cord blood banking: ambiguous policy

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Benefits of sanitation immense, but task ahead is toughByNareshKapoor

Prime Minister Narendra Modi’sSwachh Bharat campaign is a well-thought out move. It needs to be im-

plemented seriously. Human excreta arethe potential source of transmitting manyinfectious diseases such as cholera, ty-phoid, infectious hepatitis, polio, cryp-tosporidiosis, and ascariasis. Ensuring thatpeople have access to safe drinking wateris another critical dimension of sanitation.

Unsafe water, poor sanitation and hy-giene leads to under nutrition, pneumonia,worminfestations,reducedphysicalgrowth,weakenedphysicalfitnessandimpairedcog-nitivefunction,particularlyforchildrenun-der the age of five. Heavy metals, toxic or-ganic and inorganic substances also canpose serious threats to human health andenvironment, particularly when industrialwastes are added to the waste stream.Therefore, benefits of sanitation are im-mense, but the task ahead is not so easy!

ThePMhasgiventhecountrymenataskto be achieved in a holistic manner. Sani-tation is not only about maintaining clean-

liness around human habitats. If looked atin totality, sanitation is all about ensuringa healthy environment to all living crea-tures, which can come by self-realisationand awareness on good health. A surveyconducted by the National Sample SurveyOffice (NSSO), Union Ministry of Statisticsand Programme Implementation betweenJuly 2012 and December 2012 had madesome startling observations, which werebased on the findings covering 4,475 vil-lages in rural areas and 3,522 urban blocksspread over all states and Union Territo-ries. About 88.5 per cent households in ru-ral India had improved source of drinkingwater while the corresponding figure was95.3 per cent in urban India. Among ruralhouseholds, 85.8 per cent had sufficientdrinking water and for urban India the cor-responding figure was 89.6 per cent.

This means that making available safedrinking water to Indian masses is not adifficult task. It just needs one major push,which will bring the whole populace withinthe ambit of pure and safe drinking watersupplychain.Itwillalsotremendouslyhelpanimal husbandry as well. By providing

safe drinking water, we will only save ourpeople suffering from water borne dis-eases. To have pure source of water, overallsanitation needs to be improved upon.What about latrines? The survey showsthat 59.4 per cent and 8.8 per cent house-holdsinruralandurbanIndia,respectively,had no latrine facilities. It needs to be ad-dressed on a priority basis. A healthy Indianeeds toilet facilities for all. About 38.8 and89.6 per cent households in rural and ur-ban India, respectively, had access to ‘im-

proved’ type of latrine.Providingairyaccommodationisanoth-

erimportantdimensionofsanitationgoals.If we force a large populace to live in com-pressed accommodation, then most ofthemwillenduppickingupmanyailments.We will never have healthy children fromthese areas. It is a major problem in urbanIndia, where a chunk of people are con-strained to live in slums against all oddsand health hazards. If one goes by the sur-vey,thenonly26.3and47.1percenthouse-holds in rural India and urban India, re-spectively, had dwelling units with ‘goodventilation.’As much as 31.7 per cent of ru-ral households and 82.5 per cent of urbanhouseholdshad‘improveddrainage’facilityin the environment of their dwelling units.

It is not that people do not want to moveout of slums or squatter settlements, butthey need to be provided with opportuni-ties to do so. At all India level, 70.8 percent of households had cited ‘better ac-commodation’ as the main reason forwhich they thought to move out of slumor squatter settlement whereas 11.7 percent households had identified ‘proximity

to place of work’ as the main reason.

Best practicemodelsThere is a need to spread awareness onsanitation related issues and opting for the‘best practice’ models. We must under-standthatsanitationisacross-cuttingissueand has implications for a variety of devel-opment areas. To attain the target of totalsanitation, we need to work as well-knitunit. Total sanitation has to go beyond justtoilets. Urban women use sanitary napkinsbut in rural areas, women use a piece clothand have no private space to dry the pieceof cloth in sun. It is used while still wet.This has health and hygiene implications.

