April 11, 2010

Amit Sen Gupta

“Yes we can”. This was the slogan that galvanised millions of Americans and voted Barack Obama into the White House in 2008. A rainbow coalition of Americans, representing the working people, people of colour, hispanics and Asians – traditionally sections that have lost out while pursuing the great “American Dream” – thought they were voting for a different America. They believed they were voting to start a process that would dismantle an apparatus that thrived on exploitation and greed.

Perhaps nowhere is the evidence of crass greed taking precedence over peoples needs more apparent than in the health care system in the US. That is why one of the major planks of President Obama’s election campaign was a reform of the health care system in the US. In the past year, the Obama Presidency has been engaged in cobbling together a package of reforms for the US healthcare system. The efforts culminated in the signing of two bills in March this year. The Patient Protection and Affordable Care Act (known as the "Senate bill"), became law on March 23, 2010 and was shortly thereafter amended by the Health Care and Education Reconciliation Act of 2010 which became law on March 30.

Is this the reform that people were looking for when millions cheered on President Obama in his victory ceremony? By all accounts, the answer would be a resounding no! Who are the people who are cheering from the sidelines? We do not see the same faces that cheered on President Obama as he swept towards victory. In fact President Obama’s approval ratings are at an unprecedented low. Instead the cheers are led by a very different kind of constituency – the American Medical Association, the pharmaceutical industry, and the Insurance Industry.

So what went wrong? Why this gap between rhetoric and delivery? To find some answers we need to first understand how much of a problem healthcare is in the United States and how it is organised.

US HEALTH CARE : MOST EXPENSIVE & LEAST EFFICIENT

Health care in the US is the most expensive in the world – the country spends a greater portion of its GDP on health than any other country. It is estimated that spending on health care in the US is about 16 per cent of its GDP. In 2007, an estimated $2.26 trillion was spent on health care in the United States. Further, health care costs are rising at a rate that is much higher than the inflation rate and it is projected to reach 19.5 per cent of GDP by 2017. We can look at this figure in another way – total health care costs in the US is about twice that of India’s entire GDP – which means the US Health Care Industry is twice the size of India’s entire economy! The US also spends the most on pharmaceuticals per capita in the world and the US pharmaceutical market is about 1/3rd of the entire market for medicines in the world.

Yet, this enormous expenditure on health care does not translate into secure care for millions of Americans. In 62 per cent of all personal bankruptcy in the United States, medical debt is cited as a factor -- the biggest single factor of reasons cited. Studies indicate that the number of uninsured in the US (for all or part of the years 2007-2008) was 86.7 million, i.e. about 29 per cent of the US population, or about one-in-three among those under 65 years of age. The important thing to understand is that if you are not insured in the US, you either go bankrupt or die. Only a small percent (mainly the old and disabled and those designated as poor) can legally access subsidised care provided by the government. Well known US academic and health care analyst, Vicente Navarro, estimates that between 18,000 and 100,000 deaths could be prevented in the US if people had access to health care. Moreover, in the US, being insured does not guarantee secure health care. It is estimated that one of every four Americans families have problems with paying medical bills – a majority of whom have health insurance.

The US stands 38th in life-expectancy (i..e. the average number of years a person is expected to live), behind all other G7 countries (Canada, France, Germany, Italy, Japan, UK, US) and even behind developing countries such as Cuba and Chile. In 2000, the World Health Organisation (WHO) ranked the US 72nd by overall standards of health enjoyed by its citizens.

STRUCTURE OF HEALTH CARE IN THE US

The reason why the US health system is held out as an example of how not to organise health care lies in how it has historically been structured. As we discussed earlier, Americans are already paying enormous amounts to access health care. About 40 per cent of this expenditure is borne by the government and the rest by individuals – directly or through insurance premiums. So clearly, lack of resources is not the constraint. The real reason lies in the way private corporate interests – pharmaceutical companies, insurance companies and health management organisations (HMOs) – combine to make huge profits and undermine the health care of millions of ordinary Americans.

The current system of health care in the US is based on the 1948 Taft-Hartley Act, that gives freedom to employers to negotiate with individual insurance companies. This is very different from the “single-payer” system that exists in most other developed countries – in Europe, Canada, etc. In the latter case the government manages the insurance coverage available, ensures that the coverage is adequate (covers all conditions) and universal (covers all citizens). The US system allows individual insurance companies to negotiate different terms and conditions with employers. Further the US system leaves out a huge number of people who are not employed or whose employers find ways to dupe them and negotiate inadequate deals with insurance companies. A part of this gap is covered in the use by government run health care programmes – Medicare and Medicaid – that target the old (over 65) and the poor, respectively. However the coverage in these cases is grossly inadequate. Those under government schemes have to pay out-of-pocket when their medicines budget exceeds the cap on medicines expenditure. Such expenses are often enormous, given that medicines in the US are about the most expensive in the world.

