THE HINDU EDITORIAL : 2 August- 2017
THE HINDU EDITORIAL : 2 August- 2017
Dear Bankersdaily Aspirant,
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i) Breaking addiction
The U.S. Food and Drug Administration has struck panic among tobacco companies by announcing a comprehensive proposal to reduce the amount of nicotine in cigarettes to non-addictive levels. This is aimed at striking at the root of the problem of smokers getting addicted, and being unable to quit the habit. While the proposal is at an early stage and it may take a while before it gets implemented, if at all, it outlines a powerful strategy. Nicotine does not directly cause cancers and other diseases that kill people, but is extremely addictive. By keeping smokers addicted for the long term, nicotine exposes them to nearly 7,000 chemicals, many of them deadly, every time they smoke. Reducing nicotine in cigarettes to non-addictive levels would therefore have multiple benefits — reduce the likelihood of new users (those in the 15-24 age group) getting hooked to cigarettes, increase the chances of habitual smokers being able to quit, and cut smoking-related disease and death burden overall. In the U.S. alone, nearly half a million smoking-related deaths are reported each year. While more studies are required to establish clear causality, a paper published in the New England Journal of Medicine in 2015 showed smokers using reduced nicotine cigarettes lit up fewer cigarettes a day compared with those smoking standard cigarettes. The FDA, however, has no plans to regulate nicotine content in electronic cigarettes and other nicotine-replacement products, which are seen to be alternatives to help smokers quit the habit. A study published a few days ago in the journal BMJ found that a “substantial increase” in e-cigarette use among adult smokers had led to a “significant increase” in the quitting rate among smokers. By making it illegal a year ago to sell e-cigarettes to children, the FDA has effectively addressed the growing concern about children taking to vaping. Yet, the U.S. has much to learn from India on tobacco control measures. While India is yet to prohibit the sale of e-cigarettes to minors, it has followed most of the measures mentioned in the WHO Framework Convention on Tobacco Control guidelines. Unlike the U.S., India banned tobacco advertisements long ago, introduced pictorial warnings (covering 85% of the front and back of packages of tobacco products), and prohibited the use of descriptors such as light, mild and low as well as the sale of flavoured cigarettes. Threatened by the dwindling number of young smokers, there is the possibility that tobacco companies will target developing countries such as India with renewed vigour. While they may pull out all the stops to subvert or dilute tobacco control measures, the government should remain resolute in not losing the gains made in the last few years — the number of tobacco users reduced by more than eight million between 2010 and 2016.
ii) Barriers to well-being
The recent controversy around the health care of Charlie Gard, a terminally-ill 11- month-old baby in the United Kingdom who was finally taken off life support and passed away on July 28, got huge media coverage, polarised public debate and unleashed tense legal battles around complex ethical issues related to the health care of a baby. The infant was born with a serious mitochondrial disorder that led to the wasting of his muscles and brain. There is no definitive treatment and the baby was on life support since last October.
Protecting a child’s interests
His parents wanted to take Charlie to the United States where an experimental therapy of nucleosides would have been attempted, with an estimated 10% chance of benefit. Doctors at Great Ormond Street Hospital in London said that his clinical condition ruled out any benefit and felt it unethical to subject the baby to the turmoil of a “futile” journey. As serial scans showed severe brain damage, they held out no hope of survival and felt that the boy should be allowed to die with dignity. The parents wanted to try out the experimental therapy and repeatedly took the hospital to court. They failed to convince British courts and the European Court of Human Rights which deferred to the hospital’s assessment. The U.S. Congress intervened to grant extraordinary citizenship to Charlie so that he could travel for treatment but the British court did not permit his release from the hospital. Last week, the parents finally gave up after the American expert said that the latest scan ruled out any possible benefit at this stage. The ethical and legal tangles involve questions of what is in the best interest of the baby. Here, the court decided on behalf of the baby after hearing all the parties in an emotionally drenched contest. As expected, public opinion mostly supported the parents while the legal verdict upheld the medical recommendation not to prolong or aggravate the baby’s suffering. The key message that emerged is that society has the final responsibility to protect the child’s interests, however determined.
