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Hepatitis and the Thousand Dollar Pill

Amit Sengupta 17th September 2014 Capital’s greed to maximize profits respects very few boundaries. If the pharmaceutical industry were to be used as an example, it would seem that greed that is predicated on the helplessness of the sick and the ailing knows no bounds at all. Recent evidence for this comes from the marketing of a drug, called Sovaldi, by the US based company, Gilead. Sovaldi has quickly gained notoriety for being the ‘1,000 dollar pill’. New Treatment option for Hepatitis C Gilead commenced marketing of Sovaldi in 2013, and its sales in the first quarter of 2014 had already touched $3.48 billion. Many predict that the annual sale of Sovaldi will outstrip that of the biggest block-buster drug ever – Pfizer’s Liptor (generic name Atorvastatin -- a drug to reduce lipid levels in blood), whose sales touched $12.9 billion in 2006. Or, to put it in another way, at an equivalent of approximately Rs.78,000 crores, the projected sales of Sovaldi in 2014 would be more than the entire domestic market for medicines in India! Sovaldi (generic name: Sofosbuvir) is one of a new class of drugs that have been launched recently as treatment for Hepatitis C. Called ‘Directly Acting Antivirals’ (DAA), these drugs have the potential to radically change the lives of patients suffering from Hepatitis C. Image Courtesy: wikipedia.org Till recently not much was known about the Hepatitis C virus. It was discovered in the 1970s, as a viral infection that causes liver damage, that was distinct from the known viruses that cause liver infections – namely Hepatitis A and Hepatitis B. The disease was, thus, tentatively named as ‘non A non-B hepatitis’. It was only in 1989 that the causative virus was isolated and the disease was named as Hepatitis C. The conventional treatment for Hepatitis C revolved around a drug called ‘pegylated interferon’ (or peg-interferon), a drug that acts on the immune system of the body. Treatment of Hepatitis C with peg-interferon has many drawbacks. The drug itself is expensive and overall success rates are about 50%. Because the drug modifies the body’s immune response, treatment regimens involving the use of peg-interferon exposes the body to serious infections, some of which can be life threatening. Also, because of its effect on the immune system, peg-interferon cannot be used on those who are already very sick – thus ruling out treatment for those Hepatitis C patients who are the worst affected. The new DAAs do not share many of the negative aspects of peg-interferon treatment and can be used on almost all stages of Hepatitis C treatment, though evidence of efficacy in patients with frank liver failure is still not conclusive. Importantly, cure rates are in excess of 90% and may touch almost 100% when two DAAs are combined. Typically treatment duration is 12-24 weeks depending on the type of Hepatitis C infection. Depending on the genetic makeup of the virus, there are 6 distinct (but related) types (called ‘genotypes’) of the Hepatitis C virus. Gilead’s 1,000 dollar pill targets a huge market. As awareness regarding Hepatitis C has grown, so has information about the prevalence of the infection. However most figures are still crude estimates, as hard data would require large cross sections of the population would need to be tested. However even the crude estimates are frightening. Globally, an estimated 160-180 million people harbour the Hepatitis C virus and many of them will eventually die of the infection. This means that, globally, the number of Hepatitis C patients is five times that of those infected by HIV/AIDS. Each year about half a million people succumb to Hepatitis C infection and Hepatitis C is the single largest cause of patients requiring a liver transplant – in itself an expensive procedure, available in very few centres in developing countries such as India. In India there are about 12-18 million people who are infected by the virus and about a 100,000 are estimated to die each year because of the infection. Some countries have extremely high rates of Hepatitis C infection, with Egypt reporting that 14-22% of its population is infected. The following Table provides information about Hepatitis C prevalence in the countries with maximum disease load. Symptoms and Transmission of Hepatitis C The difficulty in estimating the real extent of prevalence is related to the peculiar way in which the Hepatitis C virus works in the human body. Hepatitis C infections vary in their effects on different people. A person infected by Hepatitis C may not show any symptoms at all, but 20% will show symptoms. These appear 2 weeks to 6 months after the initial infection. The acute symptoms are similar to those seen in other forms of hepatitis (A or B), and include fever, nausea, vomiting, dark colouration of urine and jaundice (yellow discoloration of skin). These symptoms are seldom life threatening and resolve over a few weeks. However, irrespective of whether or not there are acute symptoms, 15-45% of those infected are able to fight off the initial infection and get rid of the virus from the body. The rest become chronic carriers of the virus. While all chronic carriers are capable of infecting others (if their blood gets mixed with that of another person), only a portion of them will show signs of liver damage later in life. The damage caused to the liver progresses slowly, and some may exhibit symptoms 2 decades after they were initially affected. Those who die of the disease usually succumb because of liver failure. Hepatitis C infections are transmitted through blood and blood products and sometimes through other body fluids. This is a characteristic that Hepatitis C infections share with another form of hepatitis, called Hepatitis B. However in the latter case most people who are infected exhibit acute symptoms and serious adverse events (including death) occur as a result of the acute disease. The most common pathways for the transmission of Hepatitis C are: use of unsterilized surgical (including in dental practice) equipment, needles and syringes; blood transfusion with infected blood; and among injecting drug users who share needles. Less common methods of transmission include transmission to infants from infected mothers, and through sexual contact. Being a blood borne infection, Hepatitis C cannot be spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person. All patients who are infected will develop antibodies (the body’s immune response) to the virus, including those who eventually get rid of the virus on their own. These antibodies persist in the body and the screening test for Hepatitis C tests for their presence. A positive test indicates that the person has been infected at some point by Hepatitis C but does not prove that the person is still infected. A second test, which tests for a particular compound (a nucleic acid) that is part of the Hepatitis C virus, is needed to confirm that the person continues to harbor the infection. New Hope for Hepatitis C patients Clearly, Hepatitis C is a complex disease with a variable course and requires fairly advanced facilities for detection. This is the reason why only rough estimates are available regarding the prevalence of the disease. Because of the difficulties in diagnosis and the expense involved in treatment, even in developed countries most Hepatitis C patients do not receive treatment. Treatment rates vary from about 21% of those affected in the United States, to 3.5% in Europe, to a small fraction of a percent in developing countries. However, two things have changed: the new drugs are much more effective, approaching a cure rate of 100%; and more recent estimates indicate that the disease burden from hepatitis C is much higher than earlier estimates. Further, the availability of the new drugs (a handful of these – apart from Sofosbuvir -- are available, though most currently recommended treatment regimens include Sofosbuvir in combination with another drug) now makes it theoretically possible to eradicate Hepatitis C across the globe. But for that to happen the new class of drugs must be accessible to all patients of Hepatitis C. Which brings us back to the story of the 1,000 dollar pill. So why is Sofosbuvir so expensive? There is nothing in the drug itself that should make Sofosbuvir expensive to manufacture. In a recently published paper by Andrew Hill an others, titled “Minimum Costs for Producing Hepatitis C Direct-Acting Antivirals for Use in Large-Scale Treatment Access Programs in Developing Countries”, the authors estimated that the total treatment cost over 12 weeks with Sofosbuvir should be in the range of $68-$136. The authors base their estimates on manufacturing costs, after factoring in a fair profit margin. So, with a fair profit included, a tablet of Sofosbuvir should cost one dollar and not a thousand dollars! Does the reason for the high price of Sofosbuvir lie in high research costs? Even this is not true, as Sofosbuvir is not an original research product of Gilead. Sofosbuvir was developed in a small company – Pharmassett, and Gilead spent $11 billion to acquire the company in 2011. It was a purely commercial decision by Gilead, not based on the actual cost of developing the drug and entirely unrelated to its manufacturing cost. Gilead will have recouped more than what it had spent to acquire Pharmassett by the end of 2014, and is poised to make billions of dollars of profit through future sales. Will India Respond to the Hepatitis C crisis? Patients of Hepatitis C from across the world are hoping that Indian generic companies will provide them a lifeline by manufacturing and exporting low cost generic versions of Sofosbuvir. These expectations are based on the role that Indian generics played in making HIV/AIDS drugs accessible at affordable prices at the beginning of the 21st Century. The entry of Indian generics in the global market saw the cost of HIV drugs plummet from $10,000 for a year’s treatment, to $350 and progressively to less than $100. Indian generics made HIV/AIDS drugs accessible in low and middle income countries, thus saving millions of lives. Can the same happen in the case of Sofosbuvir? Unfortunately 2014 is not 2001 (when Cipla launched anti HIV/AIDS drugs for the first time, and other Indian companies were soon to follow suit). The patent on Sofosbuvir has been challenged in India, and there is a good chance that it will be rejected. This would theoretically allow Indian companies to manufacture Sofosbuvir at a small fraction of its current $1,000 per pill price. But Indian generic companies are loath to confront giant American and European companies, unlike in 2001. A range of changes in public policy (including the amendment of the Indian Patent Act in 2005 as a consequence of India having become a party to the WTO agreement in 1994) have drastically reduced the bargaining power of Indian generic companies. There are reports that several prominent Indian companies are in discussion with Gilead to enter into collaborative arrangements. Gilead could license Sofosbuvir to a handful of Indian companies, but there would be severe restrictions on exports and the price reduction would be nowhere near what could happen if Indian companies were to have acted independently, without any licensing arrangement with Gilead. Another barrier to a quick launch of generic versions of Sofosbuvir is the requirement to conduct clinical trials on the drug in India, which has been imposed by the Indian drug regulatory agencies. While India’s Drugs and Cosmetics Act allows a waiver on the requirement to do clinical trials when a new drug is introduced, if clear evidence is already available regarding the safety and efficacy of the drug, this waiver is not being applied any longer. This change in practice relates to a parliamentary committee report which had indicted the CDSCO (Central Drug Standard Control Organization) of corrupt practices while allowing new drugs to be launched. None of these barriers are insurmountable if the Government were to intervene. The requirement to do clinical trials (and thus delay the entry of the drug) can be waived by the Government as the relevant provisions already exist in the Indian Drugs and Cosmetics Act. The government can also expedite the rejection of Gilead’s patent application. It can also wean away Indian generic cos. from entering into a collaboration with Gilead, by drawing up a collective plan to make available Sofosbuvir to Indian patients through the public health system and to export it to developing countries. An opportunity beckons again for India to reinforce its role as the prime supplier of low cost life saving drugs to poor patients across the globe. Unfortunately the government appears to lack even the vision to start acting along these lines.

