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A turning point for The Lancet: The medical journal is using Healthcare as an instrument of politics

Having evidently failed to follow their own proposal mentioned in 2014, regarding issues at crossroads of Medicine and Politics, any guess then what option the Lancet now has?

A recent Editorial in the acclaimed Medical Journal Lancet on August 17th, titled “Fear and uncertainty around Kashmir’s future, created a furore. Two events in the Indian state of Jammu and Kashmir have been connected to each other while being economical on the truth with both. To further reinforce, a democratic Government has taken a major political and administrative decision for settling a historical conflict, has been held guilty of the related Healthcare crisis which will actually now improve.

Further mixing the two events to give a title of “fear and Uncertainty about Future” amounts to the ultimate fear-mongering with the hypocrisy written all over, by making Healthcare an instrument of politics, and naturally has irked Indian Doctors including the diaspora worldwide. Very strangely, the only other report on the same issue was in the BMJ two days later on similar lines, which is also a voice of exception.

Our utmost sympathy to those who are suffering. But to shrewdly distort decisions taken, to solve the larger vexed issue festering since 70yrs while ignoring larger suffering since decades, that the same Kashmiri people were victims of, smacks of contempt to all rational and democratic values. Why would the forces behind these two publications want the problem to continue, rather than support the bold decisions taken to solve them? Why is the elected Government of a vibrant democracy being vilified, while all those who have caused and aggravated the problem being deftly ignored?

Very interestingly, both these publications in British Journals came barely hours after related events in the UN Security Council on August 16th. Pakistan which pursues terrorism as a state policy, and is widely accepted as the fountainhead of terrorism worldwide, pushed for a resolution by the UN Security Council against India, along with their all-weather ally China. All of the other members clearly declined support, the exception being Britain. An administrative decision related purely to the Indian Constitution was carried out by the elected Government and approved by it’s Parliament. All this in a sovereign state where the Military is under complete control of the Elected Government, who in turn can be pulled up by an independent Judiciary.

With utter disregard to History and geopolitical facts, a narrative since decades centred on just three political families from the same Kashmir valley has been peddled by the Lancet editorial as the opinion of the entire state of J&K. Very likely the same was justified by an ingenious study design being sequentially quoted in the references cited by The Lancet. Why was the data from Kashmir Mental Health Survey 2015 analysed as a cross-sectional study, when same data could’ve been analysed as a comparative study with a much higher level of evidence, simply by using a control population to compare the results to? Was this to avoid focus on the unique socio-demographic make-up of the Kashmir valley, with the dominant Sunni Muslim population, just like in the state of Pakistan who openly supports an armed separatist movement against the Indian Government?

J&K receives massive funding amounting to 10% of India’s GDP, despite the state contributing only 1% to the same, though most of this is siphoned off by the powers & opinion makers in the valley, thanks to regressive Laws without any transparency. All of this is conveniently ignored by the Lancet though it admits few Health parameters in J&K are better than the rest of India. Imagine the benefit to healthcare once the same Laws & accountability will be in force in J&K hereon, just like the rest of India. Having lost 4 wars against India, Pakistan pursues a policy of state-sponsored terror and bleeding Indian through a thousand cuts, implemented by the separatists, terrorists and paid stone-throwers. Those who oppose the welfare centric decisions by India, go completely silent on the repeated shutdown in the valley & Kashmir called by these forces repeatedly over the decades. No mention of the brutal massacre, rape of Kashmiri Hindus amounting to genocide, which the same vested interests are responsible for, easily the biggest incident of ethnic cleansing in recent decades.

The vast majority of Indian Muslims oppose this blatant aggression & interference in J&K by the state of Pakistan since 1989, despite the attempts to paint the violence as a religious war for self-determination. This is despite a failed attempt earlier with a similar effort in, the adjacent state of Punjab between 1984-89 by inciting the Khalistani terrorists to wage a war against the Indian Nation. Many reports in Indian Media toe the same distorted narrative, to applaud the Lancet Editorial while condemning the huge uproar by Indian Doctors on the same. Some of these have precisely followed the line that Pakistan wants, and even called the Indian move as “against the only Muslim majority state in the Nation”. Will they ever equate the same demographic profile to all the gory despicable events in the same state over the decades? Do these Media reports support rights without any responsibility?

One would wonder what is the role of India and it’s native Hindu community in the Muslim dominant land of Kashmir. One only needs to refer to this ancient Sanskrit shloka:

It reads as “Salutations to you, O Sharada, O Goddess, O one who resides in Kashmir. I pray to you daily, please give me the charity of knowledge”.

Kashmir was part of Indian Culture not just before Pakistan was born, but even before Islam itself. Considering this bit of History & Culture will not suit the purpose of Lancet.

