Editorial 1 : ‘Green-beard’ genes could explain how altruism arose in nature
Introduction
Altruism in animals refers to behaviors where an individual sacrifices its own well-being for the benefit of others within the same species or sometimes even different species.
Examples
- Altruism is widespread in nature. Worker honey bees devote their entire life to foraging and caring for their sister, the queen, and her offspring, but do not themselves reproduce.
- In widow spiders, a male allows a female fertilised by him to eat him, and thus nourish herself and her offspring.
- A meerkat, a mongoose found in Africa, assumes the role of a sentinel, perching itself on a mound or rock, keeping a lookout for predators, instead of foraging for food, while the rest of the clan is feeding. If a predator is sighted, it alerts the others.
A genetic switch
- Most of the progress in answering this question has come from studies of a simpler organism: the social amoeba Dictyostelium discoideum.
- The take-home message of these studies is that if a gene makes a worker bee altruistic, it also helps the copy of the gene in the queen and her offspring to be passed on to the next generation, even if the worker herself does not reproduce.
- Such so-called ‘green-beard’ genes allow the individuals bearing them to recognise and preferentially cooperate with each other.
- Alternatively, a green-beard gene could provoke individuals to behave harmfully towards those carrying a different version of the gene.
- Thus, scientists have postulated, green-beard genes encode some kind of tag that helps the genome to know their identity (i.e. self-recognition).
Altruistic amoebae
- Dictyostelium discoideum is a free-living, fast-growing, unicellular amoeba. In the wild, it feeds on bacteria that grow on decaying vegetation.
- In the laboratory, researchers have been known to feed them a bacterial ‘lawn’ grown in a Petri dish.
- When the bacteria run out, the amoebae stop multiplying and gather in the hundreds of thousands to form multicellular aggregates visible to the naked eye.
- The aggregates then transform into fruiting bodies, each a few millimetres tall. A fruiting body is composed of a slender stalk made of dead cells, and it holds aloft a droplet of spores.
- About 20% of the amoebae in an aggregate altruistically sacrifice themselves to form the stalk. The remaining 80% become the spores.
- Small fauna, such as ants and earthworms, disperse the spores to new food sources where they germinate to release amoebae. The newly released amoebae then go on to repeat the cycle of growth, division, and dispersal.
Beware of cheaters
- Not all the amoebae in an aggregate necessarily share kinship. Some could be only distantly related, so the aggregates can potentially be genetic chimaeras — structures in which not all amoebae have the exact same genome.
- And when the genome differs, there is a risk that some strains may have found a way to ‘cheat’ and avoid becoming stalk cells, and as a result become represented in more than their fair share among the spores.
- The tgrB1 and tgrC1 genes are located next to each other in the D. discoideum genome, and are expressed together (so if one isn’t expressed, the other isn’t either).
- They contain information for cells to make two cell surface proteins called TgrB1 and TgrC1.
- The TgrB1 protein on one cell binds to the TgrC1 protein on another. If the binding is strong, the TgrB1 protein is activated, and confers altruistic behaviour — manifesting as the amoeba’s willingness to form the stalk.
- The binding between the TgrB1 and the TgrC1 proteins of cells of the same strain is strong, and leads to self-recognition and cell-cell cooperation.
- Pure cultures of cells that lack the tgrB1andtgrC1 genes fail to develop because they are unable to recognise each other as being alike.
- The tgrB1 and tgrC1 genes are also very polymorphic: within the same population of D. discoideum amoebae, they have multiple variants.
- When the researchers deleted the tgrB1 gene but left the tgrC1 gene intact, the amoeba did not cheat on ‘non-self’ amoebae that carried a different tgrC1. Instead, it cheated those with the same tgrC1 variant as itself — i.e. its kin. Every family has its black sheep!
Conclusion
- These findings demonstrate the logic that green-beard genes use to produce altruism plus the corresponding ability to keep altruistic amoebae from being exploited by greedy ones.
- As far as we know, amoebae do not use rational numbers. Instead, they use their rapidly evolving genes to estimate kinship with other amoebae.
- If the genes have not diverged at all, or have diverged very little, there is kinship and it is good to cooperate. If they have diverged significantly, there is less kinship and hence cooperation is risky.
