January 13 2015, Tuesday
editorial (…Contd.)
Effective intervention in TB care and Control will be a continuing project of IMA.
Dr There are other public health programmes of paramount importance being taken up by the IMA in alliance with various organizations. Some among them include:
  • National Initiative for Safe Sound (NISS)- an initiative against noise pollution in association with the Otolaryngological Society of India
  • Reduction in maternal and infant mortality, in association with the professional organizations like FOGSI and IAP.
  • Initiatives on Mental Health and programmes against substance abuse in association with the Indian Psychiatric Society.
    (…Contd.) Read More ...
eMedipics
IMA,IJCP,HCFI
Health Check Up and CPR 10 Camp at G B S S School, No–2, Ambedkar Nagar on 19th December 2014
editorial
Kidney stones linked to higher heart risk
Dr KK AggarwalBad news for North Indians who live in a stone belt as two large prospective cohort studies have shown that women (not men) with a history of kidney stones have a modestly increased risk of coronary heart disease. The magnitude of the increase ranged between 20% and 50% in the two studies. Similar increases emerged from separate analyses of fatal and nonfatal heart attacks and revascularization. The findings are reported by Dr Pietro Manuel Ferraro, of Columbus–Gemelli Hospital in Rome, and colleagues online in the Journal of the American Medical Association. The findings suggest that women with a history of nephrolithiasis might warrant more scrutiny for signs of heart blockages.

A previous study has indicated that light exercise can lower the risk of kidney stones in women.

Several other studies have identified associations between nephrolithiasis and systemic diseases, including atherosclerosis, hypertension, diabetes, metabolic syndrome, and cardiovascular disease.

In the present study the investigators analyzed data from three large, prospective cohort studies including 45,748 men, ages 40 to 75, and 196,357 women, ages 30 to 55, all without heart blockages at baseline. The studies' data encompassed follow-up of 18 years in women and 24 years in men.
IMA,IJCP,HCFI
 
Quote of the Day
Ambition is the path to success. Persistence is the vehicle you arrive in. Bill Bradley
 

News on Maps

CPR 10
Total CPR since 1st November 2012 – 101095 trained
 

IMA Facebook Likes
Click here
 27791 likes
 
IMA in the News
  • Indian Medical Association will bring major changes: Deccan Herald
  • MCI in fix as govt docs face leave hassle: Mail Today
  • Code of conduct will break doc-pharma nexus: Hindustan Times
  • Indian Medical Association will bring major changes: Deccan Herald
  • Prevent swine flu by adhering to cough and respiratory regimen: Medindia.net
IMA in Social Media
https://www.facebook.com/ima.national 27791 likes
https://www.facebook.com/imsaindia 45662 likes
https://www.facebook.com/imayoungdoctorswing 235 likes
Twitter @IndianMedAssn 710 followers
http://imahq.blogspot.com/
http://www.ima-ams.org/
http://www.imacgpindia.com/
http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
Events
IMA,IJCP,HCFI
THE DRUGS AND COSMETICS (AMENDMENT) BILL, 2015
(w) "new cosmetic" means any cosmetic containing ingredients which have not been established as safe for use in cosmetics;
(x) "new drug" means–
(i) a drug, including bulk drug substance, which has not been used in the country to any significant extent under the specified conditions, recommended or suggested in the labelling thereof and has not been recognised as effective and safe by the Central Licensing Authority for the expected claims and its limited use, if any;
(ii) a drug approved by the Central Licensing Authority for certain claims, which is proposed to be marketed with modified or new claims, namely, indications, route of administration, dosage and dosage form, including sustained release and novel drug delivery systems;
(iii) a fixed dose combination of two or more drugs, individually approved earlier for certain claims, which are proposed to be combined for the first time in a fixed ratio, or if the ratio of ingredients in a marketed combination is proposed to be changed, with certain claims, namely, indications, route of administration, dosage, dosage form, including sustained release and novel drug delivery systems;
(iv) vaccines, recombinant Deoxyribonucleic Acid (r-DNA) derived products, living modified organisms, monoclonal anti –bodies, stem cells, gene therapeutic products and xenografts which are intended to be used as drugs;
(y) "new medical device" means a device which has not been approved by the Central Licensing Authority;
The Year in Medicine 2014: News That Made a Difference
6. Open Payments Data Release Has Big Gaps

On September 30, the federal government published information on 4.4 million payments worth almost $3.5 billion from drug and device makers to almost 1360 teaching hospitals and 546,000 physicians, dentists, podiatrists, and other clinicians on its new and controversial Open Payments website.(17) The idea behind the website, created by the Affordable Care Act, is to spotlight and deter potential conflicts of interest that might cause a clinician to lose sight of a patient’s best interest, such as prescribing an expensive brand–name drug when a generic would do. The American Medical Association and others had expressed concern about the data’s accuracy, urging CMS to delay the data release until March 31, 2015, saying that physicians needed more time to review the payments. Site outages and difficulty registering plagued the data release. (Source: Medscape)
Dr Good Dr Bad
IMA,IJCP,HCFI
Cardiology eMedinewS
  • A new technique, developed by researchers at The University of Manchester, may help surgeons find the exact location of heart defects and save lives and help them to treat patients more effectively by allowing non-invasive detection of the origin of heart problems. The report is published in PLoS Computational Biology.
  • The drug tetrahydrobiopterin may be able to reverse the overactivation of the sympathetic nervous system, leading to positive effects on the sympathetic nervous system and some measures of arterial stiffness in patients with chronic kidney disease. The findings are published in American Journal of Physiology.
Wellness Blog
Add fiber to the diet only slowly

Fiber is a plant substance that is required for a healthy diet. Lots of fiber is needed each day to help reduce the risk of heart disease, improve digestion, prevent constipation and maintain a healthy body weight.