Sanitation has also a strong connectionwith human dignity and well-being, publichealth, nutrition and even education.Which is why Mahatma Gandhi once said:“Sanitation is more important than inde-pendence.”Sanitation issues should be giv-en priority in our development policy ap-proaches. Its implications need deep studyand greater understanding. The role ofcommunity leadership in changing oldhabits and ways of thinking will be crucial

as our own experience has shown. Simi-larly, sanitation has to be located in an in-tegrated framework of public health policyto ensure that sanitation activities are in-deed adequately funded. For example,hand washing with soap can reduce the in-cidence of acute respiratory infections(ARI’s) by around 23 per cent accordingto the World Health Organisation.

Thereisalsoaneedtodevelopsanitationtechnologies for diverse eco-systems. Newtechnologieshavetobeaffordableandsus-tainable. Traditional water systems hadbeenengineeredinourvillagestooptimisescarceresourcesincludingtheuseofwater.Wemustusescientific ingenuitytotakeIn-diatothenextgenerationofsanitationtech-nologies. Human waste should be treatedas a resource to be recycled. With more ur-banisation and industrialisation, this chal-lenge will gain importance. We have tostrive for sanitation for dignity and health.Good sanitation should be a birthright ofevery citizen of India. Total health will onlycome through total sanitation.(The writer is Director, BLK Super Special-ity Hospital, New Delhi)

By JadMouawad

Space travel has long been the preserve ofgovernments and sci-fi fans, but in recentyearsacropofnewcommercialventures,

often backed by billionaire entrepreneurs, hassought to get into the race.

The list of so-called thrillonaires has onlygrown, along with their ambitions: Jeff Bezos,the Amazon founder who set up Blue Origin tolower the cost of space technology; Elon Musk,who founded SpaceX with the aim of going toMarsoneday;andRichardBranson,whostart-ed the space tourism company Virgin Galactic.

But two recent accidents involving commer-cial rockets have underscored the high risksand soaring costs involved in any spaceflight.

Last Friday, a Virgin Galactic space planeexploded during a test flight over the MojaveDesert, killing one pilot and injuring another.Daysearlier,anOrbitalSciencesrocketcarryinga supply vessel to the International Space Sta-tion blew up seconds after it was launched.

Both accidents are under investigation. Al-though they were unrelated, their occurrencejust days apart was a stark reminder that thepathtospaceisjustasarduousforprivatecom-panies as it is for government-funded pro-grammes.

“The engineering and physics of space tendto be unforgiving, no matter who is doing this,”said Scott Pace, director of the Space Policy In-stitute at George Washington University and aformer assistant administrator at the NationalAeronautics and Space Administration.

The common thread between these newspace initiatives is that they all are looking forwaystosharplycutthecostofspaceflight.With-out that, analysts say, there is no realisticprospect of making spaceflights both routineand affordable in the future.

“What you are seeing playing out are differ-ent experiments, by different groups, tryingdifferent approaches,” Pace said. “To me, thisdoes not call into question the basic logic of re-lying more on the private sector.” The push toprivatisespaceflightisinpartborneofnecessity.Afterpioneeringspaceexplorationandlandingon the moon with programmes like Mercury,Gemini and Apollo, NASA has had to adapt totighterbudgetsandredefineitsmission.Today,one of its main goals is to encourage and fundthe development of commercial space entities.

Lori B. Garver, a former deputy administra-tor at NASA and one of the most prominentadvocates for commercial space during hertenure, said that public funds should focus onactivities that advance technology and providepublic benefits to all, like planetary science. Atthesametime,shesaid,thegovernmentshouldencourage private companies to move aheadand find innovative ways of reducing costs.

“In my view, the private sector has the sameincentive, or even more, to get things right asthe government does,”Garver said. “If we onlytrusted risky things to the government, wewould only fly in government-owned and oper-ated airplanes.”

Many of the current commercial operationshavesomeformofgovernmentsupport.OrbitalSciences is operating under a $1.9 billion con-tract from NASA to deliver cargo to the spacestation.ItsAntaresrocketexplodedonthethirdof eight resupply missions.