The US system, thus, depends critically on the negotiating power of trade unions. Typically, packages available where unions are strong (viz. in the manufacturing sector) are comparatively better. This also explains the very wide variation in insurance packages that are available to Americans. Interestingly, the linking of health insurance to employment also compromises the bargaining power of workers, because workers who lose their jobs also lose the health insurance coverage. It has been argued that this phenomenon, in part, explains why the United States is the country with the fewest working days lost due to strikes

There is another side to this form of structuring of the health care system in the US. The insurance and the pharmaceutical industries are the two most profitable industry sectors in the US – in 2008 they had profits of $12 billion and $49 billion respectively. Put in another way – just the profits that the US pharma industry makes is four times the total turnover of the pharma industry in India! Clearly, US drug companies not only exploit patients in other countries, it makes a large part of its profits by consistently over-charging ordinary Americans for every single medicine that they consume.

THE POWER OF LOBBYISTS

It is easy to understand the enormous clout of vested interests that have a stake in continuing the present system of health care in the US. America's health care industry is understood to have spent hundreds of millions of dollars in 2009 alone to block the introduction of public medical insurance and stall other reforms. It is estimated that there are six registered health care lobbyists for every member of Congress in Washington.

During the 2008 US presidential elections, the Center for Responsive Politics in the US estimated that (as of February 12, 2008), the insurance industry had contributed $525,188 to Hillary Clinton, $414,863 to Barack Obama, and $274,724 to John McCain.

It is instructive to hear what the pharma industry had to say after the signing of the bill on health care reforms. The Pharmaceutical Research and Manufacturers of America (PhRMA) responded thus: “The legislation, signed into law amid much fanfare on 23 March, is 'not perfect' but represents a step in the right direction by helping to ensure that all Americans have access to high-quality and affordable healthcare”.

Clearly the lobbyists have won, and the American public has lost – once again!

PROPOSALS IN THE BILL

Let us, in the above background, examine the reforms that President Obama has finally managed to push through. His reforms package will cover an additional 32 million Americans who are currently uninsured. Those covered by the government run medicare scheme will not have to make out-of-pocket payments to procure prescription medicines beyond a certain cap. The government run medicaid will be expanded to include families under 65 with gross income of up to 133 per cent of federal poverty level and childless adults. Insurers can no longer deny coverage to those with pre-existing conditions. The uninsured and self-employed will be able to purchase insurance through state-based exchanges and low-income individuals and families wanting to purchase own health insurance will be eligible for subsidies. Those not covered by Medicaid or Medicare must be insured or face fine. Part of the excess costs to the government will be paid for by and extra cess on high income tax payers.

What is however more important is what the reforms package has not done. It has left intact the freedom of employers to negotiate with individual insurers. Its coverage of uninsured people still falls grossly short of the real need. It has no ways to significantly curb the profitability of pharmaceutical and insurance companies. Most importantly, it does not promote a single payer system, and thereby does not curb the power of private insurance and health management companies. Whatever new money is going to be pumped into the system will go to further strengthen the triumvate of insurance companies, pharmaceutical companies and health management organisations.

Seldom has any president in the United States been endowed with so much goodwill at the start of his presidency. Most importantly, this groundswell of support came primarily from the poor working people of the United States. If the Health Care Act is any indication, Barack Obama stands in danger of losing this support faster than he acquired it. He will do well to remember the experience of his Democrat predecessor to the White House – Bill Clinton. The American electorate punished Bill Clinton for reneging on his promises to make America a more humane society – including on his promise on health care reforms. 2012 may well see the same happen to Barack Obama if he continues to remain captive to the system.

March 28, 2010

Amit Sen Gupta


IN the early 1960s, across Europe, doctors were confronted with a strange and distressing phenomenon. Hundreds of reports started pouring in about babies being born without arms and legs. They had flippers or fingers emerging from their shoulders. Many were born with eye and ear deformities, and severe internal damage such as malformed kidneys and anal  atresia (a condition where there is no external opening to the bowel). Some were born with deformed genitals, or no genitals at all.