Fiber can be found in fruits, whole grains and vegetables. Most adults should eat at least 20 to 35 grams of fiber every day; though the doctors say most people only eat about half as much. It’s best to slowly increase the fiber in your diet instead of piling it on all at once. A sudden increase in fiber intake can cause abdominal discomfort.

Fiber intake should be at least 14 grams per 1000 calories daily; higher fiber intake may improve glycemic control. Saturated fat should be less than 7 percent of calories and there should be minimal trans fat. Total cholesterol should be less than 200 mg daily.

There is an average fall of 1.2/1.3 mmHg blood pressure with average 10 gram intake of fiber.

Certain soluble fibers (psyllium, pectin, wheat dextrin and oat products) reduce bad LDL cholesterol. Every gram increase in soluble fiber reduces LDL cholesterol by an average of 2.2 mg/dL. The message is incorporation of greater amounts of fiber, in which carbohydrate is derived from unprocessed whole foods.
Pediatrics eMedinewS
  • New research from the University of Colorado Denver has suggested that women who experience racial discrimination while pregnant suffer significant health impacts that are passed on to their infants. The report is published in the journal Social Science & Medicine.
  • An elaborate analysis of data from more than 40,000 cases of brain trauma in children, published by the New England Journal of Medicine, provides convincing evidence that protecting children in advance from head injuries is the key to reducing their severity.
Make Sure
Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI
Reaction:Oh my God! Why was a statin not started earlier?
Lesson: Make sure that all patients with even normal cholesterol are considered for statins if the hsCRP is high.
Twitter of the Day
Dr KK Aggarwal: Blood Pressure: A silent killer http://bit.ly/14zrIUm #Health

Dr Deepak Chopra: Believing in a personal God who cares for you is one thing; activating God to help you is another http://tinyurl.com/q7ebpvk
Rabies News (Dr A K Gupta)
The IM dose of Verorab (PVRV) and Abhayrab (PVRV) is 0.5mL; that of Rabipur (PCEC) and PVRV (Coonoor) is 1mL. Is the ID dosage of all vaccines uniformly 0.1mL?

The ID dosage of all approved vaccines is uniformly 0.1 mL per ID site irrespective of their IM dosage
Dr KK Spiritual Blog
Why Spirituality is Friendly to wellbeing
  • What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  • Positive thinking produces nearly a 30% drop in perception of pain.
  • Spirituality and the practice of religion are associated with a slower progression of Alzheimer’s disease.
  • Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12 percent a year.
  • People undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  • Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  • Spirituality stimulates the relaxation response. When the body is relaxed, the heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  • Spirituality can affect function of the immune system. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  • Prayer heals the heart. Positive talking and thinking in the ICU produces better results.
  • Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.
Inspirational Story
Finding Happiness

Once a group of 50 people was attending a seminar, suddenly the speaker stopped and started giving each person a balloon. Each one was asked to write his/her name on it using a marker pen. Then all the balloons were collected and put in another room.

Now these delegates were let in that room and asked to find the balloon which had their name written, within 5 minutes. Everyone was frantically searching for their name, pushing, colliding with each other, and there was utter chaos. At the end of 5 minutes, no one could find their own balloon.

Now each one was asked to randomly collect a balloon and give it to the person whose name was written on it. Within minutes everyone had their own balloon. The speaker began: This is exactly happening in our lives. Everyone is frantically looking for happiness all around, not knowing where it is. Our happiness lies in the happiness of other people. Give them their happiness, you will get your own happiness.

And this is the purpose of human life.
News around the Globe
  • The three different subtypes of Cushing’s syndrome offer different outlooks for recovery of adrenal function after surgery to remove the causative tumor, suggests a new study published online in the Journal of Clinical Endocrinology and Metabolism.
  • It may be possible to stratify diabetes patients into lower- and higher–risk categories for retinopathy and then customize the recommended screening intervals depending on individual risk, points a new study published online in Diabetes Care.
  • A new study has revealed that patients with focal segmental glomerulosclerosis, a type of kidney disease, may have a more advanced form of the condition at diagnosis if they possess certain genetic variants – variants in the APOL1 gene. The study is published in the Journal of the American Society of Nephrology.
  • Female smokers' craving for cigarettes may be influenced by their menstrual cycle, suggests a new imaging study published online in the Psychiatry Journal. Researchers noted varying brain activation patterns in the participants across their menstrual cycle, with higher activation during the follicular phase in parts of the frontal, temporal, and parietal lobes.
  • In Asian patients hospitalized with community-acquired pneumonia, ceftaroline fosamil appears to be more effective than ceftriaxone, suggests a new study published online in The Lancet Infectious Diseases.
Medicolegal
Medicoleagal
Media
TodAy Media
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
https://www.youtube.com/watch?v=Mc3kKDXKWvs
Kishan, SM Heart Care Foundation Fund,
Post CHD Repair
https://www.youtube.com/watch?v=OTEG7toVkAQ
Deepak, SM Heart Care Foundation Fund,
CHD TOF https://www.youtube.com/watch?v=rjOel0aaqt0
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues
h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -
WhistleblowerDumped/videoshow/4468283.cms
Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health
https://www.youtube.com/watch?v=6Ktz5-iUINE
Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
https://www.youtube.com/watch?v=TGEGauzE0kg
eMedinewS Humor
Communication technician

A communication technician drafted by the army was at a firing range. At the range, he was given some instructions, a rifle and 50 rounds. He fired several shots at the target. The report came from the target area that all attempts had completely missed the target. The technician looked at his weapon, and then at the target. He looked at the weapon again, and then at the target again. He then put his finger over the end of the rifle barrel and squeezed the trigger with his other hand. The end of his finger was blown off, whereupon he yelled toward the target area: "It’s leaving here just fine, the trouble must be at your end!"
eMedi Quiz
A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1.Pain sensation on the ipsilateral side.
2.Proprioception on the contralateral side.
3.Pain sensation on the contralateral side.
4.Propriception on the ipsilateral side.

