Towards a healthy India

A renowned name in biomedical innovations, public health and medical research, Balram Bhargava is currently the Director General of the Indian Council of Medical Research (ICMR) as well as the Secretary of the Department of Health Research (DHR). He will carry out these roles until 2021. Bhargava, a celebrated cardiologist, was a Professor at AIIMS prior to his new assignment at ICMR. He has also been honoured with Padma Shri for his contributions in the field of medicine. He has also developed indigenous low-cost coronary stents and founded the Society for Less Investigative Medicine (SLIM).

Since assuming your coveted role at ICMR, what has been your focus areas and what are the challenges you have encountered in this research organisation?

My only objective is to develop a robust healthcare system with adequate quality research that will make our country disease-free. Both organisations – AIIMS and ICMR – are landmarks in the healthcare sector. ICMR, in over 100 years of its existence, has contributed tremendously to the treatment of malaria, filariasis, communicable diseases, etc. Besides all these, now we have another major challenge of non-communicable diseases (NCDs) such as diabetics, hypertension, stroke, high cholesterol, smoking, etc. While at the helm of affairs at ICMR, my most crucial challenge would be bringing down all cases of non-communicable diseases to 0 per cent. The real disease burden is NCDs as it cannot be treated; rather it can be cured and prevented by creating adequate awareness among masses about the disease. My focus would be on NCDs and ICMR would play a pivotal role in controlling the spread of NCDs.

Since this is an issue is of national importance, you must be preparing a comprehensive plan to address it. Tell us about your plans to address the non-communicable disease burden.

The plan has already been rolled out. We have decided to develop 10 centres of excellence in medical research at the best performing colleges across the country to address the spread of non-communicable disease. The focus is to put a check on non-communicable diseases such as hypertension, smoking, controlled use of sugar and salt to maintain better blood levels.

Is it true that alcohol is becoming a major cause of liver cirrhosis? What are your plans to address the issue?

Yes, it's absolutely right. Alcohol is becoming the major cause of liver cirrhosis in the country. Right now, we don't have any method to address the issue, but we are working in this direction. As of now, we can reduce liver cirrhosis cases by educating people about the ill-effects of alcohol in causing this fatal disease. It has been found that when 10 lay people on the street or science students or even some doctors were asked whether alcohol causes cancer, they were found saying that it doesn't. Rather, it is tobacco that causes cancer. The reality is totally different as alcohol causes up to 10 types of cancers such as liver, prostate, oral, etc. People, thus, have to be educated about alcohol and, once they reduce consumption of alcohol, the cases of cirrhosis would also drop.

Given that non-communicable diseases can be cured through prevention, I urge young people to take their health into their own hands. Proper and timely diagnosis is always helpful in curing diseases. Some defend the consumption of alcohol by saying that a controlled amount of alcohol is good for health, which is true in the case of reducing mortality by heart attacks, but at the same time, it increases total mortality. Some people may not die due to heart ailments, but more people will die from liver cancer, depression, stroke, road accidents.

Is it right to say that Nipah virus has been neutralised?

We have successfully controlled the spread of the deadly virus. ICMR acted swiftly in coordination to bring the Human Monoclonal Antibody (M 102.4), a non-patented drug, from Australia to neutralise the Nipah virus. Now, we are trying to manufacture Monoclonal Antibody in the country itself, which would be licensed to manufacturers through a government agency. The plan is to have a pool of Monoclonal Antibodies through a public-private partnership that can be used by us or anyone in the region. It would not be for commercial purposes. It would be for a humanitarian purpose only.

Tells us about National Cancer Registry programme that is being run by ICMR.

The National Cancer Registry programme has been very successful and is one of the flagship plans of ICMR. It has been undertaken by the National Centre for Disease Informatics and Research (NCDIR), Bangalore. At present, we have 53 cancer registries and it has provided us with the picture of our country's cancer map. The programme has proven to be beneficial in tracking cancer patients and, from this registry, we came to know that Punjab has the highest incidence of cancer.

How is ICMR going to assist the Ayushman Bharat scheme?

Under the Ayushman Bharat scheme, the government is going to provide an annual health insurance cover of up to Rs five lakh to 10 crore families, benefitting about 50 crore people. The role of ICMR and DHR in this programme is to provide standard treatment guidelines, which has to be followed by the government as well as private hospitals. The guidelines would be about basic treatment protocols with 200 conditions. This will be prepared within the next year.

Second, we have a Health Technology Assessment Board, which is deciding how much the government can reimburse for every procedure as per the available packages under the scheme. We are working on it and it would be developed very soon. The model will be developed by DHR.

What are your comments regarding the target set by the government to make India a TB-free country by 2025?

Despite all the challenges associated with the elimination of tuberculosis, we are looking forward to achieving the target within the stipulated timeline. As of now, the prevalence of TB is about 40 per cent and the multi-drug resistant (MDR) TB is posing another big problem. As the prevalence of TB in certain tribes is nearly 50 times, proper diagnostics, treatment, hygiene conditions, follow-up treatment and compliance to treatment play a key role in achieving the target. This is an ambitious goal given to us by Prime Minister Narendra Modi and we all are working in tandem to achieve the target.

We have deployed 35 mobile vans in different parts of the country for the diagnosis of TB. All the vans have PCR and X-ray machines. Also, we have 80 research units in 80 medical colleges in the country where we are propelling the NCD agenda. All the research units have been established as they were started in 2015.

Given the fast and busy lifestyles today, stress is turning out to be another major cause of NCDs. What are the ways to overcome stress?

To beat stress, people should practice meditation, yoga, exercise as these are preventive methods. They should also try to keep away from mobile phones. Patients should trust their doctors and they should not think that everything can be treated electronically. A biological system is very different from an electronic system. If a mobile phone becomes dysfunctional, it would not work until you get it repaired, which is not the case with the human body as it has its own healing properties and can recuperate by itself. That is the basic difference and people have confused it with electronic items. This mindset has created a lack of trust between patients and doctors as patients think that their doctor would set them right automatically, which is impossible. A doctor has to use his head, his wisdom, hands, heart, and skill and then prescribe suitable medicine and, in some cases, it may or may not work even in the best of the centres.

Could you elaborate on the dietary guidelines of the ICMR?

We have launched 'Nutrify India Now', a first-of-its-kind comprehensive mobile app launched to play a key role in the Prime Minister's National Nutrition Mission. The app has been developed to act as a nutri-guide that would help users assess the nutrients in their food. It would also help the users keep a track of their energy balance. It is India's first comprehensive nutrition-related mobile app with names of food items in 17 Indian languages. The app is available for both Android and Apple users. It contains BMI and BMR calculators.

(Dhirendra Kumar is Special Correspondent with Millennium Post)