14 Feb 1985
9, mfc, Medical Relief and Research in Bhopal — the realities
and recommendations.
10. mfc, Approach document of a project to evolve a strategy
of medical relief and rehabilitation which best meets the
peoples’ medico social needs and expectations
11. Rani Bang, Effects of the Bhopal disaster on the women’s
health — an epidemic of gynaecological disease : reports
I & II
12. Lancet editorial, Calamity at Bhopal, 15 Dec 1984

1.

The people are not being informed about the
tests being done. Nor is consent being taken for
being included in the studies or for procedures to
which many of them are being subjected to. This is
a minimum medical ethic.
8.

Lack of coordination

This is a universal problem and the ultimate
sufferer’s are the disaster victims themselves. This
incoordination is occuring between goverment
services and research efforts in the medical college,
between the different research workers themselves,
between government and non-government relief
efforts, between voluntary agencies involved in action,
relief, rehabilitation and of all these groups with the
disaster victims themselves.
While a more detailed report is awaited, we in
the mfc appeal to government decision makers in
Bhopal, medical college professors, ICMR scientists,

3

The K.E.M. Study

Bhopal needs You

Results of a limited but thorough study of
113 MIC affected people carried out at K E M
Hospital (the only available comprehensive source
of hard medical evidence of the degree of destruc­
tion caused by MIC).
Sample

Your support, donations and in­
volvement are urgently needed for
mfe’s interventions in Bhopal.
Please don’t let us down.
(Cheques in favour of mfc Bhopal
fund)

Relatively mildly affected midd’e class peo­
ple living in pucca houses at a distance of 2 kms
from Union Carbide Plant who voluntarily presented
to K E M Hospital, Bombay —8 to 53 days after
exposure to MIC.

Women's Health

Salient findings
*

Breathlessness on exertion 95%

*

Persistent dry cough 97%

*

Throat irritation 66%

*

Chest Pain 68%

------ an epidemic of gynaecological diseases

Sample study
218 women in field clinics established by a
gynaecologist in Bhopal (114 gas affected group
and 104 controls).
Salie’nt features
(C= Controls)
* Leucorrhoea 90% (C=27%)
* Pelvic inflammatory disease 79% (C=27%)
* Cervical erosion and endocervicitis 75%
(C =44%)
* Excessive menstrual bleeding 31% (C=l .2%)
* Suppression of lactation 59% (C= 12%)
* All above are statistically significant when
compared with incidence in controls.
* Spontaneous abortions (7); still births (4);
incomplete abortion (1); and threatened abor­
tion in affected group, Nil in controls
* Severe pallor in control group 36% and in
affected group 3%

* Vomiting 42%
• Muscular Weakness 22%
* Altered conciousness 28%

*

Low vital capacity of lungs 27% (less than
60% of normal)

*

Impaired oxygen uptake 55%

*

Central airway obstruction 43%

*

Respiratory alkalosis 59%

*

Abnormal low oxygen pressure in blood 23%

*

*

Neurological conditions such assensory
motor loss, depression, tremors, loss of
concentraton, irritability in a significant
number of cases.
X-ray—97% had abnormal findings

*

Carboxyhaemoglobin—96% high

*

Methaemoglobin—79% high

*

Percentage showing no improvement at all
despite medication and carefully adminis­
tered treatment 30%.
—‘Bhopal’s unending tragedy’
Praful Bidwai
Times of India, March 25—27, 1985.

,

Note:
A much more thorough project consisting of
a medical survey and treatment of the gas affected
people Jias been organized by the Nagrik Rabat
Aur Punarwas Committee, a local!' relief and re
habilitation group and the Voluntary Health Associ­
ation of India. This study includes many important
investigations and was undertaken by a group of
over 20 doctors and paramedical personnel drawn
from K E M Hospital of Bombay and VHAI. The
results are eagerly awaited!

4

Conclusions
The exposure to the gas has produced excessive
gynaecological disease in women apart from suppression of lactation and pregnancy wastage.
These aspects are presently unstudied and
uncared for. Immediate relief and research need to
be initiated for the silent suffering women.
Suggestions
1. Need to study gynaecological diseases
2. Need for field clinics and involvement of
female paramedics
3. Need to health educate women on their
gynaecological problems.
4. Advise on supplementation/weaning foods
for mothers who have suffered lactation
suppression
5. Information to women regarding risk to the
foetus
6. Need for voluntary agencies and women s
organisations to help slum women build
pressure on authorities to implement care
services
—rani bang (wardha)
mira sadgopal (hoshangabad)
(copies of detailed study reports I&H are
Wi
fr°m Ran‘ Bang’ G°Puri pO, Dist Wardha