Yesterday’s Mind Teaser: A 64–year–old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end–tidal carbon–dioxide decreased to 20 from 40mm of Hg followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1.Fat embolism.
2.Hypovolemia.
3.Bronchospasm.
4.Myocardial infarction.

Answer for yesterday’s Mind Teaser: 2.Hypovolemia.

Correct Answers received from: Raju Kuppusamy, Dr Janiendra Upadhyay, Takaram Pagad, Dr Avtar Krishan.

Answer for 11th Jan Dec Mind Teaser: 3.Atracurium.

Correct Answers receives: Dr Janiendra Upadhyay.
IMA NEWS
1. No Evidence for Most TV Medical Advice, Study Shows

Patients should be skeptical about claims and recommendations made on mainstream television medical talk shows, according to a Canadian media study published online December 17 in the British Medical Journal.

In many cases, investigators found that specific details on the magnitude of benefit or harm and the cost and inconvenience of following recommendations were lacking, and evidence supporting them was contradictory or absent. Viewers had little basis for informed decision making.

The prospective observational study, led by Christina Korownyk, MD, associate professor, family medicine, University of Alberta, Edmonton, Canada, randomly recorded 40 episodes each of the widely watched programs The Dr. Oz Show and The Doctors from early January 2013 to early May 2013 and assessed all recommendations made on both shows.

These influential internationally syndicated shows, which in 2012 to 2013 each attracted 2 to 3 million daily viewers, typically featured a host or hosts and guests discussing one to five health topics per episode and making an average of 11 or 12 recommendations to consumers, some of which were stronger than others. On both shows, the visitors made a substantial proportion of health recommendations: 65% on Dr. Oz and 33% on The Doctors.

To critically assess the content of these shows, experienced evidence reviewers independently searched and then, as a team, evaluated the evidence for 80 pieces of advice, randomly selected from what they considered stronger recommendations.

The most frequent topic on both programs was general medical/public health advice ("Get vaccinated"; "Sneeze or cough into your sleeve to prevent the spread of germs"), followed by non–weight–loss dietary advice; for example, on immune–boosting diets. The combination of dietary and weight-loss advice represented 43.2% of the topics discussed on Dr. Oz and 16.8% of those on The Doctors.

On Dr. Oz, the recommendations were most often dietary (39.2%; e.g., "Carb–load your plate at breakfast"), although the researchers reported no direct links to specific dietary products. On The Doctors, the most common advice involved consulting a healthcare provider (17.8%): "Go to your primary care doctor or talk to their nurse before going to the (emergency department] to help relieve the load in the [emergency department)." Potential conflicts of interest of hosts and guests were acknowledged only four times out of 924 recommendations.

On both shows, exercise took a definite back seat to diet, with dietary advice accounting for 39% of recommendations vs 5% for exercise on Dr. Oz and 10% versus 5% on The Doctors.

On either program, a specific benefit was mentioned for only about 40% of recommendations. Even less commonly mentioned were the magnitude of benefit (<20%), potential harms (<10%), costs (<15%), and potential conflicts of interest (<1%). "We did come across a couple that had evidence of harm associated with them, and we are compiling this data now," Dr Korownyk told Medscape Medical News.

Overall, the Alberta investigators found that 87 of the 160 recommendations assessed (54%; 95% confidence interval, 47% – 62%) had some level of published evidence to support them. Believable or somewhat believable evidence supported 33% of recommendations from The Dr. Oz Show, and 53% on The Doctors.

Conversely, believable or somewhat believable evidence was found against 11% (Oz) and 13% (Doctors) of the recommendations. For slightly more than 1 in 3 (Oz) and 1 in 4 (Doctors) recommendations, no evidence was found. "Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence," the authors write.

Among the limitations of the study, the authors acknowledge the shows' complexity, the subjective nature of much of the advice, and the difficulty of distinguishing between what was said and what was implied. They raised the question of whether medical talk shows should provide more than entertainment. "If the shows are perceived as providing medical information or advice, viewers need to realize that their recommendations may not be supported by higher evidence or presented with enough balanced information to adequately inform decision making."

2. Recent call by President and Secretary General IMA for improving the facilities at state forensic laboratories

Sir,

Read with interest the recent call by President and Secreatry General IMA for improving the facilities at state forensic laboratories.

Forensic Science is treated with scarce respect by the mainline scientists. The Indian Science Congress did not even entertain research papers in this discipline till about two decades back and needed lot of prodding.

IMA has therefore done well to emphasize need for setting up state of the art facilities in the country for ensuring that guilty do not go unpunished and innocence of others can be established beyond reasonable doubt – arguments by smart lawyers on either side notwithstanding.


With best wishes,
Yours sincerely,
(Er Anuj Sinha)

What should be the role of AYUSH in health care?

1 The ancient systems of medicine, whether in India, Greece or China or Africa, as well as the various herbal medicines used, are a great repository of human endeavor towards improving health and alleviating disease and suffering and need to be studied, researched, developed and promoted.

