POSTSCRIPT: CAN ANYTHING BE DONE TO STOP HAIR LOSS IN SOUTH ASIA?
If we could initiate solutions to hair loss in the South Asian region — India, in particular — they would be as follows:
1. Improve nutrition on two levels: by increasing nutrients for the poor and reducing wasted calories for the middle and upper classes.
2. Provide proper and effective medications to those most affected by black piedra, ringworm and other infections.
3. Identify stress management techniques for the emerging middle class of skilled workers.
4. Reveal how dubious hair fall “cures” are, in fact, ineffective, and instead make genuine finasteride and minoxidil available and affordable.
The prospect of climate change in the region does not bode well for food security among the underclasses. This makes it all the more challenging to work on hair loss prevention through improved nutrition. A 2008 study by UNESCO, stemming from the International Conference on Climate Change, Biodiversity and Food Security in the South Asian Region determined
“[T]he agriculture sector needs to develop new cropping systems which have a potential to better adapt to changing climates. The focus of agricultural research needs to be on evolving stress resistant crop varieties, advocating crop diversification (both, between species & varieties), assessing economic loss to agricultural sector due to climate variations and its impact on national and regional economies, exploring possibilities of the use of ICT [information and communications technologies for the poor] and biotechnology for promoting sustainable agriculture and compiling and disseminating indigenous traditional agrarian knowledge.”
Addressing the need for nutritional improvements in the middle and upper classes, a report in February 2011 by Jaya Shankar Kaushik, Manish Narang and Ankit Parakh speaks to the problem of Westernization of diets in India. The report took a specific look at how the country’s children are eating as a result, on behalf of the Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital in Delhi. There were several findings and recommendations:
- Limit or eliminate fast-food promotion to children. As in the United States, children and young adults are marketed to by fast food and processed food product companies through sports sponsorships and cultural events, specifically using athletes and film celebrities as spokespeople, as well as targeted television program sponsorships.
- Enable children of working parents to have a healthier meal option. “Fast food chains are gaining popularity with nuclear families as working parents have less time for meal preparation at home,” note the researchers. “The vast majority of working parents with school going children are labored with exhausting commutes, other household chores and stress.”
- Reverse the perception of fast food as a luxury good. “Socioeconomic status is an important factor related to fast food consumption among children,” the research team reports. However, how it affects different classes is diametrically the opposite of how this plays out in the West. “In a study conducted in Hyderabad, children from high socioeconomic status preferred fast foods to traditional foods despite their better nutritional knowledge” (T. Vijayapushpam, K. K. Menon, R. D. Rao and G. Maria Antony, “A Qualitative Assessment of Nutrition Knowledge Levels and Dietary Intake of School Children in Hyderabad, Public Health Nutr. 6 : 683-638).
- Cut the trans fats. Trans fat content in Indian fast food is far higher than in Western foods: In bhatura, paratha and puri the trans fat content is 9.5 percent, 7.8 percent and 7.6 percent, respectively, as compared with 4.2 percent in regular French fries (adapted from an article in the Times of India, “Indian Food Worse than Western Junk”).
- Use India’s price control system to make healthier foods more attractive. [The Indian government plays a large role in controlling the price of goods such as foods and medicine.] “Price reduction is one of the most effective strategies to increase the purchase of healthy foods among children and adolescents. Price reduction on low fat snacks (fresh fruits and salad) and placement of low fat label were associated with significant increase in their consumption among adolescent population. In a study by Powell et al., it was observed that a 10 percent increase in the cost of fast-food meals led to 3 percent increase in consumption of fruits and vegetables.”
- Revisit trade liberalization policies that fostered fast-food expansion. In developing countries such as India, where poverty still prevails in a major part of the country, the government has taken measures to liberalize international trade to reduce the cost of food grains. “However, trade liberalization has led to massive infiltration of Indian market with fast food joints,” note the researchers. “Imposing heavy tax on imported and manufactured readymade food items might control this encroachment.”
Relative to hair-saving pharmaceuticals, the role of pharmaceutical companies in India presents a curious mix. The country became the manufacturer of generic drugs for developing (“third world”) countries, beginning in the 1970s. But with the influence (or intervention, as some might call it) of the World Trade Organization, resulting in the 2005 amendment to the India Patents Act, greater patent protections were granted to pharmaceutical companies from that date forward. A loophole for India-based manufacturers was left open: If they made a significant investment in producing a drug prior to 2005, they were released from observing a patent to any great degree. All they needed to do was create drugs and other medications according to their own processes in a slightly different formulation.
This in part explains why there are “similar-but-not-the-same” products such as near-Rogaine and near-Propecia available in India today. If a manufacturer sees an opportunity to sell the real deal at a profit — and contracts with the patent holders of those medications — more men and women will be able to halt hair loss to the extent that those products can be effective. According to studies done on Propecia (finasteride) by its manufacturer, Merck & Co., 86 percent of users see a cessation of hair loss and 48 percent regrow hair. Propecia comes in pill form, taken internally. The extra-strength (5 percent) formulation of Rogaine (minoxidil), which is applied topically to the scalp, has a 50 to 60 percent rate of effectiveness at halting and reversing hair loss, according to research by its original manufacturer, Upjohn Pharmaceutical (now Pfizer).
However, a report from the Harvard School of Public Health on India’s pharmaceutical product-pricing system (“How Effective Is India’s Drug Price Control Regime?” by Sakthivel Selvaraj, July 30, 2007) found the following:
Both in terms of bulk drugs and formulations production, India’s drug manufacturing capacity and its capability to “reverse engineer” is considered to be one of the top among developing economies.
However, due to a crumbling and dilapidated public health care system, most of the drugs are either out of stock or the system simply does not have adequate resources to buy them. This has largely resulted in a private sector takeover of the health care system in the country. Due to this development, households are increasingly paying out-of-pocket (OOP) for the purchase of health care and more so for drugs [but] India hardly has any social insurance cover to its over one billion population.
Moreover, the private voluntary insurance sector, whose contribution is around half a percent of the health care market, excludes drug reimbursement from its coverage. Hence, a substantial proportion of population is largely exposed to the drug market whose purchasing power is extremely low.
This latter point suggests that access to medications that can stem other causes of hair loss, such as black piedra and ringworm, may be difficult to overcome purely because of economics.
As for stress management, the problems that affect the huge portion of the population living in poverty have been considered intractable for generations. How do you bring a sense of peace to someone who cannot feed his children adequately?
Employers of anxious professional and technology workers, however, might offer stress-reducing activities for their employees, such as classes in yoga and meditation, many of which originated on the subcontinent and as such are more culturally familiar. Western-style family-friendly human resources policies might help companies also become the employer of choice.
Finally, concerning unproven techniques and methods for stemming hair loss, a communications program directed at this problem might follow the examples of other campaigns to improve public health. Perhaps a Bollywood actor or actors could take up the cause of improving health by criticizing “snake oil” medicines and methods, pointing to websites, posters, community health centers and other resources where valid alternative methods might be made available.
It can be said the culturally strong preference for youthfully thick and dark hair is one that consequently drives the unfortunate pursuit of false cures. But it would be exceedingly difficult to engineer cultural change. That task largely lies with Bollywood — perhaps with one star who can emerge in the same way that Yul Brynner, Telly Savalas, Bruce Willis and Vin Diesel have in Hollywood.
In short, there are no easy answers or silver bullets to the dilemma of hair loss. But in a region of the world where people are naturally imbued with strikingly beautiful hair, the drive toward real hair loss solutions may one day yield effective results.