May 12  2015, Tuesday
editorial
7 highest paid medical malpractice cases in 2014
Dr KK Aggarwal
  1. $32.8 Million – Chester, Pennsylvania for delayed delivery causing brain damage & cerebral palsy.

    Lily Ciechoski was delivered 1:49 AM in November 14, 2009 in Phoenixville Hospital, with brain damage and Lily suffers from spastic quadriplegic cerebral palsy. January 17, 2014, Common Pleas Court jury found negligence on the part of two nurses attending Leslie, Lily’s mother. The Ciechoskis were awarded $38.8.
  2. Strep infection leads to amputation of all limbs: $25.3 Million – Milwaukee, Wisconsin

    Ascaris Mayo, 53, mother of 4, had a Strep A infection (normally causes sore throat), which went undetected causing septic shock and massive infection leading to amputation of all 4 limbs. July 7, 2014, Milwaukee County jury ruled medical negligence; Ascaris and her husband were awarded $25.3 million; $15 million for pain and suffering/ $8.2 million in past and future health care costs/ $1.5 million for husband’s loss of companionship and $32.8 Million – Chester, Pennsylvania
  3. Delayed delivery resulted in brain hemorrhage: $14.5 Million – Cleveland, Ohio

    April 10, 2003, 9:00 PM, Alijah Stewart was born via emergency caesarian section with a massive brain hemorrhage. Alijah currently has cerebral palsy, cognitive delays, visual impairments and other issues that require lifelong care. June 10, 2014, Cuyahoga County Common Pleas Judge Ronald Suster and the jury awarded Alijah, 11 and Stephanie $14.5 million for this medical malpractice case: $8 million for future care costs, $5 million for pain and suffering, $1 million for cost of services and $500, 000 for past economic loses.
  4. $12 million – Redding, Connecticut: Hernia operation led to coma & permanent injuries

    Vivian Gagliano 65, had a routine hernia operation in 2008. A doctor was said to have punctured her colon which sent Vivian in a month-long coma, massive abdominal infection that required multiple other surgeries and resulted in the loss of most of her large intestine. May 30, 2014, jury of the medical malpractice case in Danbury Superior Court awarded $12 million to Vivian after 31 hours of deliberations.
  5. $4.5 million – Plymouth, Massachusetts, fractured rib punctured artery due to delayed intervention

    March 24, 2005, Geraldine Moran, 40 and mother of 3 died after a fall. Benjamin Novotny of Lubin & Meyer said Dr. Conn and Dr. Velmahos failed to order chest imaging nor assemble a trauma team to perform measures on the displaced rib. After 2 week trial, the doctors settled and paid $4.5 million for failing to take measures that might have prevented Geraldine’s death.
  6. Heart attack misdiagnosed as stomach illness: $4 Million – Jasper, Alabama

    January 15, 2008, Terry Hallmark 40, died of sudden cardiac arrest. After 7 days of a medical malpractice trial by Circuit Judge Hoyt Elliot, the Walker County jury gave a verdict in favor of Donna, Terry’s wife, and she was awarded $4 million. The defendant failed to consider and rule out a cardiac problem before sending the patient home.
  7. $1.3 Million – Jackson, Michigan: Tummy-tuck causes complications &long term medical issues

    On June 4, 2009 Katie Pagan, 44, underwent an elective surgery abdominoplasty or commonly called a tummy-tuck, which also included liposuction of the abdominal flap. February 18, 2014, the 10-day medical negligence case trial ended. Circuit Judge Thomas Wilson found Dr. Rifai breached the duty to meet a standard of care which caused Pagan’s physical and economic losses. After just 6 hours of deliberation, the jurors awarded a total of $1.3 million to Katie with breakdown as follows: $500,000 in damage for the physical pain and disfigurement and mental or emotional distress, $382,000 for loss of income and $430,000 for the economic loss through 2017.
IMA,IJCP,HCFI
eMedipics IMA,IJCP,HCFI
This World Health Day, the Indian Medical Association commits to making food safety a priority within its Swachh Bharat Swasth Bharat program
News
  • Intravesical mycobacterial cell wall-nucleic acid complex shows significant activity in high-risk non-muscle invasive bladder cancer patients who have failed treatment with Bacillus Calmette-Guérin (BCG), suggests new research published online in the Journal of Urology.
  • The US Food and Drug Administration (FDA) has approved the antibiotic moxifloxacin 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.
  • Adding a once-a-day long-acting muscarinic antagonist (LAMA) to salmeterol/fluticasone propionate improves outcomes in chronic obstructive pulmonary disease (COPD), suggests a report from Australia and New Zealand published online in Thorax.
  • Patients with tension-type headache have relatively weak neck extension muscles, suggests a new study published online in Cephalalgia.
  • The inhalation of nitrous oxide during the insertion of an intrauterine device (IUD) increases satisfaction with the procedure, suggests a new study presented at the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting 2015.
IMA,IJCP,HCFI
Dr KK Spiritual Blog
Panchamrit body wash