2—As per the government web site:

"Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was created in March,1995 and re–named as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November, 2003 with a view to providing focused attention to development of Education & Research in Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy systems. The Department continued to lay emphasis on up–gradation of AYUSH educational standards, quality control and standardization of drugs, improving the availability of medicinal plant material, research and development and awareness generation about the efficacy of the systems domestically and internationally.

Objectives:
  1. To upgrade the educational standards in the Indian Systems of Medicines and Homoeopathy colleges in the country.
  2. To strengthen existing research institutions and ensure a time–bound research programme on identified diseases for which these systems have an effective treatment.
  3. To draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these systems.
    1. To evolve Pharmacopoeial standards for Indian Systems of Medicine and Homoeopathy drugs." --http://indianmedicine.nic.in/
      index2.asp?slid=19&sublinkid=15&lang=1
3—It is unfortunate that in spite of the stated aims and objectives, the government continues to spend its efforts and utilizing its information machinery towards the objectionable vision of promoting quackery (as defined by the Supreme Court) by claiming parity with allopathy, which has now come to be used as a short name for the modern system of medicine.

4 The question as to who is a quack arose in Poonam Verma Vs. Ashwin Patel and Others, decided by the Supreme Court on 10.05.1996, reported as 4 SCC 332, (Kuldip Singh, S. Saghir Ahmad JJ). The judgment can be viewed at— http://www.indiankanoon.org/doc/611474/

Para 41 of the judgment is reproduced below:

"41. A person who does not have knowledge of a particular System of Medicine but practices in that System is a quack and a mere pretender to medical knowledge or skill, or to put it differently, a charlatan."

5—It needs to be remembered that mere possessing knowledge of a particular System of Medicine is not enough. One must be licensed by the concerned statutory authority to practice that particular system of medicine. The three main councils established for this purpose by statute are the following:
  1. The Indian Medical Council established under the IMC Act, 1956.
  2. The Central Council of Indian Medicine established under the Indian Medicine Central Council Act, 1970.
  3. The Central Council of Homoeopathy established under the Homoeopathy Central Council Act, 1973.
In order to make it clear, let us assume that a student completes the MBBS course and passes the examination but does not get himself registered with the medical council. Or, in the alternative, let us assume that a doctor registered with the medical council ceases to be so registered. In both these instances, he would continue to possess knowledge of the modern system of medicine but, in spite of this, he would be legally incompetent to practice medicine as a medical practitioner.

6—While it is the essence of democracy that there should be freedom to have and implement different and even divergent views and practices, such freedom cannot be allowed so far as to condone illegality. Practice of allopathy by AYUSH is clearly illegal as held by the Supreme Court in the Mukhtiar Chand judgment.

Unfortunately, the government and its ministers have been spreading falsehood in the very name of the Mukhtiar Chand judgment, as detailed below.

Dr. Mukhtiar Chand & Ors. Vs. State Of Punjab & Ors., Date of Judgment: 08/10/1998, K. T. Thomas, Syed Shah Mohammed Quadri, AIR 1999, SC 468, (1998 (7) SCC 579). http://indiankanoon.org/doc/23583/

7—The example of an attempt to mislead the people about the permissibility of AYUSH to practice allopathy is the statement dated 24–8–2005 in the Lok Sabha parliament in the form of answer to a question. Both the question and the answer are reproduced below:

Unstarred question no. 4235 in Loksabha, regarding "Permission to BAMS graduates to practice modern medicine",

"QUESTION ––Will The Minister HEALTH AND FAMILY WELFARE be pleased to state:-
  • Whether the Bachelor of Ayurvedic and Medicine Services (BAMS), Integrated Medical Graduates are being allowed to practice Modern System of Medicine in the country;
  • If so details thereof;
  • If not the reasons thereof; and
  • The time by when it is likely to be considered by the Government.
Answer

THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. ANMBUMANI RAMADOSS)

(a) to (d) This matter was examined by Hon’ble Supreme Court in the case of Dr. Mukhtiar Chand and Ors. Vs. the State of Punjab, civil appeal No.89 of 1987.Hon’ble Supreme Court has held that harmonious reading of section 15 of Indian Medical Council Act 1956 and section 17 of Indian Medicine Central Council (IMCC) Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian Medicine or Central Register of Indian Medicine to practice Modern Scientific Medicine in any of its branches unless the person is also enrolled on a State Medical Register within the meaning of 1956 Act; However the right to prescribe Modern Medicine by practitioners of Indian Medicine under rule 2 (ee)(iii) of Drugs and Cosmetics Act 1940 would be available in those States where privilege of such right to practice any system of medicine is conferred by the State Law under which practitioners of Indian Medicine registered in the state."

8. It appears that the Health Minister has purposely given an evasive answer. Though the answer is basically correct, he should have quoted the SC judgment correctly. It is correct that––"However the right to prescribe Modern Medicine by practitioners of Indian Medicine under rule 2(ee)(iii) of Drugs and Cosmetics Act 1940 would be available in those States where privilege of such right to practice any system of medicine is conferred by the State Law under which practitioners of Indian Medicine registered in the state". It needs to be remembered that, at present, there is no state where the privilege to practice any system of medicine is conferred by state law upon practitioners of Indian Medicine registered in the state". The minister ought to have mentioned this fact for sake of truth and clarity rather than give a vague and potentially misleading answer.

The evasive intention of the minister is obvious. He evaded giving direct and specific replies to specific questions. He has quoted from the Mukhtiar Chand judgment and has avoided a clear reply. He should have been straightforward and taken the bull by the horns. If I were the minister, I would have replied to each specific question as follows:

Clear and specific replies ought to have been as follows:

(a)Whether the Bachelor of Ayurvedic and Medicine Services (BAMS), Integrated Medical Graduates are being allowed to practice Modern System of Medicine in the country;

ANSWER—No.

