This is an account of a seven year old boy and his journey of writing and ultimately publishing a book, sent to me by his mother.
As a Medical Doctor I ask myself what are some potential uses of blockchains in healthcare?
Okay, so for those who must be wondering,
What is a blockchain?
In general a blockchain is defined as a distributed system which records and stores transaction records.
Blockchain more specifically is defined as “…a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger.”
Blockchain is also similar to a database which stores information, however the main difference is that the data is located in a network of personal computers called nodes where there is no central entity such as a government or bank controlling the data.
How can blockchain be used in healthcare?
- Drug Traceability where each transaction between drug manufacturers, wholesalers, pharmacists and patients can be tracked to verify and secure drug product information important for tackling issues such as counterfeit drugs.
- Improvement and authentication of health records and protocols on record sharing.
- Smart contracts where certain rule-based methods are created for patient data access. Here, permissions can be granted to selected health organisations.
- Clinical trials where altering or modifying data from clinical trials fraudulently can be eradicated.
- Precision medicine where patients, researchers and providers can collaborate to develop individualised care.
- Genomics research via access to genetic data secured on blockchain
- Electronic health records (EHRs)
- Nationwide interoperability
As a medical Doctor who is also interested in Total person care and treating each individual as equal and worthy of dignity and respect, blockchain technology gives me the technological possibility of actually implementing my values in practice.
I look forward to more developments in the field of Blockchain in healthcare. God bless.
Evolution theory. It has been a subject close to my heart for many years. Why is it controversial now?
For starters, recently [first week of Jan 2018] in India Union minister Satya Pal Singh , who is the minister of state for human resource development had stoked a controversy saying that our ancestors have nowhere mentioned that they saw an ape turning into a man, thereby casting doubts on Darwin’s evolution theory.
In January 2018, he stuck to his claim that Charles Darwin’s theory of evolution of man is “not scientific” and called for an international debate on the issue to decide if it merits a place in school textbooks.
Blaming the media for fuelling a controversy over his statement, Singh said the issue calls for debate and not controversy. “In the last 100 years, many evidences have come out against the theory, in favour hardly anybody. It is not my statement. So many world scientists have said it,” Singh, the former Mumbai Police Commissioner, said.
I felt this is good time to try to clear the murky atmosphere of Evolution.
What do I mean by evolution? It may be totally different from what you understand, so let me explain by defining it as I understand.
Evolution is a change in the characteristics of a living being over generations.
Sounds simple, right?
The problem starts when people start assuming or rather over estimating the degree of change that this simple process can bring about.
For example, let us look at the dog.
If you call this evolution, fine. I would agree. Dogs have been selectively bred by intelligent human beings to give them desired characteristics over hundreds of years.
But look at this picture
The above picture is what I call stretching your imagination 🙂
It is okay to think that dogs can evolve, but to think a dog can evolve into a cat? It just shows how ignorant these people are about the complexities of life and especially about genetics.
Let me explain in simple terms:
There are millions of species of living beings on earth [and the numbers are fast declining every day]
Each species is unique and cannot breed or produce viable offspring when mated with another, no matter how similar looking.
I believe that an intelligent being, popularly called God, created species and defined them some time in the past.
He also gave the creatures he created the ability to adapt and survive in this physical world that we inhabit. This is again a testimony to his wisdom, his ability to see beyond time and space, into the future, where he knew that we humans would be altering the world due to our greed and mindless consumption.
This ability to adapt and survive is being stretched beyond its designed parameters and hence we see species getting extinct these days.
However many species do adapt and survive, some better than others. For example pests like flies, cockroaches and mosquitoes seem to thrive in these conditions.
But there is a limit to how much a species can adapt or change, and that is written in its DNA by the one who made it in the first place.
The problem with us humans is that we like to think we are gods. That we can decide what is true. That we can simply issue a statement and it will change the facts:
For example, the United States National Academy of Sciences states:
Today, many religious denominations accept that biological evolution has produced the diversity of living things over billions of years of Earth’s history. Many have issued statements observing that evolution and the tenets of their faiths are compatible. Scientists and theologians have written eloquently about their awe and wonder at the history of the universe and of life on this planet, explaining that they see no conflict between their faith in God and the evidence for evolution. Religious denominations that do not accept the occurrence of evolution tend to be those that believe in strictly literal interpretations of religious texts.— National Academy of Sciences, Science, Evolution, and Creationism
The confusion caused by the definition of Evolution adds to this. If you go by the simple definition that I gave earlier of dogs, it is nothing but adaptation. If you try to go by the definition proposed by some over-imaginative “scientists”, it would mean something like the Creative Imagination picture I posted.
