Attempt to dent medical tourism
Amidst the huge media frenzy over the Lancet infectious diseases article on the superbug, there are good reasons why India should try to get the journal to retract the article. Going by their publication record, none of the Indian and other South Asian authors is a very well-known researcher or clinician. Why were they invited for this study and their trips paid for by pharma players? Was this just to hunt isolates? Why was convenient sampling done at tertiary hospitals? Who cleared the transfer of isolates from India to the UK? Do Indian hospitals mentioned in the study hold export licences for classified biological agents? Do they have HMSC (an Indian Council of Medical Research watch-dog) clearances?
I am doubtful whether the culture and antibiotic sensitivity screening protocols were approved by biosafety committees at respective Indian centres and hospitals. I wonder why the Hinduja Hospital team was dropped for authorship when there were analyses of isolates presented from Mumbai? Researchers back home are eager to know the number of isolates Hinduja shipped to the UK, and also whether the first author, Kumarasamy, carried them to the UK and his trip was funded by Wyeth?
If our doubts are genuine, should they be overlooked, especially, when the study falls within the ambit of prestigious funding agencies such as European Union and Wellcome Trust?
There are additional problems involved in the research aimed at blaming India. There’s no mention of how many isolates were supplied and by whom? Much of the discussion appears to be directed towards denting medical tourism in India and is based on popular media reports and articles from strange-sounding journals (J Assoc Physician India and J Infect Dev Ctries). It seems that the involvement of Indian centres was merely for collecting the isolates. Such research collaboration cannot be justified.
These points must be investigated and taken up by the Indian Council of Medical Research and Union (ICMR) health ministry with the journal and the Indian institutions/hospitals that cleared implementation of the study. Unless documents supporting ethical and biosafety clearances are produced, the journal should be asked to retract the report with an apology. Also, the ICMR and other agencies should formulate concrete policies on such ad-hoc collaborations which are meant only for hunting and exporting of genetic material and patient isolates.
The data does not support clonality of the Indian and UK isolates. Hence there was no need to espouse transcontinental spread. A scientific thesis should only advise future directions in terms of research and development. The travel advisory embedded in the article clearly reveals the intention was to dent medical tourism in India.

Keep a check on antibiotic abuse
Whether the superbug originated in India is debatable, but it is certainly time for introspection, in particular to look at some of the facts relating to antibiotic abuse in India. We should look inward before blaming others.
It is now well recognised that there is widespread antibiotic misuse/abuse in our country. This has serious effects on public health. For example, upper respiratory infection is a common diagnosis. More often than not it is caused by virus or fungus. However, the vast majority of these patients are wrongly prescribed antibiotics. Unless secondary bacterial infection sets in, there is absolutely no role for antibiotics.
Most people not only self-medicate, they are also prescribed antibiotics carelessly by doctors, even for low grade pyrexia (fever) regardless of whether it is physiological or pathogen-induced. It is precisely this careless phenomenon from both patients and doctors that is leading to the development of multidrug-resistant bacteria.
With this frightening trend, in the not too distant future, antibiotics will not act on common bacterial infections and many more superbugs will develop that could potentially cause multi-antibiotic resistant life-threatening infections.
In addition to developing resistance, antibiotics disrupt the normal bacterial flora in the bowel leading to a multitude of problems like diarrhoea and flatulence. There is now evidence to suggest that bowel disorders like ulcerative colitis and even cancer can be caused by antibiotics abuse. Allergic reactions ranging from rash to shock, and suppression of body’s immunity, are some of the other ill effects of antibiotic abuse.
Legislation must be brought in to prevent sale of antibiotics at pharmacies without a valid prescription. The concept of General Practice (family physician), which is more or less extinct in India, must be revived. We, as a country, must switch from the doctrine of practising the more aggressive “Americanised Medicine” to “British Medicine”, which is far more conservative and evidence-based. Doctors should, wherever possible, try and identify the causative organism before commencing antibiotic therapy.
Frequent hand washing by healthcare professionals and prompt identification and isolation of patients with drug-resistant infections will most certainly minimise the spread of multi drug resistant infections in hospitalised patients. Hospital-infection control registry is almost nonexistent in most hospitals in India. There should be a national hospital registry. Also, national guidelines regarding antibiotic prophylaxis and antibiotics usage for established infections must be developed.
When antibiotics were first invented in the 20th century, this was considered a medical miracle. In the 21st century, the efficacy of these miracle drugs is in jeopardy as a result of their gross misuse, causing a host of problems.