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National Pharmaceutical Pricing Authority's move to cap pricing of coronary stents would adversely affect well-to-do patients and medical tourism industry in India

After the Delhi High court passed the order to slash the price of stents, National Pharmaceutical Pricing Authority (NPPA), a government regulatory agency issued a order on 13th Feb, 2017. This order came as a boon for the BJP Government which was busy with their UP & BMC campaign. PM Narendra Modi made it sure, that price capping of stents becomes an USP during his election speeches. Neither the Government nor the NPPA took suggestions from doctors, hospitals before issuing new regulations.

To summarise, stents were capped in 2 broad categories.
1. Bare Metal Stents - Rs.7260
2. Drug Eluting Stents and Bioresorbable Vascular Scaffold/Biodegradable Stents - Rs.29600

As of now, Abbott and Medtronic have filed for withdrawal of their premium coronary stents from the Indian market, as it wasn't commercially viable after the price cap. Boston Scientific might withdraw their premium stents too after the completion of their corporate sustainability review. Now Indian patients won't have access to high end stents even if they are ready to spend money. Government has every right to make doctors work for the poor, but they can’t deprive middle and upper class of what they can buy. This is not beneficial for a democracy. This is extreme health care rationing. Bare metal stents could be made of stainless steel, cobalt or platinum. The pricing of these differs.

It's the basic law of economics. If tomorrow, Government decides to put a price cap of Rs.30,000 on smartphones. Then Apple will only sell older iPhone models like SE, 6 and won't sell newer 7, 7S models.

To make matters worse, NPPA has rejected the withdrawal plea of Abbott and Medtronic. They also directed stent manufacturers to have stock for 6 months or face action. Basically forcing them to sell their high end products at a loss. This lame restriction could be easily evaded by importing only basic stents while not importing premium stents. Imagine, Mercedes Benz being forced to sell their high end car for Rs. 10 lakhs. This is borderline insanity, Government can't dictate companies to sell their non-essential, premium products at a specific price. This isn't North Korea.

If Government is serious of public healthcare in India then why does it spend a meagre 1.4% of the GDP on healthcare? Because that doesn't favour their PR based governance. BJP's print advertisement on the eve of BMC election read, “expensive angioplasty stent now cheaper by 85%; decision of a sensible government”. Modi Government isn't interested in reforms and instead prefers managing headlines over economy.

What should the Government have done to help the poor as well as to not harm the middle/upper class?

1. Create 4 classes of stents instead of current 2 classes.

2. Leave the last one uncapped, so those who could afford have access to newer tech.

3. Adopt an ala carte approach, making available stents at Rs. 7000, Rs. 28000, Rs. 85000 and uncapped.

4. Provide first two only through RGJAY and other schemes.

5. Use the expertise of public sector rate contracts and declare the rates at which all varieties of stents can be bought into India. Get these prices in public domain for everyone’s knowledge and information.

6. Audit the procedures in public and private hospitals through a third party.

7. Audit individual cardiologist’s annual performance to know for which class he is working more.

8. Consider SEZs for implant companies to manufacture these high end products in India.

These suggestions were provided by Dr. Sanjay Oak in his article in Mumbai Mirror.

This is how a handbook of bad policy would read. First, impose price controls. Then watch goods disappear from the market. And finally threaten producers with punishment for the shortages that your price controls have created. Multi-speciality hospitals across the country are reporting a fall in foreign patients due to shortage of premium stents. Patients are instead getting operated in Singapore, Bangkok. Thanks to this move, we are now losing valuable foreign currency too. Why is Indian Gov't promoting reverse medical tourism? Undoubtedly we need to care more for our poor, but we can’t at the same time ignore the desires of millions of people who belong to upper and middle class and who are honest tax payers. Why should they be denied a choice?

Today it’s cardiac stents, tomorrow it will be orthopaedic implants, and after that, maybe oncology drugs. There is no doubt that the government’s intentions are laudable and the efforts are an attempt to ensure equitable distribution of medical care and to curb medical malpractices. But the execution is misdirected and mal-aligned. Hospitals may hike cath lab rent per procedure and try to bridge the gap. Surgeons may prefer bypass surgical procedures. All these regulations appear as knee-jerk reactions done to control medical malpractice. I am not claiming here that everything was hunky-dory in the stent and implant business. But, putting a cap on prices is not the answer to the problem.