That, dear reader, is what mainly causes the controversy. The degree of change considered possible by this process of ‘Evolution’.
And of course among other things the refusal to consider that there even exists a loving and intelligent being who could have created you and me and the entire universe.
The God who created you and me so wonderfully, has also given you free will to choose absolutely anything. You can decide what or whom to believe. Ultimately it is a matter of the heart.
I do not want to give you enough scientific reasons to make you realize the fallacies of the 2nd picture, but I want to plant a seed of a desire to find out for yourself what is true. Because in that way the faith you find would be truly yours.
The Moghul vs British debate in social media reminded me of the words of Jesus: A tree is known by its fruits.
What did the most ardent Mughal followers of Islam do in India?
As Sadguru pointed out, “Building harems after making kafir women their slaves, destroying Indian traditions, destroying temples & building mosques over them, imposing Jizya tax on the people whom they hated the most & considered them kafir, carrying out mass scale conversions at the point of sword, killing brutally legendary Indians like Guru Teg Bahadur, Sambhaji, etc. etc. just bcoz they refused to accept their religion. These are only few examples of their brutalities. They were extremely intolerant & barbaric. Even Osama Bin Laden was nothing more than a child in front of them.”
That may be an extreme view no doubt but there is a lot of truth in the statement.
What about the British?
As Sadguru said, “they were interested in doing scientific researches & technological innovations & engineering.”
While most of the British were Christians only by name, [most were primarily businessmen and soldiers and some were openly against any faith based activities], there were a few, notably the Evangelicals, who could be called genuine followers or disciples of Christ. [A true disciple of Christ will never use force or inducements to convert anyone, because he believes that God who created us, gave us free will to choose, and He respects it. A genuine change of heart from within is what God desires for all of us.]
What did they do? They sincerely did what they believed was needed for the welfare of Indians.
They built schools, hospitals, orphanages, took care of widows and the out-castes of Indian society out of unconditional love, the same love that motivated Jesus to give His life for us. In general there was a lot of work in the field of public health done by the British.
William Carey, a missionary in Serampore, was instrumental in getting the practice of Sati banned after decades of efforts. The reformation movement in Hinduism also was sparked by those who came in touch with him in Bengal.
So as you can see, the Mughals and the British were very different in a few vital areas.
There is a common misconception about what are called the Abrahamic faiths. Christians and Jews are part of the Abrahamic covenant and worship Yahweh.
On the other hand, Islam is not an Abrahamic faith, and the God they worship, Allah, is in no way connected with the God of the Bible no matter how ardently the Muslims may claim it.
The fruits, I believe, are self-evident.
I often hear that in India poor people are being pushed deeper into poverty when they have to pay out of their own pockets for healthcare, especially when they avail of private healthcare.
We also often hear about the “high cost of healthcare” in the private sector in India which services 70% of India’s healthcare needs.
What are the solutions we hear being proposed by almost every stakeholder?
- Universal Medical Insurance
- Increased Government spending on Healthcare
Let me try to explain why these are definitely not the best things that could happen to Indian healthcare @drspmathew.com
Whats wrong with Universal Medical Insurance [UMI]?
If there is one thing we know for sure from the experience of other countries, it is this: Universal Medical Insurance ensures in the long run that no middle class or poor person will be able to afford medical care without Medical Insurance. In a sense, UMI does everything to ensure its own survival!
Why does that happen? There are several factors:
When people do not have to pay for their own healthcare: Have you thought through the way people approach their own health when they know they are covered by Medical Insurance and they believe they need not worry about taking care of their own health, especially in terms of the non communicable diseases NCD’s which are the leading causes of death? worldwide? http://www.who.int/mediacentre/factsheets/fs310/en/index3.html
When people have medical insurance and do not have to spend for their own healthcare, it encourages a very casual approach to their own health, which is fueled by the media hype about how medical technology is able to treat every known disease on earth. So, the common attitude is, I have insurance, so no problem. If I fall sick, I am covered by insurance, and medical technology will make me alright. Wrong thinking, friend!
