SAFETY ARTICLES

Joyride : Ride to Death

Be Cautious About Irrational Prescription

Drinking Milk or White Poison?

Joyride: Ride to Death? 

The business of fun is getting bigger in India. Currently there are over 100 amusement parks throughout the country. An estimated 600 million Indians venture out to various melas, exhibitions and shrines year after year. The Rs 1,300 crore amusement and theme park industry has big hopes to flourish in India with an investment of Rs. 400 crore that will add a dozen fun parks across the country in the next two years. 

But while everyone is keen on making profits; do they give adequate attention to safety measures? 

No! They do not. 

The recent tragic death of a Faridabad businessman clearly revealed how Appu Ghar, one of the biggest amusement parks in India, lacks basic safety measures. This was the second major accident in the park's history. Five years back another 50-year-old man died of heart failure, after riding the Appu Columbus ride. 

Although the amusement park has a valid license to operate till December 31 2003, the licensing authority has suggested the examination of all the rides at Appu Ghar to see whether they have been maintained properly as required under the license agreement. The question arises of why the authorities always wait for the accident to happen and then take action, especially when such accidents are so serious? 

Every year several such accidents take place many of which go unreported. Sometimes accidents occurred due to human negligence whereas sometime the machine misbehaves. Most of the time, the amusement parks and joyride operators do not follow safety norms.  A look at some of the major recent joyride accidents will clarify the picture: 

Date: May 28, 2003

Place: New Delhi

Incident: At a festival a Ferris wheel collapsed under strong winds and rain, killing 12 people and injuring 20. The victims were crushed by the ride, which was carrying at least 30 people when it collapsed.

Legal action: Police stated that the owner of the ride did not have legal permission to operate the ride, and that criminal charges would be filed.

Question:  How could they operate without permission? 

Date: May 2003

Place: Tiruchirapalli

Incident: At a temple festival a giant wheel snapped and crashed in a gale, injuring 23 and killing eight people. Some say the ride was not installed properly, others blame faulty equipment.

Question:  Who is to blame? 

Date: March 2003

Place: Taj Expo at the Palace Ground, Basaveshwarnagar, Bangalore

Incident: A woman while riding a dashing car at Fun World asked the operator to stop it when it suddenly started moving erratically. The car suddenly moved in the opposite direction and rammed into the side of the stage. The jerk caused whiplash that turned to a huge swelling. She had to spend nearly Rs 10,000 on medical treatment and tests.

Authority's excuse: GM of Funworld tried to avoid their responsibility by stating that their rides have fitness certificates issued by authorised chartered engineers, who test the equipment annually. The authority also pointed out that since 1995, no accidents have taken place on this ride or any other and that their staff daily checks all rides.

Question: Who will compensate the woman?              

Date: January 19, 2003

Place: Pavagadh, Gujarat

Incident: Seven people were killed and 45 others were injured when a chairlift, which carried pilgrims to a temple at the top of the hill, partially collapsed. A drive pulley got displaced near the third support tower, causing the cable to separate from the pulley and snap. Two cars fell 150 feet and crashed to the ground. Three cars slid down the cable and hit a support tower, knocking at least three passengers to the ground.

Legal action: The state government ordered an inquiry into the incident.

Question:  Technical fault or lack of maintenance? 

Following is a case of death of a six-year-old boy in an amusement park in June 2002 where some positive legal action was taken. 

Date: June 28, 2002

Place: Thunder Zone Water Park Resort in Swara, Mohali district

Incident: A six-year-old boy was drowned in the pool of this park due to lack of safety measures. There was no tube given nor was there any life jacket. Absence of signboards and lifeguards showed the utterly irresponsible manner in which it was being run. There was no ambulance available at the amusement park.

Legal action: In July 2002, Punjab and Haryana High Court ordered the park to be shut down with immediate effect. It also directed the Punjab Chief Secretary to have the matter thoroughly investigated and fix the responsibility of the officers who granted the license for operating of the amusement park without proper safety arrangements. 

Often the rides during fun fairs organised at different points of time lack even basic safety measures. Take the case of the fun fair at Vastrapur in June 2003.The following points will clear the picture:  

•          Tora-Tora ride that rotates at a 360-degree angle and balanced on a platform revolves on its own axis featured scary 
     heights with no safety belts.