While Modi led BJP came to power with the slogan of, "Minimum Government, Maximum Governance". Their actions are nowhere near it. Instead the License Raj that we left off in the 1980s, is making a comeback.

 

29 March, 2013 -- In a bid to intimidate fenceline communities living around the Kalpakkam nuclear reactors, the Tamil Nadu Police has jailed 129 people of the 650 that were detained in wedding halls yesterday. Those detained were protesting to highlight that the nuclear complex in Kalpakkam was all threat and risk to the local community with no benefits either in the form of jobs or electricity.

 

Kalpakkam: Madras Atomic Power PlantA peaceful protest involving more than 1000 people was broken up by the police. Nearly 650 people peacefully boarded buses to court arrest. Given the peaceful nature of the protest, and the cooperation extended by the people to the police, those detained would normally have been released by evening. However, the Police invited a magistrate to the wedding hall where 129 people were detained, and filed two separate cases against them -- one case naming 27 people (mostly leaders and organisers); and another naming 102 people.

 

Prominent among those arrested are leaders of the Manithaneya Makkal Katchi and the Marumalarchi Dravida Munnetra Kazhagam.

 

The police has slapped the following charges against the villagers:
Section 143 IPC: Punishment for Unlawful Assembly
Section 147 IPC: Punishment for rioting
Section 148 IPC: Rioting, armed with deadly weapons
Section 158 IPC: Whoever is engaged, or hired, or offers or attempts to be hired or engaged, to do or assist in doing any of the acts specified in section 141, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.
or to go armed. or to go armed.-- and whoever, being so engaged or hired as aforesaid, goes armed, or engages or offers to go armed, with any deadly weapon or with anything which used as a weapon of offence is likely to cause death, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.
Section 353 IPC: Assault or criminal force to deter public servant from discharge of his duty.-- Whoever assaults or uses criminal force to any person being a public servant in the execution of his duty as such public servant, or with intent to prevent or deter that person from discharging his duty as such public servant, or in consequence of anything done or attempted to be done by such person to the lawful discharge of his duty as such public servant, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

 

All above sections are to be read with Section 7(1)(A) of the Criminal Law Amendment Act, 1953:
"with intent to cause any person to abstain from doing or to do any act which such person has a right to do or to abstain from doing, obstructs or uses violence to or intimidates such person or any member of his family or person in his employ, or loiters at or near a place where such person or member or employed person resides or works or carries on business or happens to be, or persistently follows him from place to place, or interferes with any property owned or used by him or deprives him of or hinders him in the use thereof, or. . ."

 

 

 

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A PIL has been filed by Anand Jondhale in the Mumbai High Court about irregularities in Sailing. Some of the stories are among those I exposed here. Others are ones I had been meaning to write. This quick post just places it all out for your convenience.

The PIL names:

  1. Union of India
  2. State of Maharashtra
  3. The Secretary of the Ministry of Youth Affairs and Sports
  4. President, The Yachting Association of India (YAI)
  5. Captain Homi Motivala
  6. Captain Arvind Raghuwanshi
  7.  Lt. Col Gautama Dutta
  8. Captain Monty Khanna
  9. Captain Rajesh Sarin
  10. The Commissioner of Customs
  11. Central Intelligence Unit
  12. The Chief Commissioner of Customs,Zone-I
  13. The Director of Income Tax (Intelligence)
  14. The Special Director,  Directorate of Enforcement
  15. The Ministry of Shipping Mercantile
  16. The Chief Surveyor and Marine Engineer
  17. The Secretary, Home Department
  18. Mr. Anil Ambani
  19. Mrs. Tina Ambani
  20. M/s. Reliance Transport & Travels Pvt. Ltd.
Quoting salient parts of the petition. You can download the original petition here: Sailgate - PIL filed in Mumbai High Court

This Petition is being moved for an exemplary action in relation to corruption by certain personnel of Armed forces in the Sports of Yachting, illegal commercial exploitation of boats/yachts for personal benefits without valid permissions and customs clearance which has resulted in huge misappropriation of taxpayers money spent by the Ministry of Youth Affairs and Sports for winning an Olympic Medal in the Sports of Yachting and the unchecked, unimpeded, unhindered, unrestricted movements of boats and yachts which has already caused a gigantic terror attack on the city of Mumbai on 26th November, 2008.

...

