May 11  2015, Monday
editorial
Prescribe insurance to all patients in your prescription
When we do not take our car on the roads without insurance then why do we take our body out without insurance? Dr KK Aggarwal
  • Everybody should be insured and for those who cannot, the government must pay for their insurance. Insurance should be added in the prescription of a doctor.
  • Even if a patient has a disease, he or she needs insurance so that he is covered for other illnesses. Remember one is entitled for 1% of the cover as room rent or 2% for the ICU bed.
  • The coverage amount is for one full year. Do not exhaust it in one admission.
  • The patients should choose their insurance so that even OPD treatment is added to the coverage.
  • A person can have more than one insurance policy.
  • Health is not mere absence of disease but a state of physical, mental, social, environmental, spiritual and financial well being.
  • The purpose of life should be to desire for inner happiness and for that to earn righteously.
  • One must plan for old age; remember that today one can live above the age of 80 and old age treatments can be very costly.
  • Most disputes are due to property and one must write his or her will in time. Property dispute is number one cause of heart attacks in the country.
  • All doctors should be insured against malpractice. To err is human and malpractice is not a criminal negligence.
  • The banks should come out with schemes so that patients can get loans for treatments on the spot.
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Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
News
  • Obesity is a complex multifactorial disease that acts as a gateway to many other chronic conditions with an enormous impact, and should actually be viewed as a brain disease, argues one expert speaking at the 2015 European Congress on Obesity.
  • The detection of new intracranial aneurysms among patients with a history of aneurysm through radiographic screening is exceptionally low, only about 1%, suggesting that such surveillance in most cases is likely not justified, suggests new research presented at the American Association of Neurological Surgeons (AANS) 83rd Annual Meeting.
  • The US Food and Drug Administration (FDA) has approved the Senza spinal cord stimulation (SCS) system to aid in the management of chronic intractable pain of the trunk and limbs, including pain associated with failed back surgery syndrome, low back pain, and leg pain. The new system can reduce pain without paresthesia, or tingling sensation, by providing high-frequency stimulation at 10 kHz, with low-stimulation amplitudes.
  • Dr. Anthony Ormerod, of the University of Aberdeen, Scotland, and colleagues write online April 29 in JAMA Dermatology that twice-daily application of sodium nitrite and citric acid creams cleared anogenital warts more effectively than placebo.
  • The US Food and Drug Administration (FDA) has approved the antibiotic moxifloxacin (Avelox, Bayer Healthcare Pharmaceuticals) to treat two forms of plague, a rare but sometimes fatal bacterial infection that surfaced last year in Colorado and possibly spread through human-to-human contact.
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Dr KK Spiritual Blog
Forgetfulness and Age

By the time we cross 40, most of us suffer from minimal cognitive impairment and have a memory loss of very recent events or objects. This is age related and should not be confused with dementia.

This can also happen in patients who are vegetarians and vitamin B12 deficient. People often have difficulty in naming objects and name of the people.

Just as a computer hangs up while doing multiple tasks, so does the human mind. When you handle multiple projects at the same time, you may experience thought blocks, which is natural and not a sign of a disease.

When we introduce ourselves to a new person, we often tell our name first. It is possible that by the time you finish your conversation, the person may forget your name. Therefore, one should either introduce themselves last after the conversation is over or introduce oneself at the start and also at the end of the conversation.

Some people introduce themselves before the conversation and hand over their visiting card at the end of a conversation. This is also taught in how to market yourself.

