, the first woman editor of the BMJ (originally called the British Medical Journal), is no ivory-tower academic. A crusader for medical ethics, Godlee is known for blasting governments for being lax, taking on global pharma giants such as Roche and GlaxoSmithKline for reportedly hiding trial data, speaking fearlessly against corruption in science , and championing the cause of patient-centric healthcare. In India to attend the BMJ South Asia Awards 2016, Godlee talks toon a wide range of issues, from air pollution to corruption in medicine and the work that the BMJ does in the country. Edited excerpts:(Laughs) I love this country. It’s a wonderful place and am coming back here after two years. The air now looks a lot better from what I read and saw a few days back. To look at the positive side of things, air pollution is back on the agenda of the people . You have to make the public aware and the governments accountable for moving us away from burning fossil fuel.Your recent report reveals that most of the people with diabetes in India are largely dependent on foreign-made insulin, which is expensive… There are certain things which are not going right. To put patients on insulin is a big push by industry and the doctors who in turn are influenced by the industry.Rather than tackling the lifestyle issues, going straight to insulin is not the right option. That is a big worry because insulin is not without its harm and is expensive in India. I think it’s a medical scam, an industry scam. Patients think that this is the best drug for them, and they need to pay for it or else they would die, and a very big group of people are vulnerable to it.I think we need to speak out against the pressure to put people on insulin. With diabetes becoming such an epidemic in India, we need to look at the root causes and put money there rather than putting people on insulin.Caesarean births are a problem globally, and not just in India. It’s more convenient for the doctor, who also gets paid more, and people are encouraged to think it’s safer.In some cases, it may be true but not in all cases. It’s not a riskfree procedure: anaesthetics, surgery, medical cost, long time of recovery and even more difficulty in having subsequent babies. It’s a global issue.Again, it is a global phenomenon, not just confined to India. There’s corruption in medicine globally. But if you have a system where doctors are paid more to do more, then you are going to end up with a system which seems to reward that kind of behaviour.If so, then it’s going to get much more likely that doctors would tend to push more for surgery, for investigations… kickbacks encourage more such behaviour.And, on the positive side, there are doctors in India who have started speaking against this.Consumer activism too is missing in India… That may be the case. Consumer activism is a huge potential benefit if we can harness it in a big way.We need to educate people that more is not better, more medicine can be worse. They need to ask questions, take second opinion , ask about the benefits of treatment.The same thing can be done regarding air pollution. Awareness has to be created. Hard questions need to be asked. There needs to be a cultural shift where doctors and patients are much like partners.The biggest change is exceptional tertiary care, which even puts the rest of the world to shame. Many countries in the world would be surprised to see the kind of expertise that doctors have here. The second big change is highvolume, high-quality medical care, which is again startling.Lack of quality primary care is the biggest concern. With money and energy spent in tertiary medical care, it requires strong political intervention to create infrastructure for primary healthcare. You need to give incentives to young doctors and nurses to work in the primary healthcare system. The pressure that doctors work under has also not changed.The breakdown of the doctor-patient relationship is disturbing. There have been reports where doctors have been abused and assaulted. It is happening in China as well. There’s an unrealistic expectation from medicines and doctors.But there are other issues as well. We are overpromising in terms of offering treatment. Then there are issues about patients taking loans to meet medical expenses. There have been reports of people selling assets and getting bankrupt. These are awful decisions that people have to make.The government in India has been doing something to bring price control in drug treatment. That’s the issue right across the world where drugs are hugely overpriced. Drug companies, for their part, say that they have to recover research and development costs. Since the markup is huge, we need to incentivise drug companies to behave in a different way. The problem of drug pricing is more apparent in India because people are paying themselves.