Moral philosophy, pragmatism, and the larger cause: why “war” metaphors are needed during pandemics

Coronavirus disease (Covid-19), which originated in China, is now a full-blown pandemic which has thrown governments and societies off-track in an unprecedented manner. War metaphors have been used widely to describe the scenario, but many critics decry them as harmful narratives. In this piece, we discuss the utility of the war metaphor to build solidarity and fraternity, which will be essential to get through the crisis. We also explain how concerns regarding increased authoritarianism and state excesses due to the use of these narratives are misplaced. We then tease out the colonial era concept of war that guides the arguments against the use of war metaphors in pandemics. We argue that in the post-modern world and in South Asian and African philosophies, wars are seen through the prism of the larger cause of dharma or ubuntu and that individual losses or gains in these contexts are part of a larger cause. The use of war metaphors reflects the need to get together for a societal cause. These metaphors are largely understood across societies while other alternatives are exclusionary, poetic and tangential in nature.

Read the full article in Indian Journal of Medical Ethics here (open access)

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Soumyadeep Bhaumik’s review of Indian medical papers—18 June 2013

One of the most enthralling articles that caught my attention last month was one entitled “Knowledge and practice of clinical ethics among healthcare providers in a government hospital, Chennai” published in the Indian Journal of Medical Ethics. It revealed that 30% of the responders did not give a definition of healthcare ethics (and I am inclined to think they did not know what it is), and 40% did not name a single ethical principle (again, I suspect they did not know of any). What I found more alarming was the fact that, “25 out of 51 physicians stated that they did not have time to listen to their patients.” 25 out of 51 physician responders also did not respond to the part of the questionnaire that asked them to name the principles of the Hippocratic Oath. All this makes me think that medical ethics in India is not well known, or adhered to strictly enough.

However, the good news is that India does plan to introduce medical ethics in the medical curriculum. Whether a single dose of ethics will be sufficient, or whether students will need a continuous infusion to dramatically change the scenario in the long run is open to debate, but it is a good start nevertheless.

Another issue that needs to be addressed in India is GP prescribing practices. A paper in the Indian Journal of Pharmacology reveals that nearly half of rural GPs, and 25% of urban GPs do not sign their prescriptions. What is more alarming and incredibly scary is that, “Details regarding the drug strength and dosage schedule were present only in 0.7% of the rural GP’s prescriptions, and in 11% of the urban GP’s prescriptions.” Coupled with the fact that most pharmacies in India do not employ pharmacists, this can only mean that it is a random world out there.

Toxic epidermal necrolysis is a disease with mortality rates as high as 30%, and there is no real evidence with regards to the use of the most commonly used current treatments i.e. systemic steroids, cyclosporine A, and intravenous immunoglobulins. The last issue of Indian Journal of Dermatology Venereology Leprology compared low dose intravenous immunoglobulins and steroids with only steroids in toxic epidermal necrolysis. But then again the study was not randomised. It seems there is still a lot to go for this high mortality condition.

Heard about honeymoon asthma? Well a case report from Salem, India published in the May issue of American Journal of Medical Sciences mentions it and a subsequent literature review led me to (what I believe is ) the first similar report by Specken in 1958. In fact in all such cases of post-coital asthma, the trigger might not be just sexual excitement (or honeymoon). It might be condom induced due to latex allergy, or in females due to what is known as human seminal plasma allergy. So it might not exactly be a “honeymoon” to diagnose honeymoon asthma.

Soumyadeep Bhaumik is a medical doctor and independent medical researcher from Kolkata, India. He freelances for various national and international medical journals.

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare that I have served a paid editor position in an Indian medical journal before and freelances for various national and international medical journals. No other relevant conflicts of interests.

ARTICLE ORIGINALLY POSTED AT BRITISH MEDICAL JOURNAL BLOGS AND SHARED UNDER CC-BY-NC LICENSE

Research Covered in British Medical Journal

Dr. Soumyadeep B’s research published in the latest issue of  Indian Pediatrics has been covered by the British Medical Journal owing to its massive importance in the Indian Medical Publication Arena.

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Putting humanity back into medicine

CaptureDr. Soumyadeep B’s  response to His Royal Highness, The Prince of Wale’s “Integrated health and post modern medicine” plan  has been published in the Journal of The Royal Society of Medicine in its latest issue.

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