The monetary angle
Still, there is a strange deviation from this rule when it comes to paying for the treatment of a child with serious conditions such as heart disease or treatable leukaemia. In countries with high levels of treatment coverage under a system of universal health coverage (UHC), this cost is covered in part or full. In many countries it is not, especially when the cost of the procedure is high. The child gets treated only if the parents can afford it or risk bankruptcy to save their child. Is this fair? In countries where social services are very sensitive to child rights, the child is taken away from the parents if the child is abused or even neglected. The responsibility of a civilised society to protect the child is thereby affirmed. How is it then that the neglect of a child’s medical problem is not seen as a failure not just on the part of parental care but of the obligation of society too to protect the vulnerable child? Economists will say that UHC cannot cover all treatments for everybody because resources are finite. They are right. However, how does this stance reconcile with society’s duty to protect the child? Even if complex diseases with limited benefit from treatment are excluded, should not UHC cover conditions that seriously affect the health and the wellbeing of the child but have treatments available that add many years of functional life? What about funding for improving the functionality of children with disabilities? While allocating resources in the health sector, economists also prioritise public good over private good. Immunisation programmes, for example, protect persons from infectious diseases which can spread across a population and are, therefore, regarded as a public good. Personal health care is regarded as a private good. In case of children, where society assumes a caring custodial responsibility, how does this distinction hold? In the Indian context, costly treatments that can provide high returns of longevity and functionality for children are obtained through sporadic philanthropy or limited coverage social insurance schemes funded by the government. These do not remove the barriers of access and affordability. It is time health professionals, policy makers, economists, ethicists, legal experts, parent representatives and community leaders are brought together to decide by consensus on the dimensions and delivery pathways of societal responsibility for child health care.
Meaning: Including or dealing with all or nearly all elements or aspects of something.
Example: A comprehensive list of sources.
Meaning: A word or expression used to describe or identify something.
Example: The descriptor words themselves appeared one or more times within a particular obituary or across different obituaries.
Meaning: Diminish gradually in size, amount, or strength.
Example: Traffic has dwindled to a trickle.
Synonyms: Diminish, Decrease
Antonyms: Increase, Flourish
Meaning: Admirably purposeful, determined, and unwavering.
Example: He was resolute in his fight to uphold liberal values.
Synonyms: Determined, Purposeful
Antonyms: Irresolute, Half-hearted
Meaning: Cause (a strong or violent force) to be released or become unrestrained.
Example: The failure of the talks could unleash more fighting.
Synonyms: Release, Free
Meaning: A state of great disturbance, confusion, or uncertainty.
Example: The country was in turmoil.
Synonyms: Confusion, Turbulence
Antonyms: Calm, Peace
Meaning: Incapable of producing any useful result; pointless.
Example: A futile attempt to keep fans from mounting the stage.
Synonyms: Fruitless, Vain
Antonyms: Useful, Fruitful
Meaning: Put off (an action or event) to a later time; postpone.
Example: They deferred the decision until February.
Synonyms: Postpone, Put-off
Meaning: The action of assessing someone or something.
Example: The assessment of educational needs.
Synonyms: Evaluation, Judgement
Meaning: (of an event or circumstance) occur as a delay or obstacle to something being done; Take part in something so as to prevent or alter a result or course of events.
Example: He acted outside his authority when he intervened in the dispute.
Synonyms: Intercede, Occur
Meaning: A confused mass of something twisted together; Become involved in a conflict or fight with.
Example: They usually come a cropper when they tangle with the heavy mobs.
Synonyms: Snarl, Mass, Entangle
Meaning: Cover (something) liberally or thoroughly.
Example: Cool patios drenched in flowers.
Meaning: Make (a problem, injury, or offence) worse or more serious; annoy or exasperate.
Example: Military action would only aggravate the situation.
Meaning: Bring (a place or people) to a stage of social development considered to be more advanced.
Example: A civilized society.
Synonyms: Enlighten, Edify
Meaning: An act or course of action to which a person is morally or legally bound; a duty or commitment.
Example: I have an obligation to look after her.
Synonyms: Duty, Commitment
Meaning: Make or show to be compatible.
Example: The agreement had to be reconciled with the city’s new international relations policy.
Synonyms: Make compatible
Meaning: Excellence that sets someone or something apart from others.
Example: A novelist of distinction
Synonyms: Importance, Significance
Meaning: Occurring at irregular intervals or only in a few places; scattered or isolated.
Example: Sporadic fighting broke out.
Synonyms: Occasional, Infrequent
Antonyms: Frequent, Regular
Meaning: An expert in economics.
Example: The bull market in bonds in a deflation is completely ignored by mainstream economists.
Meaning: A general agreement.
Example: There is a growing consensus that the current regime has failed.
Synonyms: Agreement, Harmony