Health

Pushing the Debate on Public Health

In honour of Krishna Raj, the legendary editor of Economic and Political Weekly, the Anusandhan Trust established the Krishna Raj Memorial Lecture series on Health and Social Sciences. This year’s lecture is being delivered by Dr Eric Suba, an eminent pathologist and medical activist on February 4, 2016 in Mumbai.

Krishna Raj, editor of the Economic and Political Weekly from 1969 to 2004, seen here with the  trustees of the Sameeksha Trust. Credit: EPW

Krishna Raj, editor of the Economic and Political Weekly from 1969 to 2004, seen here with the trustees of the Sameeksha Trust. Credit: EPW

Krishna Raj was editor of the Economic Political Weekly for 35 years when he passed away suddenly on January 16, 2004. It would be commonplace to say that his death left a void in the lives of many. Less recognised is the fact that his passing left bereft the many young people and projects – in research and publishing – that he had quietly and informally mentored.

Among those was the Anusandhan Trust, set up in 1991 to pursue research in issues of health relevant to the health and labour movements and to take on inquiries that had been deliberately under-explored. The young founder trustees so filled with idealism and hailing from various backgrounds and affiliations – doctors, social scientists, scientists – had known him in various individual capacities. It was only natural that when they came together to form an organization, he should be a reference point and sounding board. To Krishna Raj it was an important association allowing him perhaps to glimpse at areas in which he had always had an interest.

For a journal that focused on broader issues of economic development, EPW carried the earliest path breaking work on the social analysis of health, health care and medical education. It also published some of the earliest incisive editorial denouncements of the pharmaceutical industry and the deleterious impact of its unethical marketing practices on public health. While these were unsigned, they were the editor’s own. Given this, it was curious that the advertisements of the Organization of Pharmaceutical Producers of India (OPPI), the erstwhile association of drug MNCs in India continued to run regularly. When health activists protested that the OPPI’s messages ran contrary to not only the journal’s edits but to the drug consumer movement’s painstakingly produced critique of the industry, Krishna Raj offered equivalent advertising space in the EPW to the movement to put out its counter message.

Contrary to EPW’s image as a haphazardly run ‘cottage industry’ the ever pragmatic Krishna Raj systematically focused on giving the journal stability in various ways – EPW’s first real estate purchase years before his death was to house its ‘nerve centre’ as he called it, the typesetting, proofreading and production department and the newly founded EPW Research Foundation. The journal’s survival did not worry him as much as ensuring financial security for his staff, in the case of a disaster, especially since he had had to endure almost a year without a salary in the first year of EPW’s existence. This he did remarkably successfully, by “husbanding resources”, to use his archaic phrase, in spite of severe financial limitations.

For over 40 difficult years he struggled against all odds to detail the scripting of a unique template for academic publishing that the founder editor Sachin Chaudhuri had put in place with the Economic Weekly in 1949. As his colleague and friend M S Prabhakara pointed out in his tribute to Krishna Raj (Frontline, Jan 31, 2004), “… he built EPW into a forum where the most distinguished scholars in the discipline sought to publish their work.” Krishna Raj also diligently ensured that EPW remained an open space for debate for a wide range of issues, resisting affiliation with particular groups or ideologies.

Journals, he maintained, would live or collapse depending on whether they were relevant to the public life of the day. To ensure this, Krishna Raj’s strategy was to actively engage with people in and out of academia/policy circles to persuade them to address public issues covering a wide spectrum. Towards this end, he spent enormous time with young scholars whom he thought showed potential as thinkers and writers, and was always available to contributors even in the midst of catching deadlines and sending the Weekly to bed.

Promoting new thinking on health care issues

Krishna Raj’s outlook on niche publications like the EPW, was bracing. Over the years he was ever willing to support smaller journals and periodicals. One such was the Socialist Health Review (later the Radical Journal of Health) that found assistance from the EPW and was, when need arose, typeset and proofread by the journal’s highly professional and well-trained production department. When asked if these alternative publications would not draw away contributors from the Weekly, he would say, with typical nonchalance, “Let a thousand journals bloom.”