The deformed babies had one thing in common: their mothers had taken a drug called thalidomide, that was marketed during the 1950s and early 1960s as a sedative. By the time the drug could be withdrawn, over 8,000 thalidomide babies were born worldwide.

FIFTY YEARS AFTER THE THALIDOMIDE TRAGEDY

The Thalidomide tragedy brought out into the open a practice that the pharmaceutical industry indulges in on a regular basis even today. The Thalidomide tragedy occurred because the German drug company, Chemie Grunenthal, and a number of other companies worldwide, produced and marketed thalidomide, without paying attention to existing evidence that the drug could be extremely toxic. They were following what was standard industry practice – keep denying reports of toxicity and influence doctors to prescribe a toxic medicine even if it jeopardises the health of thousands.

Before the drug was marketed, Grunenthal’s own studies showed that the drug was toxic, but the company continued to recommend that the drug was absolutely safe. The company even started selling the drug as a sedative for children as well. Grunenthal’s campaign to “prove” the drug’s safety included 50 advertisements in major medical journals, 200,000 letters to doctors around the world, and 50,000 circulars to pharmacists. In Britain, Grunenthal's distributor -- Distillers Company Biochemicals Ltd. (DCBL) --  sent pamphlets to doctors claiming that: "Distaval (the brand name for thalidomide in Britain) can be given with complete safety to pregnant women and nursing mothers without adverse affect on mother or child."

By the winter of 1961, neither Grunenthal nor DCBL could ignore the information detailing thalidomide's devastating effects. In November, Grunenthal pulled the drug off the market and in December, DCBL followed suit. But this came too late for thousands of women who were to deliver deformed babies – finally over 8,000 thalidomide babies were born in 46 countries, and some estimates put the number of stillbirths (babies born dead) at twice that number.

PROMOTION OF MEDICINES – PROFITS BEFORE PEOPLE

The Thalidomide saga ended with the companies involved finally having to pay millions as compensation to the families of victims. But, sadly, little changed as regards how drug companies market medicines. Fifty years have passed since the thalidomide tragedy, but companies continue to put profits before the lives of people across the world. It is estimated that one-third of the cost of a medicine is made up of by money that the manufacturing company spends in promoting the drug.

Among all industry sectors, the pharmaceutical industry is by far the most profitable in the world. The industry, in order to maintain this extremely high level of profitability, uses different methods to influence how medicines are used and prescribed. They need to do this because most new medicines that they introduce are not real advances over existing medicines. In fact many of them are inferior to existing medicines and may also have unacceptable side-effects. Studies show that, in the last decades, less than 3 per cent of medicines that were introduced, actually could be termed as major advances over known treatments. The challenge, then, before the industry is to promote medicines that have little additional benefit to offer, and in addition may have serious adverse effects. To circumvent this problem the industry has built a vast network, whose sole aim is to influence doctors, chemists and consumers into prescribing, selling or consuming medicines that they may not need or which may have serious side effects.

This network, aimed at promoting medicines, uses all kinds of means – fair or foul – to solicit higher sales for medicinal products. Inappropriate promotion of medicines is the norm rather than the exceptions. The World Health Organisation (WHO) has for long taken note of this phenomenon. It defines drug promotion as: “all informational and persuasive activities by manufacturers and distributors, the effect of which is to influence the prescription, supply, purchase or use of medicinal drugs”. There have been several attempts to curb unethical, and often criminal, methods employed by companies to promote medicines. The WHO has attempted to promote a “model code of conduct” on promotion of medicines, which has consistently been obstructed by the pharmaceutical industry. Many countries, especially developed countries, now try to monitor the promotion of medicines. There is also a growing attempt by associations of medical professionals in many parts of the world to curb the complicity of doctors in promoting medicines. However, most such efforts have been only partially successful, and the bane of unethical promotion continues to afflict the health sector like a festering sore, that distorts rational and scientific practice of medical science.

THE INDIAN STORY – TRAIL OF CORRUPTION

India is typical of what happens as regards drug promotion in many countries in the world today. Indians spend, approximately, Rs 50,000 crore every year in buying medicines, i.e. Rs.2,000 for every family in the country. It has been estimated that at least 50 per cent of this expenditure is incurred on irrational or unnecessary drugs. This adds up to a colossal waste of Rs 20,000 - 25,000 crore every year.

