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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 15 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

9th February 2013, Saturday

The generic drug controversy

In his show Satyamev Jayate, Amir Khan had asked doctors across the country to not write brand names and instead write only the generic chemical names of the drugs. This generated a lot of controversy in the country. The reason was a huge difference in the cost of various brands. Different divisions of the same company have brands with different prices. This cost difference is even more evident in case of surgical consumables and devices.

Recently, Medical Council of India Code of Medical Ethics 1.5 issued a re-notification and said that the rule 1.5 should be followed in its spirit. The rule says:

Medical Council of India Code of Medical ethics: 1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that there is a rational prescription and use of drugs.

The Indian Medical Association recently held a meeting which was attended by its office bearers along with the Drug Controller of Delhi, Director Health Services, President Gynecological Society of India, representatives from pharma industry and lawyers.

Dr K K Aggarwal National Vice President Elect IMA discussed the Code of Ethics of Medical Council of India 1.5 interpretation in its letter and spirit.

What was the intention of the MCI when the regulation was made? Was it the rational use of drugs with concern on quality and safety or to provide cheaper drugs? Apparently the first concern was more important.

In MCI regulations, the phrase “Use of GENERIC NAMES OF DRUGS” does not talk about using GENERIC DRUGS. The word ‘generic name’ means the CHEMICAL NAME. It is called INN or International Proprietary Name. For example, for aspirin, it is Acetyl Salicylic Acid.

The phrase “Every physician should” makes it binding. The only interpretation one can take from this is that the name of the chemical salt SHOULD be written in a prescription.

The phrase “As far as possible” means that there will be situations where a person may not be able to write the name of the salt. For example, the name of the salt may be too long to write like ‘Monosorbide nitrate’ or the drug is a combination of four or five drugs and in emergency, it may not be possible to write the chemical name of all the drugs. In that case, not writing chemical name would come under the exception “as far as possible”.

Another example is the drug NASOREST PLUS which contains acrivastine 8 mg, paracetamol 325 mg, caffeine 25 mg and phenyl ephedrine HCL 5 mg. In this case a person has to write only the brand name without the generic constituents. Similarly every multivitamin tablet in the market differs in the dose of the vitamins and other constituents. In Ayurveda all drugs have over 10-40 ingredients for e.g. chyawanprash has over 40 constituents. Every brand of chyawanprash differs in the doses of each constituent.

The phrase “Prescribe drugs WITH GENERIC NAME”: It is not the same as prescribing GENERIC DRUGS, it only means that name of the chemical salt should also be written.

The phrase “Shall ensure that there is a rational prescription” means that prescription of drugs should be evidence based and/or with informed consent. It would also include that one should justify the cost benefit ratio to be decided on case to case basis. Prescribing costlier brands without justification or a brand only from a particular chemist would amount to unethical act under this.

The phrase “And use of drugs” means the above is applicable for dispensing practice also.

Drug terms were also elaborated as under:

PATENT drug means a drug belonging to the original innovator company, which has researched the molecule. The company gets the right to sell this drug exclusively for 20 years and during this period no other company can manufacture and sell this compound. After 20 years when the patent is over, the drug becomes a GENERIC DRUG.

BRAND is the name given to the marketed drug specific to a company for selling. Both patented drugs and generic drugs can be sold under a brand name. Brand names are usually so named that the doctor can easily remember the chemical constitution or its action or the disease in which it has to be used. It is usually a shortcut so that it is easy to remember. For example ‘Ramipril” is chemical salt and most brands will have the word “ace” as a prefix or suffix, for e.g. HOPace, CARDace, RAMace etc reminding the doctor that it is an ACE inhibitor.

GENERIC NAME means the name of the chemical salt and is not synonymous with a generic drug.

A drug can be dispensed in the market as under:

  • The name of the generic salt with no brand name: For e.g., Dr Reddy’s Amlodipine or Zydus Amlodipine. In both the situations, the company’s name becomes a brand. It is available at the cheapest price as there is no marketing cost.
  • Unpopular brand: It is usually pitched for a bulk supply in any institution. It is costlier than company branded generic salt but cheaper than the popular branded drug.
  • Popular brand: It is marketed for the individual doctor’s use in a chemist shop and is the costliest.

