emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
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; 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


10th August, 2010, Tuesday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Can capping profits on drugs provides the answer?

The Health and Family Welfare Parliamentary Standing Committee has come UP with a series of measures like increasing the number of drugs under price control, a blanket cap on profit margins of all drugs and promoting generic drugs to make drugs more affordable, reports Rema Nagarajan in TOI. These measures may tackle rising drug price, which account for up to 80% of total healthcare costs (the second biggest reason for rural indebtedness).

The committee has also sought regulation of pharma companies caught bribing doctors, with stringent punishment such as cancelling their drug manufacturing licenses through Drug Controller General of India as Medical Council of India (MCI) has no jurisdiction over pharma companies.

The capping on profits can be done under the Essential Services Maintenance Act (ESMA). In the original Drug Price Control Order there was a proposal for a cap on overall profitability of drug manufacturers to discourage them from shifting from price–controlled (less profitable) to uncontrolled (hugely profitable) medicines. The proposal was never implemented.

"The Committee recommends that the department of health and family welfare in coordination with the department of pharmaceuticals immediately move the inter–ministerial coordination committee and initiate a process of examining the issue of putting a blanket cap on profit margins of all medicines across (the) board."

"The Committee is shocked to note that despite there being irrefutable evidence of a strong link between high prices of medicines and poverty as also despite the fact that one of the avowed objectives of the Eleventh Five Year Plans is to include all essential drugs under a system of price regulation, the number of drugs under price control still remains a pathetic 74."

"Prescription of irrational and useless drugs by many of the doctors with ulterior motives is rampant. The committee is, therefore, convinced that there is no other alternative but to include more essential and life saving drugs under price regulation."

At present the National Pharmaceutical Pricing Authority has no jurisdiction over the pricing of new patented medicines, they were being sold at exorbitant prices.

Generic drugs are equally good, clarified the panel. All drugs are required to comply with the standards specified in the Drugs and Cosmetics Rules. A generic medicine is equivalent to the branded product, meeting the same standards of quality. This needs wide publicity so that the apprehensions of the general public about generic drugs not being of good quality could be dispelled.

At present, the manufacture and distribution of medicines are looked after by five different ministries– import and export policies under the Commerce Ministry, fiscal matters under the Finance Ministry, the policy effects on small scale pharma units dealt with by the Ministry of Small and Medium Enterprises, pricing of drugs by the NPPA under the Ministry of Chemical and Fertilisers and quality of drugs monitored by DCGI under the Health Ministry. They will now have a inter–ministerial coordination committee as per the recommendations of the department–related standing committee on health and family welfare.

Let us now critically evaluate the report.

We need to know whether it covers the disposables and devices as unless they are covered, the reduction in cost of the health care will not make much difference. Most drugs may be sold at a profit margin of 60–70% but most devises and disposable are sold at margins of over 300–500%. For example a stent costing 20,000 may be sold in the market for over one lakh. The same is true for most surgical disposables.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature( From HCFI File)

Mr. Ashok Chakradhar distributed awards to winners of Debate competetion of the event Divya Jyoti, a festival of nurses during Perfect Health Mela in 2007 organized by Heart Care Foundation of India (HCFI) at Sanjay Lake Park, New Delhi.

In the photo: Renowned Hindi poet, Mr Ashok Chakradhar, and Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President HCFI

Dr k k Aggarwal

 

News and Views

Duties of a Doctor (Dr G M Singh)

The title "doctor" is derived from the Latin word 'docere' to teach, and the physician should share information and medical knowledge with others and be willing to teach, what he or she has learnt, to colleagues as well as to students of medicine and related professions. The practice of medicine is dependent on the sum total of medical knowledge, which in turn is based on an unending chain of scientific discovery, clinical observation, analysis, and interpretation. Advances in medicine depend on the acquisition of new information, that is, on research, which must often involve patients; improved medical care requires the transmission of this information.

ME AND MY NATION – INDIA: Ignited Minds by Dr. A.P.J. Abdul Kalam (Dr G M Singh)

As a young citizen of India, armed with technology, knowledge and love for my nation,
I realize, small aim is a crime.
I will work and sweat for a great vision, The vision of transforming India into a developed nation, powered by economic strength with value system.
I am one of the citizens of a billion, only the vision will ignite the billion souls.
It has entered into me, the ignited soul compared to any resource, is the most powerful resource on the earth, above the earth and under the earth.
I will keep the lamp of knowledge burning to achieve the vision — Developed India.

Expectation drives placebo response in Parkinson's

A small randomized study has found hat patients with Parkinson’s disease who strongly expect a therapeutic benefit are likely to exhibit significant dopamine release when given a placebo. According to Sarah C. Lidstone, PhD, of the Pacific Parkinson’s Research Centre in Vancouver, and colleagues, a significant dopamine release (P=0.03) was noted among patients who were told that they had a 75% chance of receiving active levodopa vs those told their chances of being given the active drug were 25, 50 or 100%. The study is published in the August 2010 issue of Archives of General Psychiatry.