Editorial 2 : The delicate balancing of health-care costs
Context
Access, innovation, and affordability need to be kept in mind while shaping equitable and sustainable health-care policies.
Equitable and cost effective health care services
- As we navigate the dynamic landscape of Indian health care, cost considerations are increasingly influencing every aspect of service delivery and patient care.
- With rising health disparities and uneven access to medical services, the need for equitable and sustainable health-care policies has never been more urgent than now.
- Ongoing discussions about setting rates for medical services are not just bureaucratic exercises. They fundamentally shape how we perceive, access, and deliver health care across India.
- In this globalised era, we see a variety of responses to similar challenges worldwide, shaped by differing cultural, economic, and systemic factors. By learning from these international examples, we can refine our strategies to manage health-care costs more effectively.
- Private hospitals are not only centres of specialised care but also innovation hubs.
- Take the examples of the Joint Commission International (JCI) and NABH (National Accreditation Board for Hospitals)-accredited big hospital groups, which have embraced cutting-edge technologies to significantly enhance patient outcomes, especially in complex procedures.
- These institutions invest heavily in top-tier infrastructure and advanced technologies, enabling them to seamlessly integrate telemedicine and remote care, thus broadening access and building patient trust.
Price caps, quality and innovation
- As the Supreme Court deliberates on standardising medical procedure rates across government and private sectors, we must consider the allure of affordability.
- Yet, imposing one-size-fits-all price caps could severely undermine health-care quality.
- A Health Care Management Review study shows that hospitals under financial pressure from price caps report a 15% increase in patient dissatisfaction.
- Moreover, such caps could drastically slow the development of new treatments and technologies, notably in fields such as cancer research and robotic surgery, where significant investment is crucial.
- The broader economic implications of health-care pricing policies reach far beyond the health-care sector itself.
- Properly implemented rate standardisation can alleviate health-care disparities, yet we must be cautious not to destabilise providers’ economic health.
- Economists recommend dynamic pricing models that adjust based on medical complexity and the financial status of patients, offering a fair solution.
- For instance, Thailand’s tiered pricing system, which considers patient-income levels and medical necessity, successfully balances cost and care and could serve as a model for India’s diverse economic landscape.
Legal and regulatory challenges
- Managing health-care costs effectively demands legislative reform. Tailoring approaches to accommodate local demographic and economic conditions can support rate standardisation and high-quality care.
- Technology is revolutionising health care, making diagnostics faster and more accurate with artificial intelligence and improving care coordination through electronic health records.
- For example, telemedicine initiatives in Karnataka have slashed hospital visits by 40%, demonstrating how technology not only makes medical care more accessible, especially in remote areas, but also more cost-effective.
- This integration reduces pressure on health-care facilities while delivering timely care directly to patients’ homes.
- Moreover, innovations such as mobile health apps and wearable devices are crucial in managing chronic conditions outside hospitals, significantly cutting costs and enhancing patient outcomes.
- Investing in infrastructure for broader Internet access and improving digital literacy will empower more people to benefit from these advancements, setting the stage for India to lead globally in health-care innovation.
- Recent surveys with health-care professionals across India show a consensus on the need for flexible pricing strategies that mirror the complexities of medical procedures and patient-care requirements.
- Engaging all stakeholders, including private health-care providers, is essential in order to grasp the nuanced dynamics and craft effective, sustainable policies.
Role of data in shaping policies
- In today’s big data era, health-care policy decisions should increasingly rely on data-driven insights.
- Data analytics can shed light on patient outcomes, treatment efficacy, and cost-efficiency, informing more nuanced rate-setting frameworks.
- Balancing access, innovation, and affordability in health care is delicate but imperative.
- Implementation of pilot projects in select districts to gauge the impact of rate caps on health-care quality and innovation, allocating government subsidies to support research and development in private hospitals, and establishing public-private partnerships to integrate cutting-edge technologies in public hospitals, ensuring widespread access to advanced health-care solutions.
Conclusion
As India aspires to be a global health-care leader, fostering an environment conducive to innovation while ensuring equitable access to quality health care is crucial. It is time to prioritise the well-being of every individual, as Affordable healthcare is not just a necessity but a priority for our nation, and we are committed to innovating and leveraging technology to bring down healthcare costs for every citizen.
