Published in The Hindu on August 15, 2010

All the authors, including the Indian researchers, involved in the project approved the final version of the paper on the superbug that appeared in The Lancet Infectious Diseases. The fine print in the journal explicitly states: “All authors were involved in the compiling of the report, and approved the final version.”

A day after reports on the superbug broke out in the Indian media, the lead author of the paper, Karthikeyan K. Kumarasamy of the Department of Microbiology at the Dr. ALM Post Graduate Institute of Basic Medical Sciences (PGIBMS), University of Madras, was quoted in a newspaper as saying: “I do not agree with the last paragraph which advises people to avoid elective surgeries in India. While I did the scientific work, [the] corresponding author Timothy R. Walsh of Cardiff University was assigned to edit the report.” He was quoted by another newspaper as explaining that “some of the interpretations” found their way into the paper “without my knowledge.”

His research guide and co-author, Padma Krishnan, was also quoted in the Press as complaining that “the research was taken up in the interests of patient care, but the report has projected a negative image of India.”

At the end of the discussion section, the paper noted that “several of the U.K. source patients [who were infected with NDM-1] had undergone elective, including cosmetic, surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and NDM-1 will likely spread worldwide.” It commented: “It is disturbing, in context, to read calls in the popular press for U.K. patients to opt for corrective surgery in India with the aim of saving the NHS money. As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving, and we would strongly advise against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide are clear and frightening.”

These observations are seen by several Indian doctors as besmirching the reputation of Indian healthcare and denting the prospects of medical tourism in India. The central government has also made public its displeasure. The attempt by Indian co-authors to distance themselves from a section of a paper that specifically states that the final version was approved by all the authors has certainly introduced an element of controversy into the process of writing and editing for science and medical journals.