As medical doctors, we face these difficulties quite often. People send SMSs without their names or call without telling their names. For example, I once got a call "Malhotra Bol Raha Hoon Pehchana Kya?" As a doctor, we may have had hundreds of Malhotras as our patients and it is not expected from us, especially after the age of 40 to recall a person just by his surname. Unless we are given complete information by the patient on phone, mistakes can be made, especially if it is a phone consultation. In any way, phone consultation needs to be avoided. Even Supreme Court in one of its judgments said that giving phone consultation may amount to professional misconduct on the part of the doctor.
Cardiology eMedinewS
  • The use of prasugrel in patients with acute coronary syndrome (ACS) undergoing PCI with stent implantation does not decrease the risk of major adverse cardiac events (MACE) compared with patients who receive clopidogrel, suggest data from a new retrospective cohort analysis presented at the Society for Cardiac Angiography and Interventions (SCAI) 2015 Scientific Sessions.
  • The largest review of all the evidence to date shows that digoxin use is associated with an increased risk of death, particularly in those being treated for atrial fibrillation. The report is published online in the European Heart Journal.
Pediatrics eMedinewS
  • Children with Crohn's disease who receive anti-tumor necrosis factor (TNF)-alpha inhibitors show improvements in bone density and structure, suggests new research published in the Journal of Clinical Endocrinology and Metabolism.
  • Children 10 years old and younger do just as well as older children with endoscopic type 1 tympanoplasty for repairing perforated ear drums, suggested a new study published online in JAMA Otolaryngology-Head & Neck Surgery.
Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure of 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.
Dr Good Dr Bad
Situation: An elderly diabetic patient came with a blood pressure (BP) of 160/80 mmHg.
Dr Bad: You need more intensive treatment.
Dr Good: It is ok to have it at this level.
Lesson: BP is a marker for mortality in elderly type 2 diabetes mellitus patients; but, has an inverse relationship. In a prospective observational cohort study of more than 800 patients aged =60 years, a decrease of 10 mmHg in systolic BP, diastolic BP and pulse pressure led to a mortality increase of 22% (95% confidence interval (95% CI): 13–31%), 30% (95% CI: 13–46%) and 22% (95% CI: 11–33%), respectively (Age Ageing 2010 Sep;39(5):603-9).

(Copyright IJCP)
Events
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eMedi Quiz
Brocq's phenomenon is analogous to which clinical sign in psoriasis?

a. Olfleck's phenomenon
b. Auspitz sign
c. Salmon patch
d. Candle wax scales

Yesterday’s Mind Teaser: The main enzyme responsible for activation of xenobiotics is:

1. Cytochrome P-450
2. Glutathione S-transferase.
3. NADPH cytochrome P-450-reductase.
4. Glucuronyl transferase.

Answer for yesterday’s Mind Teaser: 3.NADPH cytochrome P-450-reductase
Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Kailash Sharma, Tukaram Pagad
Answer for 9th May Mind Teaser: AV bundle.
Correct Answers received: Daivadheenam Jella, Dr Avtar Krishan
Quote of the Day
However difficult life may seem, there is always something you can do and succeed at. Stephen Hawking
Wellness Blog
Food poisoning with rice dishes

Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit.
  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic–type food poisoning associated with B. cereus.
  • The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating such as stir frying
  • Two distinct types of toxin-mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B. cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one–third of individuals. Symptom onset is usually within 1 to 5 hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice–based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.
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IJCP Book of Medical Records
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
eMedinewS Humor
Never be rude to anyone

An American tourist asked a boat guy in Zanzibar, "Do you know Biology, Psychology, Geography, Geology or Criminology?"

The boat guy said, "No. I don’t know any of these."

The tourist then said, "What the hell do you know on the face of this Earth? You will die of illiteracy!"

The boat guy said nothing. After a while the boat developed a fault and started sinking. The boatman then asked the tourist, "Do you know Swimology and Escapology from Crocodiology?"

The tourist said, "No!"

The boat guy replied, "Well, today you will Drownology and Crocodiology will eat you. I will not Helpology and you will Dieology because of your Badmouthology."
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
Press Release
Physical illness can trigger depression

If you have depression, a thorough physical exam and careful medical history should be elicited to pinpoint a physical source of the problem for an appropriate treatment, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

In depression, it is important to not only look for what’s going on in the mind and brain but also check for what’s going on in the body. Many medical problems have been linked to mood disturbances.

Over fifty percent of heart attack survivors and those with cancer report feeling depressed. Depression is also linked to diabetes, Parkinson’s and other chronic conditions.

Depression too can affect the course of a physical disease. Depression is linked with slower recovery from a heart attack and an increased risk for future heart trouble.

Thyroid disorders also affect mood. Overactive thyroid can cause mania and under active thyroid can cause depression. Other medical conditions associated with mood disorders include certain neurological conditions (multiple sclerosis, Parkinson’s disease, Alzheimer’s), other hormonal imbalances and lack of vitamin B12.
Rabies News (Dr A K Gupta)
What does humanizing your dog means?
  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.
eIMA News
Delhi Master Plan: Clinics, labs in residential areas face closure
MCD, anti-pollution agency begin drive to shut medical facilities but no one knows how many there are, and where. However, sources said, efforts to send notices to clinics and labs over the last week have resulted in confusion as there is no database on such establishments.

The Delhi government’s environment department and municipal corporations are preparing to crack down on doctor’s clinics, nursing homes and laboratories operating in residential areas for allegedly violating provisions in the mixed land-use category as laid out in the Delhi Master Plan.

However, sources said, efforts to send notices to clinics and labs over the last week have resulted in confusion as there is no database on such establishments.