The incidence of NCD’s have skyrocketed in all developed countries and increasing even in the developing countries. There are multiple reasons for this rise but behavioral or lifestyle disorders are so called for a reason: Bad behavior causes bad health, and the false sense of security that insured persons have is a major cause for this behavior according to me.
As a result of this increasing burden of NCD’s, Insurance companies keep increasing the premiums, and the overall burden on healthcare increases dramatically.
Where do you think Insurance companies get the money to pay your Medical bills?
[Read more on The Relation between Universal Health Insurance and Cost Control http://www.nejm.org/doi/full/10.1056/NEJM199503163321111 ]
Disruption of Free Market economics:
Mediclaim and other forms of Medical Insurance try to dictate pricing based not on actual costing studies but on a collective bargaining with providers. Paradoxically this has been shown to raise healthcare costs and lower healthcare quality, rather than bring them down as one would have hoped.
On the other hand, when people do not have medical insurance and must spend on healthcare out of their own pockets, they take all steps possible to avoid getting sick in the first place. They also behave more responsibly to take care of their own health and are very cost conscious.
This cost consciousness enables enabling free market economy forces in the private healthcare sector to keep costs low without unnecessary bureaucratic intervention. This is what has been happening till now in India to a large extent.
Whats wrong with Increased Government spending on Healthcare?
What really happens when the Government tries to step in to provide Healthcare?
The US spends 17% of its GDP on Healthcare. India barely 4%. Per capita annual Healthcare spending in the US is 8600 US Dollars which equals 551195.50 Indian Rupees, while in India and other such countries, annual average healthcare spending is 88 US Dollars which equals 5641.23 Indian Rupees.
In the real world, healthcare costs skyrocket when the Government and Medical Insurance companies step in. All that they are concerned about is their own survival.
When left to the economies of the free market as with any other industry or business, the price of healthcare will remain reasonable, access and quality will be determined by market forces, and there will be no opportunity for corrupt Governmental agencies to dictate their own often selfish agendas. I am not denying that there are several good people in the Government who sincerely believe that they are trying to do good, but the vast majority do not understand the realities and complexities of the healthcare system.
The Government, instead of wasting tax payers money in areas which are not its core competencies, should rather focus on providing basic things needed for health, starting with good infrastructure and a lot more! In these areas the Indian Government can do well to learn from the developed world!
Poverty and sickness:
But why do poor people in India find healthcare expensive?
Poverty is a big problem everywhere but more so in India. Is the healthcare industry responsible for poverty? A better question would be to ask, why are these people poor? And why are they falling sick?
Many poor people in India fall sick and die, because the environment and infrastructure essential for good health were not adequately provided for by the government and other agencies responsible for the same.
The Government also did not provide a conducive environment for businesses to function transparently and efficiently, resulting in corruption and low wages for the workers. Of course there are diverse reasons for low wages, each of which is equally responsible for the poor person not being able to pay for healthcare.
The result: Poor people living in unhygienic conditions, getting underpaid for whatever work they do.
And when they fall sick, where do they go? Government healthcare, if available, is crowded and not free either. They lose days waiting in line, losing what little income they earned. So what alternative do they have? Private healthcare, that is fast, efficient, and much cheaper than any healthcare anywhere in the world. Why? Because when the pricing of healthcare is left to market forces, competition keeps costs low as in any business in the free market economy.
If this poor person cannot afford the fees at a private healthcare setup, something is drastically wrong in the economics. The poor person is not being paid adequately or unable to save enough.
So, who is really to blame for the poor sick man being pushed into poverty due to sickness? Who is responsible for him falling sick in the first place?
Is it not the Government, which has not provided him basic needs for good health like clean air, pure drinking water and good sanitation? Which has not ensured that he gets adequate opportunities to earn his reasonable livelihood?
Every person in India has a right to claim that the taxes he pays are adequately utilized, not to line the pockets of corrupt politicians through short sighted mega projects in ‘Government healthcare’, but to ensure a life of dignity to the poorest, with the basic needs for good health provided to every citizen of the land.