4.1 The Petitioner states that, the Government of India is spending crores of rupees through the Ministry of Youth Affairs and Sports to win an Olympic medal in the sport of yachting and this is done through Yachting Association of India (YAI) which is headed by none other than the Chief of Naval Staff. The Petitioner would like to bring the following facts to the notice and request for exemplary action in relation to corruption by certain personnel of the armed forces in the sport of yachting and illegal commercial exploitation of boats for personal benefits without valid permissions and customs clearance. The Petitioner states that, in June 2005, the Honorary Secretary General of the YAI had reported cases of misappropriation of Government funds by some serving / retired armed forces personnel. A xerox copy of report of the Honorary Secretary General of the YAI dated 03/06/2005 is annexed herewith and marked as Annexure “A” to this Petition.
The Petitioner states that, It was brought to the notice of the President YAI, that a few yachtspersons who had participated in overseas events, during 2004 - 2005, had allegedly submitted false bills and supporting documents and thus claimed excess funds from the Ministry of Youth Affairs & Sports, Government of India, through the YAI.

4.2. The Petitioner states that, accordingly, the Indian Navy conducted an enquiry to ascertain the facts and determine the total amount misappropriated, so that necessary action could be initiated to punish the guilty and the excess money claimed by submission of false bills by them could be refunded to the Ministry of Youth Affairs & Sports, Government of India. The Petitioner further states that, It was established that some of the yacht persons had indeed falsified bills, receipts and other supporting documents and claimed excess funds. A copy of the report dated 28/11/2005 submitted by Captain Rajesh Sarin to the Honorary Secretary General is annexed herewith and marked as Annexure “B” to this Petition.
The Petitioner states that, it can be noted that while the investigation / inquiry were conducted most of those who had submitted false accounts were serving with either the Indian Navy / Indian Army and once it was established that they were guilty of misappropriation of Government funds, no action was initiated to punish the guilty and for unknown reasons token sums were recovered and deposited with the Ministry of Youth Affairs and Sports, Government of India in late 2011. A copy of the YAI letter dated 22/11/2011 is annexed herewith and marked as Annexure “C” to this Petition.

4.3. The Petitioner further states that, those found guilty of embezzlement were quietly let off and Captain Homi Motivala, Captain Arvind Raghuwanshi and Lt Col Gautama Dutta resigned from the armed forces, without any action being taken against them. The Petitioner states that, it is pertinent to mention that when the enquiry was being conducted by Captain Rajesh Sarin, the then President of the YAI and Chief of the Naval Staff had appointed Captain Monty Khanna as the Secretary General of the YAI. It was during his tenure that the necessary actions on the guilty had to be initiated, however, he manipulated the system in such a manner that all those found guilty were permitted to get away. The same officer, who is now promoted to the rank of Rear Admiral, has once again been appointed as the Secretary General. This is in utter disrespect of the high standards of morality that should be exercised by the Indian Armed Forces and action needs to be forthwith taken on the guilty and the YAI Secretary.

4.4 The Petitioner further states that, some of the yachtspersons are operating bank accounts in foreign countries. It is pertinent to mention that no individual is permitted to open a bank account outside India without the approval of the Reserve Bank of India, however, despite knowing the rules no action was ever initiated against such officers by the administrators of the YAI. Several of the active defense personnel and participating in government funded sports events have been fraudulently claiming pension from the ministry of sports and youth affairs since 1998 despite being actively participating and claiming sports prize. The Petitioner states that, YAI had recommended Captain Homi Motivala for the cash award, for coaching sailors, who had won a Gold Medal at the World Championship. This bogus claim of coaching was refuted by some members of the YAI and when it was established that the claim had been irregularly made, Captain Motivala, was asked to donate Rs. 7.50 lakhs to the YAI and no further action was ever taken. In addition, Captain Motivala was recommended for award of the Dronacharya Award which was conferred by the Government of India in 2003. The Petitioner states that, it is pertinent to mention that when it was found that he was not eligible for the cash award or conferment of National honor, why no action was ever taken to revoke these awards and even today these officers get their monthly pension for cheating. A xerox copy an email dated 03/05/2004 from Commodore S. K. Mongia to Admiral Madhvendra Singh describing aforesaid illegal activities is annexed herewith and marked as Annexure “D” to this Petition.