The decision came months after the Supreme Court, in its order issued on March 20, slammed the Delhi Pollution Control Committee (DPCC) and the municipal corporations, while ordering the closure and shifting of Dr Dangs diagnostic laboratory in South Delhi. The lab has been ordered to close by June 22.

The order was issued to the lab for alleged violations of the master plan norms, including provision of parking space and using more than the permitted 25 per cent space in the place of residence — as mandated in the mixed land-use policy.

When contacted, Dr Navin Dang, director of Dr Dang’s Medical Diagnostic Centre said, “I am a law-abiding citizen. Our lab is a quality lab in Delhi. I do not want to comment on the matter at the moment as our lawyers are still examining the judgment.”

According to the Delhi Master Plan, the “area/street for mixed use activity should be identified by conducting a study of the impact on the traffic in that area/street in which such mixed use activity is likely to take place. Environmental needs and impact on municipal services of the area must also be evaluated if mixed use is allowed.”

So, officials explained, clinics and healthcare establishments can only operate in residential areas if they produce documentation of such a survey.

“Even if the survey finds such a clinic feasible, they are allowed to operate only on the ground floor of the premises. So doctors cannot go and set up clinics or labs in residential areas where they do not live.

If they live in the area, only up to 25 per cent or 50 sqm (whichever is less) can be used for the establishment,” a senior official said.

Sources said these provisions, as mandated by the SC in its order, are not met by a large majority of clinics, labs and nursing homes in residential colonies.

With the deadline approaching for the closure of Dr Dangs lab, the DPCC — during a meeting held last week — had decided to seek data of clinics, labs and nursing homes that are operating in residential areas from the health department.

A DPCC member who attended the meeting said, “While the order is against one lab, on examination we found that it should extend to all such establishments. Meetings were held with municipal corporation authorities and the health department, because the court questioned the DPCC’s role.”

However, sources said the government’s legal department has said the matter doesn’t lie within the jurisdiction of the DPCC alone. “The matter pertains to the violation of building bylaws. The master plan has to be dealt with by the appropriate department such as the municipal corporations. So while we have asked for lists of such labs from the health department, the DPCC cannot regulate them on its own. We need co-operation from municipal and Health department authorities,” another official at the meeting said. Meanwhile, municipal corporation authorities have already started visiting labs and hospitals in different parts of Delhi to direct them to comply immediately.

“It has been jointly decided that such hospitals, clinics and labs will be asked to comply with the norms within 30 days or close down and shift their premises from residential areas. Our teams are visiting clinics, hospitals and nursing homes, but it is very difficult because there is no comprehensive list of these establishments, particularly the small ones,” a source said. Sources said the department is also trying to issue specific guidelines for labs and clinics. While the existing DPCC rules state that “health care establishments” should apply for “consent to establish” under the air and water pollution Acts, it exempts establishments set up prior to November 2008 which have less than 50 beds. New facilities established after that with more than 10 beds should apply for the certificate. “We have been getting complaints from labs that the rules are specifically for establishments with beds with no mention of labs or clinics. So many of them do not have the certificates,” an official explained

(Source: Pritha Chatterjee (Indian Express))
ACP Highlights: Top Studies of 2014
  • Using a national database of over 5,400 nursing home residents with advanced dementia, researchers found that over half were prescribed at least one medication of questionable benefit. Most common were cholinesterase inhibitors, memantine, and lipid-lowering agents.
  • A randomized prospective trial of patients with probable Alzheimer dementia found that 20-30 mg of citalopram improved agitation but decreased cognition and prolonged the corrected QT interval.
  • Patients ages 65 or older with polypharmacy, including use of benzodiazepines, were randomly assigned to receive a booklet on benzodiazepine risks and a tapering protocol. At 6 months, 27% of those in the intervention group had stopped taking benzodiazepines and 11% had reduced the dose, compared with 5% and 7% in the control group. Withdrawal symptoms occurred in 42% of patients who attempted to taper, though none were hospitalized.
  • Thiazide treatment of hypertension was associated with an increased risk of hospitalization for electrolyte disturbances and acute kidney injury. The prospective observational cohort was primarily white men.
  • Atypical antipsychotic use was associated with increased risk of hospitalization for acute kidney injury, found a retrospective study of nearly 100,000 Canadian patients.
(Source: Medpage Today)
IMA Rise & Shine: Fight for your dignity
  1. Boycott all movies of Akshay Kumar and Sanjay Leela Bhansali: http://tinyurl.com/kzkg48o
  2. IMA asks doctors to boycott Mika functions: http://tinyurl.com/mqat9b3
  3. Doctors want censor's scissors for Bhansali's 'Gabbar Is Back': http://tinyurl.com/m85dftz
  4. Doctors demand laws against violence - Navbharat Times: http://tinyurl.com/kelvn4t
Sonal Namaste
How do you use hand sanitizers?
  • Apply the product to the palm of one hand (read the label to learn the correct amount).
  • Rub your hands together.
  • Rub the product over all surfaces of your hands and fingers until your hands are dry.
Chronology of Rewari Events -
Distt. Appropriate Authority ( DAA ) of Rewari resorted to sealing of ultrasound machine belonging to Dr Sumitra Yadav wife of Dr Kartar Yadav President IMA Rewari on false, flimsy & frivolous grounds. Only irregularity they mentioned on papers was that 4 referral slips were not signed, rest of the part of referral slips were complete including seal of the doctor. Only signature part was missing