•          Except for the Cage, none of the other rides have any instruction boards, age limits, precautionary measures or 
     other guidelines for visitors to follow. A cardiac patient or a pregnant woman can judge the actual hazards only after 
     trying the ride. 

What was the excuse of the Authority?  It claimed that it has an insurance of Rs 50 lakh and a public insurance of Rs 20 lakh. The fair had the best of engines, quality and technology and also a medical kit for emergency. However, a close inspection of their first-aid kit revealed a body lotion and an unfamiliar "ointment". There was no fire extinguisher or contact with any local doctor. Even the authorities who issued No Objection Certificates (NOC) admit negligence of such organisers. 

So why did they issue the NOC? Should not they be more cautious and responsible? 

The main reason for deaths and injuries on amusement park rides is preventable error. This would include such things as the lack of routine maintenance and the disregard of safety rules by both operators and riders. 

The following are some recommendations, which if adopted, could help avoid such accidents in future: 

•          There should be proper norms and regulations for issue of certificates to be followed by all.

•          Rides and attractions in an amusement park must be inspected and certified at least annually.  Certificates for 
     rides and attractions at itinerant fairs and carnivals should not be valid for not more than 30 days.

•          Each time a ride or attraction is moved to a new location, it must be inspected and a new certificate issued before  
     operation begins.

•          The officers responsible for grant of licenses to amusement parks or owners of joy rides should have the technical 
     expertise to understand the functioning of these machines. Those who grant license without verifying whether 
     proper safety arrangements have been made should be punished.

•          Random follow-up inspection is needed to ensure compliance with recommendations issued.

•          Licenses to be revoked upon failure to maintain adequate insurance coverage and also if the operator fails to make 
     proper repairs.

•          Every amusement park should have clear safety instructions in the local language and also list whether or not the 
     rides are safe for the very young, the elderly, cardiac patients, expectant mothers etc.  There should be an 
     ambulance, doctor and a first aid kit.

•          There should be emergency provisions at every amusement park. Public gathering places should certainly have 
     fire-fighting equipment ready. The venue should clearly specify the do's and don'ts.

•          Safety clasps should have childproof locking systems.

Be cautious about irrational prescription

Anindita Mukherjee consulted a doctor when she started a fever along with a running nose and headache. She was given a full-page prescription with a large number of medicines and medical tests. Sounds familiar to you? Then like Anindita you might have become a victim of irrational prescription. This is what is happening not only in India but all over the world. Unnecessary services are commonplace and doctors are said to prescribe drugs excessively and inappropriately which not only deplete consumers’ pocket but also affects their health as all drugs have side effects.

The World Health Organisation (WHO) has defined irrational prescribing as use of a therapeutic agent when the expected benefit is negligible or nil or when its usage is not worth the potential harm or the cost (1985 draft).

There are three aspects of over prescription:

•        Prescription of expensive drugs where cheaper ones could suffice

•        Prescription of drugs, which are not indicated by the disease either due to wrong diagnosis or as a defensive 
    measure.

•        Prescription of wrong drugs despite their potential side effects.

Intake of strong drugs in diseases like common cold, viral fever, diarrhoea etc may cause problems like nausea and weakness and may even affect kidney and liver functioning. While such medicines may be essential and life-saving in specific cases, their indiscriminate use leads to drug resistance not only in the patient but in the disease-causing bacteria everywhere. As it has become a global phenomenon, accompanied by virulent outbreaks of diseases and infections, World Health Organisation (WHO) has called for urgent action worldwide to fight the spread of such drug-resistant diseases.

In an all India survey carried out by Voluntary Consumer Action Network and Consumer Unity & Trust Society (CUTS) in 1995, data of over 2000 prescriptions were collected by consumer groups of West Bengal, Rajasthan, Gujarat, Maharastra, Tamil Nadu and Andhra Pradesh. The survey revealed that there was a gross tendency to prescribe useless medicines like tonics, restoratives, vitalisers and vitamin formulations when these were hardly indicated. It also showed that government doctors were comparatively more rational than private practitioners.  West Bengal showed the highest number of irrational/incomplete prescriptions.