Blood marker zeros in early on cardiac hypertrophy

A biomarker of collagen production in the heart could help identify patients with sarcomere mutations early, before cardiac fibrosis and hypertrophic cardiomyopathy set in. In a study, mutation carriers showed considerable increase in serum levels of C–terminal propeptide of type I procollagen (PICP) whether they already had overt left ventricular hypertrophy or not (69% and 31% higher, respectively, both p<0.001) than controls. Gadolinium–enhanced MRI –– the current noninvasive method of choice for detecting fibrosis in overt cases –– didn’t pick up any of the mutation carriers who did not already have hypertrophy. The study conducted by Carolyn Y. Ho, MD, of Brigham and Women's Hospital in Boston, and co-authors is reported in the Aug. 5 issue of the New England Journal of Medicine.

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

What is lust murder? Dead body do tell tales

In America the term ‘lust murder’ is also used in a related but slightly different forensic sense, to refer to an individual who gains sexual arousal from the act of committing murder, or has persistent sexual fantasies of committing murder, even if the murder itself does not involve the genital mutilation or other typical/signature characteristics. Based on my experience as autopsy surgeon, lust murder is a type of paraphilia. The dynamics of violent fantasy in lust murders is understood. However, an individual’s violence fantasy alone is not enough to determine if an individual has or has not engaged in lust murder. Moreover, to conclude that an individual is the murderer because he has drawn multitudes of violent images – some of which involve women is over reaching. The scene of crime is fabricated in many cases by the offender. The body is often removed from the crime scene. He may do this to "taunt" the police or to prevent its discovery by transporting it to a location where it would be well hidden.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

(Dr. Neelam Mohan – Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity)


Diagnosis of Acute Pancreatitis

Serum Amylase: It has a relatively low sensitivity (75% – 92%) and specificity (20% – 60%). Its serum level rises within 2 to 12 hours, and in uncomplicated cases, remains elevated for 2–5 days. A protracted elevation raises the suspicion of a pseudocyst or macroamylasemia. Serum amylase levels greater than three times normal are considered significant for the diagnosis.

Serum Lipase: The clinical sensitivity is 86-100% and clinical specificity is 50-99%.

Using serum amylase and lipase determination together, increases the clinical sensitivity for the diagnosis of pancreatitis to 94%.

Question of the day

What are the recent treatment methodologies in diabetic retinopathy? (Dr John Beno, Chennai)

  • Intravitreal injection of triamcinolone is being used in many centers for the treatment of refractory macular edema not responding to laser treatment and cystoid macular edema.

  • Intravitreal implantation of fluocinolone is also being tried for the same conditions.

  • Intravitreal injection of bevacizumab, an anti–VEGF, is being tried for refractory macular edema and severe proliferation.

  • Ruboxistaurin, a PKC selective beta–inhibitor and octreotide, a somatostatin analog are being currently studied.
 

Public Forum (Press Release for use by the newspapers)

Do not take drugs with juices

Grapefruit juice can boost the absorption of certain medications and other common juices, including orange and apple, may limit the body’s absorption of drugs, compromising their effectiveness said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil ka Darbar & MTNL Perfect Health Mela. Quoting Dr David Bailey from University of Western Ontario, Canada, Dr Aggarwal said that grapefruit juice markedly boosts the amount of drug that gets into the bloodstream.

As per American Academy of Family Physicians, doctors traditionally warn against drinking grapefruit juice if you’re taking certain medications for high cholesterol, high blood pressure and heart rhythm problems.

New research has shown that grapefruit juice, as well as orange and apple juice, can lower the body’s absorption of some drugs like anti–cancer drug Etopophos, beta–blockers, like Atenolol, anti-transplant rejection drug cyclosporine and antibiotics, including ciprofloxacin, levofloxacin and itraconazole. Healthy volunteers who took the allergy drug fexofenadine with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water.

Substances in the juices affect the absorption of drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs.

In general, it’s safest to take medication with water. A glass is better than a sip. It helps dissolve the tablet. Cool water is better than hot, because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.

 

Conference Calendar

Dermazone South 2010 – XVI South Zone Conference of IADVL 2010

Date: August 13 15, 2010
Venue: JSS Medical Institutions, Mysore, Karnataka.

 

An Inspirational Story

Life is indeed the most excellent of all virtues

If we were to even for a single moment reflect upon Life and its trajectories, all we could be able to perceive is that Life is encompassed and has bestowed each and every one of us with excellence in each sphere and facet of this most adventurous journey called Life.

Life has always provided each and every one of us with the very best, all times, all instances, always in all ways. We should always appreciate with immense gratitude this precious gift, "Life", that we have been awarded fortunately.

To Live each and every moment with Awareness, Gratitude, Responsibility and Appreciation is an Excellence by itself.

We live once. Let us Live excellently, with thanks.