4.5 The Petitioner states that, Property of the Indian Navy is being commercially utilized by a Private Limited Company which has been registered with the address of Indian Naval Waterman Ship Training Centre, Colaba, Mumbai. Commander R Mahesh,a serving Naval Officer, is one of the Board of Directors of this Private Limited Company. This is against all rules of the Armed Forces. How can pvt ltd company operate from defence property? A copy of the incorporation certificate and PAN CARD of the said company is annexed herewith and marked as Annexure “E” to this Petition.

The Petitioner states that, there was a time when the citizens of India, our great country used to look at the officers of the armed forces with great respect due to their dedication to this country and for their willingness to sacrifice their lives to protect the country. However the incidents highlighted above, have tarnished the image of the armed forces. The xerox copies of the news paper reports regarding the scam committed by the Respondents Nos. 5 to 7 are annexed herewith and marked Annexure “F” to this petition.

4.6. The Petitioner states that, Lt Col Gautam Dutta has been found guilty of several financial irregularities in the Army Court of Inquiry but his father Maj Gen S Dutta threatened and pressurized the enquiry officer. Lt Col Gautam Dutta quietly resigned from the Army to escape punishment and set up Marine Solutions Pvt Ltd to import luxury yachts for the rich and famous. The Petitioner states that at the behest of Respondents Nos. 18 to 19, 120 feet luxury yacht TIAN was imported by marine solutions by fraud to cheat the customs of import levies. The xerox Copy of the notice u/s. 124 of the Customs Act issued by the Commissioner of Customs (Imports) in this matter is annexed herewith and marked as Annexure “G” to this Petition.

TIAN was impounded by the Customs and it was given provisional release restricting the movement of the TIAN yacht. TIAN commander captain Homi Motivala who also resigned from the Navy because of an enquiry into financial irregularities and got Dronacharya award on bogus claims has been filing false TIAN YACHT MOVEMENT REPORTS with the Customs. TIAN is not supposed to leave Mumbai harbour without customs approval but the Goa Port Master and Harbor Master reports show that TIAN has been in Goa Panaji port regularly. Commander Homi Motivala has submitted passenger and cargo manifest of TIAN yacht with Goa Port Authority at the same time the Customs Fortnightly Movement reports shows TIAN is in Mumbai harbor. The Petitioner states that, TIAN is a Pleasure Yacht from Ferretti, Italy and cannot be used for any other purpose except for passenger transport but the Cargo manifest submitted with the Panaji Port reveals Iron Ore cargo on TIAN. After inflatable dinghy-borne terrorists laid siege to Mumbai in the country’s worst terror attack four years ago, security agencies and politicians both at the Centre and State had spoken of improving coastal security. Four years later little seems to have changed. The xerox copies of Detention Memo, Port Clearances, Vessel Profile, Provisional Release Letter are annexed herewith and marked as Annexure “H Coll.” to this Petition.

4.7 The Petitioner states that, Marine Solutions also operates an illegal party barge ISOLA at the restricted Mora coast, Uran. ISOLA was originally constructed as a dumb service pontoon meant for transportation of waste and scraps from ship to shore and was registered as DUMB SERVICE PONTOON PIT STOP at KALYAN in 2009 but has been operating as a luxury floating hotel ISOLA from 2010 onwards by Lt Col Gautam Dutta and his father Maj Gen S Dutta without permission or approvals from Mumbai Port Trust, Mercantile Marine Department of the Shipping Ministry, Coast Guard, Navy and the local authorities like the Maharashtra Maritime Board. ISOLA is frequented by top business corporates and bureaucrats with music and free flowing liquor on the high seas posing grave security threat and risk to the shipping traffic and underground power and data cables linking the commercial capital Mumbai to the financial world centers viz. Hong Kong, Singapore, London and New York. All relevant documents are annexed herewith and marked as Annexure “I” to this Petition.

....

:: SYNOPSIS ::

Year 2003:

Captain Motivala was recommended for award of the Dronacharya Award which was conferred by the Government of India.

03/05/2004:
Commodore S. K. Mongia writes to Admiral Madhvendra Singh describing the illegal activities of the Respondents Nos. 5 to 7.