The WHO definition of Health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
The Government can do much more for the health of India if it focusses on what it is paid to do, govern impartially and without corruption, rather than try to enter into Healthcare and muddle it up. In that way it would be doing a great favor to the health of its citizens.
The Government can mess up Healthcare even if it is relatively non-corrupt like in the developed nations. So one can only guess what is going to happen to Healthcare in India once the Government tries to do anything.
Private Healthcare Providers and the responsible Free Market:
I must salute the private healthcare provider, who despite the odds, is providing a reasonable level of service to large segments of society at a fraction of the cost worldwide. No doubt there are black sheep here also but the model is one that has a hope for a better future, bringing about Shalom Healing to people.
Let us stop blaming those who are trying to do good, and focus on the real culprits. The people get the Government they deserve, an old saying goes.
I hope I have made myself clear. Neither increased Governmental spending on healthcare nor Universal Medical Insurance is the answer dear friend.
Instead, if it really cares for the health of its people, let our Government take serious steps to improve the basic essentials for good health. Let it restore and improve the quality of our air, water, food and soil.
Let the Government eradicate corruption and red tape within itself, help honest businesses to establish and grow, thus providing people with a reasonable standard of living. This will help to not only improve the health of our nation, but to transform India into a world class nation. Hope better sense prevails in our country. Please pass this on to those who care. Jai Hind!
I was shocked to see two men from a roadside garage burning wires made of copper and insulated with PVC, apparently to extract the copper.
If someone were to suggest to you that the solution to your headache would be to shoot your head off, how would that sound? I know it can sound absurd, but to me this whole debate about the solution being offered for the woman who is pregnant but does not wish to become a mother, the solution that the Medical fraternity is only too eager to offer in India especially, of aborting the life she is carrying, doesn’t sound too different.
What wrong did that unborn child do to be prematurely killed when it is in the most dependent state of its life?
Justice K. Kannan who is a former judge of the Punjab and Haryana High Court wrote an interesting article in the Hindu recently questioning the way abortion is fast being offered as a solution to myraid cases of pregnancy: The fundamental question is: what makes killing a human being wrong? We may then consider whether these characteristics, whatever they might be, apply to the earliest stages of human life in the womb. Explanations that have roots in religion include the traditional Christian doctrines such as that all humans are made in the image of God or that all humans have an immortal soul.
Apart from the point of view of health and avoidance of disability, with modern notions of individual liberty, many a pregnant woman believes that apart from her, no one else will have a right to decide about what she wishes to do with the foetus.
It is also suggested that an alternative for parents faced with the decision to terminate their pregnancy is a perinatal hospice. A perinatal hospice recognizes the value of bringing these infants to term by treating them as beings conceived with a tangible future. This alternative is preferred because of post-termination psychological distress and because biblical teachings emphasise the dignity and worth of each foetus.
In response to this, a few well educated people from India including female Medical Doctors wrote about choice: [http://m.thehindu.com/opinion/op-ed/abortion-womens-rights-and-human-rights/article8969843.ece]
“According to international human rights law, a person is vested with human rights only at birth; an unborn foetus is not an entity with human rights. The ethical issues here are not just of the rights of the foetus. The foetus is not an independent entity and depends completely on the welfare of the woman. Without her well-being, one cannot talk about the well-being of the foetus. We also need to consider the fact that the woman herself is a living human being in the here and now — the pregnancy takes place within her body and has profound effects on her health, mental well-being and life. Thus, how she wants to deal with this pregnancy must be a decision she and she alone can make.”
What even a school child understands is that there is life inside the bulging tummy of the pregnant woman.
The PCPTND act which forbids disclosure of the sex of the fetus in India, designed to thwart the warped sex ration in the country due to selective female foeticide over the ages, recognizes that there is life in the womb! Then what is the confusion?
I am reminded of a phrase: We have educated ourselves into imbecility. No wonder educated people can write such responses to the article written by Justice Kannan.
Perhaps this last image sums up my message:
I would also like to add, the men who caused the pregnancy must learn to take responsibility for taking care of the outcome equally if not more.
I hope you would say Amen. Even if you do not, remember, the King who created you, and loves you, decides what is right and what is wrong, not me and not you. His Kingdom is advancing swiftly.
On which side would you be, my friend?