Panchamrit is taken as a Prasadam and is also used to wash the deity. In Vedic language, anything that is offered to God can also be done to the human body. Panchamrit bath, therefore, is the original and traditionally full bath prescribed in Vedic literature. It incorporates the following steps:
  • Washing the body with milk and water, where milk acts as a soothing agent.
  • Next is washing the body with curd, which is a substitute for soap and washes away dirt from the skin.
  • The third step is washing the body with desi ghee, which is like an oil massage.
  • Fourth is washing the body with honey, which works like a moisturizer.
  • Last step is to rub the skin with sugar or khand. Sugar works as a scrubber.
Panchamrit bath is much more scientific, cheaper and health friendly.
Cardiology eMedinewS
  • In a small, 1-year study of patients receiving warfarin, obese patients had an 84% greater risk than nonobese patients of developing a major bleed that required hospitalization, suggested a study presented at the Arteriosclerosis, Thrombosis and Vascular Biology/ Peripheral Vascular Disease 2015 Scientific Sessions.
  • The anti-inflammatory drug dexamethasone helps prevent serious kidney complications that can arise following heart surgery, suggest the results of a randomized clinical trial published in the Journal of the American Society of Nephrology (JASN).
Pediatrics eMedinewS
  • The measles virus may weaken children's immune systems for up to 3 years after infection, making them vulnerable to a number of other diseases, suggests a new study published in the journal Science.
  • A new study suggests children are much more likely to sleepwalk if their parents have a history of sleepwalking, indicating there may be a genetic element to the disorder. The findings are published in the journal JAMA Pediatrics.
Make Sure
Situation: A patient on ACE inhibitor developed angioneurotic edema.

Reaction: Oh my God! Why was ACE inhibitor continued?

Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately if swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
Dr Good Dr Bad
Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.

Dr Bad: Do not worry.

Dr Good: Rule out diabetes.

Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).

(Copyright IJCP)
Events
IMA,IJCP,HCFI
Inspirational Story
Helping Yourself

Well my story starts 3 years ago. I was working in a retail store; I like to talk to everybody and know what’s going on in their lives. I remember this one girl who started working there a few months after me. I remember always seeing her. I don’t know why but for a weird reason we would never talk. We would just see each other and smile.

She would always smile in a really happy way until one day when we got to work in the same department again. She smiled as if she was the happiest girl in the world. I went up to her and asked "What’s wrong with you?" She answered "Why?" I said, "I could feel you’re very sad and you're always trying to hide it."

Her mouth just dropped as if I had discovered her deepest secret, so we started talking. She told me why she was feeling like that and why she was trying to hide it. Time went by and we became good friends. She’d always tell me I had changed her life in so many ways. I could not imagine. I would just smile, not really understanding what she meant by that. Today this girl is one of my best friends. I really don’t know what I would do without her. She has been there for me in every possible way a friend could be.

I guess what I’m trying to say is you never know when you’re helping yourself. I helped this girl never knowing that at the same time I was helping myself by finding a truthful friend.

