The dilemma of trying out new cures for
Mains Paper 5: Health
Prelims level: World Health Report, CHIM
Mains level: Health related issues
- In 2015, the World Health Report stated that there had been 214
million cases of malaria worldwide with 438,000 deaths from it.
- This represents an 18% decrease in cases and a 48% decrease in
mortality compared to 2000.
- However, what these figures hide is that over the past decade,
there has been an alarming rise in reported cases of drug-resistant malaria
all over South-East Asia from Vietnam to
Myanmar and in Pakistan.
- Given this geographical spread, it is inevitable that
drug-resistant malaria will come to India sooner rather than later.
- There is, therefore, an urgent need for us to develop new
treatment regimes for this disease.
Concerns for India
- The trouble with using therapies developed in the West on Indian
populations, particularly in the case of vector-borne diseases such as
malaria, is that the host-pathogen relationships in those countries could
vary significantly when compared with India.
- Given our genetics, history of infections, co-infections, immune
status and even environmental factors, it is more than likely that
treatments that work well on European populations will be somewhat less
effective in Asia.
- What we need to do is to find ways to effectively test new
therapies on the Indian population to identify remedies that best address
the risk drug-resistant malaria poses to us.
Highlighting the CHIM studies
- Controlled human infection model (CHIM) studies offer a means by
which this can be done.
- A CHIM study calls for the infection of perfectly healthy adult
volunteers with a carefully selected strain of a disease.
- This allows researchers to observe the progress of the infection,
its response to treatment and the efficacy of both naturally acquired as
well as vaccine-induced immune responses.
- Everything, from the strain of the pathogen to the timing, route
and dose of infection, is carefully controlled to avoid causing harm to the
volunteers and to allow researchers to make accurate observations of the
disease that they would otherwise have been unable to do.
- The benefit of this method is that it makes results available in
far shorter time frames than would have been possible with traditional
clinical trials, resulting in considerable reductions in the cost of drug
- As far fewer participants are exposed to experimental therapies,
it puts a much smaller proportion of the population at risk.
Problems with CHIM studies
- CHIM studies throw up several ethical issues that need to be
addressed before we proceed.
- In the first place, the basic premise of a CHIM study requires
doctors to intentionally infect previously healthy human beings with a
- This approach bears an uncomfortable resemblance to the
experiments that Nazis conducted on prisoners in concentration camps, making
it impossible to even consider without dealing with the revulsion that such
- In addition, the doctors and medical researchers who conduct these
studies will have to consider for themselves how the act of intentionally
making a healthy person ill sits with their Hippocratic obligation to do no
Steps needed to be taken
- Though all CHIM studies obtain, as a pre-condition, the informed
consent of volunteers before proceeding.
- There is understandable scepticism as to whether, in the Indian
context, those who participate in these studies will actually understand the
many known, unknown, and potential risks of these experiments.
- This is further exacerbated by the poor reputation of the Indian
research community with clinical trials in general particularly following
the death of seven girls who participated in Human
Papillomavirus Vaccine trials in 2009.
- Among poorer sections of society, financial incentives have the
effect of being coercive, impairing the consent they provide.
- One way to address this could be to stipulate that CHIM studies in
India should not offer any financial incentives whatsoever, other than
covering the cost of treatment during the study and beyond in case of
- This will ensure that anyone who takes part only does so
altruistically with no interest other than to further the scientific
understanding of the disease.
- Above all, the government needs to quickly establish a robust
regulatory framework within which any such study should proceed, with strict
punishments prescribed for anyone attempting to conduct rogue trials.
- Only research institutions with impeccable credentials should be
granted a licence to conduct CHIM studies and should, throughout the
process, be subject to the supervision of an independent ethics board.'
- CHIM studies offer many benefits. However, before we take
advantage of them, we need to address the many ethical challenges they pose.
Q.1) 'Dual or double government' in the context of the East India
Company’s rule in Bengal refers to a system where:
(a) the company had the power to collect the revenue while the Nizam of
Bengal controlled the nizamat.
(b) the company collected the revenue and enjoyed the control over the nizamat.
(c) the nizam collected the revenue while the police and the judicial system was
controlled by the company.
(d) the powers to collect the revenue and the power to control the police and
the judicial system was shared between the Nizam and the East India Company
Q.1) What are the major highlights in accordance with CHIM studies published by