Over-prescription is common in other parts of the world also. Take the case of antibiotic. The misuse and overuse of antibiotics has given rise to the serious problem of antimicrobial resistance worldwide. A 1992 study conducted at six government hospitals reveals that Malaysians were taking far more antibiotics than they needed to because doctors were prescribing them excessively. Similarly, a study of an emergency room in a private hospital in Manila showed that over 90% of patients who received antibiotics did not really need them. Japanese doctors allegedly prescribe three times more antibiotics per patient than their Western counterparts.

But, why do doctors over prescribe? Well, according to doctors in India, the Supreme Court judgment to bring doctors under the purview of Consumer Protection Act, has increased the incidence of over prescription. To be on the safe side, doctors often knowingly prescribe certain unnecessary drugs and medical tests as a defensive measure rather than for a specific diagnosis.

While this may be true in some cases, there is also another story in the background.  As a large number of brands of the same molecule are available in the market, pharmaceutical companies are after the doctors to prescribe their brands. Their medical representatives frequently visit and offer gifts to influence doctors to prescribe their brands even in cases where they are not really necessary.

Generally doctors are given free sample medicines and small gift items like note pads, pens and pen-stands with the name of the medicine printed on them. But important doctors who are trend setters and sees a large number of patients per day i.e. those who have high potential of prescribing their brand are offered attractive gifts like foreign trips, sponsored conferences, air fare, new expensive model of fridge, car etc. The unholy nexus can also be found in medical services too. Many doctors receive commission for referrals to other doctors, laboratories and diagnostic clinics.

Many Indian states also permit the practice of un-qualified personnel to prescribe scheduled drugs. Often these doctors have “LMP” (Licenciate in Medical Practice) or “RMP” (Registered Medical Practitioner) after their names, which basically means that they have learnt medicine by serving as assistants or compounders to qualified doctors. Such “doctors” cater to the poorer and often less-educated patients and are prime targets for pharmaceutical companies.

The whole health care scenario gets more dubious given systemic problems such as the absence of any regulatory legislative measures for the drug industry pertaining to the promotion and sales of drugs. Very rightly, the US government has taken action against the pharma companies and has issued instructions that expensive gifts should be curtailed. But yes, there are some doctors in India who do not accept any gifts or even medicine samples. Unfortunately, they are few in number.

India should take some positive steps to protect patients from financial loss and exposure to unnecessary or hazardous formulations. The following steps are recommended:

•        A regulatory mechanism should be instituted to keep a check on the malpractices in the pharmaceutical industry 
    particularly in regard to promotional measures. Total promotional, sampling and “educational” expenditure, including 
    expenses on sponsorship of medical conferences and symposia, should be restricted to a percentage of turnover 
    arrived at by a pre-agreed formula.

•        Awareness among the common people about drug misuse and resulting drug resistance should be raised.

•        Introduce a Patient Package Insert (advising patients about the use, dosage, possible side-effects, contraindications, 
    drug interactions etc. in simple language.) This can be given away with each filled prescription for a drug and can 
    replace the present doctor-oriented package leaflets, which are incomprehensible to the patient.

•        Ban on irrational drugs/combinations

•        Self-monitoring by the Indian Medical Council with penalties or punitive measures for defaulting doctors.

•        Compulsory reporting by hospitals, nursing homes, consulting physicians etc. of cases of over dosage of drugs. Such 
    reports should be sent to the State Drugs Control Authorities who may advise the Medical Council of 
    repeated/deliberate over-prescription by doctors.

Drinking Milk or White Poison? 

Milk has been an essential item in the diet of every mammal. Parents insist on including milk in the breakfasts of their children and get angry if their children do not want to drink milk. But, in some cases this could actually be a blessing in disguise. This is because the milk may be adulterated by unscrupulous milkmen/traders and may contain bacteria, pesticide residues or even dangerous hormones. 

A. Adulterated Milk: 

Milk, which is apparently frothy, may contain adulterants like urea, detergents, shampoo, chalk powder, vegetable oil, paints, rice flour, wheat flour, starch, baking soda, sugar etc. that could seriously affect health. These adulterants are used in milk to increase the “Solid Non Fat” (SNF) content. The specific gravity of the adulterated milk is so dexterously adjusted that one cannot distinguish between pure and impure. Consumption of such adulterated milk can cause Septic Sore Throat, Bruscellosis, Gastro-enteritis and other ailments. 

