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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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; Chairman Ethical Committee 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


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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

    Dr KK Aggarwal on Social Media …

DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan
ASAR-Aamir Khan And Dr KK Aggarwal on Satyamev Jayate

  Editorial …

7th June 2012, Thursday

Thin line between ethical and unethical acts

  • Giving commissions and cut is an unfair trade practice in terms of section 2(r) (6) of the Consumer Protection Act, 1986. It is also violation of regulation no. 6.4 and 6.5 of the MCI, 2002, regulations. “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.”
  • A treating physician, a path lab, an imaging centre and a surgeon – are all service providers and provide service under a contract of service against service charges. The contract of service, whether written or unwritten or implied, does not include a term of contract that the service provider, in addition to providing service against payment received in cash, will also obtain from or give further payment to another service provider. (Dr M C Gupta)
  • A physician is not a businessman or a trader. He is a service provider. It is legal to charge a commission in many trades. The sellers of stocks and debentures and even the government organizations like the LIC and the PPF organization give commission to their agents. But the LIC agent gives a service to the person who gets his life insured and, as a service provider; it is illegal for him to pass on a part of the commission received to the beneficiary of his services. (Dr M C Gupta)
  • A doctor purchases drugs from the stockist at concession rates and dispenses it at MRP. This cannot come under cut, commission or an unethical act. But the doctor cannot bill the drug separately. It has to be a part of dispensing service. Many GPs buy generic drugs and charge for the drugs as part of service fee.
  • Most doctors run a lab collection centre and collect the charges and pay 75% to the labs. They are providing the service.
  • Most hospitals are buying the services of full time doctors and selling it for a premium to the patients.
  • In the United States, for every imaging test (for example CT scan) there are establishment charges, operator charges and reading charges. The referring doctor often gets trained in reading and interpretation imaging tests and can charge money for the same. The service provider only sends the CD and does not report the test.
  • For charging any money it has to be established that a service has been provided. A service is said to be provided if:
    • If you accompany a patient for CT scan or MRI test
    • If you discuss with the reporting doctors about the clinical condition and share all the reports
    • If the patient comes to you with the report and you give your opinion.
    • If you order for a test after seeing a patient.
    • If you are present in OT when surgery is being done to your patient.
    • If you visit your patient daily while he is admitted in a hospital.
    • If you make a referral note with all the details.
    • If you make a summary of a case.
    • If you are involved in the interpretation of any test.
    • A pharma representative comes and consults you about the efficacy of their molecule.
    • If a pharma company invites you to an industry symposium and wants you to listen and react to the molecule.
    • If a CRO representative comes and wants you to be a part of a survey.
    • If you are a panelist, speaker or a chairperson in any symposia whether by an association or pharma sponsored.
    • If you issue a medical certificate
    • If the patient wants a second opinion and wants you to discuss with the treating doctor.
    • If you assist in any procedure in a health care setting.

For any service if you are paid, it’s ethical and legal. But the client must know about the same and it should be legal and accounted for. The following come under the purview of what is unethical or when is it a cut and not a service.

  1. When you do not provide any service and you charge for it.
  2. When you are not entitled to private practice and you charge for the services provided.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Transit of Venus, Solar eclipse and lunar eclipse – the health effects

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Bimaari Ek Ilaj Anek

All pathy consensus organized by Heart Care Foundation of India in association with All India Radio

Dr K K Aggarwal
    National News

Kerala-based IT co launches software for doctors

KOCHI: City-based Coresys Infotech launched eClinician, the mobile version of its clinical decision support system ( CDSS) for Android, which will help medical professionals diagnose disease easily. eClinician allows doctors to diagnose an illness easily and efficiently by choosing the symptoms of a patient from a drop-down listing. It processes the data and generates an output mentioning all the possible diagnosis for the given group of symptoms, the company officials said. The disease information is delivered under nine standard headings for ease of access: basics, clinical presentations, clinical examination, etiology, differential diagnosis, lab investigations, treatment, medication and prognosis.

The database has covered more than 4500+ diseases in the differential diagnosis (the distinguishing of a disease or condition from others presenting with similar signs and symptoms). Managing director of Coresys E.S. Jose said this software was now available on the Android App Store and anyone around the world could download it for their mobile phone or table PC at a very low launch price of 99 cents. "With the new application, now doctors and medical students can use the system in their palms. We also plan to launch the iPhone, Nokia, and Blackberry compatible versions soon," said Jose. This system will help the patients as well, because it will save precious time and money to reach conclusive diagnosis. (Source: TOI, Jun 4, 2012)

For comments and archives

Lady doctor leaves green footprints to office

AHMEDABAD: Dr Niyati Lakhani, 46, left her home early at 4 am for work. She had to reach her office — Gandhinagar Civil Hospital — in time at 10 am sharp. But then she had to leave in the wee hours as she had decided to give her car a miss and walk 30 km from her home in Paldi to Gandhinagar instead! Dr Niyati, who walked on the World Environment Day on Tuesday without making any noise about her journey on foot, says she wanted to leave some green footprints as her contribution to saving planet earth.

