Once upon a time, there used to be something known as the medical profession, comprising of doctors, nurses and others who worked at hospitals. in those good old days, over 90 per cent of hospitals and health centres were publicly owned – central or state government, municipal corporations, companies and so on. there were also a few charitable trust hospitals that functioned in a similar manner as the public hospitals. Things began to change in the 1980s, when the first ‘for-profit’ hospital (apollo) was set up, and the central government redefined hospitals as the “healthcare industry” making them eligible for bank loans and other forms of financing. and medical professionals became known as “healthcare providers” though some senior doctors didn’t quite like the new designation. The book, Healers or Predators, is not just timely, but also very appropriate. in his foreword, Nobel Laureate, Amartya Sen describes the scenario as depressing, but the situation is much more – a dystopian world from which there is no escape! the reason is a combination of exploitative hospitals, a callous government, nearly non-existent regulation of all parties – doctors, hospitals, medical gadget manufacturers, and the pharma sector! The book covers a wide canvas: from the flaws in the Medical Council of India, to moral, ethical and societal questions affecting the medical profession.

1. Business India u the maga zine of the cor por ate wor ld Books
u 79 u
AUGUST 13-26, 2018
O
nce upon a time, there used
to be something known as the
medical profession, compris-
ing of doctors, nurses and others who
worked at hospitals. In those good old
days, over 90 per cent of hospitals and
health centres were publicly owned –
Central or state government, munici-
pal corporations, companies and so on.
There were also a few charitable trust
hospitals that functioned in a similar
manner as the public hospitals.
Things began to change in the
1980s, when the first ‘for-profit’ hospi-
tal (Apollo) was set up, and the Central
government redefined hospitals as the
“healthcare industry” making them
eligible for bank loans and other forms
of financing. And medical profession-
als became known as “healthcare pro-
viders” though some senior doctors
didn’t quite like the new designation.
Over the decades, thousands of
such hospitals came up all over the
country, of which a few have even got
listed in the various stock exchanges
in the country. Side by side, private
medical colleges mushroomed all over
India, and they raised the cost of med-
ical education far beyond the reach of
ordinary people. Add to this, luxury
hospitals, ultra-modern technology
and the latest medicines. Quite natu-
rally, healthcare services have become
so expensive that even middle class
families consider a hospital admission
nothing less than a disaster!
Thus the book under review, Healers
or Predators, is not just timely, but also
very appropriate. In his foreword to
the volume, Nobel Laureate Amartya
Sen describes the scenario as depress-
ing, but the situation is much more –
a dystopian world from which there is
no escape! The reason is a combination
of exploitative hospitals, a callous gov-
ernment, nearly non-existent regula-
tion of all parties – doctors, hospitals,
medical gadget manufacturers, and
the pharma sector! Also, the stronger
the medicine, the greater are its side
effects, and truly rare is the doctor
who will explain this to the patient!
To make it worse, judicial review of
healthcare actions takes so long and
costs so much that it is quite useless in
most cases.
All this is known; it has been writ-
ten about extensively in the media
over the years. But Nundy and his col-
laborators have put it all together, so
that a comprehensive examination
of the situation now becomes possi-
ble. It covers a wide canvas: from the
flaws in the Medical Council of India,
to moral, ethical and societal ques-
tions affecting the medical profession,
and the regulatory framework applica-
ble to various aspects of the industry.
Hence the book is best used as a refer-
ence or text book, reading each essay
on its own, rather than at a single
stretch. The wide spectrum of articles
also means that there is no common
thread running through it from start
to finish.
Significantly, Keshav Desiraju, one
of the co-editors, was Union Health
Secretary towards the end of his ias
career. He was thus a part of the health-
care establishment, and who better
than an insider to critique the system?
Some will say that given his position,
he should carry a part of the respon-
sibility for the healthcare industry’s
woes. But there is only so much that
an individual can achieve.
The entire book comprises of 41
essays, some written by researchers,
some by current and former report-
ers, yet others by development profes-
sionals and the style of writing varies
considerably. This approach makes
it more interesting to read, but takes
something away in terms of consis-
tency. A few essays read like academic
research papers and others like a racy
magazine article.
Among the most interesting parts
of the tome is Section VI, titled “Per-
sonal views” comprising of three
essays: authored by Dr Kunal Saha, an
nri doctor, an activist against medi-
cal corruption, Dr Farokh Udwadia,
a renowned specialist in respiratory
medicine, with decades of simultane-
ous experience in both government
and private hospitals, and Dr Ratna
Magotra, who retired in 2001 as head
of Cardiovascular and Thoracic Sur-
gery at Seth G S Seth Medical College
(kem Hospital).
In the concluding article, the three
co-editors concede that they were basi-
cally trying to put the pieces together,
rather than offer some new insight or
knowledge. Also they acknowledge
the difference in style of presenta-
tion in the essays but claim that it was
inevitable. This is admirable, because
it responds to concerns that a reader
might have upon finishing the book.
u SUMIT GHOSHAL
feedback@businessindiagroup.com
A dystopian world
The book covers a wide canvas: from the flaws in the Medical
Council of India, to moral, ethical and societal questions affecting
the medical profession
Healers or Preda-
tors – Healthcare
Corruption in India
Samiran Nundy,
Keshav Desiraju,
Sanjay Nagral
Published by: Oxford
University Press
Pp: 657, Price: R750
Nobel Laureate Amartya
Sen describes the scenario
as depressing, but the
situation is much more –
a dystopian world from
which there is no escape!
The reason is a combination
of exploitative hospitals, a
callous government, nearly
non-existent regulation
of all parties – doctors,
hospitals, medical gadget
manufacturers, and the
pharma sector!