PRESS RELEASE

The MFC Bhopal Study
The Medico Friend Circle, an all-India group of
socially conscious doctors and health workers has
just completed a systematic study of the continued
effects of toxic gas in two bastis in Bhopal. The obser­
vations of the study conducted between March 18-25
in the highly affected Jayaprakash Nagar and the less
affected Anna Nagar are yet to be fully analysed.
However, the initial findings definitely indicate that
(i) the affected population is already showing signs of
reduced breathing and working capacity which is
likely to be permanent unless remedial measures are
urgently introduced; (ii) pregnant women who had
been exposed to the gas in the first three months of
pregnancy or have become pregnant since the disaster
have still not been informed about the possible
dangers to the foetus.
Moreover, detoxification
measures recommended by ICMR over a month ago—
the administration of sodium thiosulphate has not
been implemented. The Medico Friend Circle is
deeply concerned and agitated about the situation.

sodium thiosulphate so that their suffering is reduced
and they may go back to work. This service and
other medical facilities should be urgently provided
in a decentralised way, close to the bastis in affected
areas.
The insight that sodium thiosulphate may well
be effective was known even in the first week after the
disaster. It is extremely disturbing and deplorable
that decisions on vital issues like this which affect the
lives of thousands of people should have been so long
delayed. Even more shocking is the fact that even
now, a month after the recommendation was publici­
sed, mass detoxification of MIC victims has not
begun.

Possible risks to the foetus

Another disturbing feature is that pregnant
women who have been exposed to MIC have not been
given any advice regarding the possible risks to the
foetus. Given the fact that the first three months of
pregnancy is the most sensitive period, it is likely that
these women as well those who became pregnant
immediately after the disaster are likely to give birth
to deformed babies, since MIC or its breakdown
products are very reactive chemicals. Moreover many
of these women have received several types of drugs
when as a rule no drug should be given in the first three
months for fear of drug induced deformations. Some
of these drugs, especially steroids are known to cause
deformities.

Reduced breathing and working capacity among the
affected population
The Medico Friend Circle’s study team has
observed that men are not able to go back to work
because of breathlessness on accustomed exertion
(exertional dyspnoea). Those who have returned to
work report definitely reduced working capacities.
Most women find it difficult to carry on their usual
household chores. The team has noted with particu­
lar concern that very few of the children can even
play or participate in normal physical activity in the
affected bastis.

There is an urgent need to inform people,
especially women about these dangers and to allow
them the option of medical termination of pregnancy.
Adequate and free facilities should be made available
to those women who opt for it without coercing them
to undergo sterilization. Further, those couples who
have lost children and want reversal of sterilization
must be offered these facilities free of charge.

It is well known that a large proportion of the
MIC affected population is likely to develop fibrosis
of the lungs (development of scars) following inflam­
mation of the lungs due to irritation. This condition
permanently affects breathing and hence working
capacity. Such a condition is already in evidence in
the population covered by the MFC study.

Doctors belonging to MFC had pointed out
these dangers in a earlier note sent to the concerned
authorities a month ago. But to date nothing seems
to have been done.

Simple breathing exercises are known to help
to reduce this disability. Information about these
exercises must be made widely known and their
importance stressed.
z

Many of these women have by now crossed the
five-month limit of pregnancy beyond which MTP is
unsafe. But there are some who can still terminate
their pregnancy although the risks are greater than in
the first weeks. Facilities for ultrasonographic exami­
nation should be made available to these women
immediately to detect gross abnormalities in their
, foetuses.

Mass detoxification by sodium thiosulphate

More than a month ago the ICMR had recom­
mended the administration of sodium thiosulphate
for detoxification of all patients suffering from sym­
ptoms of MIC poisoning. This recommendation was
based on conclusions drawn from a double-blind clini­
cal study. But as yet, there appears to be no strategy
in action with regard to administration of sodium
thiosulphate to the vast majority of affected people.
Only a tiny fraction consisting of the seriously ill are
receiving the injection.

That this is not being done is a reflection of
the indifference of health authorities towards the
health problems of poor women. Moreover MFC
feels that the ICMR study designed to follow up these
women on a long term to assess the percentage of
deformities without informing women about the

MFC emphatically feels that as suggested by
the ICMR, all patients suffering from symptoms of
MIC poisoning should be urgently administered

(Continued on page 8)
5

Scientific Medicine

t^Dear friend. . .