June 2005:
The Honorary Secretary General of the YAI had reported cases of misappropriation of Government funds by some serving / retired armed forces personnel. It was established that some of the yacht persons had indeed falsified bills, receipts and other supporting documents and claimed excess funds.
YAI had recommended Captain Homi Motivala for the cash/Dronacharya award, for coaching sailors, who had won a Gold Medal at the World Championship.This bogus claim of coaching was refuted by some members of the YAI and when it was established that the claim had been irregularly made, Captain Motivala, was asked to donate Rs. 7.50 lakhs to the YAI.

2009-10:
Property of the Indian Navy is being commercially utilized by a Private Limited Company which has been registered by the Respondents Nos. 5 to 7 with the address of Indian Naval Waterman Ship Training Centre, Colaba, Mumbai. Commander R Mahesh,a serving Naval Officer, is one of the Board of Directors of this Private Limited Company. This is against all rules of the Armed Forces. How can pvt ltd company operate from defence property?

22/11/2011:
While the investigation / inquiry were conducted most of those who had submitted false accounts were serving with either the Indian Navy / Indian Army and once it was established that they were guilty of misappropriation of Government funds, no action was initiated to punish the guilty and for unknown reasons token sums were recovered and deposited with the Ministry of Youth Affairs and Sports.

Year 2011 :
Lt Col Gautam Dutta (R.No.7) quietly resigned from the Army to escape punishment and set up Marine Solutions Pvt Ltd to import luxury yachts for the rich and famous. At the behest of Respondents Nos. 18 to 19, 120 feet luxury yacht TIAN was imported by Marine solutions by fraud to cheat the customs of import levies. A notice u/s. 124 of the Customs Act was issued by the Commissioner of Customs (Imports) in this matter.

TIAN was impounded by the Customs and it was given provisional release restricting the movement of the TIAN yacht. TIAN commander captain Homi Motivala who also resigned from the Navy because of an enquiry into financial irregularities and got Dronacharya award on bogus claims has been filing false TIAN YACHT MOVEMENT REPORTS with the Customs. TIAN is not supposed to leave Mumbai harbour without customs approval but the Goa Port Master and Harbor Master reports show that TIAN has been in Goa Panaji port regularly. Commander Homi Motivala has submitted passenger and cargo manifest of TIAN yacht with Goa Port Authority at the same time the Customs Fortnightly Movement reports shows TIAN is in Mumbai harbor. The Petitioner states that, TIAN is a Pleasure Yacht from Ferretti, Italy and cannot be used for any other purpose except for passenger transport but the Cargo manifest submitted with the Panaji Port reveals Iron Ore cargo on TIAN. After inflatable dinghy-borne terrorists laid siege to Mumbai in the country’s worst terror attack four years ago, security agencies and politicians both at the Centre and State had spoken of improving coastal security. Four years later little seems to have changed.

Marine Solutions also operates an illegal party barge ISOLA at the restricted Mora coast, Uran. ISOLA was originally constructed as a dumb service pontoon meant for transportation of waste and scraps from ship to shore and was registered as DUMB SERVICE PONTOON PIT STOP at KALYAN in 2009 but has been operating as a luxury floating hotel ISOLA from 2010 onwards by Lt Col Gautam Dutta and his father Maj Gen S Dutta without permission or approvals from Mumbai Port Trust, Mercantile Marine Department of the Shipping Ministry, Coast Guard, Navy and the local authorities like the Maharashtra Maritime Board. ISOLA is frequented by top business corporate and bureaucrats with music and free flowing liquor on the high seas posing grave security threat and risk to the shipping traffic and underground power and data cables linking the commercial capital Mumbai to the financial world centers viz. Hong Kong, Singapore, London and New York.

 

Transcript of Globalizing Inequality - a lecture by P. Sainath, sponsored by the Center for Social and Environmental Justice of Washington State University, Vancouver. Video by pdxjustice Media Productions.

Part 1 || Part 2 || Part 3 || Part 4

http://www.youtube.com/watch?v=TjIcO_mqFKc

We did it weeping in our hearts for we too live in slums and we know our turn will come. The police constables giving protection to the demolition also live in slums and they did not take any pleasure in the actions they were forced to undertake by the government of Maharashtra. The people doing the demolitions were from the slums.

Incidentally. a United Nations habitat report of around late 2003 makes the assessment that by 2030, 25 years from now, fully one-third of humanity will live in urban slums. One third. The largest number of those are going to be in india and Africa.

None of this got covered. Even in covering the Tsunami, even in covering... this is the mindset of inequality. What happened? The poor have no rights. Even in the coverage of the Tsunami.