Science, history and mythology: Hindutva discovery of ancient India

…D.Raghunandan Delhi Science Forum & President, All India Peoples Science Network (raghunandan.d@gmail.com) A special symposium on science and technology (S&T) in ancient India as gleaned through Sanskrit texts was organized as a side event at the 102nd Indian Science Congress held in Mumbai in January 2015. The symposium itself, with an obvious Hindutva agenda, and the claims made there, generated headlines both nationally and globally as the organizers may have hoped, but for very different reasons. Far from highlighting important contributions in ancient India, or uncovering hitherto unknown facts, the symposium presentations proffered fantastic claims showing a complete inability or disinclination to distinguish between science and history on the one hand and mythology and sophistry on the other. According to numerous press reports that were not contradicted, and reports of press conferences addressed by paper presenters and symposium organizers (copies of papers were not made available), one presentation claimed that ancient India possessed advanced aviation technology as far back as 7000 BC, including huge 40-engined aircraft that could even undertake inter-planetary travel. In response to subsequent objections that this was simply impossible, the presenter said, “Modern science is not scientific.” Another presentation claimed that futuristic surgical techniques are recorded in the Susruta samhita “not later than 1500 BC,” and have also been mentioned in the Rig Veda “considered as first text of universe (sic), created not later than 6000 BC.” All this came after several other such claims were made by Hindutva proponents on previous occasions (see http://www.firstpost.com/politics/plastic-surgery-to-ivf-things-bjp-sayshum-indiawaale-had-before-the-world-did-1833759.html for a listing of many such hindutva claims). In his now notorious speech at a hospital function in Mumbai, Prime Minister Narendra Modi himself said ancient India knew advanced plastic surgery techniques as could be seen from the god Ganesha having an elephant’s head attached to a human body, and also knowledge of in vitro fertilization since, in the Mahabharata, Kunti had given birth to Karna outside the womb. A storm of criticism in the media and from scientists in India (mostly anonymous) and abroad to these and other claims, objected to unscientific statements, mixing of history and mythology, and assertions being made without proper evidence, the cornerstone of the scientific method and of the Indian Science Congress itself. Anyone who thought the criticism would have embarrassed Hindutva proponents was quickly proved wrong. And to show that these were not stray comments by “fringe elements,” a string of unapologetic comments followed by Union Government Ministers and leading lights of various Sangh Parivar affiliates, directly or indirectly defending the views expressed at the symposium, or making additional assertions along the same lines, revealing a determined effort to reinforce what was evidently an ideological campaign. Former Minister in the Vajpayee-led NDA government and present Governor of Uttar Pradesh, Mr.Ram Naik, in his valedictory address to the Congress, felt the need to stress that ancient India had made huge strides in sciences like medicine, astronomy, mathematics and astrology (emphasis added), and that he “pitied those who are ashamed of our history,” which none of the critics had said they were. Former BJP President and now Home Minister and No.2 in the Cabinet Rajnath Singh said after the Congress that local pundits or astrologists should be consulted rather than NASA scientists for astronomical predictions on eclipses and such, making one wonder if the government would so advise ISRO for the next launch to the Moon or to Mars! The above developments make clear that this was a resolute attempt by Hindutva proponents to put forward a specific point of view. It is argued here that taken together, these different claims and assertions amount to a cohesive set of formulations which, for want of a better term, may be termed the Hindutva narrative on science in ancient India. It is also perhaps a harbinger of a determined ideological campaign of considerable significance for contemporary intellectual and political discourse in India. The present essay seeks to unpack this narrative and examine its implications. Concerted Hindutva narrative Several distinct yet interconnected propositions are discernible in this narrative. First is the claim to antiquity, the idea that Vedic (or Sanskritic) Hindu civilization and its later evolutionary manifestations, seen as congruent Indian civilization, is the oldest civilization in the world, that knowledge of science and technology here pre-dated and was far in advance of that in other civilizations, and that key breakthroughs in these fields were achieved here much before their appearance elsewhere. Second, as this antiquity itself shows, knowledge creation in ancient India was a purely indigenous process and other civilizations borrowed knowledge from India, often without acknowledgement, thus establishing the inherent superiority of Hindu civilization compared to all others. Third, that India would have retained this superiority had it not been for loot and suppression by alien cultures with other faiths, but can reclaim its greatness now by regaining and reasserting Hindu cultural supremacy. Fourth, that modern historical and general intellectual understanding in India and elsewhere with regard to science and technology in ancient India is a distorted, pro-Western and secularized creation, which has underplayed and deliberately belittled Vedic Hindu civilization’s contributions to science, and which has been propagated particularly in India by a westernized, mainly Leftist, elite who have internalized the colonial mindset. Hence, evidence advanced to contradict