The same is true of SpaceX, which was re-cently awarded $2.4 billion by NASA to build atransportationsystemforastronautswithinthenext three years. SpaceX was also the recipientofanearlier$1.4billioncontracttodelivercargoto the space station. Boeing also won a NASAcontractfor$4.6billiontobuildaspacecraftca-pable of flying astronauts to the space station.

SpaceX and Orbital Sciences have sought toreducecostsindifferentways.Orbital’srocketsuse a pair of refurbished engines built in theSoviet Union in the 1960s and 1970s. The en-gineswereintendedforSovietrocketsdestinedfor the moon, but were never used and lay instorage for decades. The engines were refur-bished by an American company and incorpo-rated into the Antares rocket by Orbital.

SpaceX, by contrast, builds its engines for itsFalcon 9 rocket and aims to reduce costs, inthe long term, by reusing the rocket. The com-panyhassucceededinfiringatestrocketcalledGrasshopper, having it hover at around 2,400feet and then returning it to its point of launch.

But its efforts to land Falcon 9 rockets haveso far been unsuccessful, though the companysays it is getting closer. In August, a bigger testrockettryingahigh-altitudetestwasdestroyed

shortly after takeoff. No one was injured.NASA is “looking for cheaper access to

space,” said Marco A. Caceres, a space analystattheTealGroup,aconsultingfirminVirginia.Thetroubleisthatreliabilityandpriceareoftentiedtogether.“Itmaybeunreasonabletoexpectto pay under a certain amount to get a reliablevehicle,”Caceres said. “That comes at a cost.”

To theedgeof spaceVirgin Galactic is an exception to the model ofgovernment-funded launchers. The companyhas been working on an experimental vessel totake paying passengers to the edge of spaceand back.

The craft, called SpaceShipTwo, was de-signedtobelaunchedfromaplane,thenrocketup to its apogee at about 62 miles, an altitudeconsidered the boundary of outer space. At thetop of its ascent, two tail booms would rotateupward into a so-called feathered position in-tended to create more drag and stability, andallow the plane to descend gently back into theatmosphere.

Federal accident investigators said that theplane had shifted early into this high-drag con-figuration shortly before its accident on Fridayfor reasons that are still unclear. The investiga-tors said it was far too soon to draw any conclu-sions about the crash.

Investigators have located almost all of theimportantpiecesofthespaceplane,whichhadfallen along a debris field five miles long. That

included the fuel tanks and the engine, whichwere “intact, showed no signs of burn through,no signs of being breached,” said ChristopherA.Hart,actingchairmanoftheNationalTrans-portation Safety Board. “There is much morewedon’tknow,andourinvestigationisfarfromover,”Hart said during a news conference Sun-day night at the Mojave Air and Space Port inCalifornia.

In a statement Sunday, Virgin Galactic re-sponded to criticism that the design of Space-ShipTwo was flawed and that the test flightswere reckless. “At Virgin Galactic, we are dedi-catedtoopeningthespacefrontier,whilekeep-ing safety as our ‘North Star,’” the companysaid. “This has guided every decision we havemadeoverthepastdecade,andanysuggestionto the contrary is categorically untrue.”

Caceres said the new space entrepreneurswere good at creating excitement about theirventures. Before Friday’s accident, about 700people had reserved seats on Virgin Galactic,with tickets costing $250,000 each.