So the next time you see a stranger and they look like they need someone who will listen to them, listen to what they have to say. You never know, you might just end up helping yourself.
Wellness Blog
White Rice Most Dangerous
 
  • White rice is much more dangerous in terms of glycemic index than white bread. It has glycemic index of 102.
  • We often tell people not to take cola drinks but they eat white bread. The glycemic index for white bread is 100 and that for cola drink is 90.
  • Traditional Indian drinks like Rooh Afza, Khas Khas may also contain more than 10% sugar.
  • The recommended sugary drink should not contain more than 2–3% sugar, which is the amount present in oral rehydration solution.
  • People leave a cola drink and take mashed potato, which has glycemic index higher than that of a cola drink (102 versus 90).
  • Pizza has a glycemic index of only 86.
  • Table sugar has a glycemic index of 84, while that of jam is 95.
  • French fries have a glycemic index of only 95.
  • To avoid refined carbohydrates in diet, if one has to choose than most dangerous is white rice, followed by white bread and then comes white sugar.
  • Most people add sugar in food and snacks because sugar is a preservative. Less the sugar, earlier the food will be spoiled.
eMedi Quiz
What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.

B. About 20 percent of your daily calories.

C. About 30 percent of your daily calories.

D. About 40 percent of your daily calories.

E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Yesterday’s Mind Teaser: 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

Answer for yesterday’s Mind Teaser: b. Auspitz sign

Correct Answers received from: Dr K C Sharma, Dr Deepak V, Dr Jainendra Upadhyay, Dr K Raju, Dr KV Sarma, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 10th May Mind Teaser: 3.NADPH cytochrome P-450-reductase

Correct Answers received: Dr Avtar Krishan.
eMednewS Humor
Wo Man

An English teacher wrote this phrase on the board and asked her students to properly punctuate it:

"Woman without her man is nothing."

MEN WROTE: Woman, without her man, is nothing.

WOMEN WROTE: Woman! Without her, man is nothing.
Reader Response
  • Sir, With reference to the news in Indian Express, please clarify the situation as facts given are not as per revised master plan. I still recall your article in DMA news about these matters many years back when Master Plan was being revised. This will help in facing MCD DDA DPCC executives. Thanks. Dr Kamlesh Kanodia.
  • The response to ‘Gabbar is Back’ is in the right direction. The medical fraternity is facing public wrath for quite sometime. The doctors working in remote areas are at higher risk of assault /even death. I support the IMA Protest. Dr P Jagota.
IMA,IJCP,HCFI
Quote of the Day
It is wise to direct your anger towards problems – not people; to focus your energies on answers – not excuses. William Ward
Rabies News (Dr A K Gupta)
Is it essential to perform skin sensitivity test prior to the administration of ERIG?

Majority of reactions to ERIG result from complement activation and are not IgE mediated and will not be predicted by skin testing.

The recent WHO recommendation states that there are no scientific grounds for performing a skin test prior to the administration of ERIG, because testing does not predict reactions and ERIG should be given whatever the result of the test.

However, skin test is mandatory to avoid any possible litigation under Consumer Protection Act in India.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
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
News on Maps
eIMA News
ACP Highlights: Top Studies of 2014
  • In a phase II double-blind trial, 168 patients with severe psoriatic arthritis were randomized to receive placebo or brodalumab, an anti-interleukin-17-receptor antibody. Significantly more intervention patients achieved the primary endpoint of an ACR20 response (20% improvement in the American College of Rheumatology response criteria). "I think if the (antibody) is FDA approved for psoriatic arthritis, that's what will change practice," said Fox.
  • Patients with early rheumatoid arthritis with low disease activity who received methotrexate plus etanercept had higher rates of remission compared with those who received methotrexate alone or a placebo.
  • In a phase III double-blind study, 958 patients with active rheumatoid arthritis were randomized to receive methotrexate or tofacitinib. Significantly more intervention patients achieved the primary endpoint of an ACR70 response at 6 months. However, current clinical practice states that those who do not respond to monotherapy with methotrexate step up to combination therapy or receive biologic agents. Due to the high cost and potential toxicity of tofacitinib, "methotrexate will probably remain the initial (disease-modifying antirheumatic drug) of choice," concluded the authors.
  • Researchers have identified a genetic cause of the rare disease familial polyarteritis nodosa.
  • Patients with ANCA-associated vasculitis in complete remission who received rituximab relapsed less frequently than those who received azathioprine. The study was limited to patients whose remissions were induced by cyclophosphamide and glucocorticoid therapy.
WMA Marks International Nurses Day
(11.05.2015) The World Medical Association congratulates nurses around the world on the occasion of International Nurses Day tomorrow (May 12).