The company may market all three products under different divisions and there may be a huge cost difference of all three varieties within the same company.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Even when large volumes are ingested, PEG induced diarrhea is associated with minimal electrolyte losses or gains. PEG 3350 electrolyte solutions are thus safer than osmotic salts such as magnesium and sodium sulphate or phosphate, especially in patients with impaired renal or cardiac function (Attar A, Lémann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44(2):226)

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Weight loss may improve sexual health of
obese diabetes

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

CPR 10 camp at Mount Abu School, Rohini

Dr. KK Aggarwal, President Heart Care Foundation of India with principal of the school and winners of the CPR 10 competition

Dr K K Aggarwal
    National News

Designer Genitalia: Fad, Benefit, or Mutilation?

(Dr Anita Kant, Asian Institute of Medical Sciences, Faridabad)

Q. Is plastic surgery of the female external genitalia common in India?

Ans. Yes and it’s not a recent development. Vaginal tightening operations have been a fad since a long time now. It generally means tightening of the anterior and posterior vaginal by tightening the connective tissues, trim and close.
It's our ethical obligation to listen to our patients and to educate them. Many women are really bothered because they think that they are supposed to look a certain way. And they may have partners who are also telling them that they need to look and feel a certain way. So it's not just about educating women; it's also about educating both men and women. Ethically speaking they should be evaluated properly and taught about normal anatomy and pelvic support. Women with increased body weight needs to lose weight for it will help her in many more ways then just good sex.

Q. What are the surgeries they commonly come for?

Ans. Vaginal tightening as they are distressed due to their partner complaining of loose vagina. Then, hymenoplasty, especially young women, unmarried to suppress that they have been sexually active and to live out the myth of bleeding at the time of first intercourse, and married to please their husband. The internet and media make it sound so simple, pain-free, and a daycare procedure with no hassles and no complications. Labiaplasty is one more procedure many women walk in for mostly on the complaint of their partner and sometimes due to a genuine discomfort on wearing tight clothes. Hair removing techniques have brought the LOCAL looks to the forefront.

Q. How should these problems be dealt with?

Ans. The specific complaints of the couple must be heard out, followed by a thorough examination. The suggested procedure, its implications such as pain, risk of infection, abstinence for a time period, expected outcome need to be discussed. Many a times it is a distressed wife wanting to reign in a two-timing husband who puts the blame on the wife for his action. The problem does not go away even after the surgery! A botched up surgery can lead to dyspareunia, severe rectal pain and pain in the region of buttocks has been reported by patients due to nerve injury.

To sum up, esthetic surgery is a woman's right no doubt but a gynecologist has to ethically explain everything including the power of kegel's exercises, weight loss etc.

(Source: IJCP February, 2013)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Mothers acting alone or with another person amount to 4-8% of perpetrators.

    Valvular Heart Disease Update

Mitral stenosis in the elderly

Mitral stenosis remains a valvular disease of predominantly young people, and rheumatic fever remains the leading cause of mitral stenosis in all age groups.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

High UV-B exposure may increase allergy, asthma risks

Living near the equator, where medium-wave ultraviolet light (UV-B) exposure is high, may increase the odds of developing allergy and, for people who are genetically predisposed, asthma, according to an article published in the February issue of the Annals of Allergy, Asthma & Immunology. (Source: Medscape)

Second-generation CT reduces angiography radiation dose

A new, second-generation computed tomography (CT) scanner provides excellent image quality while significantly decreasing radiation exposure for patients undergoing coronary CT angiography, according to a study led by Marcus Y. Chen, MD, from the Advanced Cardiovascular Imaging Laboratory at the National Institutes of Health, Bethesda, Maryland. (Source: Medscape)

Intimate partner violence screening recommended in guideline

Clinicians should routinely screen all women of childbearing age for intimate partner violence (IPV), according to a new clinical guideline from the US Preventive Services Task Force (USPSTF). There is insufficient evidence to recommend for or against screening of all elderly or vulnerable adults for abuse or neglect, the guideline states. The recommendations were published online January 22 in the Annals of Internal Medicine. (Source: Medscape)

Fitness in 40s, 50s tied to later dementia risk

Individuals with the highest levels of cardiorespiratory fitness during middle age were significantly less likely to develop dementia in their senior years, a long-term prospective study suggested. (Source: Medpage Today)

  Twitter of the Day

@DrKKAggarwal: 3 cops to protect each VIP, just 1 policeman for 761 citizens You cannot be called as a politician if you need protection from the public.