Hindutva claims on science in ancient India is intrinsically suspect and reflect precisely those anti-biases that the Hindutva narrative seeks to overcome. The latter two propositions are often presented as sub-texts, and their fullthroated articulation in the form of a campaign is probably yet to come. It is argued in this essay that the claims and evidence advanced in support of each of these propositions violate accepted disciplinary principles and practices in both history and science. It is further argued that, while some of this could be attributed to naivety or ignorance of these disciplines and of earlier work done in them, the cohesive messaging and assertiveness of the Hindutva narrative suggest that Hindutva forces believe, and will sooner or later explicitly and concretely insist, that these propositions are true regardless of any evidence to the contrary, all such evidence being presumed to be a product of the very biases which are sought to be countered by the Hindu nationalist narrative. Nature of evidence Let us first examine the nature of the evidence adduced as basis for these claims and assertions. The paper on aviation in ancient India presented at the Mumbai Congress by one Captain Anand J. Bordas, said to be a retired principal of a pilot training facility, may be taken as an illustrative case. Capt. Bordas’ passion for proclaiming the superiority of ancient Hindu civilization clearly exceeded his knowledge of both aeronautics and historiography. According to Capt Bordas, the claims about aircraft in the Vedic period were based on Sanskrit texts by the sage Bharadwaja, the putative progenitor of the gotra or clan by that name, “at least 7000 years ago.” The text in question, “Vymanika Prakaranam,” turns out to be one familiar to Indian scholars. It was seriously studied for over a year in 1974 by a team of scientists, engineers and Sanskrit scholars including renowned aerospace engineer Prof.H.S.Mukunda of the Indian Institute of Science, Bengaluru. The IISc study found that the text in Sanskrit and its translation into English authored by one G.R.Josyer, published around 1920, was written in contemporary rather than Vedic-period Sanskrit. As stated by Josyer in the book, the Sanskrit verses themselves had been dictated by one Subbaraya Shastry, who was given to similar flashes of inspiration, who had claimed in turn that they had been “revealed” to him by Sage Bharadwaja. After scrutiny of the different descriptions and drawings in the book, the IISc team concluded that the text showed “complete lack of understanding of the dynamics of the flight of heavier‐ than‐air craft,” defied all principles of aerodynamics, and “none of the planes [described or drawn] has properties or capabilities of being flown.” (Report of this IISc study is available with its authors) Captain Bordas basing his entire presentation on a single text stated to be a “revelation,” whose provenance itself is suspect or at least indeterminate, and which was not assessed critically, is a fatal flaw. To be taken seriously, historiography demands not only textual references, that too from multiple authenticated sources, but also requires support from other kinds of evidence such as artifacts, archeological finds and so on. In as complex a subject as aviation, there should surely also be some evidence from the period in question of knowledge and practices in aerodynamics, materials, manufacturing techniques and so on. The Hindutva champions, however, appear not to have any conception of, or to care much about, what constitutes acceptable evidence or how to assess evidentiary value. Hence the leap from the imaginative notion of god Ganesha having an elephant’s head to the inference that this “proves” knowledge of advanced cosmetic surgery in ancient India, and the leap from the legend of Karna’s immaculate conception or the birth of the Kauravas from parts of Kunti’s discarded womb to the conclusion that ancient India “must have known” of in vitro fertilization or stem-cell research. Half and half making one-and-a-half which is said to be four! Stories of immaculate conception abound in myths and legends across civilizations, and mythical half-man half-beasts too are very common in other ancient civilizations, for instance the Minotaur (head of a bull on body of a man), the Centaur (human face and neck, horse’s body), the Chimera (with a lion’s head and body, a goats head arising from the torso, and a snake for a tail). Did all these civilizations too have knowledge of cosmetic surgery? Was in vitro fertilization a universally known technique? The issue of antiquity When challenged thus, the Hindutva narrative skirts the question by asserting that whatever other civilizations may have known, India knew it first, among other reasons (such as the outstanding brilliance and far-sightedness of the ancient Hindus) because ancient Vedic civilization is the oldest in the world. The claim to antiquity of the Hindu civilization is in turn based on a far earlier date being ascribed to Vedic-Sanskritic texts without substantiation, and sometimes to taking literally the periodization claimed within the great epics, myths or legends, even while refuting the dating arrived at by historians. In the papers presented at the Congress, as well as in numerous other articles, books and Hindutva literature, the period 6,000-7,000 BC is frequently cited, in turn based on the Rig Veda or other text being ascribed to such a historical period. The dating of the Sushruta Samhita to “around 1500 BC” by the ayurvedic physician Dr.Sawant at the symposium, while most authorities put it at around 500-600 BC, also has no reasoning other than mere assertion. Most academic historians date the Rig Veda to roughly 1,200-2,000 BCE, which Hindutva proponents simply abhor, with Prof.Romila Thapar being their bête noir in this regard. Hindutva arguments in favour of dates several thousand years earlier, are mostly