An estimated 80,000 brands of various drugs available in the Indian market, while the WHO lists a little over 300 drugs which can take care of an overwhelming majority (over 95 per cent) of the health problems of a country. A majority of the estimated 80,000 products in the market are either hazardous, or irrational or useless. The pharmaceutical companies and the government regulatory bodies are both to blame for allowing such a situation to develop in this country. But all this would not be possible without the active involvement of the medical profession, who contribute by prescribing such irrational and useless drugs. One reason for this is the fact that there is almost no source of regular unbiased, authentic information on drugs available in the country. Given the rapid changes in treatment procedures and introduction of a large array of new drugs (many unnecessary as we have discussed earlier), medical practitioners need to update their knowledge regularly. Such a system of continuing medical education is largely absent in this country, and most doctors do not find the need to take time out from their busy practice to update their knowledge by reading the most recent books and journals. Thus we have the sad practice of a bulk of medical practitioners depending on promotional material supplied by Pharmaceutical companies. Obviously such promotional material only provides biased information to doctors, with a view to maximising the sale of the products being promoted.

The drug industry in India spends 20 per cent of its annual sale – approaching Rs 10,000 crore – in promoting medicines. This works out to about Rs 100,000 per doctor per annum and each doctor prescribes drugs worth Rs 50,000 per annum. The practices adopted by the industry to promote medicines has been documented by various studies, including one that was published in the Indian Journal of Medical Ethics (April – June 2007). As we have discussed earlier, the most prevalent method of “pushing” medicine sales is through distribution of drug information that conceals more than it reveals. But this is just the tip of the iceberg.

Representatives of drug companies are taught to give small gifts to doctors, to keep their brand in the doctor's memory. These "brand reminders" vary from desktop items to minor medical equipment, including prescription pads and rubber stamps (with the names of drugs manufactured by the company). Such apparently innocuous “gifts” constituted the bulk of “gifts” from drug companies to doctors even a few decades back. But today the situation has started changing rapidly and brand reminders are increasingly being replaced by gifts of greater value. These range from jewellery to electronic items such as air conditioners, washing machines, microwaves, cameras, televisions, and even automobiles! Pharmaceutical companies offer larger “incentives” to consultants and specialists who are considered "good" prescribers, as verified by neighbourhood chemists. Doctors in public teaching hospitals are also considered a prize catch as they are in a position to influence new entrants into the field (medical students and junior doctors).

To ensure that the “incentives” actually work in generating more prescriptions for a particular brand of a medicine, such incentives are now linked with the number of prescriptions generated. Printed handouts are distributed by companies giving targets for doctors, with incentives like a cell phone handset for prescribing 1,000 tablets, an air cooler for prescribing 5,000 tablets and a motorcycle after 10,000 tablets were prescribed!

The story becomes murkier still. Select doctors are sponsored for foreign conferences organised by drug companies under the garb of “scientific” conferences -- registration fees, air tickets and stay for doctors and their spouses are paid for by the company. Not just individual doctors, associations of medical professionals are prime targets as well. Over the past decades, conferences of medical associations have moved out of academic institutions to five-star hotels which serve lavish cocktail dinners – entirely paid for by drug companies.

In perhaps the most blatant display of corrupt practice yet, companies have even abandoned the fig leaf of “scientific conferences” to justify all-expenses paid trips for doctors to exotic locales, and have been known to announce such trips to locales ranging from the Sunderbans to Bali.

TIME TO BREAK THE UNHOLY NEXUS NOW!

Clearly, such practices make a mockery of the Hippocratic oath and jeopardize the health of millions of unknowing patients – many of whom receive medicines only because his physician has been unduly influenced into prescribing it. As we have noted earlier, a part of the solution to this state of affairs lies in instituting mandatory continuing medical education (CME) programmes for all doctors and by regularly producing unbiased drug information (on the lines of the British National Formulary, for example).

In recent months two initiatives instituted by the Department of Pharmaceuticals (DoP) and the Medical Council of India, need to be taken note of. The DoP has been engaged in persuading industry associations to adopt an Uniform Code of Pharmaceutical Marketing Practices (UCMP). Several meetings have been held and while the department claims that such a code has been finalised, other sources indicate that the associations representing big companies are attempting to dilute the model code to make it unworkable. Concerns have been raised about the fact that this is a “voluntary” code, and no punitive measures are indicated against those who violate the code.