To give credit to Lancet, it is true they have reported on healthcare issues arising directly out of political situations across the world, but there is a selective pattern to it. Why are there no reports on much bigger Healthcare issues running since decades, as in the Pakistan controlled areas of Kashmir and Baluchistan, Tibet and Hong Kong controlled by China, or closer to home in Northern Ireland controlled by their own British government? What about the healthcare issues arising from religious extremism in their own backyard, whether in Rotherham or the numerous terror attacks across the UK and other Western Countries right since the 9/11 attacks in the USA? Will they conveniently club the terrorists with the protectors, to trivialise the former and vilify the latter, in any of the above-mentioned issues? The opening line in the Editorial mentions “autonomous status revoked” though the word “autonomy” is not mentioned even once in Article 370 that was abrogated. The last line of the Editorial deftly accuses the Indian PM of alienation & subjugation, while his bold decisions have hit those who make a living out of terrorism.

Going by the angst pouring out in their Editorial seems the bold move by the Indian PM has “hit” even the Lancet. No wonder they find the move as “revoking” and “controversial”, while a Billion Indian citizens including majority form J&K, find it a step to improve the state administration and strengthen the National integrity, and are grateful for finally integrating Kashmir into India after 70 years.

A few years back, an earlier Editorial in the Lancet had denounced Israel for the aggression in Gaza and called upon all to denounce the perverse propaganda created. Acknowledging the angry debate that followed the publication.

Richard Horton wrote as a Comment in the same Journal a week later “Last week was a turning point in the sometimes angry debate that followed publication of a letter..” He also added, as reflections: The clearly anti-Semitic worldview expressed in an accompanying video, shared by two of the Co-Authors, is abhorrent and deserves universal condemnation. He concluded with:

  1. Here is our proposal for new guidance to help us in these rare circumstances— ”Editors will, from time to time, be faced with submissions that lie at the difficult intersection of medicine and politics. Health and health care do have political determinants and editors should not shy away from those. But politics, by its very nature, can be disruptive and divisive, with many different points-of-view held. While taking strong editorial positions on issues of relevance to health is sometimes necessary, editors should always pause, reflect, and consult before publishing any manuscript that might unnecessarily polarise, or foster or worsen the political division.”
  2. We will initiate a new partnership to publish a series on Israel’s health and medical research system, its strengths and challenges, and prospects for its future

Interestingly, the Editorial in 2014 on Gaza had 4 names as “Authors”, and the “Comment” was by the Richard Horton. The present Editorial on Kashmir, does not have any name mentioned as “Author”, making one wonder “have they closed the door for a course correction”?

What can Lancet do to justify it’s a claim of being concerned about healthcare issues in conflict zones. Few of them are include:

A visit to Kashmir which the Indian security forces would be most happy to arrange, and see the partnership by the forces and local Kashmiris with support from the rest of India, just like a visit to Israel after the earlier fiasco.

If this sounds difficult, an updated/additional Editorial is also another good idea, to include all that they missed:

  1. How the unrest in J&K is due to state-sponsored terrorism from Pakistan, and their impending inclusion in the blacklist of FAFT
  2. How separatists, and vested politicians in the state of J&K, indulged in long-standing corruption to siphon off funds meant for governance and citizens’ welfare.
  3. How a peaceful minority of Kashmiri Hindus, were usurped from their native land of centuries, in an act of ethnic cleansing and genocide not seen in the recent past, while state administration kept mum
  4. How the move to extend the administration of India & including progressive Laws to the state of J&K will improve governance and healthcare.
  5. How the Indian authorities have extensively planned the aspects related to this process of integration, and possible repercussions, thanks to which the hardship faced in the interests of long term definitive welfare are only a fraction of that during repeated shutdowns in the Kashmir valley, sponsored by separatist, insurgents. Up to a dozen daily deaths were fairly common, over the shutdown imposed, the last being after the death of terrorist Burhan Wani in 2016. In contrast, there is not even a single death reported, as a direct consequence of the clampdown after August 4th, 2019.

Regarding other conflict zones:

  1. Human rights violation in Guatemala and health consequences thereof
  2. Issues in Baluchistan, Gilgit & Baltistan, are invaded by Pakistan since 1947, with the violent suppression of the native, including forced change of Demography.
  3. Violations and healthcare issues in Tibet & Hong Kong under the control of China.
  4. Issues in Northern Ireland since the suspension of the Stormont assembly.

Once these are done, we will truly agree that the Lancet has done it’s the alleged duty of highlighting healthcare issues in troubled areas across the world. However, having evidently failed to follow their own proposal mentioned in 2014, regarding issues at crossroads of Medicine and Politics, any guess then what option the Lancet now has?

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Dr Satish P
Practicing Surgeon, Bharatiya, Medical Law, Medical Technology

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