We, the Pharm Animals

This week let me share with you my short article that appeared in Economic Times Corporate Dossier of July 8, 2011 under the title We, the Pharm Animals 

Most of us do our  best to stay clear of two places: the court and the jail.

The court is where we’re supposed to get justice. But the brand of justice it dispenses is tied to evidence.  Because wily lawyers can emasculate evidence in devious ways, the guilty often walk out with a DGP Rathoresque smirk and, at least occasionally, innocents get gavelled on the head.

As penetrating legal jargon is harder than entering Fort Knox, we are at the mercy of lawyers if we are unfortunate enough to have to deal with the law court either as a plaintiff or as a defendant.  In legal battles, which enter a cycle of rebirths at higher and higher levels sucking in more and more money, the lawyers are invariably the winners. Our savings suffer all the collateral damage. Naturally we want to avoid the court.

The trouble with jails is that they give us a forced holiday but won’t let us enjoy it in peace even if we have a discounted 2G licence in our pocket. Unless we belong to the super-privileged category called political prisoners, the jail brings us nothing but bugs and bad company. Not surprisingly, we shun the jail also with all our might and moolah.

But there is a rather dangerous place we sleepwalk into: the hospital. We are like farm bullocks that walk to the yoke raised by their master and allow themselves to be tied to it as if it were the most natural thing on earth to do.

“Infections acquired in health care settings are,” says a 2002 WHO report, “among the major causes of death and increased morbidity among hospitalized patients.” Yet, we rush into those very places even when we don’t need to or we have better options.  We now take it for granted, for example, that hospital is the ideal place for a natural biological process like childbirth. (Soon we may be persuaded to go there for conception too!)

Are we being conned into such blind faith in hospitals by smart ‘pharmers’ – medical professionals who have their services to sell and pharmaceutical companies that have their products to sell?

What are the compelling arguments in favour of hospital births? There is just one: if there is a complication, a well-equipped hospital with a team of doctors can deal with it far better than a midwife at home.

Of course. There is no need to debate it. The life of both the mother and the baby is precious. So we must leave them in the hands of professionals in a good hospital if we anticipate any complication. But why take a pregnant woman to that dangerous place if she is healthy, the pregnancy has been normal, and a natural birth is expected?

The pharma community has persuaded us to do precisely that by clever framing. They ask: “Do you want to take a risk with the life of the mother or of the baby or both?” When that question is so framed, none of us have the guts to say, ‘I do’ because the ‘risk to life’ does not appear to be a distant possibility but an immediate threat. So it unnerves us unlike the risk of fatal cancer from smoking or cardiac arrest from gorging on junk food. We scream, “No, no! We don’t want to take any risk. Let’s take her to hospital.”

Once a perfectly healthy pregnant woman is admitted to hospital, she is treated like a patient and monitored closely. She and her folks are made to look at the natural process of giving birth (which millions of mammals go through successfully every day without any monitoring or assistance whatsoever at whatever place they consider home) as a tension-filled, high-risk drama rivalling the capture of Osama bin Laden. The fear that anything can go wrong any moment makes the process tricky because no one, especially the woman, can relax.

To prevent anything from getting out of hand and possibly to justify expensive hospitalisation, most obstetricians strike without giving the natural process a chance to succeed. In an article on this topic in The Economist (‘Is there no place like home?’ March 31, 2011), the writer says, “Hospital births are more likely to end in Caesarean sections, and to involve episiotomies (cutting the perineum) and epidurals (which increase the odds that the labour will require forceps, which can tear the perineum).” Not at all surprising. Once you involve a professional, she has to demonstrate that you’re lucky she was around.

What if we frame the question differently? How risky is it for a healthy woman expecting a healthy baby to give birth at home with the help of a trained midwife? There is research data, but, as The Economist article points out, home-birthers and hospital-birthers gather and interpret data differently. Each group comes out with data that supports its position. Obviously, the better funded hospital-birthers with the trump card of horrible but unspecified risks to mother and baby, have been winning.

Healthy babies will continue to be born in homes of the poor and those who are far from hospitals, but we, the pharm animals, will troop into hospitals firmly believing that nothing could be safer or more natural. Together the medical professionals and the pharmaceutical companies seem to have done a fine job of mass persuasion.