“You are talking about a brand new era ofspace,” Caceres said. “You have personalitieslike Richard Branson and Elon Musk and JeffBezos, who are not engineers. These are dif-ferent kinds of people and they can generate alot of excitement and capital investors who arewilling to give you a lot of money.”However, headded, “the downside is that if you have prob-lems,youhaveallthisattentionfocusedonyou.”InternationalNewYorkTimes

Risk and cost intravelling to stars

Twoback-to-backexplosionsareastarkreminderthatthepathtospaceisarduousforprivatecompanies

UNFORTUNATEOCCURENCES:Thewreckageof theVirginGalactic’sSpaceShipTwo,whichcrashed into theMojaveDesert,killingonepilotand injuringanotheronFriday. (INSET)AnunmannedOrbitalSciencesrocketexplodedafter liftoff inVirginia lastTuesday.AFP/AP

Thirdhandsmoke to

have lingeringeffectThird hand smoke con-tinues to harm healtheven hours after smok-ing ends, scientists atthe US Department ofEnergy’s LawrenceBerkeley National Laboratory have found.

They looked at the levels of more than 50volatile organic compounds and airborne parti-cles for 18 hours after smoking had taken place.

Hugo Destaillats said that in the US, the homeis where nonsmokers are most exposed to secondand third hand smoke and the goal of their studyis to provide information supporting effective

protective measures in the home.Destaillats added that many smokers know sec-

ondhand smoke is harmful, so they don’t smokewhen their kids are present, but if, for example,they stop smoking at 2 pm and the kids comehome at 4 pm, up to 60 per cent of the harm frominhaling thirdhand smoke remains.

The study found that the total integrated harmrises sharply in the first five hours after a ciga-rette has been smoked, continues to rise for an-other five hours, and doesn’t start to level off untilafter 10 hours.

Switchtohealthydietdoesn’t

nullify impactofearlierhabitsA new research has revealed that earlier pooreating habits may impact health even after diet is

improved. The scientists used mice to show thateven after successful treatment of atherosclero-sis, lowering of blood cholesterol and a change indietary habits, the effects of an unhealthy lifestylestill affect the way the immune system functions.

This change in function occurs largely becausepoor eating habits alter the way genes expressthemselves, including genes related to immunityand this change in gene expression (epigenetics)ultimately keeps the risk of cardiovascular disor-ders higher than it would be had there been noexposure to unhealthy foods in the first place.

Researcher Erik van Kampen said that thisdemonstrates the importance of diet-inducedchanges in the epigenome and encourages fur-ther research into the interaction between di-etary patterns, DNA methylation and disease.

John Wherry, Deputy Editor of the Journal ofLeukocyte Biology said that the ability of nutri-

tional history to have durable affects on immunecells demonstrated in this new report could haveprofound implications for treatment of diseaseswith immune underpinnings.

‘Mindfulness’meditationgood

forbreastcancersurvivorsPracticing “mindful-ness” meditation or be-ing involved in a sup-port group has apositive physical im-pact at the cellular lev-el in breast cancer survivors, a study conductedby Alberta Health Services’ Tom Baker CancerCentre and the University of Calgary Departmentof Oncology has demonstrated.

The study points out that telomeres – proteincomplexes at the end of chromosomes – maintaintheir length in breast cancer survivors who prac-tise meditation or are involved in support groups,while they shorten in a comparison group with-out any intervention.

Linda E. Carlson, lead research, said that theyalready knew that psychosocial interventions likemindfulness meditation would help one feel bet-ter mentally, but now for the first time they hadevidence that they could also influence key as-pects of their biology.

A total of 88 breast cancer survivors of around55 years of age were involved in the study. Mostparticipants had ended treatment two years priorand to be eligible they also had to be experiencingsignificant levels of emotional distress. All partici-pants had their blood analysed and telomerelength measured before and after interventions.

WHAT’S THE BUZZ

By Shashank S Tiwari

In the interim Union Budget2014, then finance ministerP Chidambaram had an-

nounced exemption of servicetaxoncordbloodbankingserv-ices. In his budget speech, hehad said that “(the) Ministry ofHealth and Family Welfare hasrequested that services provid-ed by cord blood banks are alsohealthcare services and shouldbe exempt from service tax. Ipropose to accept the request.”

The request from the min-istry is a clear indication of con-flict between biomedical agen-ciesinIndiaatthelevelofpolicyformulation. Given that, in therevised 2013 stem cell researchguidelines, the Indian Councilof Medical Research (ICMR)has raised concerns over thecommercialisation of privatecord blood banking in India. Itis worth mentioning here thatthe newly elected BJP-led gov-ernment also did not indicaterolling back of that decision.