founded on suppositions and assertions, circular arguments such as dating Rama’s or Krishna’s time periods based astrological references in relevant epic literature, deducing a very early date from these, often taking literally a yuga-based age, and thus “showing” that the Rig Veda “could not possibly have been later” than this date and hence “must be” several thousand years before that! (Just google “Rig Veda date Romila Thapar” and see the Hindutva websites and blogs tumble out, full of assertions and vituperation against her and anybody else with a differing viewpoint!) It is way beyond the scope of this essay to delve into the dating question more thoroughly. Suffice it to say that the real issue is not the date itself but what methods are used to arrive at one, what evidence is used and whether this stands up to scrutiny according to accepted historiography. Let us turn our attention to the motivation for insisting on maximum antiquity for Vedic-Sanskritic Hinduism, particularly as gleaned through Sanskrit texts, and especially as regards science and technology and knowledge creation in general. Three major promptings may be identified and are briefly discussed here. Firstly, there is the familiar Hindutva project to galvanize “Hindu pride,” overcome past “humiliations” in the form of conquests or subjugation by outsiders of different faiths, and re-build confidence for the future, by projecting Vedic Hinduism as the most ancient, advanced and knowledgeable of all civilizations. But this Hindutva endeavour itself is not a new one, and harks back more than a century and a half to the early stages of the national movement in India against colonialism. These early efforts by intellectuals in India, and by several abroad, aimed to uncover and translate into European languages ancient Indian, mostly Sanskrit, texts in philosophy, metaphysics and the sciences so as to showcase the greatness of Indian civilization. Rediscovering ancient Indian knowledge and capabilities had an important role in the struggle against colonialism. (Franz Fanon’s brilliant essay ‘On National Culture’ in The Wretched of the Earth eloquently discusses this, and its pitfalls.) However, as so often happens in the midst of such revivalist fervour in India, there was also much myth-making, pseudo-history and “unearthing” of a mythical golden past with a common thread of placing all these events in an improbably ancient past. So pervasive and noticeable was this phenomenon that sociologists even coined a term for it: “ancientization”! Secondly, in the Hindutva version, this traditionalism is not just about nostalgia and projecting a past with great achievements, but also about promoting uncritical acceptance of the Hindutva version of Indian history. In the Hindutva narrative, most historians come with euro-centric baggage if they are Western or are “Macaulay putra,” sons of Macaulay. You don’t need evidence because we say it was so. Remember the debate on the historicity of the Ram Temple in Ayodhya? It is our faith that Rama was born at this very spot, therefore it MUST be so. Are the Hindutva forces heading in the same direction regarding science in ancient India? Is scientific evidence considered irrelevant in the face of belief, just as historical evidence is? Vedic-Sanskritic Exclusivity Thirdly, a little noticed aspect of the emphasis on Sanskrit texts. The obvious motivation here is that Sanskrit texts from ancient India would almost exclusively focus on Vedic or early Hinduism, not allowing any scope for distractions about what Indian thinkers learned from Greeks, Romans, Arabs, Persians and from Central Asia or China in the late ancient or medieval periods. The Hindutva narrative has no place for composite culture or even for cultural exchanges. And it speaks of Indian contributions to what was even in ancient times a global knowledge creation process, with all cultures learning from each other, as if others had stolen Indian knowledge as Dr.Harsh Vardhan alleged with regard to Algebra. Al Khwarizmi himself, who brought algebra to world attention and who is therefore often mistakenly credited with the innovation, generously acknowledged the Indian primacy. Similarly, the Arabic translation around 800 AD of the Sushruta Samhita is named Kitab-i-susrud. The exclusive attention paid to Sanskrit texts also completely ignores writings in Pali and Prakrit in ancient India, thus excluding epistemological and methodological streams from Jaina and Buddhist traditions. Reputed mathematics scholars and historians (see for instance S.G.Dani {Prof at TIFR, Mumbai}, “Ancient Indian mathematics: a conspectus,” available at http://www.ias.ac.in/resonance/Volumes/17/03/0236-0246.pdf and “Mathematics in India: 500 BCE-1800 CE” by Kim Plokfer, Princeton University Press, 2009; a highly instructive extract is available at http://press.princeton.edu/titles/8835.html) have argued that this would mean leaving out of consideration important knowledge and mathematical traditions since Jaina and Buddhist scholarship had several concerns that were significantly different from those of the Vedic Brahmins, such as a lack of interest in if not antipathy towards ritual performances which were major promptings for so much of Vedic mathematics. Whether deliberate or stemming from ignorance, this certainly echoes the insularity and arrogance of the eurocentrism that Hindutva forces love to decry. Of course, Hindutva proponents are fully capable of turning around and arguing that Buddhism and Jainism are after all part of the larger Hindu family, that all indigenous faiths are but Hinduism in different forms, never mind the bitter doctrinaire disputes and sometimes bloody rivalry between supporters of these different religions. Science in ancient India not unknown One of the key organizers of the special symposium at the Science Congress, Dr.Gauri Mahulikar of the Sanskrit Department, Mumbai University, which also vetted