(b)If so details thereof;

ANSWER— Not applicable.

(c) If not the reasons thereof;

ANSWER— Because it is not permitted in terms of the existing laws and the Supreme Court judgments.

(d) The time by when it is likely to be considered by the Government.

ANSWER— The government cannot consider something which is against law.

9—The above was followed by a question in the Rajya Sabha regarding the same issue. Intriguingly, this was widely spread, for reasons not clear, by the Ministry of Health in the form of a press release reproduced below:

"Ministry of Health and Family Welfare20–August, 2007 13:20 IST

"AYUSH practitioners prescribing allopathic medicines"

Rajya Sabha

The matter regarding qualified practitioners of Ayurveda, Unani, Siddha and Homoeopathy systems prescribing allopathic medicines has been examined in depth by the Hon'ble Supreme Court of India in Civil Appeal No.89 of 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others. Representations have been received from time to time on this matter and accordingly Department of AYUSH entrusted the study of the contemporary acts on medical practice in the light of judgment of Hon'ble Supreme Court in 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others and other similar judgements. Drugs can be sold and supplied by a Pharmacist or a Druggist only on a prescription of a Registered Medical Practitioner and who can also store them for treatment of patients.

According to Section 2 (ee) of the Drugs and Cosmetics Rules, 1995, Registered Medical Practitioner means a person –

(i) holding a qualification granted by an authority specified or notified under Section 3 of the Indian Medical Degrees Act, 1916 (7 of 1916), or specified in the Schedules to the Indian Medical Council Act, 1956 (102 of 1956); or

(ii) registered or eligible for registration in a medical register of a State meant for the registration of persons practicing the modern scientific system of medicine (excluding the Homoeopathy system of medicine); or

(iii) registered in a medical register (other than a register for the registration of Homoeopathic practitioners) of a State, who although not falling within sub-clause (i) or sub-clause (ii) is declared by a general or special order made by the State Government in this behalf as a person practicing the modern scientific system of medicine for the purposes of this Act.

Hon’ble Supreme Court upheld the validity of Rule 2 (ee) (iii) as well as the notifications issued by various State Governments there under allowing Ayurveda, Siddha, Unani and Homoeopathy practitioners to prescribe allopathic medicines.

In view of the above judgement, Ayurveda, Siddha, Unani and Homoeopathy practitioners can prescribe allopathic medicines under Rule 2 (ee) (iii) only in those States where they are authorized to do so by a general or special order made by the concerned State Government in that regard. Practitioners of Indian Medicine holding the degrees in integrated courses can also prescribe allopathic medicines if any State act in the State in which they are practicing recognizes their qualification as sufficient for registration in the State Medical Register.

This information was given by the Minister for Health & Family Welfare, Dr. Anbumani Ramadoss in a written reply to a question in the Rajya Sabha. KR/SK/95 – RS (Release ID :30117)"

http://pib.nic.in/newsite/erelease.aspx?relid=30117

10—The above long winded press release is nothing but a camouflaged misrepresentation of the Mukhtiar Chand judgment given by the Supreme Court in 1998. The job of the government should be to correctly inform the public and not to motivatedly give misinformation in the guise of information. The government, unfortunately, has been misinforming the public to achieve its hidden agenda, which is to support quackery so as to ensure a vote bank.

The above release is, in fact, correct in what it says in words but is incorrect, in what it implies. It is clear that the government tried to spread the implied meaning in such a language that was full of legalese and legally correct, though coloured enough to confuse an ordinary person and lead him to arrive at a contrary, intended and illegal conclusion.

In this connection, the following points need to be noted:

i) Ref: "Hon’ble Supreme Court upheld the validity of Rule 2 (ee) (iii) as well as the notifications issued by various State Governments thereunder allowing Ayurveda, Siddha, Unani and Homoeopathy practitioners to prescribe allopathic medicines."

>> The judgment says that they can prescribe only those medicines known as OTC (Over the Counter medicines which can be bought by anybody from a drug store without a medical prescription). This part of the judgment has been concealed in the press release.

ii) Ref: "In view of the above judgement, Ayurveda, Siddha, Unani and Homoeopathy practitioners can prescribe allopathic medicines under Rule 2 (ee) (iii) only in those States where they are authorized to do so by a general or special order made by the concerned State Government in that regard.”

>>> The fact is that there is no such state as mentioned! The Minister certainly knew this but gave a misleading reply to the extent that he concealed this fact.

iii) Ref: "Practitioners of Indian Medicine holding the degrees in integrated courses can also prescribe allopathic medicines if any State act in the State in which they are practicing recognizes their qualification as sufficient for registration in the State Medical Register.

>>>As per the Indian Central medicine Council Act, 1970, there is NO degree like "a degree in an integrated course"! Moreover, there is no state act of the type mentioned in any of the states!

11 The AYUSH graduates claim that a very high bulk of their teaching course consists of modern medicine and, by virtue of such claim, they possess knowledge of modern medicine and hence they should be permitted to practice allopathy / modern medicine. Such a claim has been rejected by the Supreme Court in the Mukhtiar Chand judgment in the following words:

"However, the claim of those who have been notified by State Governments under clause (iii) of rule 2(ee) of the Drugs Rules and those who possess degrees in integrated courses to practice allopathic medicine is sought to be supported from the definition of the Indian Medicine in Section 2(e) of 1970, reproduced below: "(e) "Indian Medicine" means the system of Indian medicine commonly known as Ashtang Ayurveda, Siddha or Unani Tibb whether supplemented or not by such modern advances as the Central Council may declare by notification from time to ime………………………………………………………Lot of emphasis is sought to be laid on the words "whether supplemented or not by such modern advances" to show that they indicate modern scientific medicine as under integrated systems various branches of modern scientific medicine have been included in the syllabi. Based on those clarifications, the arguments proceed that persons who registered under the 1970 Act and have done integrated courses, are entitled to practise allopathic medicine. In our view, all that the definition of ‘Indian Medicine' and the clarifications issued by the Central Council enable such practitioners of Indian medicine is to make use of the modern advances in various sciences such as Radiology Report, (x–ray), complete blood picture report, lipids report, E.C.G., etc. for purposes of practising in their own system. However, if any State Act recognized the qualification of integrated course as sufficient qualification for registration in the State Medical Register of that State, the prohibition of Section 15(2)(b) will not be attracted."