In parallel, the Medical Council of India moved an amendment last year in the Indian Medical Council Act and inserted an additional Section 6.8, titled: “Code of conduct for doctor and professional association of doctors in their relationship with pharmaceutical and allied health sector industry”. The amendment is designed to bar doctors from receiving gifts, sponsorships, etc. from the industry and from promoting specific medicines in any other manner. Recently, the chairperson of the MCI has indicated that the MCI is going to recommend to the government quantum of punishment for those who violate the new amendment to the MCI’s regulations. In themselves, these are welcome measures. Concerns however remain regarding how these measures will be implemented. The MCI and the state Medical Councils, till now, have earned the reputation of being toothless bodies and very few actions have been initiated against erring doctors by them. Amendments to the Act need to be followed up with granting of statutory powers to the MCI that allows it to take suo moto note of violations of the Act (at present the MCI acts only if there is a complaint). Further, the amendments moved by the MCI cover individual doctors but do not address the nexus between the industry and professional associations.

The nexus that exists between the drug industry and a section of doctors in the country is extremely deep and well organised. Powerful vested interests have a stake in making infructuous any attempts to break, or even dent, this nexus. The government needs to play a much more proactive role in breaking this chain of corruption and malpraxis that hits at the very root of rational practice of medicine.

March 21, 2010

Prabir Purkayastha

Subsidising Foreign Suppliers with Indian Money

THE Congress led UPA seems to have now got second thoughts on the Civil Liability for Nuclear Damage Bill, which they were scheduled to table in Lok Sabha on March 15. Whether this is only a tactical move --- waiting for the Budget to be passed before taking up such legislation or is it a desire to dialogue with other parties on the bill remains --- to be seen. However, the high voltage campaign unleashed in the media with now the National Security Advisor Shiv Shankar Menon briefing the Congress MPs seems to indicate that this is only a temporary retreat. For the Congress, it is only an issue of how to create a positive spin on a bill which is nothing but subsidising foreign suppliers using Indian taxpayers’ money along with Indian people carrying all the risks.

There are three sets of issues in the above bill. One is the political one: why is such a bill necessary now, considering that India has had operational nuclear reactors since the 1960s. The second sets of issues are the provisions on compensation --- the cap on total liability, the operator liability and also the suppliers liability. The third set of issues are the legal ones – the attack on common law on liability and even violations of constitutional provisions of citizens right to move courts. Has the government in its eagerness to please the US suppliers and possibly future Indian private operators, gone beyond the certain fundamental principles of jurisprudence.

The government's argument for the bill is that all suppliers --- the Russians, French and now the Americans --- have asked limiting their liability; therefore, this is not an exclusive measure for the US suppliers. What the government is hiding is that only US suppliers have made passing of a liability Act as a precondition for nuclear supplies. The Russians have supplied two reactors in Koodankulam without any such legislation. Similarly, France has linked the supply of Areva reactors dependent on India passing such an act.

The US ambassador Roemer made clear not only the US interest in the Nuclear Liability Bill but explicitly linked it to the Indo-US nuclear deal completion. Speaking to journalists on March 15, Roemer said, “Now we are hopeful and optimistic that this (passing of Nuclear Liability Bill) will happen sooner than later and that India will step up to its responsibility and obligation to complete this deal." He continued, “This (Indo-US nuclear agreement) is an important deal that the United States and India need to be able to finish and complete and part of this completion is for the parliament to pass this bill” (emphasis added). The link between the two --- passing of the Nuclear Liability Act and completion of the India-US nuclear deal --- is not being made by only the Left as the UPA government would have the people believe but also by the US officials.

This is not the only statement that US officials have made on India needing to pass a nuclear liability bill for the US companies do business in India.

Why is the US government so keen on India passing a Nuclear Liability Bill? The reasons are quite simple: without legal protection from claims of liability, no US supplier is willing to supply equipment to any country. The Price Anderson Act in the US passed in 1957 was explicitly designed to give private operators and suppliers this comfort and this is what they seek in all countries. In the US, as in Canada where a similar law exists, the critics have pointed out that this is a huge hidden subsidy to the nuclear industry. The US suppliers have no economic liability in the US under the Price Anderson Act --- all economic liabilities are channelled exclusively to the operator. What the US suppliers want are that US conditions must apply to them irrespective of the country they operate in.