It is to pay homage to this remarkable editor and friend that the Anusandhan Trust’s Krishna Raj Memorial Lecture Series on Contemporary Issues in Health and the Social Sciences was established in 2006. It salutes Krishna Raj’s consistent efforts at promoting and encouraging scholarship in the then relatively new field of health studies. And showcases his contribution to the making of a generation of social scientists.

Several eminent scholars pursuing new lines of thinking on health care issues have delivered the KR Memorial lecture in the past. Its inaugural lecture by Anirudh Krishna (Duke University, US) on ‘Making and Unmaking of Poverty’ set the tone for the series. More important than measuring poverty, he pointed out, is to ask what moves people in and out of poverty. And a critical factor here is how much people spend on health care. Following through on this, in 2010 Gita Sen (IIM, Bangalore) delivered a trenchant critique of the increasing inequity in access to health care in the post 1990s era of reforms.

The series has also provided space for discourse on politically sensitive issues. In 2015 the Trust invited noted social scientist Betty Hartmann, (Amherst, US)   to report on her sharply critical review of population education in the US and in India and the resulting public misconstruction of the relation between population and development.

Reflecting people’s distress at the State’s actions against dedicated health activists such as Binayak Sen in Chhattisgarh, the lecture series invited Ilina Sen to speak on the distorted development underway in the region and its consequences for people’s welfare and health.

Over the years the format of the Series has altered to fit the theme. A high point of the series was the charged public debate in 2011 on the report on Access to Health Care’ anchored by an articulate and learned panel comprising Srinath Reddy then the chairperson of the High level expert group on Universal Health Coverage, Armando de Negri Filho, a Brazilian public health specialist who was then the Coordinator of Global Conference on Social Security Systems and Universal Health, Gautam Mody the national secretary of the New Trade Union Initiative (NTUI) and Renu Khanna of SAHAJ Baroda and the Medico Friend Circle.

 Anusandhan Trust, through its research centres, has attempted to enrich the debate on health and health care by including under the Lecture series, issues in ethics in medical practice and clinical trials. In 2009 it hosted a debate on ethical concerns in clinical trials that showed how incentives and inducements trap vulnerable groups into enrolling in clinical trials without adequately understanding the potential risks.

In this year’s lecture, on February 4, 2016, Dr Eric Suba will bring to the public platform details of a study on three large randomised controlled trials (RCTs) of cervical screening for cancer trials in India that are a shocking commentary on the deliberate flouting of ethical norms and negligence.

Since 1997, three separate randomised controlled trials (RCTs) of cervical screening of a total of over 40000 low income women have been conducted in India by Tata Memorial Hospital and by the World Health Organization’s International Agency for Research on Cancer. These RCTs compared the death rates due to cervical cancer among who were offered cervical screening and those who were deliberately denied screening.

Suba’s well-substantiated argument is that these trials were highly unethical because they deliberately and selectively denied some women any hope of survival by not offering cervical screening services. Were these RCTs necessary even, addressing as they did, questions that need not have been asked at all?

Eric Suba is the Director of Clinical Laboratories at Kaiser Permanente Medical Center in San Francisco, California and leads the Viet/American Cervical Cancer Prevention Project, an all-volunteer non-profit organization. He has found disturbing similarities between the studies of cervical screening in India and the now-infamous Tuskegee Syphilis Study in the US.

Only time will tell if the Krishna Raj Memorial lecture series has indeed prompted informed public debate on issues impinging on public health. The point has been, in the tradition set by Krishna Raj, to expand the space for a knowledge-rich engagement among diverse groups and people.

All published lectures from the series are available at http://www.cehat.org/go/KRMemorialLecturehome  and at www.esocialsciences.org

Padma Prakash is editor of esocialsciences.com. Her email address is padma@esocialsciences.com