12 Those who claim that AYUSH can practice allopathy cite in their support Section 2(1)(e) of the Maharashtra Medical Practitioners’ Act, 1961, reproduced below:

"2(1)(e) "Indian Medicine" means the system of Indian medicine commonly known as Ashtang Ayurveda, Siddha or Unani Tibb whether supplemented or not by such modern advances as the Central Council may declare by notification from time to time."

It has been claimed that by virtue of the words "whether supplemented or not by such modern advances”, in the above definition, Indian Medicine is inclusive of Modern Medicine. This has been held as incorrect by the SC in the Mukhtiar Chand judgment in the following words:

"However, the claim of those who have been notified by State Governments under clause (iii) of rule 2(ee) of the Drugs Rules and those who possess degrees in integrated courses to practice allopathic medicine is sought to be supported from the definition of the Indian Medicine in Section 2(e) of 1970 Act, referred to above, meaning the system of Indian medicine commonly known as Ashtang Ayurveda, Siddha or Unani Tibb whether supplemented or not by such modern advances as the Central Council may declare by notification from time to time. Lot of emphasis is laid on the words underlined to show that they indicate modern scientific medicine as under integrated systems various branches of modern scientific medicine have been included in the syllabi. A degree holder in integrated courses is imparted not only the theoretical knowledge of modern scientific medicine but also training thereunder, is the claim. We shall examine the notifications issued by the Central Council to ascertain the import of those words.”

13 . The first notification of the CCIM was dated March 11, 1987, and reads

"This meeting of the Central Council hereby unanimously resolved that in Clause (e) of Sub–section 2(1) of 1970 Act of the IMCC Act, 'the modern advances', the drug has advanced made under the various branches of modern scientific system of medicine, clinical, non-clinical, biosciences, also technological innovations made from time to time and declare that the courses and curriculum conducted and recognised by the CCIM are supplemented by such modern advances."

14 The second notification of the CCIM was dated 30–10–1996 and reads––

"As per provision under Section 2(1) of the Indian Medicine Central Council Act, 1970, hereby Central Council of Indian Medicine notifies that ‘institutionally qualified practitioners of Indian system of medicine (Ayurveda, Siddha and Unani) are eligible to practise Indian system of medicine and modern medicine including Surgery, Gynecology and Obstetrics based on their training and teaching which are included in the syllabi of courses of ISM prescribed by Central Council of Indian Medicine after approval of the Government of India. The meaning of the word ‘modern medicine’ (Advances) means advances made in various branches of Modern scientific medicine, clinical, non-clinical bio-sciences also technological innovations made from time to time and notify that the courses and curriculum conducted and recognised by the Central Council of Indian Medicine are supplemented by such modern advances."

15. The Supreme Court considered the above notifications and held as follows:

"Based on those clarifications, the arguments proceed that persons who registered under the 1970 Act and have done integrated courses, are entitled to practise allopathic medicine. In our view, all that the definition of 'Indian Medicine' and the clarifications issued by the Central Council enable such practitioners of Indian medicine is to make use of the modern advances in various sciences such as Radiology Report, (x–ray), complete blood picture report, lipids report, E.C.G., etc. for purposes of practising in their own system. However, if any State Act recognized the qualification of integrated course as sufficient qualification for registration in the State Medical Register of that State, the prohibition of Section 15(2)(b) will not be attracted. A harmonious reading of Section 15 of 1956 Act and Section 17 of 1970 Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian Medicine or Central Register of Indian Medicine to practise modern scientific medicine in any of its branches unless that person is also enrolled on a State Medical Register within the meaning of 1956 Act. The right to practise modern scientific medicine or Indian system of medicine cannot be based on the provisions of the Drugs Rules and declaration made thereunder by State Governments".

16. In short, the Supreme Court has clearly held in the Mukhtiar Chand judgment that “A harmonious reading of Section 15 of 1956 Act and Section 17 of 1970 Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian Medicine or Central Register of Indian Medicine to practise modern scientific medicine in any of its branches unless that person is also enrolled on a State Medical Register within the meaning of 1956 Act. The right to practise modern scientific medicine or Indian system of medicine cannot be based on the provisions of the Drugs Rules and declaration made thereunder by State Governments".

17. Some state governments have permitted vaids and hakims to practice allopathy illegally. The Maharashtra government issued a gazette notification in 1992 permitting hakims and vaids to prescribe allopathic drugs. Such notification is liable to be quashed by the courts. As a matter of fact, belatedly, the IMA, Maharashtra, is believed to have challenged such notification in the High Court by way of a writ petition filed in 2014.

