It's unlikely that many samples were sent to Britain. Most were analysed in India. In any case, ICMR rules allow the export of genetic material in small quantities without prior permission. Tightening the rules can only lead to xenophobia and censorship of good cross-country scientific research.

Threatening researchers won't settle the veracity of the study's claim that some strains of a bacteria group called enterobacteriace have become resistant even to carbapenems, the newest and last-line-of-defence antibiotics group. That stands convincingly established in The Lancet. Questions remain on how representative the study is, and whether naming the gene after New Delhi is meant, as alleged by Indian officials and private sector hospitals, to discredit India's growing medical tourism business.

True, the NDM-1 gene was not isolated first in New Delhi. Nor is it scientifically established that it originated there. It was first described in a Swedish patient who travelled to Delhi last year. It may have come from another city or country. But biomedical researchers often name genes or bacteria after cities from where an early high incidence of a particular phenomenon is reported.

This practice isn't odd or malicious. Indian place-names have been used in the past without anyone objecting to them, e.g. Pseudomonas deliensis and Methanolobus bombayensis. Some strains of the metallo-beta-lactamase gene were named after Verona and Sao Paolo. Bacteria/viruses have been named after Adelaide, Beijing, Berlin, Moscow, Singapore, Texas, Washington and Zurich.

It's however legitimate to question the tone of the paper's concluding paragraph, which delivers an opinion, which is unusual for a scientific article. It warns UK citizens against visiting India for medical treatment. The study is based on 37 patients hospitalised in India, 14 of whom got infected with multi-drug-resistant bacteria. It's not clear if the 37-strong sample is random or representative, and if it reflects diverse regional trends in India. Nor does the study compare the rates of drug resistance between Indian and British hospitals.

However, none of this contradicts the truth: namely, the incidence of NDM-1-induced infection in New Delhi and its spread to Chennai, Mumbai, Varanasi, Guwahati, Bangalore, Pune, Kolkata, Hyderabad, Rohtak and Port Blair. NDM-1 has since been isolated in Pakistan and Bangladesh, and in the US, the Netherlands, Australia, Canada—and on the latest reports, Japan. The World Health Organisation has just voiced serious concern about NDM-1's spread.

The Lancet paper was not the first publication on NDM-1 in India. The first systematic study on NDM-1 was conducted by an all-Indian researchers' team from Hinduja National Hospital, Mumbai, and published in the Journal of Association of Indian Physicians. It reported the isolation of 22 NDM-1 cases in just three months. This was alarming enough for Dr Abdul Ghafur K, an infectious diseases consultant at Apollo Hospital, Chennai, to write an editorial in the Journal.

Dr Ghafur said: “If a single hospital can isolate such a significant number of bacteria with a new resistant gene in a short period of time, the data from all the Indian hospitals, if available, would potentially be more interesting … than the human genome project data ….”

These studies should have jolted India's medical establishment into serious, radical corrective action. NDM-1 is easily transmitted between bacteria such as Klebsiella pneumoniae, which cause pneumonia and E coli, which cause urinary infections. Gene-induced resistance to antibiotics has frightening implications. If such genes spread, the world will have no means left to fight bacterial diseases. We could return to the pre-penicillin era, in which millions perished for want of drugs.

Antibiotics are essential to treat infectious diseases—among the biggest killers in poor countries—and in surgical procedures. Yet, bacteria become resistant to antibiotics as part of the natural process of evolution and develop new traits.

Development of antibiotics by the multinational pharmaceuticals industry has failed to keep pace with growing bacterial resistance. Drug companies invented 16 new antibiotics in 1983-87, but only seven in 1998-2002. Currently, antibacterial drugs constitute only 1.6 percent of all new molecules under development. New-generation antibiotics are exorbitantly costly. Carbapenems treatment costs Rs 6,900 a day.