Whatever was done for the Tsunami victims was a result not of their rights, but of our generosity. You are going to get a new house. Not because you are a citizen of a decent society, not because you are entitled to one, which you are, under the directive principles of the Indian Constitution.

You're not going to get a house because of that. You're going to get a house because I am sorry that half your family was washed away in the Tsunami. It's not about your rights. It's about my generosity.

We've reduced people to that. We've reduced the poor to the objects of our generosity and our sympathy.

You build your own home, we'll demolish it. But we'll give you a new one. If we choose to. That is, if we feel sorry for you.

How agonized we are over how people die. How untroubled we are by how they live.

If you look at the Indian stock market. Coming back to that central indicator of how economies are doing, the Confedration of Indian Industry, which has the most optimistic take on such figures says that the total number of people having any kind of investment in the stock exchange constitute less than 1.15% - I repeat - one point one point percent of India's hundred and eighty million plus households.

1.15% of households. That's the most optimistic figure of those participating in any kind of investment in stock markets.

Yet, as I told... when the stock market collapsed, in May 2004, it collapsed for all of two days. The country's largest newspaper had a front page mimicing 9/11. "Ground Zero!" said the headline. 2,340 billion rupees lost. Notional money. Which came back two days later. Notionally. And it had an aircraft flying into the stock exchange building and the tail of the aircraft had the communist hammer and sickle.

Well, when the stock exchange collapsed for all of 48 hours, this was following what every political analyst across the spectrum says is India's second most historic election since independence - 1977 after the emergency and 2004.

The finance minister of the country abandoned the first day of parliament, did not attend the first day of the new historic parliament. He came rushing to Bombay to the stock market to dry the tears and hold the hands of destroyed millionaires of dalal street.

Two days later it was okay, but he stayed there three days to make sure that the market behaved, then he went home.

It was... ah... meanwhile, an election that was largely fought on the key two states on the issue of farmers suicides, it took another 149 suicides of farmers in the southern state of Andhra Pradesh before the Prime Minister condescended to visit the place.

But a twitch in the SENSEX had the finance minister jetting out to Mumbai. That is the difference of attention that you get if you are poor or if you are rich.

So it is all about our generosity and our feelings and whom we are feeling sorry for today, or who we feel sorry for most of the time. If you start applying these measures to the various forms of generosity that you see, you get a very different picture from what you get from the Tsunami coverage.

One of my favorite forms of generosity is the drive to wipe out malaria in the third world. Some of you may have read about this - the distribution of - the planned distribution of millions of bed nets to protect people against malaria. Have you ever read about this?

It's a plan involving the WHO, the World Bank and anyone else out to make a dollar.

Teh fun part of this malaria nets thing is, by 1980, India had more or less successfully contained malaria. It was almost wiped out by the early 1980s. In the 1990s we entered the brave new world of structural adjustment. Huge cuts in public services. Privatization of medical services in a large way. Soaring costs of medical attention. 21% of the Indian rural public no longer seeked medical attention for their ailments - that's the latest figure we have - because they simply cannot afford it.

Now after all these cuts, malaria resurfaces with a vengeance in India and in neighbouring countries. Having caused it to resurface in the first place, now generosity demands that we distribute bed nets - millions of bed nets to people who don't have beds.

Now, if you're living in a hut, you don't fix your bed net to a wall, because you don't sleep close to the wall, because that's where the crepy crawlies reside. The scorpions and other stuff. You try sleeping a little away from the wall.

I'm a rural reporter. I spend 270 days of every year for the last 12 years in the villages and self-preservation causes you to figure out these sort of things about where you sleep and where you don't sleep.

So first, we're getting these bed nets to people who don't have beds, at the cost of God knows how many million dollars. It's planned. Every time it's been attacked, they have withdrawn quietly, only to try and bring it back through the next government.

Now, if anyone with even half a brain knows that even if these nets... oh, by the way, you'll forgive the gendered language... it doesn't mind, it's theirs. It says that these bed nets will protect you against malaria because the nets are impregnated with anti-mosquito repellent. Whatever that means.

Now, anyone with half a brain knows that the malaria ... we'll exempt the experts, right? - we're talking about people. Anyone knows that the malaria mosquito is not most active when you sleep. It is most active at dawn and dusk when people are in the fields.