Cord blood banking is aprocessofcollectingandstoringa new born cord blood for har-vesting stem cell. Cord blood isone of the richest sources ofstem cell which is widely seenas a potential to treat many in-curable diseases such as spinalinjury, muscular dystrophy,Parkinson’sdisease,Alzheimer’sdisease, multiple sclerosis, dia-betes, retinal pigmentosa etc.

There are two types of cordblood banking as per their na-ture: a) public, and b) privatecord blood banking. In the for-mer,expectantparentspayafeeto preserve their child’s cordblood while in the latter, the na-tureisaltruism.Therearemorethan15privatecordbloodbanksin India. The private cord bloodbankingisseenasacommercialventure which is largely basedon hope and hype and raisesmany ethical, social and gover-nance concerns.

The ICMR, jointly with theDepartment of Biotechnology,updated the 2007 stem cellguidelines in December 2013.InSection12.1ofstemcellguide-lines, it is stated that “procure-mentandbankingofvariousbi-ological tissues such asumbilical cord blood, placenta,extracted tooth, adipose tissueand other sources of stem cells,with the specific objective oftheirisolationand/orexvivoex-pansion, is increasingly becom-ing a commercial activity”.

Further, Section 12.2.2 em-phasises that “there are ethicalconcernsaboutthepromotionaladvertisementsbyprivatebanksoffering storage of cord bloodforpossiblefutureuse.Suchad-vertisementsareoftenmislead-ing for the public and lack com-prehensive and accurateinformation. It may be men-

tioned that there is no scientificbasis for preservation of cordbloodforfutureself-useandthispractice is not recommended.”

However, despite these con-cerns, one of the departmentsoftheMinistryandFamilyWel-fare requested the governmentfor service tax exemption oncord blood banking services.

Self useof cordbloodThe legitimate question ariseswhethertheICMRhasacknowl-edged that there is not enoughscientific evidence in favour offuture self-use of the preservedcordblood.Itisworthhighlight-ing that for biomedical gover-nance, there are two key agen-cies in India working under theMinistry of Health and FamilyWelfare – ICMR and CentralDrugsStandardControlOrgan-isation (CDSCO).

The ICMR works as an advi-sorybodywhileCDSCOisareg-ulatory body that primarilyoversees manufacturing, saleand distribution of drugs. TheCDSCO also approves newdrugs and monitors clinical tri-als. It is the licensing authorityfor cord blood banks in thecountry. Given the ICMR posi-tion in 2013 stem cell researchguidelines, it appears that CD-SCOhasrequestedgovernmentfor the service tax exemptiononcordbloodbankingservices.

Withthecontradictorystate-mentoftheformerFM andthe2013 stem cell research guide-lines,onecaninferaseriouspol-icyconflictbetweenbiomedicalagencies in India. This needs tobe addressed soon as the pro-liferation of private cord bloodbanking leads to possible eco-nomicexploitationofexpectantparents in the name of ‘biologi-cal insurance’.

However, the chances that aparticular child will develop acondition requiring cord bloodtransplantationareveryslim.Ithasbeenobservedthat0.04percent (1/2,500) of cord bloodunitsstoredwouldeverbeusedforautologoustransplantation.The reason is that the occur-rence of diseases currentlytreatedwithcordbloodissmall,and many patients would notbe eligible for autologous cordblood, including those with ge-netic disorders and leukaemia.

In addition, no one knows,whether CDSCO ensures stor-age conditions and quality con-trol especially while shippingthestoredcordbloodfromhos-pitals to banking firms. SinceUnion health minister HarshVardhan is a clinician by pro-fession,onecanexpectarobustpolicy regime and an effectivemonitoring mechanism forcord blood banking in India.(The writer, a scholar of ScienceandTechnologyStudies,isbasedin the USA)

Cord blood banking:Ambiguous policy