Dr. Xavier Deau, President of the WMA, said: ‘Physicians in every country will join us in celebrating the value of nurses in caring for patients. The WMA is proud of the teamwork that exists between physicians and nurses on the ground and at global level between the WMA and the International Council of Nurses.

‘We cannot emphasize enough the importance of nursing as a vital resource for health care around the world and the need for enough nurses so that high quality care can be provided for all patients. This requires an acceptable level of staffing, good working conditions and fair pay. International Nurses Day is an opportunity for us all to thank all nurses everywhere’.
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
Request letter from Nepal Medical Association
Ref. No. 2072/NMA/R.F 602
Date: 10th May 2015

Dr K K Aggarwal
Honorary Secretary General,
Indian Medical Association

Dear Dr Aggarwal,

Re: Medicine Support for Nepalese People.

Since 25th April 2015, Nepal has been facing huge consequences of massive earthquake, 7.8 magnitudes. This unfortunate disaster has caused utmost loss to the people of the country especially to the central development region where it had its epicenter. The most effected districts are Sindupalchowk, Nuwakot, Kathmandu, Bhaktapur, Lalitpur, Ramechhap, Khavre, Rasuwa, Dhading, Gorkha, Dolakha and Sinduli. The death toll is immense but, according to the data, more than 8000 people has been recorded till 10th May 2015, with figures still increasing, many injured, many missing and many still trapped in the wreckage.

Many houses have been destroyed, properties damaged and lives lost. People still are not being able to feel safe and with the on-going aftershocks, occurring almost daily, and are still recovering from the initial scary feeling and dread. Most people, despite their houses are safe and many government reassurances cannot still enter their houses and are forced to sleep outside in tents. The situation is made worse by unwanted and baseless rumors that a stronger earthquake will recur and has forced many to sleep outside in tents under the open sky.

Despite many professional reassurances that earthquakes cannot be predicted, people remain scared.

In this regard, we would like to request you to support these needy ones with medicines and any other kinds of relief you desire is appreciated.

We also look forward for mutual cooperation, coordination and healthy relationship with Indian Medical Association.

I hope that you are interested in joining our effort to show our respect, admiration, and support for our health workers in forthcoming days.

Sincerely yours,

Dr. Anjani Kumar Jha
President
Over 90 per cent of India's Population Deficient in Vitamin D, say Experts
By Express News Service Published: 11th May 2015 05:59 AM Last Updated: 11th May 2015 05:59 AM VIJAYAWADA: Lack of exposure to sunlight in the present day lifestyle, where people prefer less outdoor activity, is leading to Vitamin D deficiency, which is more than a vitamin for human body. Over 90 per cent of India’s population is vitamin D-deficient and is at risk from health complications like diabetes and heart disorders, say experts. “Nearly 75 to 80 per cent of the body’s Vitamin D supply is through exposure to sunlight, which of late has become a rarity among the people in the cities. Vitamin D deficiency, which doesn’t show any adverse effect early, does make people highly vulnerable to major diseases with a 40 per cent chance of early death over a period of time. Sunbath is the easiest way for the people to rid themselves of the Vitamin D deficiency,” said Dr KK Aggarwal, honorary secretary general of the Indian Medical Association.

Speaking to Express here on Sunday, he said there was lack of awareness about the Vitamin D deficiency among the public. “Most children were being affected with ‘Rickets’ and ‘osteomalacia’, usually seen in adults and which was dangerous, mainly due to the Vitamin D deficiency. They suffer from poor bone growth causing pain and bowed legs in children and leg and muscle pain in adults. It is clearly associated with diabetes, blood pressure, weakness of bones, nerve-related disorders and obesity. Even it leads to depressive illness among the people,” Aggarwal explained.