Interestingly, the idea to walk the long road to office in Gandhinagar stemmed from the recent petrol hike which had the countrymen including people in her hospital up in arms. "I realized that common man had little scope to fight the inflation battle. The only way out is to limit the need", says Dr Niyati who is head of the paediatric surgery department at Gandhinagar Civil Hospital. And walking to office was her one step forward to limit her need for fuel. She says that off late she makes it a point not to take her car to places around the house when she goes buying grocery or running errands. Of course, she had kept her husband, plastic surgeon Dr Ashwin Lakhani, in the dark about her long journey to office which began when the sky was still dark. "He called me up and said I was crazy but then one needs to do crazy things to ensure sanity on the earth", says Dr Niyati. The surgeon said that though the long road to office was smooth, she was harassed by two things — street dogs which chose to chase her during early morning, and the bottle of water she had forgotten to carry! "I was scared for a moment when the dogs came near me but fortunately they decided to let me go. The only drink I got was sugarcane juice near Indroda circle", says the gusty doctor. (Source: TOI, Jun 6, 2012)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Contributed by Dr Monica and Brahm Vasudev)

MRSA eye infections have a distinct presentation

Orbital infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are on the rise. Now, a new case series suggests physicians may be able to identify them more easily by their atypical presentation. (Source: Medscape)

For comments and archives

ASCO: Untreated prostate cancer responds to Zytiga

Men with metastatic castration-resistant prostate cancer (CRPC) had significant improvement in radiographic progression-free survival (rPFS) when treated with the androgen biosynthesis inhibitor abiraterone before chemotherapy, a randomized clinical trial showed. (Source: Medpage Today)

For comments and archives

Early imaging of low back pain unnecessary, harmful

As part of its "Promoting Good Stewardship in Clinical Practice," the National Physicians Alliance recommended against imaging for low back pain within the first 6 weeks of onset unless red flags are present. Now, a new literature and financial analysis supports and explains that recommendation. (Source: Medscape)

For comments and archives

ASCO: Markers mirror myeloma Tx complications

Levels of certain inflammatory markers may indicate the severity of disease- and therapy-related symptoms in multiple myeloma, researchers said at the annual meeting of the American Society of Clinical Oncology. (Source: Medpage Today)

For comments and archives

    Prayer Meeting

Dr. Vidya Prakash Sood (13/04/1936 – 03/03/2012)

A prayer meeting will be held to pay homage to the departed soul of Dr VP Sood (Issue Editor – Asian Journal of Ear, Nose and Throat) who passed away peacefully on March 3, 2012 in USA.

Date: Sunday 10th June, 2012
Venue: Chinmaya Mission (Auditorium), 89, Lodhi Road, New Delhi.
Time: 11 AM – 12 Noon

(IJCP and eMedinews)

    Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan, Star...: http://youtu.be/XrtCvERyLzk via @youtube

@DeepakChopra: You can only become that which you imagine is possible

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

How to finish your pending work?

  1. It involves principles of time management and some Vedic principles.
  2. First thing is to make a checklist of all the pending work by writing it down and re-categorizing them depending upon the urgency and importance.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

Will one be able to get pregnant after the damage gets fixed?

If your tubes are not badly damaged, surgery might help you get pregnant naturally. Your chance of getting pregnant after surgery is better if you are young and if the man has healthy sperm. If your tubes are badly damaged, you might need infertility treatments to help you get pregnant. In vitro fertilization (IVF) is one treatment that is used. For IVF, your egg and the sperm are joined in the laboratory and then the doctor places the fertilized eggs into your womb.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Before the Transfusion

Informed consent

The transfusion process begins with the physician’s assessment of the patient’s need and a written order specifying the component and amount to be given. Coupled with the decision to transfuse is the physician’s responsibility for the explaining the treatment along with its benefits, risks, and alternative therapies. The patient should be given an opportunity to ask questions, and his or her informed consent should be documented.

Individual institutions have different requirements for obtaining and documenting the interaction, as well as different policies about how often it is necessary. Some facilities require that a consent form, which explains the information in understandable language, be signed by the patient. Others expect the physician to make a not in the medical record (e.g., “the risks of and alternatives to blood transfusion were explained and the patient consented”). If a patient is unable to consent, a responsible family member might be asked. If no family member is available or if emergency need for transfusion leaves no time for consent, it is prudent to note this in the medical record.