Indians are among the world's worst victims of antibiotic resistance. They are highly susceptible to infections because many lack adequate nutrition and are forced to consume contaminated water, breathe polluted air and live in unhygienic conditions. Hence the high prevalence of tuberculosis, dysentery from water-borne bugs, and respiratory problems compounded by polluting cookstoves.

Antibiotics are massively over-prescribed and abused in India. They are available for the asking. No chemist insists on a proper prescription before selling a drug. No hospital in India has an antibiotics policy, under which doctors can't prescribe drugs at will, but must follow certain protocols so that bacteria don't become resistant to all classes of antibiotics, and there's always a reserve in the form of an antibiotics group not used before.

Mis-prescription by doctors—and often, paramedical personnel—leads to the simultaneous use of multiple categories of drugs, where only one or two classes will do. Bacterial resistance is probably claiming lakhs of lives in India, especially from respiratory disease (one million children's deaths a year), dysentery and TB.

To make matters worse, pharmaceutical companies heavily promote expensive antibiotics through aggressive sales representatives and recommend high-end drugs for the treatment of common ailments. For Indian doctors, who practise in a totally unregulated market, company representatives remain the principal, if not sole, source of drug information. Infectious diseases get a low priority in Indian medical education curricula. Indian doctors, says Dr Ghafur, don't learn much about antibiotics use. Nor are they made to undergo refresher courses.

In India, a medical consultation is expected to result in a prescription—automatically and inevitably. A doctor who charges Rs 300, 500 or even 1,000 for a consultation isn't expected to prescribe inexpensive drugs. Unless the prescription looks long, with seven medicines on average, the patient doesn't feel s/he has got his/her money's worth.

Drug companies buy enormous influence with the medical profession through conference sponsorships, junkets and expensive gifts, and abuse it. For instance, in the 1960s, a US-origin multinational recklessly promoted the toxic drug, chloramphenicol, for treating common colds. Chloramphenicol is only to be used in life-threatening meningitis and typhoid. When typhoid broke out in Kerala in the 1970s, thousands perished because of chloramphenicol resistance.

The hysterical condemnation in India of The Lancet article as a “conspiracy” driven by “ulterior motives” would have been entertaining if it weren't sordid. Take the charge that it was calculated to damage India's booming Rs 1,200-crore medical tourism business. This perniciously tugs at our patriotism. But we're being asked to defend an industry which bristles with ethical problems.

Indian medical tourism thrives amidst the denial of elementary healthcare to the people by a government whose spending on health (0.9 percent of GDP) is the same as that of failing or failed states. This denial, and the pampering of medical tourism, are two sides of the same coin.

India's $300-million medical tourism market is minuscule and irrelevant in comparison with health spending in the developed world. In the US, this runs at $2,300 billion. Britain's National Health Service is so overloaded that it would be only too glad if British patients went abroad for medical treatment. This conspiracy-based argument betrays ignorance, poverty of thought and insularity.

The government has belatedly announced the establishment of a task force for evolving a policy on antibiotics. Even if this produces good guidelines, it's difficult to see how they can be enforced in the bulk (80-percent plus) of our hospitals and clinics, which are in the private sector, in the absence of tight regulation of health-providers, chemists and medical practitioners. This demands radical reform, which entails fighting entrenched interests which profit from illness and disease.

Remedial action on antibiotic resistance will need a global approach to developing new molecules. Big Pharma, which works on a low-risk model of drug development, driven by profits and patent-based monopolies, is unlikely to develop them. We need open-source innovation in drugs which are relevant to the vast majority of the global public.

The Indian government must be shaken out of what Dr Ghafur calls “the notorious ostrich strategy”. This “denies the existence of the problem—stop looking for these bugs, stop looking for the hidden resistance mechanisms and closing your eyes even if you find them. … It is an Indian tradition. Why should we Indians worry? We can always depend on honey, yoghurt and cow's urine.” That means writing off the well-being of our people. (IPA Service)