Whenever there is a discussion on the diff­
erent pathies, I am confused by the profusion of
terms to describe the system of medicine that I use
in my practice. Allopathy, western medicine, mod­
ern medicine, and scientific medicine are all terms
used to distinguish our system? of medicine from
the others — ayurveda, siddha, unani, shamanism
and homeopathy. Perhaps this confusion and pro­
fusion of terms comes from muddled thinking.

*
A lot of Medical Representatives visit me in
my small hospital. Brimming with enthusiasm, they
let loose a torrent of words, a mixture of sales-talk
and pharmacology — mostly sincere, not usually
accurate.
One enthusiastic fellow tried to sell me a
new antibiotic ointment containing Fusidic acid. He
showed me pictures of a patient with eczema on the
face, before and after treatment. The “before'’ pic­
ture shows the lips and chin of “a 14-year-old girl
with extensive eczema” The “after” picture shows
the lips and chin of a shaven male^ Either the ad­
vertisement is a fraud or Fusidic acid has strong
androgenic properties.
Another poor Medical Representative gave
me the usual lecture, then left behind a lot of samp’es. Unfortunately the B-Complex capsules, though
manufactured only a month ago, were spoilt.
Now all drugs are bought only after consult­
ation between the Pharmacist, the Administrator
and myself. The B-;—Complex capsules were discar­
ded. The other samples are given freely to deserv­
ing patients. I have removed all drug advertisements
from our hospital, including calendars. But in a pro­
minent spot in the Pharmacy, you will find the
advertisement on Fusidio acid—a constant reminder,
to ths Pharmacist and myself, of the treachery of
drug advertising.
Newton Luiz, Kerala.

The word ‘allopathy’ is outdated and should
never be used‘by us; we should not define our system
of medicine in terms of someone else’s incorrect
perception of our system. Several mfc members
have pointed out that allopathy is a misnomer. The
aim> of most of our treatments is not to produce an
opposite effect to the disease at all. If homeopaths
want to continue to use the word to distinguish their
system from ours, let them- do so.
Western medicine is another . popular term?,
but it is a bit limiting. It fails to distinguish our
medicine from*
1 the 19th century pseudoscience
homeopathy. The practice of unani also originated
in the west. Besides lending an unnecessary foreign
name to our medical system-, it no longer describes
the practice as it exists in India.

The term modern medicine is also used.
Although most of the knowledge used by us is new,
it is not the distinguishing characteristic of this
knowledge. Two hundred years have passed since
digitalis was first used for dropsy. Modern is a
better emotive term than a descriptive one.

*
It was heartening to see such a large number
of people who believe in the social cause at the
^nfc meeting in Bangalore.
I shall like to contribute in mfe’s programmes.
Now a few opinions. During the discussions
on national tuberculosis programme, it became evi­
dent that the home work was not done properiy and
the active members were not prepared sufficiently.
This is a sad thing because I am sure that many of
the participants had come to the meot for getting a
i uideline on which they could work after returning to
their field. However, this promise was not fulfilled.
Secondly, the sessions were too long to be
comfortable. Not only it obstructed the enthusiasm
of participants but also did not allow for a purpose­
ful acquaintance with each other. I feel that for such
an activity as mfc has undertaken, development of
personal communication among various groups are
vital for effective working and spreading the move­
ment. It should be seen that the sessions are not
extended beyond 2—3 pm and remaining time be
left for group interactions. I have learnt a lot during
my talk with groups of participants. Though there
was not much time for this, I can say that they
were more informative than the lengthy sessions of
the mfc on NTP critique. I am sure that participants
would learn more by informal interaction with each
other and provisions should be made to encourage
such activities.
—Arvrnd Jha, Bombay.

The best term to use is scientific medicine.
Th;s contrasts our practice with the traditional sys­
tems of ayurveda, siddha, unani, shamanism; and
even homeopathy.
Scientific medicine includes all aspects of
healing that are proven (by scientific method) to
do more good than harm. This scientific method inr
eludes the powerful experimental tool of the clinical
trial.
The use of steamed, sterile, banana leaves
as dressings for burns is not western, modern, nor
allopathic. It is scientific medicine employing the
scientific principle of antisepsis and proven by clini­
cal trial to do more good than harm. The use of
Rauwdlfia serpentina for. high blood pressure is
also described in ayurvedic practice, but has become
part of our present practice of scientific medicine
only as reserpine has been proven to lower blood
pressure, and treating high blood pressure has been
shown to do more good than harm. Openminded
practitioners of scientific medicine wiB have no
diffculty integrating proven methods from ths tradi­
tional systems into scientific practice.