Experts opine that Vitamin D will benefit the heart patients. While there are a few and costly diagnostic tests to determine the Vitamin D levels in the body, the treatment for the problem costs less. They stress that maintaining adequate levels of Vitamin D is critical and assists the body to reduce bad cholesterol and increase good cholesterol, besides helping in the essential repair and maintenance activities in the body. “Vitamin D helps the body to retain calcium. It is directly linked to knee pains and osteoporosis. Despite low cost supplements being widely available, people do not know the importance of taking them. However, it should be consumed under strict medical advice. The tests cost around Rs 900 to Rs 1,000, whereas the treatment costs between Rs 100 to Rs 200.

People should prefer food supplements like wheat, milk and bread, however they will not get the sufficient amount of Vitamin D required for the body maintenance that they will get from exposure to Sun for at least one hour every day,” said Dr S Jaidev, a consultant Endocrinologist from the city.
Letter to Editor
As there were frequent physical attacks on doctors and hospitals in Andhra Pradesh (united), the AP Private Hospitals And Nursing Homes Association and IMA AP state had approached the government of AP repeatedly and submitted a number of memorandums against the violence on medical community and medical establishments.

After careful consideration of various incidents of violence on doctors and hospitals, the government of AP had issued an Ordinance, the Andhra Pradesh Medical Service Persons and Medical Service Institutions (Prevention of Violence and Damage to Property) in 2007 and it was passed in the State Legislative Assembly, Act No 11 in the year 2008 called Andhra Pradesh Medical Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act 2008 extending to the whole state of AP. The Governor gave consent to the Act on 20th April, 2008 and it was published in the Gazette on 22nd April 2008 as GO showing Act No 11 of 2008.

Though the Act was passed there was lukewarm response from police and the administrators and the Act was implemented only in a few cases and not in all cases, which disappointed the doctors.

In view of the frequent attacks on doctors and hospitals in the recent past in Telangana state including Nalgonda district, the IMA of Nilagiri branch, Nalgonda had recently conducted a Medico Legal Workshop by inviting the Judge of AP High Court Shri Rajashekhar Reddy, Dist Sessions Judge, senior lawyers, medical experts and police officials and discussed in marathon session various aspects of medico legal matters and attacks on medical community. It was a fruitful session of course with tempers rising with police personnel.

Soon after the workshop IMA, Nalgonda had approached the Dist Superintendent of Police Shri Vikramjit Duggal IPS and discussed with him how the doctors and hospitals are attacked and harassed due to any complication or death during the treatment and showed the copies of the Act and he had given good response and sympathised with doctors.

In the discussion the IMA had put a proposal that the salient features of the Act be displayed in flexi banners in all clinics and hospitals with the permission and on behalf of Dist police to bring awareness among the people. The SP immediately agreed and asked to bring the draft; fortunately the SP accepted the draft and asked us to display on behalf of police titled "Warning from Police" with police emblem.

IMA is very thankful to SP for his good response and cooperation. At the same time IMA assured him qualitative, ethical, moral and humanitarian service to the people.

IMA decided to form a grievance cell to receive complaints on doctors and hospitals on their services and if complainant is not satisfied with the decision of the cell, one can approach Consumer Court, Civil Court or any mediation from outside for settlement amicably.

The salient features of the Act:

This Act applies to all institutions providing medicare to people which are under control of State or Central Government or Local bodies etc including any Private hospital having facilities for treatment of sick and any private maternity home etc.

Medicare persons include Registered Medical Practitioners, Registered Nurses, Medical students, Nursing students, Para Medical Workers,

Offender means any person who either by himself or as a leader of group of persons or organisations commits or to commit or abets or incites the commission of violence under the Act

Violence means activities of causing any harm, injury or endangering the life or intimidation, obstruction, hindrance top any medical service person in discharge of duty or damage to property.

ANY OFFENDER WHO COMMITS ANY ACT IN CONTRAVENTION OF SECTION 3 SHALL BE PUNISHED WITH IMPRISONMENT OF THREE YEARS AND WITH FINE WHICH MAY EXTEND TO FIFTY THOUSAND RUPEES.

ANY OFFENCE COMMITTED UNDER SECTION 3 SHALL BE COGNIZABLE AND NON BAILABLE.