Dr Sumitra Yadav is a Radiologist while Dr Kartar Yadav is a Surgeon.

This was after DAA Rewari publicly issuing threats to senior leaders of IMA Rewari and sonological association that he would demonstrate in a most effective manner his powers under PCPNDT Act.

The inspection party conveyed to Dr Sumitra that she is being targeted because of her husband who is President IMA Rewari and is leading the movement against atrocities committed by the CMO. If he backs out from leading the movement, her machine will be de sealed soon. The wife of DAA who came for sealing the machine was continuously shouting " TUM LOGON NE HAMARA BP BADHA RAKHA HAI, HAME DIABETIC BANA DIYA HAI. YEH MACHINE TUMHARE HUSBAND NE NETAGIRI KA JO JHANDA UTHA RAKHA HAI , ISLIYE BAND KAR RAHAIN HAIN.

This is the height of injustice of a potentially criminal nature. The DAA is clearly and utterly prejudiced and a strong action needs to be taken against him for his totally inappropriate, blatantly illegal actions taken with a prejudiced mind and with a criminal intent.

At 10 pm on 07.05.15 an emergency GBM was called where it was decided that IMA Rewari will go on Indefinite strike.

On 08.05 .15 IMA Rewari had a GBM where it was decided to continue strike and meet Randhir Singh Kapriwas MLA Rewari and Rao Narvir Singh Minister PWD. They both have assured that this CMO will be transferred and machine will be de-sealed soon.

They were also apprised about how clerical mistakes in filling Form F is being used to harass doctors. They have promised to look into the matter and convey to the Government. The strike will continue till the CMO is transferred and machine is de sealed.

IMA Haryana has extended total support to IMA Rewari and calls upon the Govt. to take immediate action against the tyrannical civil surgeon. IMA Haryana also gives notice that should the authorities fail to act in a swift and decisive manner, then it will have no alternative but to go on indefinite statewide strike.

Dr Anil Goyal , Dr SB Bhattacharyya: President Hony. Secretary, IMA Haryana
Inspirational Story
Hospital window

Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room’s only window. The other man had to spend all his time flat on his back. The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation.

Every afternoon when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and color of the world outside. The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every color and a fine view of the city skyline could be seen in the distance. As the man by the window described all this in exquisite detail, the man on the other side of the room would close his eyes and imagine the picturesque scene.

One warm afternoon the man by the window described a parade passing by. Although the other man couldn’t hear the band – he could see it. In his mind’s eye as the gentleman by the window portrayed it with descriptive words. Days and weeks passed.

One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away. As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone.

Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside. He strained to slowly turn to look out the window beside the bed. It faced a blank wall. The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window. The nurse responded that the man was blind and could not even see the wall.

She said, "Perhaps he just wanted to encourage you."
Media
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IMA condemns Gabbar is Back
Bindu Shajan Perappadan

The Indian Medical Association (IMA) condemned the movie Gabbar is Back for its derogatory portrayal of the medical profession. Gabbar is Back showcases doctors in a hospital setting carrying out the fraudulent act of providing medical treatment to a person who is already “dead” before arrival at the hospital.

The film, which released last week, has been produced by Sanjay Leela Bansali and Viacom 18 Motion pictures. It features actors Akshay Kumar and Shruti Hassan.

IMA national president Dr. A Marthanda Pillai and honorary secretary general Dr. K. K. Aggarwal in a joint statement said, “The Association is in deep anguish about the way the medical profession has been projected in Gabbar is Back . Its portrayal is derogatory and unrealistic and we stand against it.”

“Akshay Kumar who plays the role of a doctor is shown to be aware of the patient’s death. However he makes everyone at the hospital believe that he is critical but alive,” he added.