all the papers presented, stated that "so far, Sanskrit is essentially considered a language of religion and philosophy, but the fact is that it also talks about science including physics, chemistry, geography, geometry etc. There is a lot of scientific information available in these texts and historical documents that we want to explore." (Times of India, 3 Jan 2015). This strand of the Hindutva narrative that contributions of ancient India to science were totally suppressed or unknown until Hindutva proponents “discovered” them is bizarre. Like Columbus “discovering” America with numerous indigenous peoples already inhabiting it! One may just forgive Hindutva activists who perhaps learned everything on this subject only from shakhas or in books written by one of their own mentors. But surely those engaged in supposedly scholarly work, and eminent leaders, Ministers no less, should be more aware of, and at least not deny, the extensive work done by scholars in India and abroad on science in ancient India. This work, especially from the second half of the 20th century onwards, has been based on carefully evaluated evidence of different kinds from multiple sources, including texts in Sanskrit and other classical Indian languages, both in original and in translations in Arabic, Latin or other languages. The assiduous research reflected in the exhaustive work by D.D.Kosambi, D.P.Chattopadhyaya, J.D.Bernal, Joseph Needham (incidentally all Marxist scholars) and numerous others are too well known to need repetition. The first thing expected from serious scholars is a study of extant literature on the subject, and to begin where others have left off. To claim originality where none exists is the worst kind of academic and intellectual dishonesty. Is this the kind of thinking or scholarship that Hindutva leaders want to encourage? Or an example they wish to set for the country, especially the youth? If the Hindutva goal were simply to highlight achievements in ancient India, there is no shortage of real, pioneering knowledge creation, such as the orbital motion of the planets relative to the sun, the inclination of the earth’s axis, the place value system, early estimations of the value of π, the decimal system including the zero, algebra and different aspects of trigonometry and early forms of calculus, advances in medicine, metallurgy and so on. When all these exist and can be proudly proclaimed, regardless of childish me-first games which beyond a point do not further the understanding of either history or science, what is the need for Hindutva votaries to search for and assert fictitious or imaginary claims? Such fantastic claims only serve to devalue real achievements by reflecting scepticism from the former to the latter. Far from adding to the glory of Indian civilization, Hindutva advocates are embarrassing the nation and doing a huge disservice to its great contributions to science in ancient times and to the work Indian scientists are doing today. A couple of important aspects may be touched upon in conclusion. The very act of organizing the symposium at the 102nd Indian Science Congress portends bad days ahead for science in India. It shows that, contrary to the forward-looking development-oriented outlook that they proclaim, Hindutva forces do not mind causing immense damage to knowledge creation and to major scientific institutions in pursuit of their real ideological agenda. Truly worrying too is the silence of the Congress organizers, of scientists present there, and of premier scientific bodies, on this abuse of the Science Congress and the misuse of governmental power to impose this regressive agenda. People in India, especially the poor in rural and forest areas, have in the past few decades become resentful of various developmental programmes or projects that have adverse impacts on their lives, such as large dams, nuclear power plants, GM crops and foods, pesticides and other hazardous chemicals. People have also become deeply suspicious of what they regard as “sarkari (official) scientists” who are fielded by government to defend such projects and claim they pose no dangers, even when evidence and the opinion of other experts strongly indicate the opposite. This is leading to mounting distrust of science itself. The symposium at the Science Congress, the litany of unscientific comments by Ministers and other Hindutva leaders, and the mute response of establishment scientists towards these developments only add to the growing perception that scientists owe less allegiance to unbiased evidence-based findings and work than to tailoring their opinions according to the wishes of their political masters and kow-towing to them. The key point at issue about science in ancient India is not whether the Hindutva proponents are right or not about this or that claim. Such questions are not difficult to study and to answer, provided one follows well-known scientific procedures for conducting research, testing a hypothesis or floating one, and arriving at conclusions. Science and history are serious subjects, calling for rigour, openness, scrutiny by peers, and finally acceptance, rejection or modification of hypotheses. Mythologies are not the same as history, and can never have the same ontological status as science. In fact, one should not expect them to. Anthropologists have long argued that mythologies have a different social function, and their significance is not to be assessed by their historical “truth” value. Finally, the battle underway is not just science versus mythology, false claims against historical fact, but a battle for academic and intellectual rigour, for the method of science and of historiography, and ultimately for a scientific attitude and critical questioning, as against blind acceptance of authority whoever that may be or howsoever exalted. That last is the authoritarian road, which leads to a very bleak future, however glorious our past. 