@DeepakChopra: How do you tell the difference between your intuition and what your ego is telling you? My #askdeepak reply http://tinyurl.com/a39n4dd

    Spiritual Update

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

Science behind regrets

In one of the US based study, dying people were asked about their regrets, if any. The top five regrets were:

1. I wish I had the courage to live a life I wanted to live and not others expected me to live.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is hyperprolactinemia?

Hyperprolactinemia is a condition in which too much prolactin is present in the blood of women who are not pregnant and in men. In women, this causes a decline in the body’s production of progesterone after ovulation which, in turn, can lead to irregular ovulation and infrequent menstruation, cause you to stop menstruating altogether, or cause your breasts to start producing milk, a condition called galactorrhea. Men also can experience galactorrhea. High prolactin levels in men can also lead to impotence, reduced libido, and infertility.

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

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

Timeline of successful transplants

  • 1981: First successful heart/lung transplant by Bruce Reitz (Stanford, USA)
  • 1983: First successful lung lobe transplant by Joel Cooper (Toronto, Canada)
  • 1984: First successful double organ transplant by Thomas Starzl and Henry T. Bahnson (Pittsburgh, USA)
  • 1986: First successful double–lung transplant (Ann Harrison) by Joel Cooper (Toronto, Canada)

For comments and archives

    An Inspirational Story

Learning from children

My daughter mentioned something today that made me think and want to share it with you.

I just learned from my daughter, Gabrielle. She asked me what I think about the average fourth grader. I asked her why. She said in school she was doing a project on the average fourth graders and didn't feel totally comfortable with it. Simply, when she looked around her classroom she clearly saw that each of her classmates was different, unique and that none fit perfectly into this average 'label'.

A 9-year-old was quickly intelligent enough to rip apart 'the label' so it wouldn't blind her to the facts of the individuality and uniqueness of her fellow classmates/human beings.

I've always said, "If you put toddlers/children representing many skin colors and cultures in a playground, they'd play." It seems to me there are some things adults can learn from children.

For comments and archives

  Cardiology eMedinewS

How not to get hypertension: Some clues from HARVEST Read More

No survival gain seen from beta-blockers in heart failure with AF
Read More

  Pediatric eMedinewS

CDC Advises On Meningitis Vax for Babies Read More

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic with A1c 6% had a BP of 130/88 mmHg.
Dr Bad: This is very good control of diabetes.
Dr Good: This is very good control but we also need to control BP.
Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL <100 mg/dL) and aspirin (75–150 mg/day) in patients with or at high risk for cardiovascular disease.

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure a patient with fever and cough is not given antibiotics as presence of cough is mostly due to viral infection.

  Quote of the Day (Dr GM Singh)

Thousands of candles can be lit from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared. Buddha

    Mind Teaser

Read this…………………

Heart rate is stimulated by all of the following EXCEPT:

a. excess thyroid hormone
b. increased levels of circulating catecholamines
c. the sympathetic nervous system
d. the vagus nerve

Yesterday’s Mind Teaser: So that the blood may flow from the right ventricle to the pulmonary artery, which of the following conditions is NOT required?

a. The atrioventricular valves must be closed
b. The pulmonic valve must be open
c. Right ventricular pressure must be less than pulmonary arterial pressure
d. Right ventricular pressure must rise with systole

Answer for Yesterday’s Mind Teaser: b. The pulmonic valve must be open

Correct answers received from: Dr Shashi Saini, Dr Bina R Sawhney,
Dr kanta Jain, Dr Jella, Dr (Maj. Gen.) Anil Bairaria, Dr Thakor Hitendrsinh G,
Dr Bharat Bhushan Aggarwal, Dr KV Sarma, Dr Avtar Krishan, Dr Arpan Gandhi, Dr Jainendra Upadhyay, Arun Aneja, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai.

Answer for 7th February Mind Teaser: d. Fewer than 40 bpm

Correct answers received from: Dr Deepali Chatterjee.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Top Secret Communications Center

When my son was in the Air Force, my wife and I visited quite often. On our first visit, we were allowed inside this top secret Communications Center, but everything in sight was covered up so we could look around everywhere -- Heck, even the toilet paper in the Men's room was disguised.

