Author: Balaguru Mamundi

Title: ​ ​ ​​Clarity of vision: On eye drops for presbyopia and ‘claims’

The casual exaggeration of claims in medicine, unsubstantiated by science and facts, has long been a plague in the health sector. The promise of spectacular cures advertised in the media from time to time, in fact, prompted separate legislation to curb such claims: the Drugs And Magic Remedies (Objectionable Advertisements) Act. Last week, controversy over the claims over the prowess of eye drops prescribed for presbyopia (progressive loss of the near focusing ability of the eye due to ageing), led to the Central Drugs Standard Control Organisation (CDSCO) suspending a pharma company’s permission to manufacture and market the product. The CDSCO said that the company had made claims, for which it had not been authorised (that using the drops could lead to reading glasses not being needed for presbyopia). “In view of public interest, and due to the likelihood of the public being misled by these claims,” permission had been suspended. The company, ENTOD Pharmaceuticals, held that approval for the drug was based upon a valid controlled clinical trial that demonstrated efficacy and safety in 234 patients. It ladled the blame for the ‘claims’ on to media reports on the new product “which went viral and public imagination [that] led to an unusual escalation for which ENTOD Pharmaceuticals is not responsible”. Despite these protestations, the company had posted a message on X (since deleted) tagging Prime Minister Narendra Modi: “PresVu is the first DCGI-approved proprietary prescription eye drops to eliminate the need for reading glasses”.

The main ingredient in the drops, pilocarpine, works by causing the pupils to constrict, creating a pinhole effect. This would enable someone with presbyopia to see better. Pilocarpine, itself, is not a new application in ophthalmology, or even, presbyopia. It has been used to treat glaucoma, though its use waned because of the side effects, and has since been replaced by better drugs. The U.S. FDA had, in 2021 and 2023, approved pilocarpine-based eye drops for use in presbyopia. While the announcement of these approvals was publicised at the time, the communiqués mentioned the advantages of using the eye drops, along with the side effects, a measured claim about offering another option for presbyopes, in addition to glasses, contact lenses and surgery. The intervention of the CDSCO in this case, clearly is an attempt to reinforce the Drugs and Magic Remedies Act. This is a valid intervention in India today, where frequent advertisements for fantastic cures indicate the presence of an industry that thrives on cheating gullible patients. It is the duty of the government to set store entirely by scientific data, and rein in unsubstantiated claims about drugs, no matter who makes them.

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Unrealistic expectations: On India and Russia-Ukraine peace

India’s efforts at peacemaking between Russia and Ukraine have limited potential

National Security Adviser Ajit Doval’s visit to Russia had outcomes of potential bilateral and geopolitical consequence. At the meet of high-level security officials of the BRICS grouping, his one-on-one meetings with Russian President Vladimir Putin, and Chinese Foreign Minister and senior Chinese Communist Party Politburo official Wang Yi were in the spotlight as well. The meet of BRICS NSAs came ahead of the BRICS summit in October which will bring Prime Minister Narendra Modi, Chinese President Xi Jinping, and the leaders of Brazil, South Africa, the UAE, Saudi Arabia, Iran, Egypt and Ethiopia together for the first time since the grouping was expanded in 2023. The Doval-Wang meeting was no less important, given that the two high-level officials were meeting in the wake of intensified India-China contact to resolve the four-year-old military standoff at the Line of Actual Control (LAC). Their decision to “redouble their efforts” with “urgency” to complete disengagement along the LAC indicates that they hope to make progress in time before a possible Modi-Xi meet at the BRICS summit. External Affairs Minister S. Jaishankar’s comment that 75% of the disengagement has been completed seems to point to the government’s determination to cease hostilities with China, albeit not one that would actually see a reversion to the situation at the LAC prior to 2020. Finally, there was Mr. Doval’s meeting with Mr. Putin, which was a rare protocol exception. Mr. Doval’s comments, that he had been sent by Mr. Modi to brief Mr. Putin “personally” about the Modi Ukraine visit could mean that India is essaying a more mediatory role in peace-making.

If the government is indeed serious about such a role, it must be clear about what it entails. While officials have frequently said India has “conveyed messages” between Russia, Ukraine, and western countries during the war, mediating will require India to expend considerable goodwill, time and patience to achieve results. Türkiye, Indonesia and Hungary have been speaking to both sides since the 2022 invasion, and there are now many peace proposals from Ukraine President Volodymyr Zelenskyy, Mr. Putin, the Bürgenstock Communiqué, and even a six-point proposal by Brazil and China. The conflict is far from stable with ominous signs of an escalation including Ukraine’s invasion of Kursk, Russian missile strikes, and Mr. Zelenskyy’s persistent demand to be allowed to carry out long-range strikes on Russia using American and British hardware. Mr. Modi’s travel to the U.S. this month for UN meetings, the Quad Summit and another meeting with Mr. Zelenskyy possibly, followed by his visit to Russia for the BRICS summit will carry much responsibility, but India’s efforts at peacemaking must not be over-burdened by unrealistic expectations.