AMIT SEN --CHILD MALNUTRITION IN GUJRAT

Suppression of Child Malnutrition Survey Data to Shield Gujarat

Amit Sengupta 15th July, 2015 Mired by controversies and scandals, the NDA Government has now secured another rare achievement. Recent disclosures, first reported in the ‘Economist’ magazine, indicate that the government has taken great pains to suppress a survey on child health, conducted by the UNICEF, in collaboration with the Government of India. The Rapid Survey on Children (RSOC) was commissioned by the UPA Government and covers the period between 2013 and 2014. Normally the survey data should have been seen as an important tool for decision making, given that this was the first nationwide survey on child nutrition conducted in almost a decade. The last source of data on child nutrition has been the National Family Health Survey (NFHS) conducted in 2005. What makes the suppression of the survey data particularly intriguing is that, overall, it conveys good news and projects a significant drop in child malnutrition rates in India over the past decade. Yet, the Economist magazine recently reported that the data was never made public though the final survey report was available in October 2014. Image Courtesy: flickr.com UNICEF survey finds drop in child malnutrition The overall findings of the survey indicate a significant drop in child malnutrition rates in the country in the past decade. Table: Reduction in Child Malnutrition Indicators Source: Data from NHFS, 2005, and RSOC as reported by the Economist The drop in the rate of stunting, wasting and underweight of 9, 5 and 14 percent points is significantly more than the decrease between NHFS 2 in 1998-99 and NHFS in 2005-6. In the latter case rates of stunting and underweight decreased by 6 and 3 percent points respectively between 1998 and 2005, while the rate of wasting actually increased by 3 percent points in the same period. A caveat may be kept in mind, however, while comparing NHFS data and data from the RSOC. The two use different population sets and perhaps different methodologies and are not entirely comparable. Nevertheless the fairly large reduction indicated in the RSOC data over the past decade, in all probability, suggest a real reduction of malnutrition rates. While all the three indicators – stunting, wasting and underweight – are measures of malnutrition in children, they provide different insights into the causes. The WHO suggests (Country Profile Indicators, Interpretation Guide, WHO) that the percentage of children with a low height for age (stunting) reflects the cumulative effects of under-nutrition and infections since and even before birth (thus including malnutrition in the mother). This measure can therefore be interpreted as an indication of poor environmental conditions or long-term restriction of a child's growth potential. The percentage of children who have low weight for age (underweight) can reflect ‘wasting’ (i.e. low weight for height), indicating acute weight loss, ‘stunting’, or both. Thus, 'underweight' is a composite indicator of both stunting and wasting. Stunting is a better indicator of chronic under-nutrition and wasting of malnutrition due to recent causes, viz. recent food deprivation or serious illness. India still one of the poorest performing countries The RSOC report is indeed good news and we must have done some things right in the past decade for this to have happened. However a generous dose of caution is warranted before we start celebrating. Even if we accept the improved data, India still remains one of the poorest performing countries in the world as regards child nutrition. Further, poor performance in child nutrition is also an indication of broader systemic failures – including failure to provide adequate healthcare and other public health services, failure in provision of safe drinking water and sanitation facilities, failure of our agrarian policy, and failure to control and eradicate poverty. We have failed as a society if we are not able to feed our children and nothing else that we do can condone this neglect. The continuing gravity of the situation can be understood if we compare the level of stunting among children in India (even after accepting the RSOC data) with levels reported in the poorest region of the world – Sub-Saharan Africa. If India were a nation in the Sub-Saharan region of Africa, the rate of stunting in India (39%) would be higher than the average for the region in 2013 (38%). The following Table provides a comparison of the rate of stunting in Indian children with those in all Sub-Saharan countries with a population of over 15 million. Source: UNESCO, Education For All Global Monitoring Report, Sub-Saharan Africa: Overview, 2015 As we can see from the Table, India performs worse than 11 countries in the region and better than only 8 countries. This, in spite of India’s per capita wealth being 2-5 times that of most countries in the region (except South Africa and Angola). Clearly celebrations would be premature, especially for a country which claims to be one of the “emerging economies” of the world and projected to be (many would say through fraudulent data manipulation) the fastest growing economy in the world. Yet, the stark fact is, we are worse off as regards how well we are able to feed our children, than most of the poorest countries of the world. Left influence and welfare programmes But, as the RSOC data indicates, we seem to be on a course which could lead to significant improvements. It