Of course, you could make a bold new fashion statement by walking around in your net, but it might cramp your style.

The whole thing is one unmitigated racket. This is the generosity of the generosity, you know... the charity that begins at home and stays there. It has nothing to do with the eradication of malaria in these countries.

Speaking of malaria, one of the astonishing things you can look at in the spectrum of inequality across the globe both in the terms of what's happening and how the media cover it, is what I call the globalization of communicable diseases.

Anyone in the audience remember this word - SARS? Rings a bell? Yeah, it does, doesn't it?

You remember how SARS was perceived as moving about like the black death, mowing down millions in its deadly wake? You know how many people actually died of SARS in India? Zero.

SARS sero.

You can look at the World Health Organization's website on the subject. Total number of cases identified in India? Three. But from the coverage you got from the media, you think that SARS... you know the subcontinent was in danger of its survival, right? The way it was covered.

3 cases from SARS. 0 deaths from sars. Why did SARS get so much attention? And by the way I'm not saying that SARS is not dangerous. You're going to get a hell of a lot of SARS by other names in the not too distant future, because we have globalized communicable diseases through these strategies of the last 10-15 years. Through the policies of the last 10-15 years.

However, it's important to look at why SARS or plague... you know in '94 we had a plague in India. Every aircraft going out of India was sprayed while going out, sprayed while being received at in the airports in the West. The plague killed 53 people. SARS worldwide - in its 100 days according to the World Health Organization's website, in the hundred days of its existence in the first round, across the planet, SARS killed 879 human beings.

That's about half the number of people who die of tuberculosis every day in India.

But TB never gets the same kind of coverage. Because it kills the wrong people. SARS germs, plague germs kill the beautiful people. So they get that kind of attention. In the media, in the medical systems, in the government's policies.

Plague germs, SARS germs, they are notorious for their non-observance of class distinctions. They board aircraft and fly club class to New York and that scares the pants off the world.

So they affect the wrong kinds of people. And I'm not just talking about poor countries. How many people are aware, that in August 2003... in OCTOBER 2003, the government of France, one of the best off countries in the world... The government of France acknowledged that in August 2003, 15,000 senior French citizens had died in a heat wave.

Now France has had heat waves before. Why did 15,000 people die in that heat wave and why is it that all those 15,000 citizens were elderly pensioners and retirees?

You know, the thing is, 879 people from SARS in 100 days. 15,000 people in rich France in the space of a month. And it didn't make the world headlines, because they were largely poor, elderly pensioners whose health benefits had been subjected to severe cuts in the preceeding two or three years. That's why they died.

If it had been 800 people of the flying classes, you got that kind of coverage. When 15,000 - and again, we're not talking about Bangladesh and India - we're talking about France. 15,000 senior citizens died, they didn't even make news. You can get on to the net and look at the figures and the discussion. They had a special parliamentary commission to go into it, I don't know what came out of it.

It may also be interesting to look at why China was the worst affected country by SARS. And that has a lot to do with what we're discussing today. In the 90s... in the 80s and 90s we entered this world of structural adjustment, cut some subsidies, cut some basic services, withdrawal of entitlements of poor people, and privatization of just about everything including soul and intellect.

The Chinese government closed tens of thousands of factories. Now if you are a citizen of China, you have access to health through your workplace, through your school, your factory or the local network that you were aligned with.

When tens of thousands of factories were closed down across China, millions of workers lost access to health. The chain of command, the alarm system, the signal system by which a new disease got reported and got checked at the labs and the tertiary level, that system completely collapsed.

Therefore when SARS hit, there was no plot on the Chinese government's part to conceal it. For most of the time, they really didn't know, because they had destroyed the system by which they could have known. They destroyed it to save a few million dollars, and lost a few billion dollars, because the deprivations you visit on the poor, tend to come back to you.

That was the year when the Chinese GDP took its worst hit in a decade and a half. Also leaving severe scars on the GDP of Singapore, Thailand, and a number of other countries, also hit by SARS.

The great software festival of China was cancelled. China lost billions of dollars though it saved million, in throwing workers out of work. Throwing workers out of their factories. That happened with China.

Did I mention France? In this country, I have no idea. I don't think there is a clear estimate, how many elderly American's cross the border into Mexico and Canada to buy drugs. I do know that your Federal government has responded to it by conducting police raids on pharmacies in Michigan.