For comments and archives

    An Inspirational Story

(Dr GM Singh)

The Value of Time

To know the value of an year, ask the student who failed his final exam
To know the value of a month, ask the mother who delivered a premature baby
To know the value of a week, ask the editor of a weekly magazine
To know the value of a day, ask a daily wage earner
To know the value of a minute, ask the soldier in the battlefield
To know the value of a second, ask the athlete who came second in the race

For comments and archives

    Cardiology eMedinewS

Fruit sugar may not be linked to increased hypertension risk Read More

Rise in childhood obesity may not be accompanied by increases in blood pressure Read More

Dark Chocolate: Sweet prevention for CV events Read More

    Pediatric eMedinewS

Siblings of children with ASD also at high risk for symptoms Read More

Obese kids may not have hikes in BP Read More

Exercise more important than diet in children's body fat Read More

    IJCP Special

Dr Good Dr Bad

Situation: A with non fasting patient came for cholesterol test.
Dr. Bad: Get complete lipid profile done.
Dr. Good: Get total cholesterol and HDL cholesterol done.
Lesson: Fasting is not a pre–requisite for total and HDL cholesterol.

For comments and archives

Make Sure

Situation: A patient with human bite developed infection in the wound.
Reaction: Oh my God! why were antibiotics not started in time?
Lesson: Make sure that all patients with human bite are started early on antibiotics like amoxicillin-clavulanate.

For comments and archives

    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. When I joined the service as assistant professor, the MCI requirement for promotion to associate professor was 4 years experience as assistant professor along with two publications. I have completed 3 years of service but now the MCI has changed the requirement to 7 years and 3 publications. Can it be challenged legally?


  1. If your employer never gave you an assurance that you will be promoted in 4 years, then it is not a service matter between the employee and the employer.
  2. If your employer gave you an assurance (directly or through university rules or the UGC rules etc.) that you will be so promoted, promoted in 4 years, then it can amount to a service matter and can be the subject of a writ petition.
  3. If there is no assurance but you can prove that there is discrimination (the 7-year rule applicable to you does not apply in other institutions), you can still go in for a WP.
  4. If the rule is uniformly applicable across the country, then your individual case is decidedly weak and it is better that a teachers’ association should go in for a WP/PIL if so advised by your lawyer after studying all the necessary documents.

For comments and archives

  Did You Know?

Less than one-third of osteoporosis cases have even been diagnosed, and only 14% of women with osteoporosis receive treatment. This comes in stark contrast to the fact that more than 50% of women over age 50 will encounter an osteoporosis-related fracture.

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  Quote of the Day

(Dr Veena Aggarwal)

If you want to be sad no one in this world can make you happy, But if you makeup your mind to be happy, no one and nothing on earth can take up that happiness from you.

    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Transferrin saturation or index - Anemia of chronic disease

A low serum iron is less specific. It also occurs in the anemia of chronic disease or anemia of chronic inflammation (ACD/ACI). In this setting, however, there is usually a parallel reduction in the TIBC, resulting in a near normal percent saturation. However, about 20% of patients with ACD/ACI have transferrin saturations in the iron deficiency range because of an inability to access their normal or even increased marrow iron stores.

    Mind Teaser

Read this…………………

Nurse Linda is preparing a client with multiple sclerosis for discharge from the hospital to home. Which of the following instruction is most appropriate?

a. Practice using the mechanical aids that you will need when future disabilities arise.
b. Follow good health habits to change the course of the disease.
c. Keep active, use stress reduction strategies, and avoid fatigue.
d. You will need to accept the necessity for a quiet and inactive lifestyle.

Yesterday’s Mind Teaser: What is the priority nursing assessment in the first 24 hours after admission of the client with thrombotic CVA?

a. Pupil size and papillary response
b. Cholesterol level
c. Echocardiogram
d. Bowel sounds

Answer for Yesterday’s Mind Teaser: Pupil size and papillary response

Correct answers received from: Muthumperumal Thirumalpillai, Dr PC Das, Dr Sushma Chawla, Dr BB Aggarwal, Raju Kuppusamy, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr U Gaur, Anil Bairaria, Dr LC Dhoka.