Anyway, at the exit, there's a sign above the door, which reads: “You have been exposed to Top Secret Material. Please destroy yourself before leaving the building.”

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Medicolegal Update

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

World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

  • Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.
  • In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
  • In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.
  • When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.
  • In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.
  • The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Swine flu update

Swine flu has killed 95 people in north India since 1st January, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA. Elaborating on this, he added the following points:

  • Swine flu causes fewer deaths than the routine seasonal flu.
  • The Hong Kong Study of H1N1 (Between April and December 2009)
    • Overall attack rate 10.7 percent.
    • Case-hospitalization rate 0.47 to 0.87 percent among people aged 5 to 59 years.
    • Case-ICU rate 7.9 cases per 100,000 infections in children aged 5 to 14 years.
    • Case-ICU rate 75 cases per 100,000 infections in adults aged 50 and 59 years.
    • Case-fatality rate 0.4 cases per 100,000 in children aged 5 to 14 years.
    • Case-fatality rate 26.5 cases per 100,000 in adults aged 50 to 59 years.
  • Case fatality is 0.4 – 26.5 cases per 100,000. This means 10 deaths would occur if one lakh people get the flu. To have 95 deaths, almost one crore people need to be infected. This again means 10% of the society suffering from flu or two patients per family. Either the figure 95 is wrong or the number of positive cases is incorrect.
  • From 1st Jan to 7th Feb (flu season), in 38 days, 95 deaths means 2.5 deaths per day in flu season. According to the Economy Survey of Delhi, a total of 868 people died of pneumonia in 2006 (year average per day 2.4) and 879 in 2007 (year average per day 2.4). This statistics is pre H1N1 era and will be true for seasonal flu.
  • 2.4 deaths in a year should mean that in the flu season the deaths would be many more. This proves the medical fact that swine flu cause fewer deaths than the seasonal flu. Then why panic?
  • US data
    • 0.3 percent of cases require admissions in the United States.
    • The mortality rate of 2009 to 2010 pandemic H1N1 influenza A infection was 0.12 deaths per 100,000 population.
    • The mortality is high in severe cases admitted to the ICU: In California, 31 percent of patients were admitted to the intensive care unit and 11 percent died of pneumonia and dehydration.
    • Only in Mexico, the mortality burden was 0.6 to 2.6 times that of a typical influenza season but lower than that of the severe epidemic in 2003-2004.
    • Two-thirds of deaths occur in people with underlying chronic illness.
  • Severity over time: During the second wave of influenza activity of the pandemic, which peaked in late October 2009 in the United States, there were higher rates of pediatric mortality and higher rates of hospitalization in children and young adults compared with previous influenza seasons. No change in severity was observed among hospitalized children and adults with pandemic H1N1 influenza A in the United States in the fall of 2009 compared with the spring of 2010. We do not expect this year’s H1Ni flu to be more severe.
  • Age: High rates of morbidity and mortality were noted among children and young adults across the globe. In some regions, older adults also had high rates of morbidity and mortality.
  • The highest mortality was seen in Mexico. From this trend, the case mortality will be higher in India because of overcrowding.
  • In seasonal flu, deaths occur more in people above 65 years of age and in H1N1 flu, deaths are more in 50-64 years age group.
    Readers Response
  1. Dear Dr. Aggarwal, Thank you for the clear elaboration of the generic drug and the implications of the same. I note with concern the cost implications and I am grateful that you have highlighted the important facts. Warm regards, Subra, Dr. N. Subramanian, Sr.Consultant Urologist, Indraprastha Apollo Hospitals, New Delhi.
    Forthcoming Events


Sri Aurobindo Ashram – Delhi Branch will organize the 6th Study Camp on ‘Mind-Body Medicine and Beyond’ for doctors, medical students and other health professionals at its Nainital Centre (Van Nivas) from June 8-14, 2013. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind-body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of the Mind-Body Medicine Clinic at AIIMS, and the author of Back to Health through Yoga, Eating Wisely and Well and Essays on Yoga. For more details, send an e-mail to the Ashram (aurobindo@vsnl.com) or to Dr. Bijlani (rambij@gmail.com).

    eMedinewS Special

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    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