06 Jan 2024 : The Hindu Editorial

Topic 1 :  Drug war: On use of antibiotics and antimicrobial resistance

Context: Antimicrobial resistance is a health issue that will negate advances in medicine

Introduction

• Prevention is better than cure, but taking this adage to the extreme in the practice of medicine might obnubilate the very purpose of treating patients to recovery, and even turn out to be counter productive.
• In the case of prophylactic use of antibiotics, the resultant antimicrobial resistance (AMR) will be deadly.

Multicentric Point Prevalence Survey of Antibiotic Use

• The ‘First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22’ conducted by the National Centre for Disease Control under the Health Ministry has thrown up startling statistics, but more importantly, examining the minutiae italicises key issues that have been flagged by experts for years now.
• Over 70% of the patients in tertiary-care hospitals across 15 States and two Union Territories were prescribed antibiotics; over 50% of antibiotics prescribed have the potential to cause AMR.
• But the most crucial reveal was that 55% of the patients surveyed were prescribed antibiotics as prophylaxis, or as a preventive; only 45% were prescribed antibiotics to actually treat infections; of this, only 6% were prescribed the drugs after identifying the specific bacteria.

Occurrence of AMR and causes!

• AMR occurs when pathogens evolve, fortifying themselves against drugs, and stop responding to antimicrobial drugs.
• While it is the nature of pathogens to evolve, this ever-increasing crisis is constantly being exacerbated by unsound medical, and animal husbandry practices. It is precisely the sort of misuse and overuse of antimicrobials, as revealed by the survey, which cause the development of drug-resistant pathogens that in turn pose great risk to life and exacerbate morbidity.

WHO estimates!

• The World Health Organization (WHO) estimates that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.
• AMR invalidates the multiple gains that modern medicine has achieved over years, makes infections harder to treat, but also renders other medical procedures and treatments such as surgery, caesarean sections and cancer chemotherapy, much more risky, WHO warns.
• Infectious diseases specialists and critical-care experts have for long been waving the red flag over AMR, calling for rational prescription of antibiotics, and curbs on the use of drugs to promote growth in animals and plants.
• It is also clear that there is an antibiotic research and development pipeline crisis, and urgent measures are required to develop new drug candidates, and more equitable access to them.
• The role of doctors and the government in regulating use of drugs is crucial in this battle, but more so the latter. Patients too are impatient with the medical process, expecting immediate relief to ailments; but medical science offers no magical remedy.

Conclusion

Ultimately, it is the agency with the heft to do both, establish systems that strictly regulate the use of antimicrobials and promote and fund research on newer antibiotics that will draw the line — between life and death.

Topic 2 : The need to examine the examination system.

Context: Reforming the examination system to ensure its credibility is a keyway to improve educational standards

Introduction

• Every examination season, the media reports scandals that engulf some universities or even school boards. The credibility of the examination system is linked to the standard of the certificates that the examination/school boards issue.
• The lack of credibility of the examination system in educational institutions affects educational standards because learning is conditioned by the proposed examination system. Teaching and learning should prepare a student to face any type of examination.

Other issues in the examination system

• On the contrary, if the examination pattern is known, say by testing mostly memory, then teaching will ensure that students only prepare for rote memory.
• This is the general pattern. Further, inflation of marks and achieving a very high pass percentage are the key objectives of the education administration. Consequently, the talent search cost for employers rises.
• A credible examination system is one of the keyways to improve the standard of education.

Decentralized system

• India has numerous higher education examination systems, including over 1,100 universities, 50,000 affiliated colleges, 700 autonomous colleges, and 40.15 million students. These systems have diversified modes of assessment, with 60 school boards certifying over 15 million students annually.
• However, the inconsistency of the examination system, including question papers with flaws such as language errors, irrelevant questions, and questions not testing higher order learning, has led to scandals and a lack of credibility in education.
• Employers disregard institutional certification and have their own rigorous assessments of candidates' academic achievements and suitability for employment.
• This has created a coaching market for competitive examinations and skilling. Examinations should test certain scholastic abilities, from memory to application and creation of knowledge and critical thinking.
• However, there are complaints that examination boards only test memory, leading teachers to coach students to memorize answers and score marks rather than teach them higher order thinking.
• Transparency in teaching and assessment is crucial for ensuring the credibility of assessment and standard of education.

Assessment Quality in India's Regulatory Institutions

• Regulatory institutions in India emphasize outcome-based learning.
• Advisories on curriculum design, pedagogy, and examination systems are often not followed by educational institutions.
• Syllabi often lack consistency and inadequacies, hindering higher order thinking and skills.
• Transparent oversight and professional body involvement in curriculum design and teaching are needed for a proper assessment system.
• Autonomy regulations in colleges lack oversight authority, leading to a lack of standardization of examinations.
• In a decentralized education system, confidentiality and standardization of the examination system are crucial.
• Secrecy in the examination process is a significant issue, leading to scandals and a lack of uniformity.
• Larger examination systems are prone to'malfunctioning' and malpractices, highlighting the need for improved standards.

Steps to Improve Learning Outcomes

• Academic research on curriculum design, pedagogy, and assessment systems.
• Subject-specific and skill-specific assessment processes.
• Continuous assessment through the course, with teacher's control.
• Proper documentation and real-time oversight.
• Transparent summative assessment and evaluation.
• Use of technology in assessment for credibility.
• Codification of negligence, fraud, and academic inadequacies.
• Transparency in student evaluation process and grievance resolution measures.
• External audit of assessment systems in universities and school boards.
• Audit reports should cover all processes and grade examination boards.
• Audit reports should be released after the completion of each major examination cycle.

Conclusion

• We expect university degrees and school board certificates to reflect the learning achievements of students, and examination boards should assess students comprehensively, in a challenging way.
• Grades should distinguish students by their academic attainments. While the confidentiality of the process and consistency in grading with uniform standards are desired features of examination systems, the real features are transparency in process and credibility by adhering to at least minimum acceptable standards.

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