18. It is unfortunate that hospitals and nursing homes continue to employ AYUSH graduates in the garb of regular modern medicine practitioners sporting a white coat and stethoscope. In this connection, it may be mentioned that in Prof. P.N. Thakur v. Hans Charitable Hospital, NC, (DOD 16 Aug. 2007) III (2007) CPJ 340 NC, the National Consumer Commission observed in para 20 of the judgment as follows:

http://ncdrc.nic.in/OP21497.HTML

"When a patient is admitted in a hospital, it is done with the belief that the treatment given in the hospital is being given by qualified doctors under the Indian Medical Council Act, 1956. It is not within the knowledge of the relatives of the patient that the patient is being treated by a Unani Specialist. We hold that it is clear deficiency in service and negligence by the hospital for leaving the patient in the hands of Unani doctor……….we feel it is high time that hospital authorities realize that the practice of employing non-medical practitioners such as Doctors specialized in Unani system and who do not possess the required skill and competence to give allopathic treatment and to let an emergency patient be treated in their hands is a gross negligence."

The national IMA has taken note of the above and, with the start of the year 2015, has resolved to curb this practice on the part of the modern medicine hospitals.

19. Even the central government does not want to be left behind in conferring upon the AYUSH practitioners a right to practice allopathy. An attempt in this direction is reflected in the Notification No.12015/49/2008-MCH, dated the 29th October 2014, whereby the government published on its web site a bill proposed to amend the MTP Act, 1971, in such a manner as to allow Ayurveda, Unani, Siddha and Homeopathic doctors to perform MTP. This is an undesirable move. It is not accompanied by any statement from the government regarding the background, need and objects of the proposed legislation. The proposed amendment bill. It can be viewed at

http://mohfw.nic.in/showfile.php?lid=2986

20. It is unfortunate that the AYUSH department of the ministry of health has devoted no attention to develop the indigenous and ancient systems of medicine but has mainly focused its efforts on trying to equate the practitioners of traditional systems with practitioners of modern medicine. In other words, the ministry of health is actively trying to promote quackery by legalising it.

21. There are several High Court judgments holding that AYUSH cannot practice modern medicine / allopathy. For example, the Punjab and Haryana High Court observed in CWP No.4754 of 2002 (Dr. Tarsem Singh & Others v/s State of Punjab, decided on 24.10.2002) as follows "A careful reading of the judgment of supreme court in Mukhtiar Chand case (supra) makes it clear that a person who is not enrolled on the state medical register within the meaning of the 1956 act, cannot practice modern system of medicine".

22. Similarly, the High Court of Allahabad observed in CWP No. 64481 of 2012 (Praveen Kumar versus State of U.P., DOD 16.12.2013) as follows "Said definition has been used in different context and same does not authorize incumbent having qualification under the Indian Medicine Central Council Act, 1970 to start prescribing medicine which the incumbents registered under Indian Medical Council Act, 1956 only can administer.

Petitioner cannot be permitted to prescribe allopathic/modern medicine as is provided for under Indian Medical Council Act, 1956, by any means, as a person having studied one particular system of medicine cannot possibly claim deep and complete knowledge about the drugs of the other system of medicine, and specially when right to health and medical care is fundamental right under Article 21 read with Articles 39(c), 41 and 43 of Constitution, as expressed by Apex Court, in the case of Consumer Education and Research Centre Vs. Union of India, AIR 1995 SC

922, and by further providing that right to life includes protection of health and strength and the minimum requirement to enable the persons to live with dignity. Petitioner will have to practice in his own branch, and it would be a extremely grave situation, to allow petitioner to treat and prescribe a sick incumbent with allopathic medicine. The transgression into other branches of medicine as has been prayed for is not permissible, as same would tantamount to quackery and exposing petitioner to cancellation of registration and prosecution".

http://elegalix.allahabadhighcourt.in/elegalix/WebShowJudgment.do

23. Vaids and hakims are often registered as RMPs under Rule 2(ee) of the Drugs and Cosmetic Rules, 1945. On the basis of such registration, they falsely claim that having been registered as RMPs under the Drugs Act and having been permitted to store and supply allopathic medicines, they are legally permitted to practice allopathy. This is entirely wrong. The Supreme Court has held in Mukhtiar Chand that the declaration of an unqualified person as a registered medical practitioner under Rule 2(ee) was only for the purpose of the Drugs and Cosmetics Act and not for the purpose of the IMC Act, 1956. In other words, the court clarified that if a person was labelled as a registered medical practitioner under Rule 2(ee) of the Drugs and Cosmetics Rules, 1945, such labelling only entitled him to store allopathic drugs which would otherwise be illegal under the Drugs and Cosmetics Act / Rules. The court drew attention to the fact that in terms of section 15(2)(b) of the IMC Act, “no person other than a medical practitioner enrolled on a State Medical Register shall practice medicine in any State".

24. AYUSH practitioners often claim that they are entitled to practice any system of medicine. There is no truth in such claim. The Supreme Court observed in Mukhtiar Chand as follows

"To ascertain if any State law confers ‘the right to practise any system’ we have perused Bombay Medical practitioners Act,1938; Rajasthan Indian Medicine Act, 1953; and Maharashtra Medical Practitioners Act, 1961 which deal with registration of practitioners of Indian Medicine in those States, as also some related Acts. But we could not lay our hands on any provision in the said State Acts under which the right to practice any system of medicine is conferred on practitioners of Indian medicine registered under those Acts."

25. It is sometimes claimed that the ISM practitioners have a right to practice modern medicine by virtue of the CCIM (Central Council of Indian Medicine) letter F.No.8–5/96-Ay, dated 18.10.96. This claim and the letter were considered and rejected by the Madras High Court in Dr. J. Kaleem Nawaz vs. State of Tamil Nadu & Ors., decided on 29 October, 2010. The judgment can be viewed at http://indiankanoon.org/doc/23583/

26. In the above case, the petitioner, a BUMS hakim, claimed the right to administer allopathic medicines along with Unani Medicines in accordance with the training and teaching given in the B.U.M.S. degree. His petition was dismissed. The court held as follows:

"33. In the counter affidavit filed by the third respondent, the decision of the Hon’ble Supreme Court of India in Dr. Mukhtiar Chands case, (cited supra) has been misinterpreted and it is unfortunate that the deponent of the affidavit has not gone through the entire judgment especially paragraph No.47 of the said judgment.