is important to try to make sense of how these improvements have been achieved. The past decade has been the period when the UPA Government was in power. During this period the government pursued neoliberal economic policies that promoted the interests of corporations andbig business. Yet a mitigating factor was the introduction of some policies and programs that were directed at protecting people from the worst impacts of neoliberal reforms. This did not happen by accident or as a consequence of the large hearted munificence of the Congress led UPA Government. It happened as a result of continuous pressure exerted by the Left parties, who were able to wield some influence at the time of the UPA I government. Thus we saw the introduction of the National Rural Employment Guarantee Scheme (NREGS) and the National Rural Health Mission (NRHM). Some progress, though grossly inadequate, was made in guaranteeing food security through the public distribution scheme. Other schemes, directly addressing the nutrition needs of children, such as the Integrated Child Development Scheme (ICDS) and the Mid-Day meal scheme received some attention. Even after the exit of the Left parties during the UPA II government, the earlier momentum and the pressure of peoples’ movements from below kept most of these schemes going. None of these schemes and other social welfare programs was adequately resourced, but they did mitigate the impact of the neoliberal reforms in the past decade. It is entirely conceivable that one of the positive outcomes of these welfare programs (which the bourgeois press spares no effort to term as ‘populist’) is the drop in child malnutrition rates that we are seeing today. Why suppress the survey results? But the mystery still remains. One can understand (though not condone) the motivation of a government to suppress data that paints a negative picture of the country. But why would a government willfully suppress data that indicates some improvement in an area that has given cause to shame India over the past decades. If the data shows that we are starting to make a dent in child malnutrition, why keep it a secret? The explanation lies in the disaggregated state level data. If we examine the state level data, the findings in one state stand out. Prime Minister Narendra Modi’s homes state, the state which he ruled with an iron fist for fourteen long years, is seen to perform worse than the national average in all the measures of child malnutrition. Not just that – Gujarat’s performance is at par (or worse in some cases) with the traditionally socio-economically backward states. The Table below provides a comparison. Table: Comparative Data on Indicators of Child Malnutrition: Best Performing States Table: Comparative Data on Indicators of Child Malnutrition: Gujarat and Selected states Gujarat‘s performance (or more appropriately, lack of performance) is particularly striking as it is one of the wealthiest states in India in terms of state per capita GNP. As we see in the Table, Gujarat performs worse than Rajasthan in all 3 of the indicators, worse than MP and Odisha in 2 of them, and worse than Bihar, Jharkhand and UP in 1 of them. It is the worst performer among all states as regards the percent of ‘wasted’ children. The survey data also includes information about public health programmes. The Table below provides comparative data about immunization. We can see that immunization coverage in Gujarat is worse than all other states except MP and UP. Further, it has the highest rate of dropouts in vaccination coverage. Source: Data from NHFS, 2005, and RSOC as reported by the Economist The cat is truly out of the bag now! Gujarat is the BJP’s and Narendra Modi’s poster boy of neoliberal reforms. Gujarat has been the BJP’s laboratory and the ‘Gujarat model of development’ was what the BJP has promised it shall bestow on the entire country. The Gujarat model of development is the most aggressive form of neoliberal polices that this country has known, combined with Sectarian policies that seek to further ghettoize and pauperise the already marginalised sections of society. The UNICEF survey data is but a small window to the consequences of BJP rule under Narendra Modi in the state. Attempt to suppress evidence questioning neoliberal reforms The Government’s compulsions probably do not stop at the need felt to shield Gujarat from uncomfortable questions. As we discuss earlier, the findings of the UNICEF survey also merit a close look at the kind of programs that could have contributed to an improvement in child nutrition. The problem is that it is precisely these policies that the BJP government has systematically targeted in the past one year. The recent Union budget has seen savage cuts in all programs designed to promote social protection and welfare. The BJP’s spin doctors are clearly uncomfortable with any evidence that might force a rethink on the aggressive pursuance of neoliberal reforms. Unfortunately for the BJP and the NDA government, the key findings of the UNICEF survey are already available in public domain. The government has belatedly acknowledged that the UNICEF survey report does exist. It has gone on to justify the suppression of the report with the plea that there are methodological problems with the state level data. The government has even announced the setting up of a committee to examine methodological issues related to the survey. Clearly the government is clutching at straws while trying to defend the indefensible.