If we think clearly, perhaps we will begin to
talk more clearly. We will begin to hear less of the
other pathies and will begin to hear more of the most
important pathy in the healing arts — empathy.
Jamie Uhrig •— Mitraniketan
6

Introducing the Third Anthology

Under the Lens — Health and Medicine
Within ten years of its inception, the Medico
Friend Circle (MFC) has become a familiar name
in various circles of development workers." It is in
response to this growing interest in MFC’s analy­
ses of health care, that we venture out to offer yet
another anthology of articles selected from our
monthly Bulletin.
This book does not carry the same degree of
perplexity, which its two predecessors did. For,
amidst the intricate scenario of problems, solutions
and problems arising out of solutions, one discerns
certain well-defined and definite areas of focus.
The focus is at times a bit unsteady and not so
definite as to generate dogma, not yet, we are still
searching for solutions, and have become wise enough
to admit, not the solution.
After the mad rush of critiques, arguments
and counter-arguments, which characterised the ear­
lier two books, particularly the first one, we pau­
sed to take a deep breath. A stage had arrived for
some calm thinking. This was, in a way, reflected in
the narrowing down of areas of focus, and the
near total absence of debate in issues Nos. 56—95
of the MFC Bulletin, which formed the source for
this anthology. This was a period for reflection, re­
assessment and re-structuring of ideas.
Thus, definite areas started to come under
focus. What one sees Under The Lens is not the
total picture, but a few definite foci in it. Moreover,
is not what one sees under the lens, only an image?
But the image helps in understanding the situation,
in arriving at a diagnosis and thus in finding solu­
tions.
We show you in Under The Lens, some of the
pathogens and the pathology: the wrong paths in
health care, traps on seemingly right paths and a
frightening pattern of “no health”. The book con­
tains admissions of self-made mistakes (The other
<side of Health Education, Role of the V H W); the
myths in community health (People’s participation,
community participation in Health Care; Health
For All by 2000 A.D}: the wrong directions on the
national highway of health
(Health (are vs The
Struggle for life; Misuse of Antibiotics; Is BCG
vaccination useful? How successful are supplemen­
tary Feeding Programmes?); the subtle and not so
subtle, pressures of international politics on health
(Research A Method of Colonisation; Multination­
als in Drug Industry).
In line with the earlier two books, the present
one is also a potpourri of different aspects of health
and health care, a reflection of the wide and varied
interests (but always deep) of MFC. It covers com­
munity health (questioning on the way, whether
there is a homogenous community, what is meant
by people and by Health for All), drug policies, clini­
cal medicine,' nutrition, contraception and much
more. There is a heavy emphasis on various aspects
of drug policy and therapeutics. The analyses by
Anant Phadke (Multinational® in Indian Drug

Policy), clearly bring into focus the growing concern
of all genuine thinkers regarding the dangerous and
erroneous drug policies in the Third World.
An orthodox reader may wonder how a Caste
War Among Medicos or Minimum Wages for Agri­
cultural Labourers could ever find a place in a de­
bate on health. This only helps to emphasize MFC’s
main refrain that health is not a medical subject but
a socio-economic topic, and that no true health
worker can isolate himself (or herself) from the
current
socio-cultural
and
politico-economic
forces. This understanding reveals the other side of
the coin too—finances are not the main constraint
in achieving Health care for All (Family Planning
& Problem of Resources; Kerala, A Yardstick for
India).
This book is an attempt to bring under focus
issues which have hitherto been missed or ignored
and to adequately magnify them to put them under
proper perspective. We hope you will welcome it as
enthusiastically as you did its predecessors.
Kamala S. JayaRao.

DRUGS

Consumer Alert - Action
- Welcome
9th April 1983
“Although Clioquinol can severely damage
the nervous system and has injured more people than
any other drug, it is still being sold in about 100
countries around the world.
Ciba-Geigy the biggest producer of Clioquinol
has at last decided to phase it out from- the. world
market within 3 to 5 years. But this exposes larce
populations to unacceptable risks for yet another 3
to 5 years and offers no benefits. We urge all nati­
onal drug regulatory authorities and the World
Health Organisation to ensure that the production
and sale of oral preparations containing Clioquinol
or any Hydroxyquinol ne is stopped now.”
—IOCU seminar on Health, Safety and the
Consumer, Ranzan, Japan.
26th November, 1984»
In October 1982, CIBA-GEIGY had publi­
shed a new policy on control of diarrhoeal diseases.
This policy included the announcement of the world­
wide gradual phasing out in three to five years of
Enterovioform,
Mexaform
and others, drugs
which have been used for the control of diarrhoeal
disease for decades. However, in connection with a
series of SMON- cases in Japan, these drugs
became the object of a public, controversial discu­
ssion concerning drug benefit/risk.
Within keeping of the announced policy,
(Continued on page 8)