34. The reliance placed upon by the learned counsel appearing for the petitioner on the circular 18.10.1996 and 30.10.1996 is of no consequence as the clarification issued by the Central Council of Indian Medicine, New Delhi that the practitioners of Indian system of medicine who practiced modern scientific system of medicine, allopathic medicine are protected under Section 17(3)(b) of Indian Medicine Central Council Act, 1970, is not correct as the said authority has not taken into consideration the provisions of Indian Medical Council Act, 1956. Dr. Mukhtiar Chands case,(cited supra) which came to be delivered subsequent to the said notifications had also clarified that unless a person/medical practitioner registered himself in the State Register in terms of Indian Medical Council Act, 1956, he cannot practice modern system/allopathic system of medicine."

27. It is highly unfortunate and even condemnable that the CCIM, which works under the direct control of the AYUSH deptt. of the Central Ministry of Health, should misrepresent before the court as commented by the court itself. This shows the misplaced zeal of the government authorities to circumvent law and spread misinformation and even plead falsely before the courts in support of its wrong policies.

28. The circular 18.10.1996, as given in the above judgment itself, is reproduced below:

"Letter F.No.8-5/96–Ay, dated 18.10.96 from the Secretary, Central Council of Indian Medicine, New Delhi, addressed to the Health Secretaries of all State Governments, wherein it has been stated as follows:– Subject: Rights & Privileges of Practitioners of ISM. The resolution therefore.

With reference to the subject mentioned above, I am to inform you that rights and privileges of Indian System of Medicine practitioners have been protected under Indian Medicine Central Council Act, 1970 which provides as under:- Nothing contained in Sub-section (2) shall affect privileges (including the right to practice any system of medicine) conferred by or under any law relating to registration of practitioners of Indian Medicine for the time being in force in any State on a practitioner of Indian Medicine enrolled on a State Register of Indian Medicine. I am further to inform you that the matter was considered by the Executive Committee of the Council. The Committee discussed and passed the following resolution:–

Institutionally qualified practitioners of Indian System of Medicine (Ayurvedic, Unani & Siddha) and those covered under Indian Medicine Central Council Act, 1970 are eligible to practice Indian System of Medicine and modern medicines, which is commonly known as Allopathic Medicines including Surgery, Gynaecology and obstetrics, based on their training and teaching. This training and teaching is included in the syllabus of C.C.I.M. The meaning of word Modern Medicine (Advances) means the advances made in various branches of Modern Scientific Medicine, Clinical, Non–clinical, Bio–sciences.

You are requested to implement the above resolution and notify the same in your State publicly.
Yours faithfully,
Sd/--------------
/True Copy/
Sd/– ..
REGISTRAR."



Dr. M C Gupta (Former Professor and Dean)
MD (Medicine), LLM
Press Release of the Day
Eat Gur & Chana every week

Addressing a gathering of young women, in a lecture organized by All Indian Women Congress, Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, Indian Medical Association & President, Heart Foundation of India stressed that all women should eat Gur–Chana in a week in a bleeding state. Gur is a rich source of iron and Chana contains proteins. Both together will take care of loss of blood during their monthly blood loss.

Dr K K Aggarwal further said that all women, in the coming month of Magh, should sit in sun for at least 40–60 minutes in a day and eat Sesame Seed preparation items, which is high in calcium. This will take care of any deficiency of calcium and Vitamin D.

In a joint statement, Dr K K Aggarwal, Dr. Ambrish Mithal and Dr. Alka Kriplani said that vitamin D deficiency is common in Indians and all Indians should sit for 40 minutes in sunlight exposing 40% of their body for at least 40 days in a year. If they cannot do so, they should take monthly vitamin D sachet containing 60,000 units of vitamin D3.

The function was coaddressed by Mrs. Asha Gambhir and Mrs. Ambrish, both from All Indian Women Congress.
IJCP Book of Medical Records
IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.
If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one day.
Reader Response
Dear Sir, I read news regarding IMA meet held at Chandigarh on the 10th, congratulations for its success. You being highly qualified professional holding SG post of IMA, deserve sincere congratulations and thanks. I am Senior Citizen and want to narrate heartily that we saw when we were young even the MBBS doctors were competent and handled all type of emergencies but now situation is totally changed Today MBBS qualified is not able to treat even small ailment as they are busy preparing for PG entrance exam.

Today there are highly qualified Doctors in each field but most private hospitals treat patient on commercial basis more. I pray the ethical values return back and society treat doctor as God as in the old days. There is no doubt doctor is next to God for the patient. Well any way excuse me these things are in every profession, May I request you to kindly create awareness among your profession to devote some time for the needy as the Government is not bothering such ashrams runs to look after elderly thrown by their children and mentally depressed humans in hundreds. With regards and excuse me if wrote unwanted. O P Garg, Patiala
IJCP’s ejournals
  • Indian Journal of Clinical Practice
  • Indian Journal of Multidisciplinary Dentistry
  • Asian Journal of Diabetology
  • Asian Journal of Critical Care
  • Asian Journal of Clinical Cardiology
  • Asian Journal of Obs & Gyne
  • Asian Journal of Paediatric Practice
  • Asian Journal of Ear Nose and Throat