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Last mile woes: On inflation data and the challenges

Inflation should not be allowed to undermine the economic momentum 

The latest retail inflation data from the National Statistical Office yet again highlights the challenge in achieving durable price stability. Provisional estimates for year-on-year price gains in August show the headline rate based on the Consumer Price Index (CPI) quickened marginally to 3.65%, from July’s 3.60%, as a sharp rebound in vegetable inflation led to a wider acceleration in overall food price gains. Price gains in vegetables — the third-largest constituent of the Consumer Food Price Index — surged by more than 380 basis points last month to 10.7%, spurring food price inflation to 5.66%. Among vegetables, year-on-year inflation in the most widely consumed potato and onion still remained in the high double digits for a sixth and 13th month at 64% and 54%, respectively, a moderation from July’s levels notwithstanding. Other vegetables including carrot, palak and brinjal experienced a surge in price gains with all three posting double-digit inflation. Also, disinflation in the prices of pulses and cereals remained slow, with year-on-year price gains in the former still in the double digits for a 15th straight month at 13.6%, while the latter logged an inflation reading of 7.3%. Disconcertingly, food inflation in the rural areas rebounded to exceed 6%, and this at a time when stuttering private consumption is trying to regain momentum in the economically crucial agrarian hinterland. As an external member of the Monetary Policy Committee Shashanka Bhide noted in his comments at the RBI’s policy review meeting last month, “high food inflation would therefore hit growth adversely as it affects consumption”.

A durable disinflation to the RBI’s medium-term monetary policy goal of 4% headline retail inflation also faces other challenges, a key element being a resurgence in core inflation. The price gains measure, which strips out the more volatile food and fuel components, inched up to 3.38% after having snapped a 17-month decelerating streak in July. Based on responses from goods manufacturers polled for the monthly HSBC India Manufacturing PMI survey, HSBC observed this month that there was a “marked increase in prices charged for goods in August” with the rate of output-charge inflation the second-fastest in close to 11 years. Add to this the spatial and temporal volatility of the monsoon, and the outlook for price stability becomes even more muddied. RBI Governor Shaktikanta Das on Friday said that the last mile of disinflation was proving to be “challenging”. With policymakers still having to traverse a fair distance to ensure inflation does not undermine broader economic momentum, he reassuringly acknowledged that authorities “cannot afford to look the other way”.

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Title: ​ ​ ​​Good, but not enough: On the extended coverage of the Ayushman Bharat scheme

In a welcome move, the Union government’s decision to extend the coverage of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to senior citizens over 70 years, irrespective of their income, provides a modicum of free health coverage to nearly 60 million people. With out-of-pocket expenditure for health care in India among the highest in the world, the decision is indeed laudable. While the decision to provide free health coverage up to ₹0.5 million per year for a section of the population is noble, it will in no way fulfil the public health objectives that are much needed for the targeted beneficiaries. First and foremost, the health assurance scheme is limited to secondary and tertiary care hospitalisation. The absence of coverage for outpatient care, diagnostics and medicines is particularly concerning as chronic diseases have increased sharply in India in the last few decades. Increased life expectancy and an early onset of these diseases would mean that people over 70 may very often suffer from multiple chronic diseases. Most of the health-care expenditure by the elderly will, therefore, be through outpatient care (40%-80%), which will not be covered by the scheme. Since its launch in 2018, the penetration of PM-JAY into smaller cities and towns has been low in most States. Unlike in most of the southern States, primary and secondary health care in the public sector has been largely neglected and is inadequate and ill equipped to meet the demand in other parts. Robust primary and secondary public health care will sharply cut the load on tertiary health care and hence the need for curative care; a reduced curative care load at tertiary hospitals will make the PM-JAY scheme succeed.

Thailand focused and progressively strengthened its primary health-care system, and even diverted funds earmarked for urban hospitals to build rural hospitals and health centres to attain universal health coverage. In contrast, in the U.S., banking primarily on insurance-based schemes is what led to the surging costs of health care. India appears to be going the U.S. way. Though there is waning enthusiasm in the private sector due to low treatment rates and delayed payment, as per media reports, since its launch, two-thirds of the total money spent each year under the PM-JAY scheme went to private hospitals; it was 53% in the case of the southern States. Weakened primary and secondary health care will result in an overload in tertiary health care, which the private players will be well poised to take advantage of. This can lead to a further shrinking of the government’s commitment to strengthen the public health-care system by over-relying on the insurance modality which is neither affordable nor will provide appropriate health care for the needy. In its present form, PM-JAY is a measure that is essential, but is incomplete.

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