IN ADDITION TO THE PUNISHMENT SPECIFIED UNDER SECTION 4,THE OFFENDER SHALL BE LIABLE TO PENALTY OF THE TWICE THE AMOUNT OF PURCHASE PRICE OF MEDICAL EQUIPMENT DAMAGED AND LOSS CAUSED TO THE PROPERTY AS DETERMINED BY TE COURT TRYING THE OFFENDER.

IF THE OFFENDER HAS NOT PAID THE PENAL AMOUNT UNDER SUB SECTION(1),THE SAID SUM SHALL BE RECOVERED UNDER THE PROVISIONS OF THE AP REVENUE RECOVERY Act 1864.

All the salient features will be displayed in local Telugu language in all clinics and hospitals including government, private hospitals and nursing homes of all categories registered with the government authority. This is for your information and guidance to others in the country.

The President of IMA, Nilagiri, Nalgonda, Dr. AV Srinivasa Rao, Hony Secy Dr Uday Singh along with other members had done good service and IMA is grateful and thankful to Shri Vikramjit Duggal IPS for his kind cooperation and help for the medical community in facing the violence.

With regards

Dr Jaya Prakash Reddy
Former Hony Secretary, IMA Nilagiri
Nalgonda, 508001, Telangana
Tax exemption for gifts to doctors: CAG exposes dirty tricks of pharma companies
Subodh Varma, TNN

NEW DELHI: The Indian pharma industry has been resorting to a slew of dodgy tax avoidance practices which include claiming exemptions for illegal freebies given to doctors, research work which was not taking place, and other tricks, reveals a new report of India's audit watchdog, the CAG. The report also takes to task the Income Tax Department for allowing these practices causing tax losses worth crores of rupees.

Taking an innovative approach to digging out the dirt on the flourishing pharma sector, Comptroller & Auditor General (CAG) asked the income tax department to show tax assessments of the whole pharma sector in India.

The tax office had no database of pharma manufacturers and was able to produce only 2868 assessment records. These were put under the scanner by CAG and they found 246 cases involving tax deficiency of over Rs.1348 cr.

The most startling of the dirty tricks played was that of claiming tax exemption for giving gifts to doctors to lure them into prescribing certain drugs or treatments. The Medical Council of India expressly prohibits this and the statutory Central Board of Direct Taxation has also clarified in 2012 that such expenses are not allowable for tax exemptions. Yet, the CAG found that in 21 cases spread over five states this was allowed by assessing officers resulting in a tax loss of Rs.45.43 cr.

Giving examples, the CAG report, says that a company in Gujarat spent Rs.7.48 cr on "doctors' travelling expenses along with spouse, gift articles distributed, etc." and was given exemption resulting in tax loss of Rs.2.54 cr.

In another case, a pharma company from Mumbai spent Rs.2.91 cr on what they candidly called "Heart Touching Celebration, Sponsorship of Doctors and corporate /brand recall items" and got a Rs.11.91 cr exemption.

A Bangalore company spent Rs.18.43 cr over three years towards "Doctor's domestic and foreign travelling expenses including hotel bookings, gifts" and they got an exemption of Rs.6.26 cr.

Besides these clear cut cases, there were 11 cases where such illegal expenditures were concealed within larger "sales promotion" heads of spending. Also cases of expenditure on "physicians' samples" being claimed as tax exempt were found which have been held to be illegal by the income tax department itself earlier.

The biggest deficiency caught by the CAG related to claims of exemption for research and development (R&D) that were not valid. All kinds of tricks were being utilized to this end by pharma companies. Over Rs.570 cr worth of taxes were lost because companies were claiming exemption for R&D whereas in reality they had either not been granted permission by DSIR or such permission had expired.

The CAG report again lists illustrative cases of various companies and their attempts to get exemptions in the name of R&D. Most of these also involve extreme laxity on the part of the respective assessing officers of the income tax department.

CAG has advised the ITD to clarify issues relating to freebies to its own officers and seek details of sales promotion expenses from companies. But the government has responded by saying assessing officers decide on merits of each case and remedial action is available.