Wish the very best for all, appreciate every moment, hope for the very best with an enthusiastic perspective whilst attending to the concerned assignments with due diligence, prudent acumen, a calibrated approach and a staunch belief that Life is Excellent, for it is truly Excellent.

ijcp
IJCP
IJCP
ijcpgroup
nuspera
Docconnect
IJCP
 

IJCP Special

Dr Good Dr Bad

Situation: A patient with high blood pressure came with nasal flu.
Dr Bad: Take Nasal Decongestant drops.
Dr Good: Take only Saline Nasal Drops.
Lesson: Decongestant Nasal Drops can acutely raise the blood pressure.

Make Sure

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Rection: Oh My God! Why didn’t you put him on antioxidants?
Lasson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

Good Slogans (Dr Chandresh Jardosh)

A traffic slogan: 
Don't let your kids drive

if they are not old
enough - or else they never will be...

SMS of the Day

Sometimes you may catch me staring at you, it is not because you are cute. My mom told me that devil's have horns and tails. I keep wondering where are yours.
(Contributed by Dr.Prachi Garg)

Are you fit to fly?

Deep vein thrombosis

  1. Prolonged air travel may pose an even higher thrombotic risk in those with two or more risk factors for VTE.

  2. In previously healthy patients who travel at least eight hours per flight (median duration 24 hours), duplex ultrasonography reveal an asymptomatic venous clots in 10 percent.
 

International Medical Science Academy Update (IMSA)

Seasonal influenza vaccine

Vaccination with recent seasonal influenza vaccines induced little or no cross-reactive antibody response to 2009 H1N1 in any age group.

Reference

  1. Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009;361:1748.
 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Cinnarizine 20mg + Dimenhydrinate 40mg tablets

For the treatment of vertigo

3–Feb–10

 

Medi Finance

Q Regarding any income from assets transferred to spouse, who is liable to be taxed?

Ans. When a asset is transferred by an individual to his/her spousefor an insufficient consideration directly, income from such assets shall be deemed to be the income by transferor.

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Adrenocorticotropic Hormone ( A.C.T.H.)

To help diagnose adrenal and pituitary diseases such as Cushing’s syndrome, Cushing’s disease, Addison’s disease, adrenal tumors, and pituitary tumors.

 

Lateral thinking

Read this………………

What is the meaning of:–

CCCCCCC

The answer for yesterday’s puzzle "Think Big"

Correct answers received from: Dr Chandresh Jardosh, Dr Ashok Wasan, Dr Gagan Shrivastava, Dr Mohit, Dr Girish Cally, Dr Sunita Kalra, Dr.B.N.Ganagdhar

 

Humor Section

Jokes

The CEO of a large TPA and goes to heaven. St. Peter shows him to a lovely villa, wonderful music, great views, full staff of servants, gourmet meals, etc. The CEO says, "This is terrific!"
"Don’t get too comfortable," says St. Peter. "You’re only approved for a three–day stay."

Funny One Liners

He always leave an empty milk carton in the refrigerator just in case someone wants their coffee black.

 

 

Readers Responses
  1. Commonwealth Games - Taking them as festival sounds a little like political statement. It does not come in our priority, we need roads, law and order, electricity and water supply in smaller towns rather than to have such an extravagant affair. Above all there is so much of corruption involved into it: Vivek Kumar
    eMedinewS Responds: This statement was for NCR where the CWG will take place. As far as corrupt individuals are concerned, all of them will pay in long run. As Chanakya once said 'corruption cannot last more than 8 years in one person's life.'

  2. I thoroughly endorse this excellent suggestion by a friend, Dr. K.K. Aggarwal – Treat Commonwealth Games as our own festival!: Dr Vinay Walia

  3. It is nice to introduce basics of other systems in the medical curriculum. However, an already overloaded curriculum is definitely a problem. It is more useful & desirable to introduce yoga in medical curriculum. That will improve mental & physical health of medical personnel, help them to manage stress, & equip them to deal with chronic lifestyle disorders that are the bane of modern man:Madanmohan Trakroo

  4. Dear Dr. KK Agarwal, Warm regards. I must congratulate u for ur first medical enewspaper which I read everyday. Besides the medical articles, I like ur Inspirational story section. It is really inspirational. I am sending a story for the same section for ur eMedinews. Thanks: Dr. Sushma Chawla, Founder President Hope Ek A.S.H.A

  5. Thanks Dr KK Aggrawal ji, for managing this multispecialty e medinews in medicos interest in large. Please continue uninterrupted. Thanks with regards and love: Dr K P Singh, Cardiologist Fortis–Escorts, New Delhi 25.

      6. Dear Dr. Aggarwal: Reference your comments about " Economy Class Syndrome" and DVT, can a relatively more vulnerable persont take a shot of low molecular weight heparin prior to international departure. Dr.Parashar 

        A: Yes, we ned to give them LMW heparin before they travel.

 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- 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.