PLIGHT OF POLITICALLY DRIVEN PUBLIC HEALTH DECISION MAKING PROCESS

In the last couple of weeks everyone' attention capturing issue was Pioglitazone causing bladder cancer among Diabetes. Pioglitazone an oral anti diabetic drug was banned on June 18, 2013 stating its cause for bladder cancer among diabetes patients.

The Evidence Union Ministry has was "Eight cases" of bladder cancer in patients who are on Pioglitazone. The immediate reaction was BAN THE DRUG as any panicked would do. In the next month the Ban was revoked! Wow what a surprise, plus the Ministry ordered to label the box as harmful drug.

Based on this Eight cases the Ministry had Banned a drug over night. The only Indian study available was on 958 patients who are on Pioglitazone with no cancer after two years. This is the only scientifically valid data currently available.

This decision make process evokes the dubitable skill of the Ministry. Why is that there is no scientific search process behind a major decision? If the clause it to BAN something on its immediate cause and effect for a disease, why not BAN Cigarettes/Tobacco?

If by going with facts, 80% of the people with Type 2 Diabetes are over weight and most of them are smokers/Tobacco consumers. Why not BAN them? Smoking is considered to be a the major cause for Lung Cancer, TB and what not. Isn't this laymen statistics enough to BAN it? Unless a decision is taken rationally for a country with 110+ crore population, Irrational decisions like these in Public Health is equal to nurture a Wolf to grow in Kindergarden. 

DILEMMA'S IN IMMUNIZATION

           Immunization is a critical part of quality health care and should be accomplished through routine & intensive vaccination programs. When we think of immunization there has been confrontation in my mind and I am sure many of us too have it in us regarding certain aspects of immunization. There are only 43% Indian children who are fully immunized in age group of 12-23 months (NFHS -3).

The schedule for immunization is governed by the thoughts of MOHFW&WHO in one end and IAP at the other end.

Vaccines	IAP	MOHFW
Upper limit for BCG	Advocates till age of 7 years or beyond	12 months
DPT	Up to 5 years	Up to 24 months beyond which DT to be administered
At 5 years	DPT and OPV Booster	•DT •New recommendations says DPT(Booster 2) •What about OPV(Booster 2)?

Vaccine	IAP	BSPM(Bal Swasth Poshan Mah) or Child Health and Nutrition Months
VitaminA	18 months and there after every 6 months till 5 years	In the months of June and December only

E.g. If any child receives Measles and 1st dose of Vit A at 9 months in February 2nd dose along with DPT (Booster 1) will be given in November. But as per BSPM the same dose should be given in December. 

When the goal of these bodies is to achieve universal immunization coverage why do they follow different paths and routes? This becomes difficult for the health workers who manage immunization camps which are jointly held by various agencies and organisations. It’s very important to develop a consensus pertaining to immunization in the interest of children’s, health workers and others involved in immunization.

Thiru