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Aug 23, 2019

A Lancet Through India’s Consciousness

The IMA should realise that in a democratic setup, intellectual generosity comes not through jingoism but through persistent criticism, appraisal and reevaluation of government policies on health.

The editorial on the current situation in Kashmir, published in the reputed British medical journal the Lancet, has stirred up a hornet’s nest.

The journal has been criticised by the Indian Medical Association (IMA) and by the Indian Association of Surgeons, who termed it a ‘unsolicited’ meddling with the internal affairs of India.

On a laughable note, in a letter to Dr Richard Horton, editor-in-chief of the Lancet, the IMA has said, “Indian Medical Association on behalf of the medical fraternity of India withdraws the esteem we had for the Lancet” (sic).

How appropriate is an organisation in terms of intellectual maturity to ‘withdraw the esteem’ for a journal is something which both the organisation and its members should seriously ponder upon. I am not even mentioning the necessity of a democratic process of consensus building before issuing such weird, immature statements.

The IMA has no right to issue ‘withdrawal of esteem’ rants on behalf of the whole medical fraternity of a country as diverse as India. In fact, I am not sure whether the IMA even carried out a democratic consensus building among its own three lakh plus members before calling the shots on the Lancet. Unfortunately, the culture of consensus building in India is rapidly deteriorating and to expect the IMA to be involved in one would be foolhardiness.

Also read: Indian Medical Association Lashes out at Medical Journal Lancet for J&K Editorial

Murky politics of medical associations

The dishonesty and murky politics involved in medical associations in India is no secret. Nepotism, feudal attitudes and venality mar many of these organisations. Monetary corruption while hosting medical conferences and ruses to influence organisational elections are a common occurrence. This culture is typified by the classical case of Dr Ketan Desai, who was  the president of the IMA and the chief of the erstwhile Medial Council of India when he was arrested on charges of extreme corruption.

Ironically, this news was also published in yet another British journal, namely the British Medical Journal. I am not sure if the IMA had felt a “loss of self-esteem” at that time.

The second important question which has been raised by many is whether medicine (and hence medical journals) should be kept insulated from the politics of the day. This needs serious deliberation and understanding. During the incarceration of Dr Binayak Sen, the doctor-activist from Chhattisgarh, I had personally approached editors of some reputed medical/surgical journals of the country at that time to carry out editorials/articles explaining his position.

Unfortunately, most Indian journals of the time refused to do so. Interestingly, a common thread of so called logic passed through their reasoning. Most were of the opinion that doctors should not take political positions.

For some bizarre reason, it is believed that doctors should be immune to political ideologies and more so to ideologies which question those in power. Simply speaking, most within the medical fraternity either side with those in power or more dangerously consider themselves to be politically neutral.

Having said this, political neutrality of doctors is maintained only till they are not at the receiving end of injustice.

Thus, the same IMA which doesn’t shed a tear for violence against Adivasis, Muslims or Dalits was up against the West Bengal regime when it came to the issue of violence against doctors there. It is appreciable that the IMA took a stand for its West Bengal members, but it is beyond my understanding that the same organisation failed to issue even a statement condemning the caste-based suicide of Dr Payal Tadvi in Mumbai or the innumerable acts of violence which happen on a regular basis against doctors in other parts of the country.

Also read: In a Ravaged Kashmir, One Woman’s Fight to Give Birth

It is essential for doctors to take ideological/political positions. Equally, it is also essential and in the spirit of democratic ethos that those indulged in scientific learning and its propagation also speak up with a tinge of politics, howsoever inconvenient it may be. Doctors should be political for no other than socio-historical reasons.

The Irish born pioneer of X-ray crystallography, Dr John D. Bernal had written extensively on the social functions of science, including the role of politics in the life of scientists. He believed that science could not get along well without philosophy or politics and refused to see the unexamined philosophical and political assumptions masked by a stance where the three are seen separately.

Political ignorance has also been sharply criticised by the German playwright, poet and philosopher, Bertolt Brecht:

“The worst illiterate is the political illiterate, he doesn’t hear, doesn’t speak, nor participates in the political events. He doesn’t know the cost of life, the price of the bean, of the fish, of the flour, of the rent, of the shoes and of the medicine, all depends on political decisions. The political illiterate is so stupid that he is proud and swells his chest saying that he hates politics.”

Nothing can be closer to truth and more so for the politically neutral doctors of our country.

Finally, it is also important to decipher what The Lancet has mentioned in its editorial. It has spoken on the human rights violation in Kashmir following the clampdown of communications during the process of abrogation of Article 370. In fact, the piece quotes the report of the United Nations Human Rights office of the High Commissioner, released on July 8, 2019 as a testimony to human rights violation even before August 5, 2019.

I am not sure if any of the IMA functionary has even thought about what impact their statement can have when the reference of the UNHR is incorporated into the editorial. The piece also speaks about the good health parameters of Kashmir, more so when compared with similar parameters for the country. It appears that the IMA is perturbed by the Lancet’s audacity to meddle with India’s internal matter.

This too is preposterous. Internal affairs cease to remain an “internal matter” the moment they involve violation of basic human rights, as has happened in Kashmir. This is exemplified by many global events which left the remaining world fuming in anger or sigh in despair.

The crackdown at pro-democracy protestors in Tiananmen Square in China, death of children in the conflict in Yemen, the refugee crisis of Syria, the fighting in Swat valley of Pakistan are such examples. In fact, the IMA should know that the Lancet has a long history of speaking up on issues of health activism and politics and has published editorials on nearly all of the above mentioned socio-political events.

The IMA should realise that in a democratic setup, intellectual generosity comes not through jingoism but through persistent criticism, appraisal and reevaluation of government policies on health. Politics is an integral part of a doctor’s being. To be ignorant of politics is to be ignorant of peoples’ health.

Shah Alam Khan is professor, orthopaedics at AIIMS, New Delhi and author of the book Announcing the Monster. Views are personal.

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