Dairy farmers are known to add caustic and baking soda as ‘preservatives’ to milk. According to a senior scientist at the National Dairy Research Institute (NDRI), Bangalore, excess use of caustic soda is likely to affect intestinal tissues and lead to renal complications in infants. The chemical mix of urea, soap solution, and caustic soda is known to be carcinogenic and can also lead to skin diseases. Pregnant women and kids are highly susceptible to this spurious milk. According to experts, the regular consumption of adulterated milk causes a disease called 'zoonotic' tuberculosis. 

Let us have a look at some recent milk adulteration cases in 2003: 

Lucknow: In August, a test conducted by the health department revealed the presence of urea, detergent, shampoo, soda, poster colour and refined oil in milk. 1000 samples of milk were tested, out of which 211 were found adulterated. 

New Delhi: In August, it was reported that a bulk of the 20 lakhs litres of milk sold by local dairies and milk suppliers in neighbouring states could be laced with lethal toxins that could wreck the human nervous and intestinal systems.  

Chennai: In July, the owner and a vendor of a private milk marketing agency in Vyasarpadi was sentenced to six months simple imprisonment and a fine of Rs. 1,000 for selling adulterated milk. The milk sample was lifted by the food inspector in January 2000 and was tested at the Public Analyst laboratory where it was found to be deficient in milk fat and SNF content.  

Tamil Nadu: In July, two dairies Surampatty and Mudalithottam were seized because of supplying adulterated milk and operating under unhygienic conditions.   

Guwahati: In June, 31 milk samples were tested at the Assam State Public Health Laboratory. Nine of them were adulterated with a very low content of milk fat and also impure water. 

In 2002 a survey by Foundation of Food Research and Enterprise for Safety and Hygiene (FRESH) detected the presence of neutralisers and starch in loose milk and a particular variety of private dairy milk sold in Bangalore.  

What is the government doing to prevent such adulteration? Are there no law(s) to protect consumers from adulteration? 

In India, milk and milk products are regulated primarily by the Prevention of Food Adulteration (PFA) Act, 1954 and the Agriculture Ministry’s Milk and Milk Product Order (MMPO) 1992. The first sets the quality norms for milk while the second sets norms for an entire dairy project from buildings to operations.

Rule 5 of the PFA Act defines the standards of quality for all grades of milk. For example, buffalo milk should have minimum six percent fat and nine percent SNF. For cow's milk, it is 3.5 percent and 8.5 percent respectively. If milk does not measure up to these parameters, it is said to be adulterated. But experts feel that the PFA Act is not stringent enough in case of standards of milk. 

Suggested Actions:

•          Though the PFA is a Central Act, its enforcement is the responsibility of the State governments and the health 
     ministry. Therefore the State governments and the health ministry have to activate their administrative machinery to 
     prevent adulteration of milk.

•          Mobile laboratories should be introduced to check random samples of milk.

•          To create consumer awareness about the various adulterants used in milk and the various related laws/acts for 
     their protection, consumer organisations should conduct a series of awareness programmes on the subject all over 
     the country. 

•          Consumers should appreciate that despite the hassles involved in complaining about adulteration, persistent 
     activism will lead to results in the long term which will benefit all.

•          Punishment of the adulterators should be more harsh. 1-2 years rigorous imprisonment, cancellation of licences 
     and a hefty fine need to be introduced and effectively implemented. The fine would also help the PFA department in 
     upgrading the food testing laboratories and in hiring more food inspectors to check adulteration in every corner of 
     the country.

•          Scientists are coming up with different kinds of cheap and user-friendly kits to help consumers to test adulteration 
     of milk. Steps to be taken to popularise such kits.

B. Pesticide Residues:

A proportion of pesticide sprayed on crops affects the milk since cattle consume the grass as fodder. Pesticides such as DDT and MCH (Methyl Cyclohexane) have been detected in milk samples from all over the country. While washing brings down the pesticide content in vegetables, no amount of boiling can make the milk safe. Surprisingly, no dairy in India has the equipment to effectively monitor toxic substances in milk despite the order by the Allahabad High Court for setting up of sufficient number of milk testing units to check toxic residues.