Not by trying to provide cheaper drugs to poor people, but by conducting police raids on pharmacies in Michigan and the Mexican border. To prevent people from getting cheaper drugs.

In Africa, thanks to the new institutional arrangements and the trips and the WTO... under the trade related intellectual property rights and the WTO, India... an Indian company which produced so far the cheapest - the company's name is Cipla - which produced the cheapest anti-AIDS drug. Millions of Africans were denied the right to get this drug at dirt cheap prices, by the intervention of multinational corporations of the pharmaceutical sector.

After a huge outcry - after considerable outrage across the world, a compromise was reached, but the owner of the company will still tell you that he can provide it for much cheaper if it were not for the pressures working on him nationally and internationally.

20

What happens when a child gets attention by doing adult things in an adult world?

No, I'm not talking about child porn or human traficking or other established evils. I'm talking good old TV. So many dance shows, and right now, performances by kids in the Film Awards taking place in Singapore. Nothing wrong with kids performing for audiences, but what are they performing? How is it entertaining to watch two seven year olds embracing in public to lyrics that imply heterosexual romantic relationships? Dances are increasingly sexually explicit. Am I the only one to find this really bizarre?

I'm no prude. I would probably whistle and watch with joy some attractive male strutting his stuff. But kids? I'm supposed to enjoy watching two kids doing sexual moves to lyrics describing an adult romantic relationship? This is entertainment? I find it about as repulsive as child porn (I assume, since I haven't been tempted to see any). I don't think it is quality work, and I think the role models for kids in media being so "adult" is also likely to result in increasing sexual behaviour. And I'm fine with teenagers necking. What I am not fine is a seven year old thinking that this is what hep and happening is for kids. Replace one of the two kids with an adult, and see how wrong it would feel. But we think nothing of it when a choreographer is directing kids to do such things. Parents watch with pride, talent show judges shower praise.

Another reason why I don't like it is because it simply isn't quality. An artist brings his emotion to his art. From dark paintings to songs of hope and films of love, sex, war and grief and everything else. An artist needs to feel that emotion to project it. A cheerful person needs to get in touch with some grief in him to sing a sad song well. A virgin actress playing a prostitute isn't going to be very convincing at anything beyond walk on roles of no consequence, simply because she doesn't know what she's doing, not because she is a bad actress. A person who hasn't ever hit anything isn't going to be a very effective action hero. Similarly, the actor who has experienced desire brings a certain playfulness, sensuality or even lewdness to his gestures to the actress he is flirting with. The child doing those pelvic thrusts is talented, but sterile. Exercise and expertise, not dance as an art. And if that seven year old is expressing from experience, there is even more to be concerned about.

I am not asking for censorship or tighter ratings, but how we promote kids on media, particularly TV. Under the guise of talent and modernity, what messages are we passing on as to "okay behaviour"? What messages are we passing on as to the depth of an artist's work? If you can fake it, you'll make it?

It is true that a kid sees some song with excellent music and beautiful choreography and mimics it. However, the meaning escapes them, and as adults, we don't seem to think that the meaning is anything crucial to the performance. We don't help them understand art, but polish awkward attempts and show them off as "mature performances". No wonder the whole thing is about achieving difficult steps than the performance as a meaningful whole. What is a child's life expressed as dance? Whatever it is. What is their experience that can teach them to use art as a narrative rather than sterile gymnastics? Such a glorious little explored terrain.

It is one thing to say that kids aspire to be adults. If we look deeper, there really is no reason for kids to aspire to do something that doesn't appeal to them. Flashy dance moves are cool. They hold a physical challenge, but that's about it. On the other hand, the appeal may be in adult appreciation, where adults today seem to be too stressed or busy to be interested in boring "kid things". A child's creativity often doesn't make sense to an adult. It doesn't give them something to point to and brag with other adults. It is too easy to direct them to something flashy that will bring recognition rather than engage at their level of randomness. We fail to see that presentation follows discovery and end up presenting the final product for the kids to mug up.

Sometimes I think that parents are so stressed with life, that they are in a hurry to get their kids all grown up and off the stress list.

Other times, I think that the adults in society "fake it" so often, that they see no reason that a child shouldn't do what they do, because what they do isn't sexual either.

But always I think that we are increasingly engaging in thoughtless behaviour in the name of development.