Answer for 5th June Mind Teaser: a. Hypovolemia

Correct answers received from:
Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Avtar Krishan,
Dr U Gaur, Anil Bairaria, Dr LC Dhoka

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Middle-aged man to trainer in gym. "I want to impress beautiful girls, which machine should I use? Trainer: "ATM, sir"

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

The right to refuse medical interventions - Theresa Marie "Terri" Schiavo case of United States

In 1990, 27–year–old Theresa Marie "Terri" Schiavo suffered cardiopulmonary arrest in her home leading to a persistent vegetative state requiring artificial nutrition and hydration by feeding tube. After eight years without neurologic recovery, her husband and guardian requested that her feeding tube be removed, but her parents objected and the case went to court. The judge determined that there was "clear and convincing evidence" that she would not have wanted to be kept alive in this state. Despite several attempts on the part of Schiavo’s parents’ to prevent removal of her feeding tube, including claims that she could recover, the Florida state Supreme Court affirmed that her husband could exercise his right and discontinue treatments. The US Supreme Court stood by the lower court’s decision and refused to hear the case.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Type 2 Diabetics Can reduce Weight by WAIT Program

A short-term lifestyle modification program for overweight diabetic patients can lead to long-term benefits, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President, Heart Care Foundation of India.

In a study conducted by Dr Osama Hamdy at the Joslin Clinic inBoston, patients who had a mean A1c of 7.6% at baseline were able to lower their A1c to 6.6% after 12 weeks of the intensive program and remained at 7% after three years.

The name of the program is Why WAIT (Weight Achievement and Intensive Treatment) and it has been incorporated into regular practice at the clinic.

The researchers enrolled 141 patients with diabetes in the study - 127 with type 2 diabetes and 14 patients with type 1 diabetes. Average patient age was 53 and mean time from diagnosis was about 9.5 years. The study included 91 women. The average baseline weight of the participants was 240 pounds. Six of the patients dropped out of the study before completing the study period. The rest had at least two years of follow up, including 105 followed for 2.5 years and 70 patients with three years of follow-up.

The program included diet, exercise and weight-neutral or weight-negative medications. The diet was low in glycemic index, high in fiber, and low in saturated fat.

Patients were put on a structured strength and cardiovascular exercise program that gradually increased activity. For the first four sessions, patients were encouraged to exercise 20 to 40 minutes four days a week; during the next four the exercise prescription was increased to 40 to 45 minutes five days a week; and in the final four sessions patients were told to exercise 50 to 60 minutes six days a week. The patients also attended weekly teaching and behavioral support sessions. At the 12-week program's end, participants were instructed to follow the same plan on their own.

Intensive lifestyle changes can be successful and sustainable.

  1. Average weight loss after 12 week of the study was 24.1 pounds.
  2. Weight loss averaged 18.2 pounds at one year; 18.8 pounds at two years; and 17.2 pounds at both 2.5 years and at 3 years.
  3. HbA1c fell from 7.6% to 6.6% after 12 weeks and was 7% after one year, 6.9% at two years, 7% at 2.5 years, and 7% at three years.
  4. About 82% of patients achieved the goal of 7% after 12 weeks, but that declined to 47% at two years, 43% at 2.5 years, and 40% at three years.
    Readers Responses
  1. Dear all, Our Army chiefs can fight like cats and dogs openly, blame each other for corruption...no issue. Our Politicians refuse to pass a Lokpal bill openly...no issue. Our Chief Ministers are arrested for scams...no issue. Our film actors are booked for manslaughter, terrorism and rape...no issue. Our society kills female children, burns daughter-in-laws and does honour killings...no issue. Our Police are overtly corrupt, documented innumerable times in multiple ways...no issue. Land Mafia kills RTI activists openly...no issue. Our country has the highest internal displacement rate due to politicians and businessmen grabbing every piece of land...no issue. Our country is losing forest cover at an alarming rate...no issue. Our government openly refuses to bring back black money...no issue. Almost every politician is filthy rich without an accountable source of income...no issue. There is only one issue in this country...BAD DOCTORS!! Dr. Chandrashekhar Sohoni.
  2. More then 99% doctors (qualified) are serving the humanity day and night without bothering about their comfort, children and family; some times we have to miss our meals to look after our ailing brotherhood. A doctor is available even at 2 to help you. Everybody says that medicine is a noble profession but on the other hand now-a-days our courts/society say that we are traders and patient is a consumer. Kahin to jeene do yaar.............Dr VK Goel
    Forthcoming Events
Dr K K Aggarwal

4th Asia Pacific Vascular Intervention Course (APVIC-IV)

Date: June 8-10-2012

THE OBEROI, Dr. Zakir Hussain Marg, New Delhi
In association with 'International Society of Endovascular Specialists' 'Vascular Society of India' 'Society of Cardiovascular Angiography & Interventions'


All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta