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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


1st June, 2010, Tuesday

What Constitute Unethical Acts in MCI? (part2)

Dear Colleague

CHAPTER 6: UNETHICAL ACTS:

A physician shall not aid or abet or commit any of the following acts which shall be construed as unethical –
6.1 Advertising:

6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical. A physician shall not make use of him / her (or his / her name) as subject of any form or manner of advertising or publicity through any mode either alone or in conjunction with others which is of such a character as to invite attention to him or to his professional position, skill, qualification, achievements, attainments, specialities, appointments, associations, affiliations or honours and/or of such character as would ordinarily result in his self aggrandizement. A physician shall not give to any person, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report or statement with respect of any drug, medicine, nostrum remedy, surgical, or therapeutic article, apparatus or appliance or any commercial product or article with respect of any property, quality or use thereof or any test, demonstration or trial thereof, for use in connection with his name, signature, or photograph in any form or manner of advertising through any mode nor shall he boast of cases, operations, cures or remedies or permit the publication of report thereof through any mode. A medical practitioner is however permitted to make a formal announcement in press regarding the following: on starting  practice, on change of type of practice, on changing address, on temporary absence from duty, on resumption of another practice, on succeeding to another practice and public declaration of charges.

6.1.2 Printing of self photograph, or any such material of publicity in the letterhead or on sign board of the consulting room or any such clinical establishment shall be regarded as acts of self advertisement and unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of human system shall not be treated as unethical.

6.2 Patents and Copyrights: A physician may patent surgical instruments, appliances and medicine or Copyright applications, methods and procedures. However, it shall be unethical if the benefits of such patents or copyrights are not made available in situations where the interest of large population is involved.

6.3 Running an open shop (Dispensing of Drugs and Appliances by Physicians): – A physician should not run an open shop for sale of medicine for dispensing prescriptions prescribed by doctors other than himself or for sale of medical or surgical appliances. It is not unethical for a physician to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.

6.4 Rebates and Commission:

6.4.1 A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment.

6.4.2 Provisions of para 6.4.1 shall apply with equal force to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study / work. Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision.

6.5 Secret Remedies: The prescribing or dispensing by a physician of secret remedial agents of which he does not know the composition, or the manufacture or promotion of their use is unethical and as such prohibited. 

6.6 Human Rights: The physician shall not aid or abet torture nor shall he be a party to either infliction of mental or physical trauma or concealment of torture inflicted by some other person or agency in clear violation of human rights.

6.7 Euthanasia: Practicing euthanasia shall constitute unethical conduct. However on specific occasion, the question of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death, shall be decided only by a team of doctors and not merely by the treating physician alone.


6.8 Doctor Pharma relationship: Unfair relationship with pharmaceuticals and allied health sector industry.

 Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file)


Best Poster for World No Tobacco Day

 

On the occasion of the World No Tobacco Day, May 31, 2010,
the Cancer Society of Madhya Pradesh released a poster highlighting women and antismoking with the message -Protect Women from tobacco marketing and smoke-.
Photo Courtesy: Cancer Society of Madhya Pradesh

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New FDA Drug Update

Tocilizumab

The humanized anti–human IL–6 receptor antibody, tocilizumab, has been approved by US FDA for treatment of adults with moderately to severely active RA who have had an inadequate response to tumor necrosis factor (TNF) antagonist therapy. It may be used alone or in combination with methotrexate or other disease modifying anti–rheumatic drugs. Reported serious safety concerns include elevated liver function tests, elevated low–density lipoprotein levels, hypertension, and perforation of the gastrointestinal tract.

References:

  1. FDA approves new drug for rheumatoid arthritis. January 11, 2010. www.fda.gov/ NewsEvents/ Newsroom/ PressAnnouncements/ ucm197108.htm (accessed January 28, 2010).
 

Mnemonics of the Day (Dr Varesh Nagrath)

Micocytic hypochromic anemia except iron deficiency : PSTN

Pb (lead) poisoning
Sideroblastic anemia
Thalassemia minor
Nephrotic syndrome (due to transferrin loss)

News and Views

Misoprostol found effective in treating post-birth bleeding
Two studies published online Jan. 7 in The Lancet report that treatment with IV oxytocin in women who develop excess bleeding after childbirth.


HIV infection may increase fracture risk in women
The risk of fractures may be high in the postmenopausal HIV-positive women as they are more likely to have low bone density and high bone turnover. This was reported in a study published online Dec. 4 in the Journal of Clinical Endocrinology & Metabolism.


Quercetin appears to block hepatitis C virus production
According to a study in the December issue of Hepatology, Quercetin, a natural heat shock protein inhibitor, may be a potential treatment for hepatitis C virus (HCV) infection.

Criteria for diagnosis of Obstructive Sleep Apnea: (Varesh Nagrath)

The American Academy of Sleep Medicine recommends using the following definition for the diagnosis of obstructive sleep apnea hypopnea syndrome. The patient must meet either criterion A or B plus criterion C:

  1. Excessive daytime sleepiness that is not better explained by other factors

  2. Two or more of the following that are not better explained by other factors:

Choking or gasping during sleep
Recurrent awakenings from sleep
Unrefreshing sleep
Daytime fatigue
Impaired concentration

3. Overnight monitoring demonstrates five or more obstructed breathing events per hour during sleep

Quote of the day (Paramjeet Chadha)

Never change your originality for the sake of others, because no one can play your role better than you. So be yourself, because whatever you are, YOU are the best.

Question of the Day

What is the endoscopic treatment of non-variceal upper GI bleed?

Upper GI bleed, i.e., blood loss originating above the ligament of Treitz, is a common medical problem which results in significant morbidity and mortality. Patients may present with hematemesis, melena or hematochezia. Upper GI endoscopy is indicated to determine the cause as well as to offer endoscopic therapy when necessary. The priority should be to stabilize the patient hemodynamically which may take few hours. Upper GI endoscopy should be done as soon as patient is stabilized.

On endoscopy, if ulcer is found, endoscopic therapy is offered only to the patients with stigmata of recurrent bleeding (visible vessel or adherent clot) or active bleeding. There are multiple endoscopic modalities available to treat the bleed:

  • Injection therapy
  • Thermal methods: Heater probe, Bimscap
  • Hemoclips 
  • Argon plasma coagulation, etc


Combinations of any two modalities are better than a single modality. The usually used combination is injection with thermal method. Hemoclips can be used alone. Argon plasma coagulation therapy is preferred in conditions like angiodysplasia and GAVE (gastric antral vascular ectasia) syndrome.
All these modalities have been able to reduce rebleed, the requirement of blood and subsequent need for surgery. A combination of parental PPI with endoscopic therapy is better than either

Liver Fact

In Wilson’s disease, SGOT is invariably more than SGPT and the enzymes are never more than 2,000.

Women Safety Tips

Women have a tendency to get into their cars after shopping, eating, working, etc., and just sit (doing their chequebook, or making a list, etc.) DON’T DO THIS! The predator will be watching you, and this is the perfect opportunity for him to get in on the passenger side, put a gun to your head, and tell you where to go.

AS SOON AS YOU GET INTO YOUR CAR , LOCK THE DOORS AND LEAVE…
If someone is in the car with a gun to your head DO NOT DRIVE OFF. INSTEAD gun the engine ! and speed into anything, wrecking the car. Your Air Bag will save you. If the person is in the back seat they will get the worst of it !
As soon as the car crashes bail out and run. It is better than having them find your body in a remote location.

eMedinewS Try this it Works

Easing use of eyedrops

If your patients have trouble using eye drops. Have them either lie down or tilt the head back and put the drops in the corner of the affected eye, near the nose. Then tilt the head to the left for the left eye and to the right for the right eye. The drops flow directly into the eye.

Dr Good Dr Bad

Situation: A high-risk patient for diabetes was advised PFT test.
Dr Bad: You do not need this test.
Dr Good: Get this test done.
Lesson: Men who are predisposed to develop diabetes have decreased lung function many years prior to the diagnosis, compared with men who do not develop diabetes. This decrement in lung function remains after the development of diabetes. In the Normative Aging Study, diabetic patients had lower FEV1 and forced vital capacity (FVC) at all time points. (Lung function in type 2 diabetes: the Normative Aging Study. Respir Med 2005;99(12):1583–90)

Make Sure

Situation: A patient of jaundice with fever developed complications. Reaction: Oh my God! Why were other causes of jaundice not suspected? Lesson: Make sure that in a patient with jaundice and fever, causes other than viral hepatitis are looked into. In viral hepatitis, jaundice appears after the fever subsides.

IMANDB Joke of the Day

In former times, when royalties were more important, a lady at a court ball was intensely gratified when a prince selected her as a partner. She was almost overwhelmed with pride when he danced a second measure with her.

"Oh," she gushed, as she reposed blissfully in his arms, "your highness does me too great honor."

The prince answered coldly: "But no, madam. Merely, my physician has directed me to perspire."

Formulae in Clinical Practice

Arterial Blood Oxygen Content
Formula: CaO2 = (0.0031 × PaO2) + (1.36 × Hb in g% × SaO2%/100) Comment: Normal value 20 ml%.

Milestones in Dermatology

Ultraviolet Rays: In 1801 the German physicist Johann Wilhelm Ritter made the hallmark observation that invisible rays just beyond the violet end of the visible spectrum were especially effective at darkening silver chloride–soaked paper. He called them ‘de–oxidizing rays’ to emphasize their chemical reactivity and to distinguish them from ‘heat rays’ at the other end of the visible spectrum. The simpler term ‘chemical rays’ was adopted shortly thereafter, and it remained popular throughout the 19th century. The terms 'chemical' and 'heat' rays were eventually dropped in favor of 'ultraviolet' and 'infrared' radiation, respectively.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Critical value documentation

Documentation: The critical high and low values are documented in the laboratory’s standard operating procedure and should be defined in the laboratory computer information system

MCI update

1. The bail plea of Dr. Ketan Desai has been referred to Delhi High Court by the  lower court saying that since the matter has already gone to Delhi High Court, we have no jurisdiction on deciding the bail plea of Dr. Ketan Desai on health grounds. CBI has approached the Delhi High Court regarding this and the High Court has given 2nd June as date of hearing on health grounds bail plea of Dr. Ketan Desai. In the mean time regular Bail application of Dr. Desai in the CBI Court has been deferred to 9th June. In the high court the same will come on 3rd June.

2. The CBI team probing the MCI is zeroing in on some present and former top shots of the Union health ministry for their role in the multi-crore racket, reports TOI. They have got some definite clues which surfaced during questioning of management committees of two private medical colleges in Bareilly [Rohilkhand Medical College & Hospital and Sri Ram Murti Smarak Institute of Medical Sciences]. Both the institutes were denied MCI approval at least thrice before they eventually got the nod in 2007 and 2009 respectively. Two suspects were operating as the main links between the council and the institutes. Both were reportedly vested with the powers equal to officially appointed inspectors of the MCI and led most of the inspections along with the bonafide MCI inspectors.

3. A seven-member committee headed by Dr S K Sarin, is likely to re-inspect the K J Mehta General Hospital and College of Medical Sciences, Amargadh, reports Indian express. MCI had given permission to this self financed medical college in Amargadh, Bhavnagar for the year 2009-10 and only recently it received permission to continue for the 2010-11 academic session.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Donepezil hydrochloride Orodispersible Tablet 5mg/10mg

For the treatment of mild to moderately severe Alzheimer’s dementia

15.10.2009

 

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eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .

 

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Public Forum (Press Release for use by the newspapers)

Lifestyle counseling can reduce heart disease

An intensive effort to change lifestyle in people at high risk of heart disease can help them reduce such risk factors as high blood pressure, raised cholesterol levels and smoking said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

A trial, called the Euroaction study, published in the journal The Lancet compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 high risk people. Half got the counseling from a team of nurses, dietitians, physiotherapists and the treating doctors. The counseling was given to families as well as individuals.

The trial included two groups of patients. One those who already had developed coronary heart disease, another those who were asymptomatic but at high risk because of a combination of risk factors that gives a high chance of developing heart disease over 10 years.

1. Fifty–five percent of those getting the counseling reduced their intake of saturated fat, compared to 40 percent of those not getting the advice.

2. Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart–friendly oily fish, compared to 35 percent and 8 percent in the other group.

3. Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking.

(Advertorial section)

Forthcoming eMedinewS Events: Rregister at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Dear Dr Ahooja / Dr Aggrawal, You are requested to see my earlier letter published in e medinews dated 28th may 2010 on this topic. As far as updating of list is concerned the newly constituted BOG has asked all state medical councils to enter their data for years 2009 and 2010 for IMR. I hope with cooperation of all state medical councils we shall be getting complete data on MCI website.

  2. Dr Aggrawal, I shall request you to pursue the matter of medical practitioners whose names are entered in IMR are allowed to practice anywhere in country without getting registered again with that state council. Thanks and regards: Dr Kamlesh Kanodia