Booming business in bones: Demand for real human skeletons surges in India

Gravediggers and companies are striving to profit from the surging demand for real human skeletons and replicas in India, thanks to a tradition that obliges medical students to acquire one each.

Employees of Biolab India, a Bangalore distributor of artificial skeletons and other teaching aids, pose with a Chinese-made PVC skeleton.  Courtesy Margot Cohen
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Gravediggers and companies are striving to profit from the surging demand for real human skeletons and replicas in India, thanks to a tradition that obliges medical students to acquire one each.

Somewhere behind a locked door in Indore, calloused hands strive to recreate a perfect human skeleton.

Carving, scraping, and smoothing chunks of resin, the Madhya Pradesh workers are bankrolled by Jitendra Karnawat, a Kolkata entrepreneur attuned to an unusual business opportunity.

Bones sell. And sales have been rising thanks to India’s proliferation of medical colleges and the crucial subject of anatomy.

But Mr Karnawat has turned his back on India’s historic grave-digging prowess. He seeks to develop replicas that are accurate and affordable.

Learning is intimately connected with touch, he believes. Long before he presided over Spectrum Impex, an importer and distributor of scientific teaching aids, he was just another frustrated schoolboy. “As a kid, I was never allowed to touch anything in the laboratory,” Mr Karnawat recalls.

His strategy now relies on the credo of India’s anatomy professors: fingertips don’t lie. Each new student is firmly advised to procure a skeleton for personal study. Such advice is not common elsewhere in Asia.

So watch out for the Bone Rush, as some 50,000 students jostle for skeletons, with classes proceeding at 371 medical colleges across India.

“Trying to obtain the actual bones in that number is almost an impossible task,” says Dr Ashok Sahai, vice president of the Anatomical Society of India. “I am aware that there is a scramble.”

In Kolkata, where human bones were once plentiful and cheap on the not-so-black market, rising prices have driven students to source a skeleton already in circulation.

“You have to be very fast to get it,” says Snehal Tewari, a surgery and medicine student at the Institute of Post Graduate Medical Education and Research. After returning home from a school tour, she promptly contacted the tour’s senior student guide and convinced him to give her a skeleton. Her family was petrified by it, Ms Tewari says, prodding her to hide it in her bedroom.

The price for a new human skeleton is between 15,000 rupees (Dh835) and 35,000 rupees in Kolkata, while a skeleton used by medical students can be had for 2,800 rupees.

For medical students, a skeleton’s grooves, ridges and crests must be observed, touched and committed to memory. Most students make do with a set of bones that falls short of the 206 bones that support a human body. Others resort to sharing femurs and skulls in a classroom relay. In desperation, they also share bones in student hostels.

Escalating demand partly stems from the crowd of politicians and entrepreneurs who have rushed to establish lucrative private medical colleges. They set fees especially high for non-resident Indian students.

Since 1980 the number of medical colleges in India has more than tripled, with many graduates aspiring to distant practices in the United States, Britain, Australia and the Arabian Gulf.

The supply of human bones is further strained by the rise of the animation industry in India. Typically, animation schools press their students to obtain a skeleton to hone their drawing technique. “There’s nothing creepy about it,” says Nachiketha Someswara, who graduated from the Animaster Academy in Bangalore in 2013. “It’s in my bedroom, sitting on a chair.”

India has a long history of fascination with anatomy. In the post-Vedic period, from 800 BC to AD 1000, scholars were rather generous in counting bones in the human body.

The Atreya-Charaka school documented 360 bones in the human body, while the Sushruta school came up with 300. “They included teeth, nails, cartilage, and bony protruberances, a fact that accounts for the large number they got,” said a member of a team of Mumbai researchers on the subject.

Anatomy also took centre stage at the medical colleges that the British set up in the 19th century in Calcutta, Madras and Bombay. When human bones were unavailable, professors relied on pasteboard models. Later, massive grave-digging funnelled skeletons to medical school museums around the world.

India’s ban on the export of human remains in 1985 sharply curtailed that trade, although some were nonetheless sold to overseas markets. Indian domestic trade in human remains is also prohibited. However, the government grants medical colleges a special licence to acquire human bones for study.

According to workers tasked with collecting skeletons from local graveyards, the job can be hit-or-miss. Typically, a section of a cemetary is reserved for burying unclaimed bodies, such as those retrieved from public hospitals or nearby rivers. Every six months, graveyard workers dig up that section to make room for fresh corpses. They place the old bones on the side. A recent haul in a Mysore cemetery of 20 skeletons was enough for 40 students to share.

“I am helping them with their studies,” a worker says proudly.

The requirement to own a skeleton springs from an oral tradition, not a written rule. The Medical Council of India only requires individual medical colleges to maintain a museum with ample specimens. Yet students meekly accept their obligation to acquire a skeleton for themselves.

With skeletons in short supply, some students have turned to using replicas. China dominates the global market with high-volume production of smooth, lightweight bones made of polyvinyl chloride (PVC).

The Chinese output dwarfs the more traditional cottage industry in the north Indian state of Haryana, where mostly elderly, low-paid workers have hunched over crude moulds since the 1970s.

While the Chinese imports are priced between 10,000 rupees and 12,000 rupees, the shoddy Haryana version might fetch as little as between 700 rupees and 4,000 rupees.

Some anatomy professors warn that reliance on replica skeletons could lead to serious medical consequences because the replicas lack the ridges and other rough details of real bones.

“Students will not understand properly if they study with PVC bones,” says Dr Trinesh Gowda, head of anatomy at the Mandya Institute of Medical Sciences. “If they don’t know the markings properly, they may not fix the fracture properly.”

Meanwhile, companies that produce replica skeletons in the US and Europe are targeting the Indian market, claiming that their products are far superior to their Chinese rivals’.

“We have over 30 custom formulas to reproduce virtually every characteristic of a real skeleton,” says David Kronen, managing director of Bone Clones, a California exporter.

For Miles Sprott, vice president of 3B Scientific in Germany, “India is already an important market”, he says.

“Stan”, one of 3B Scientific’s model skeletons, retails on Amazon for US$315 (Dh1,160), about twice the price of a Chinese replica. Mr Sprott says the higher price is justified because the product “doesn’t break in normal use, even if it falls over”.

Aside from Mr Karnawat, other Indian entrepreneurs are staking their future on three-dimensional digital printing and animation. In Bangalore, for example, Focus Medica India recently spent 130 million rupees on a 10-volume digital anatomy atlas. The display screen pulses with vividly coloured images and detailed voiceovers.

The atlas should complement hands-on skeleton study, rather than replace it entirely.

“The human body is very, very complicated,” says Padmaja Rao, director of Focus Medica India.

“For clear understanding of the subject, students will need this digital media. But they still need a cadaver and skeleton. They have to feel it.”

As for 3-D digital printing, df3d Creations, a Bangalore company, has started to assist doctors with creating prototypes of certain bones in preparation for complicated operations, such as maxillofacial surgery.

Although the costs of professional digital printers are expected to drop over the next three years, such bones would still far exceed the budget of the average Indian medical student.

The idea that any human hand could create the perfect artificial skeleton is simply too outlandish for some people.

“Man cannot rule nature,” says Dr Gowda. “He may try to duplicate things, but the correct ones were already made by God.”