One would be shocked to know that the government’s core group on water set up after the bottled water controversy, found that in comparison to water, much higher quantities of pesticides are consumed through milk, food grains and other food products.  

What are different tests saying in this respect? 

•          In 1993, a report by the Indian Council of Medical Research revealed that 74 percent of milk samples in 
     Maharashtra, 70 percent in Gujarat, 57 percent in Andhra Pradesh, 56 percent in Himachal and 51 percent in  
     Punjab had DDT levels above the tolerance limit. Other states had around 10 percent.

•          Analysis of 468 milk samples by the All India Coordinated Research Project (AICRP) in 2001, revealed that DDT 
     was detected in 41 percent of the samples and HCH (Hexachloro CycloHexane) in 65 percent. Among these 8  
     percent of the samples contained DDT above the maximum residue limit (MRL) while 15 percent had HCH content 
     above the MRL. DDT and HCH are known causes of cancer and genetic defects.

•          Out of 244 samples of cow’s milk tested by Punjab Agriculture University in 2002, 27 contained BHC, while 244 
     contained DDT residues.

Suggested Actions: 

Under the PFA Act, tolerance levels have been set for over 20 insecticides and pesticides in milk and its products, which include Lindane (otherwise known as BHC), DDT and Chlorpyrifos. Those must be rigorously implemented. Most importantly, India urgently needs a policy governing correct usage of pesticides since this affects drinking water and the entire food chain. This is a matter requiring intervention at the highest levels. 

C. Presence of Bacteria: 

A major problem with dairy farming in India is the milking of cows in unhygienic conditions. By the time the milk reaches the collection point or dairy, bacteria have multiplied, lowering the quality of milk. According to field level officials of milk cooperative societies although awareness is being created amongst farmers on the production of quality milk, basic guidelines on hygiene are rarely followed.

•          According to the PFA Act, the normal count of bacteria in healthy milk is below 30,000 in one ml. But the survey 
     conducted by the National Dairy Development Board (NDDB) in 2001 found the bacterial count in the most 
     unhygienic milk sample to be around two crores in one ml.

•          In 1999, 28 widely-sold brands of milk in 500 ml packets was found contaminated with bacteria in a laboratory test 
     conducted by Consumer Education and Research Society in Ahmedabad.

•          In 2003 a survey by the College of Veterinary and Animal Sciences found that about 85 percent of the milk samples 
     collected from milk societies in Kerela did not meet the Coliform standards prescribed by the Bureau of Indian 
     Standards (BIS). 

Suggested Actions: 

•          Dairy farmers should be trained properly to enable them to carry out operations under hygienic conditions. They  
     must realise the implications of not following hygienic practices.

•          It should be possible for milk cooperatives to “grade” or provide ratings for individual milk suppliers on the basis if 
     bacterial count, and to pay them a premium for milk which is free from pathogen bacteria.

•          An effective method is needed to keep a strict watch on the quality and hygiene of the milk supplied by dairies

•          Certain standards on milk like tests for chemical analysis of milk, bacteriological analysis of milk should be made 
     mandatory

•          To ensure hygiene and safety of milk, proper action should be taken so that private dairies dealing in between 
     10000 and 75000 litres of milk per day registered themselves with the concerned authority as per MMPO.  

D. Use of Hormone Injection: 

Some farmers indulge in the practice of giving injections of the hormone Oxytocin, which is used in humans to induce labour, to their cows and female buffaloes. The milk of such animals contains this hormone and thus their effects on a human consumer’s health can well be imagined. Additionally, the animal itself suffers acute pain due to uterine contractions. 

In August 2003, a report was published based on the survey conducted by the NDDB in 2001 which revealed that a large number of cattle shed owners were giving injections of the hormone Oxytocin. 

Suggested Actions: 

•          Random supplying by dairies should be undertaken to detect the presence of Oxytocin. If detected, the farmer 
     indulging    in the practice must be banned from supplying milk to the Cooperative.

•          Sales of Oxytocin through retail chemists must be banned and the drug should only be available through hospitals 
     and registered nursing homes.