The pharma industry in India had a turnover of Rs.1.2 lakh cr in 2013 and manufacturing units would run into tens of thousands. It receives several tax exemptions and concessional rates of excise duty from the government.
IMA boycotts Akshay Kumar-starrer Gabbar is Back
Monday, 11 May 2015: DNA Correspondent

Doctors feel movie shows medical profession in poor light and instigates public against them

The Indian Medical Association (IMA), the umbrella body of doctors practising modern medicine, has decided to boycott Akshay Kumar and Sanjay Leela Bhansali movies after their movie 'Gabbar is Back' showed them in poor light.

The association, which has more than 2.5 lakh members across India, has sent a letter to the union minister for information and broadcasting, saying that the movie has shown medical profession in a bad, derogatory and unrealistic manner. "IMA is anguished about the way medical profession is projected in the movie "Gabbar is Back. We have marked copies to the censor board and the Union health minister, hoping that some action will be taken on the same," said Dr Jayesh Lele, president-elect, IMA Maharashtra.

Dr Lele said the movie shows doctors in extremely poor light as they carry out a fraudulent act of providing medical treatment to a person who is dead even before arrival at the hospital.

"The hero of the movie is aware that the patient is dead as he is carrying a death certificate with him. However, he still approaches the hospital as if the patient is alive. This sends a wrong signal to society and we strongly condemn this," said Dr Lele.

Written by AR Murugadoss, the movie "Gabbar is Back" is produced by Sanjay Leela Bhansali and Viacom 18 Motion Pictures. "The movie is a total instigation of the general public against medical profession. With violence against doctors on the rise, such type of unjustified message through the movie will only add fuel to the fire," he added.

In its letter, IMA has demanded that the objectionable scenes be immediately censored from "Gabbar is Back" and till such time, the movie be banned.

As part of India’s endgame strategy, last week Lok Sabha was informed that Inactivated Polio Vaccine (IPV) will soon be given to children as an additional dose at 14th week along with DPT3 and Oral Polio Vaccine (OPV3) to children. ... read more on social.yourstory.com

After Gabbar is back, now it's Piku, where use of ventilator is in question, will your writing in these columns suffice? The medical community should introspect and the leaders (doctors) sitting in Metros should lead, corporate hospitals are the real culprits but orders of CEOs are carried out/ implemented by medicos who should think and introspect!! Kailash
Sonal Namaste
Handwashing is like a "do-it-yourself" vaccine—it involves five simple and effective steps (think Wet, Lather, Scrub, Rinse, Dry) you can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy.
Media
IMA,IJCP,HCFI
IMA in Social Media
https://www.facebook.com/ima.national 28324 likes
https://www.facebook.com/imsaindia 45617 likes
https://www.facebook.com/imayoungdoctorswing 1296 likes
Twitter @IndianMedAssn 952 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
IMA Videos
Press Release
Over 50 focus only on upper blood pressure

For patients over 50, doctors only need to monitor the upper systolic blood pressure, and can ignore the lower diastolic blood pressure reading, said Padma Shri, Dr A Marthanda Pillai National President IMA and Padma Shri, Dr BC Roy National Awardee & DST National Science Communication Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Systolic blood pressure – the top number in a blood pressure reading – is the pressure exerted at the beginning of the heart's pumping cycle, while diastolic pressure records the lowest pressure during the resting cycle of the heart. Both pressures are routinely measured when recording the blood pressure.

As per a report published in the journal The Lancet, there is such an emphasis on diastolic pressure that the patients are not getting their systolic blood pressures adequately controlled. The fact is that people over the age of 50 probably do not even need to measure diastolic – it's only the systolic blood pressure that should be the focus.

Generally, systolic blood pressure continues to increase with age, while diastolic pressure starts to drop after age 50, which is the same time when cardiovascular risk begins to rise. Therefore, there is an increased prevalence of systolic hypertension past age 50, whereas diastolic hypertension is practically nonexistent. Rising systolic pressure is the most significant factor in causing stroke and heart disease.

For people under 50, the scenario may be different. About 40 percent of adults under 40 years of age have diastolic hypertension, and about a third of those between 40 and 50 have the problem. For these patients, a continued emphasis on both systolic and diastolic blood pressures is needed. However, controlling systolic blood pressure, even among these younger patients, almost always results in adequate control of diastolic blood pressure, too.

For people 50 or older, systolic pressure is high if it is 140 mmHg or above.