The insistence by the US on protecting suppliers from liability is not with India alone. This has been a matter of dispute with Russia as well. The US suppliers have insisted that the US government ask Russia to pass a comprehensive nuclear liability law and also ratify the Convention on Supplementary Compensation for Nuclear Damage (CSC). Omer Brown, the lead lawyer for the Contractors International Group on Nuclear Liability (CIGNL) consisting of major nuclear suppliers --- Babcock & Wilcox Company, Bechtel Power Corporation, BWX Technologies Inc, General Electric Company, USEC Inc, Washington Group International Inc, and Westinghouse Electric Company LLC, wrote to the US State Department on December 18, 2003 stating that unless Russia met the above conditions, US suppliers will not be able to work in Russia. This is almost verbatim what Omer Brown has said of India as well. Give us protection from liability, only then we will supply you equipment.

Are these normal for all countries? They are not. Most countries do not exempt nuclear suppliers from product liability regime. Product liability means if a manufacturer supplies equipment which is defective, it bears the liability and must pay for all the damage resulting from the defective equipment. This allows the nuclear operator to recover the damages he must pay to those affected in a nuclear accident from the manufacturer.

The Indian bill is very clear on this. Instead of normal product liability, the manufacturer is now only liable if there is wilful act or gross negligence (clause 17 b). Otherwise, instead of the normal legal responsibility for defective products, the operator can take recourse only if the operator and the supplier have agreed to this in the contract between them. A legal right of the operator now becomes a matter of mutually agreement reached in a private contract.

India has been building nuclear plants since the 1960s. From the 1970s these plants have been built with largely indigenous supplies. Nor has any public sector or private company in India insisted that they need protection against liability claims before supplying equipment to Indian nuclear plants. While the government is now saying that the Russians in Koodankulam also wanted protection from liability, the fact is that they have supplied the reactors without any such protection.

The UPA spokespersons have tried to confuse the public by claiming that 17(b) holds the manufacturer responsible for defects. It does not. Proving wilful act or gross negligence resulted in the defect is quite different from establishing that a defect exists in the equipment. A leading TV anchor who claimed to have read the Bill, asserted that bill provides for the manufacturer to be held liable for manufacturing defects. What probably he had read is the briefing note by the government. But then this is the age of 24x7 television where the media has time for only bytes and little else.

The UPA spokespersons have argued that most countries have caps and these caps are of similar order. There is a deliberate attempt to confuse issues here. For example, Japan has a cap of 1.2 billion dollars on the operator but not the Japanese government. The Japanese state has unlimited liability. Germany and Finland have no cap on operator’s liability. Russia does not have legislation on nuclear liability and therefore the normal laws on liability apply.

In any case, the fundamental issue for us is what our concerns on nuclear plants are and not what other countries are doing. After Bhopal, it should be clear that a liability limit of 470 million dollars was a gross underestimate of the actual requirements. It is surprising that the government should come up with similar figures now when the possible damages from a nuclear accident is much greater.

The government spokespersons have now started saying that India needs to join the Convention on Supplementary Compensation for Nuclear Damage as this will provide India with higher compensation over and above the 300 million SDRs. The reality is that this US drafted Convention is unlikely to take off. It has been ratified by only four countries including the US. The other three are Morocco, Argentina and Rumania, who between them own four reactors. No other major nuclear reactor owning country such as Russia, France and Japan has ratified this even after 13 years of its existence. For the convention to become operational, at least five countries must join the convention and the countries put together must have 400,000 MW thermal. India joining will not make the convention operational – it does not have enough installed capacity to cross this number of 400,000 MW thermal.

In any case, the convention is an insurance mechanism --- India will have to pay for accidents in other countries as well and also pay into a joint insurance fund. Why is India rushing to join this US sponsored convention, when no major nuclear power country is joining, is a question that the government has to answer. There are at least three more conventions on nuclear damages. The convention on supplementary compensation is the worst. It is the only one that allows the suppliers of nuclear equipment total immunity from liability. One can understand why the US is interested in this convention. That appears to be the driving force for the government of India.

There is a further legal issue in the bill. Clause 32 of the bill makes the claims commission’s verdict final. The claims commissioners’ proceedings or its verdict cannot be challenged in any court in the country. The fundamental right of a citizen to file for an injunction or a writ petition in courts have been abrogated in clause 35 of the bill. So also the right of a citizen to move the courts for judicial review of the commission’s decisions. No other commission set up by the government has ever had such bars.

This bill has little to do with the needs of the Indian people. It has been drawn up primarily to help the US manufacturers. The US government’s position is quite clear; it is working to help US suppliers. The question is in whose interest is this government working, for the Indian people or the US suppliers?