The association noted that with cases of violence against doctors on the rise, a totally unjustified message such as the one in the movie will only add fuel to the fire and further provoke public outrage against the medical profession.
$1.3M Virginia Medical Malpractice Settlement For Misdiagnosed Lung Cancer May 9th, 2015
A judge signed off on a $1.3 million Virginia medical malpractice settlement involving the alleged misdiagnosis of lung cancer in a 68-year-old man.

The wrongful death medical malpractice lawsuit filed against a Roanoke, Virginia-based medical facility and a physician’s office alleged that the man’s chest x-rays taken in 2009 and 2010 as part of the pre-operative clearance process for the man’s two knee operations showed a possible mass in his left lung but he was not advised of such until a CT scan of his chest in February 2011 showed that he had advanced stage lung cancer. The man died on June 3, 2011.

The man’s saga started in 2008, when he decided to have his left knee replaced. The surgeon requested that the man ask his primary care physician to perform a pre-operative examination and testing, including a chest x-ray, to insure that the man was healthy enough for the surgery. One year later, when the man decided to have his right knee replaced, the man had another chest x-ray performed as part of the pre-operative clearance.

The family’s medical malpractice lawsuit alleged that the chest x-ray performed in 2009 and the chest x-ray performed in 2010 both showed a mass in his left lung, which the radiologist’s report recommended be further evaluated. The medical malpractice lawsuit alleged that neither the surgeon nor the man’s primary care physician followed up on the results of the chest x-rays.

The surgeon and primary care physician claimed that neither one of them was liable for failing to advise the man regarding the findings of the chest x-rays, due to an irregularity that happened at the time of the chest x-rays: the primary care physician had ordered the first chest x-ray at the surgeon’s request but when the man appeared for the chest x-ray at the pre-op testing center in January 2009, an employee at the center allegedly canceled the primary care physician’s order and immediately replaced that order with an order from the surgeon, resulting in the primary care physician never receiving the results of the chest x-ray and the surgeon receiving the chest x-ray results but not knowing that the x-ray order had been placed in his name. The same thing happened the following year, when the man had surgery on his right knee.

The surgeon’s lawyer argued that the surgeon was not responsible to review or act on the chest x-rays findings. The primary care physician’s attorney argued that the primary care physician could not be held responsible because he never received the results of the chest x-rays.

The plaintiff’s attorney argued that both the surgeon and the primary care physician knew or should have known of the chest x-rays results and both were responsible to follow up regarding the findings, despite the confusion caused by the manner in which the chest x-rays orders were entered in the clinic’s system.

In November 2014, a judge denied the physicians’ requests to be dismissed from the case.

The $1.3 million medical malpractice wrongful death settlement approved by the court provided that the man’s widow and their two children will receive $784,505 from the settlement, with the balance paid to their attorneys for legal fees and expenses. (medicalmalpracticelawyers,com)
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The drug price regulator has capped prices of 30 medicines including antibiotics and those used in treatment of diabetes, tuberculosis and malaria.

The move is expected to bring down prices of most of these medicines by 25-30%. However, in some cases the reduction could be by as much as 50%.

The National Pharmaceutical Pricing Authority (NPPA), which has the mandate to regulate prices of essential medicines, recently notified the new price ceilings for these medicines.

The regulator has fixed the cap after arriving at the average price being charged by medicines in a particular segment which have a minimum 1% market share. (TOI, Sushmi Dey)

TWO COMMENTS (Regarding the issue, May 10 2015, Sunday)
1--Ref: Only persons registered with DMC, MCI or SMC should be allowed to establish and run them (pathlabs).
-- This suggestion is against law. There is no law at present that a non-medical person cannot own / establish a pathlab.

2—Pathlabs should be registered by the medical council.
-- As per the medical council acts, the jurisdiction of the medical council extends only to RMPs. It does not cover establishments. --M C Gupta
 
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Reader Response
Respected Sir, Many many thanks for taking a step to safeguard doctors image and dignity and protest against the movie --- Gabbar.Regards:Dr. Sofiya

Dear Dr AMP & DR KKA Vanakkam. Hearty congrats for the prompt relief executed by our IMA at Nepal. The credit goes to the team of IMAians who dedicated themselves for this noble and brave cause. Our salute to these medical soldiers! You both deserve full credit for organizing such a relief work in a short span of time. Our best wishes to the Heart care foundation as well.
Regards.
May your efforts always. LET IMA'S LIGHT ALWAYS SHINE to help the needy society ! Dr LVK Moorthy