7

mfc bulletin: APRIL 1985

RN.2756S/76

Regd. No. L/NP/KRNU/202

(Continued from page 7)
sales of the products concerned have been discontin­
ued since October 1982 in some 90 countries. The
gradual phasing out of these drugs has taken place
with the approval of the National Health Authorities.
The World Health Organization in Geneva was
regularly informed of the present state of develop­
ments.
Today, the method of Oral Rehydration
offers a significant alternative therapy in the con­
trol of Diarrhoeal Diseases—particularly in the field
of Infant Diarrhoeal Diseases. Ciba-Geigy has deci­
ded to account the present concepts and develop­
ments in this field into a new poji'cy, thereby
abandoning the use of Clioquinol—containing and
related drugs. Consequently, Ciba-Geigy will accele­
rate it original policy on controlling diarrhoeal
diseases, whereby the supply of the Anti-Diarrhoal
products will be stopped by the end of the first
quarter of 1985.
Press release by Ciba-Geigy.
30th November 1984.
The President of IOCU, Anwar Fazal, today
welcomed the news that Ciba-Geigy is abandoning
the worldwide supply of its clioquinol containing
and related drugs by the end of March next year.
Clioquinol and related drugs—the group of
hydroxiquinolines — have been proven responsible
for a serious nerve disease “SMON” (subacute—
myelo-optic-neuropathy) which often leaves people
severdLy crippled, blind or both. There have been
more than 10,000 “SMON” victims tin Japan alone
in the late 1960s.
“We hope that this marks the beginning of
a new assertiveness on the part of Ciba-Geigy to
have nothing but the highest ethical standards in the
marketing of its products,” says Anwar Fazal.
The IOCU President added that there is a
clear moral responsibility on all manufacturers of
oral Clioquinol and other hydroxiquinoline contain­
ing drugs to follow Ciba-Geigy’s example and stop
the production and sale of these products without
any further hesitation. ‘"We will insist on thei recall
of such drugs already distributed to retailers and
there is no excuse whatsoever for governments to
allow this drug to be in circulation”.

-* Press release by IOCU

NOTE:— Malaysia has banned this drug. It is how­
ever widely available and used in Indonesia, Thai­
land and India. The two commonest preparations
are Mexaform and Enterovioform.
Editorial Committee :
kamala jayarao
anant phadke
padma prakash
ulhas jaju
dhruv mankad
abhay bang

editor: ravi narayan

mfcf ollow-up in Bhopal
Wanted volunteers for follow-up
action in Bhopal in the month of May.
This will include study of pregnancy
outcome, health education and a com.
munication strategy for doctors and
voluntary agencies. Anybody who
would like to participate/support—con­
tact mfc office immediately.

Placement Available
Required a doctor to serve the rural community
around Madurai in Tamil Nadu. Persons oriented
in community health and preventive health care
activities will be preferred. Monthly emoluments
Rs. 1200.00 (all inclusive) plus free housing.

Interested persons may apply to : The Director
Rural Theological Institute PTC Post Madurai 625022

(Continued from page 5)
possible risks or the advisability of MTP is unethical.
The dangers to pregnancy are well known and poor
women should not be used as guinea pigs in medical
research.

Contraceptive advice to affected couples

Most of the MIC-affected population is still
suffering from symptoms of cyanide—like poisoning
indicating therefore the persistence of the biochemical
changes which have occurred due to MIC poisoning.
It is safer to avoid pregnancies till complete detoxifi­
cation has taken place. Since a large proportion of
the women are suffering from menstrual disorders and
other gynaecological problems, male contraceptives
(Nirodh) should be recommended rather than Copper
T or oral contraceptive pills by the women.
We demand that the health authorities should
give serious and urgent consideration to the issues
raised here.

Views and opinions expressed in the bulletin are those of the authors and not necessarily
of the organisation.
Annual subscription — Inland Rs. 15-00

Foreign ; Sea Mail — US$4 for all countries
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Edited by Ravi Narayan, 326, Vth Main, 1st Block, Koramangala, Bangalore-560034
Printed by Thelma Narayan at Pauline Printing Press, 44, Ulsoor Road, Bangalore-560042
Published by Thelma Narayan for medico friend circle, 326, Vth Main, 1st Block,
Koramangala, Bangalore-560034
Media
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