January 19 2015, Monday
IMA NEWS
Dear Dr. K. K. Aggarwal
Hony Secy General IMA

Congratulations to you, Dr. Pillai and all the members of the new team of IMA for the auspicious beginning of the new year of the IMA.

We hope and believe that under your dynamic leadership IMA will touch new heights during the year.

I think that the biggest challenge before the IMA at present is the permission of many state governments to allow Ayush doctors to prescribe allopathic medicines. IMA Maharastra was fighting a case in the court which has been quashed. Many private institutions are taking advantage of the situation and offering short courses for Ayush doctors in emergency medicine. We are sure that this is nothing but a fraudulent commercial activity. But we cannot stop this because it is their right to offer whatever training they want to give. Only the Government can stop it.

But this is not the remedy of the problem. Our concern is they should not be allowed to prescribe allopathic medicines. This is most illogical and this will open a floodgate of quacks starting medical practice legally. It is our duty to stop this at any cost.

My suggestion is to take legal opinion immediately and move court to stop this. It will amount to a gross failure of our association if it is allowed unchallenged.

I hope you will take this matter very seriously and do the needful.

Thanking you

Sincerely yours

Dr RD Dubey
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
Stress is the reaction of the body and mind to the interpretation of a known situation
Dr KK Aggarwal You cannot be stressed unless you know the person, place or the situation. The same situation may or may not cause stress unless it is interpreted in such a way that it is uncomfortable to the person, and then it ends up causing stress.

Management of stress, therefore, involves either removing the known situation or changing one’s interpretation or preparing the body in such a way that the stress does not affect mind and the body. But, removing the known situation may not be possible all the time. For example, if you are stressful in a job, resigning may not be feasible.

The modality, therefore, is to change your interpretation towards the stressful situation for which one should start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Changing of the interpretation is what in allopathy is described as cognitive behavior therapy, the origin of which comes from Ayurveda and in Bhagwad Gita where Lord Krishna counsels Arjuna following principles of Cognitive Behavioral Therapy.

In the first chapter, Lord Krishna only listens to Arjuna explaining the importance of listening, listening and listening. The second counseling session or the second chapter is the longest conversation between Arjuna and Krishna and shows the importance of first effective counseling session. From 3rd to 17th chapters, Krishna explains what he has conveyed in chapter 2 and that tells us the importance of reasoning out every doubt that a person under stress has. During this session, Krishna creates fear and also consoles Arjuna again indicating the importance of these two factors in counseling. In the last chapter, Krishna revises what he has taught, which is consistent with the last rule of counseling to make sure that the patient has learnt what has been taught to him.

Besides counseling, one can also prepare the body in such a way that stress does not bother him. This can be done by learning the art of pranayam, relaxation, meditation, regular exercise, Dosh-specific diet and using certain Ayurvedic Rasayans, which sterilize the brain functions. Brahmi, an Ayurvedic herb, is one such Rasayan, which boosts the brain.

One should avoid taking allopathic anti–anxiety drugs, unless necessary which, of course, may be required in an acute panic state.
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Quote of the Day
Ability is a poor man’s wealth. John Wooden
News on Maps
CPR 10
Total CPR since 1st November 2012 – 101090 trained
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Twitter of the Day
Dr KK Aggarwal: Modification of four risk factors can reduces chances of death in women http://bit.ly/15qIHLr #Health
Dr Deepak Chopra: When your mind is quiet subtle intentions organize their own fulfillment
Make Sure
Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was an aminoglycoside not added?
Lesson: Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.
THE DRUGS AND COSMETICS (AMENDMENT) BILL, 2015
Amendment of Section 6.
12. In section 6 of the principal Act,-
 
(a) for sub-section (1), the following sub-sections shall be substituted, namely:-
 
“(1) The Central Government may, by notification, establish or designate Central Drugs Laboratories under the control of a Director, to be appointed by the Central Government, to carry out such functions as may be prescribed.
 
(1A) The Central Government may, by notification, designate any Central Drugs Laboratory or any other laboratory,-
 
(a) for testing of drugs or cosmetics or medical devices; or
 
(b) as an Appellate Laboratory for testing of drugs or cosmetics or medical devices.
 
(IAB) The State Government may, by notification, establish or designate State drugs laboratories or any other laboratories to carry out such functions as may be prescribed.”;
 
(b) in sub-section (2),-
 
(i) in clause (a), after the word “Laboratory”, the words “State Drugs Laboratory” shall be inserted;
(ii) in clause (d), for the words, figures and letter “under Chapter IV or Chapter IVA of samples of drugs or cosmetics”, the words, figures and letters “under Chapter IIA, Chapter III, Chapter IV or Chapter IVA of samples of drugs or cosmetics or medical devices” shall be substituted.
Substitution of new section for section 7
13. For section 7 of the principal Act, the following section shall be substituted, namely:-
Drug, Cosmetic and Medical Devices Consult active Committee
7. (1) The Central Government may constitute a consultative committee to be called the Drugs, Cosmetics and Medical Devices Consultative Committee to advise the Central Government, the State Governments, the Drugs Technical Advisory Board and the Medical Device Technical Advisory Board on any matter tending to secure uniformity throughout India in the administration of this Act.
 
(2) The Drug, Cosmetic and Medical Devices Consultative Committee shall consist of two representatives of the Central Government to be nominated by the Government and one representative of each State Government to be nominated by the State Government, who shall be in-charge of, or dealing with the matters relating to regulation of drugs, cosmetics and medical devices. (3) The Drug, Cosmetic and Medical Devices Consultative Committee shall meet as and when required to do so by the Central Government and shall have power to regulate its own procedure. (4) The Drugs Controller General of India shall be the Chairperson of the Drug, Cosmetic and Medical Devices Consultative Committee.”
Insertion of new Chapter IIA.
14. After section 7A of the principal Act, the following Chapter shall be inserted, namely:-
 
“CHAPTER IIA. IMPORT, MANUFACTURE, SALE AND DISTRIBUTION OF NOTIFIED CATEGORY OF MEDICAL DEVICE.
 
7B. (1) The classification, standards, manufacturing, testing, distribution, labeling, packaging, essential requirements for quality, safety and performance, adverse events, post marketing surveillance, conformity assessment bodies, exemptions, procedure to regulate notified category of medical device, manner and conditions of licence shall be such as may be prescribed.
 
(2) The fee for the purposes of this section shall be such as may be notified by the Central Government.
 
7C. For the purposes of this Chapter, a medical device shall be deemed to be misbranded if it,-
 
(a) is configured so as to conceal any damage or made to appear of better or greater functional value or made to appear of lesser risk than it really is; or
 
(b) is not labeled or packed in the prescribed manner; or
 
(c) bears label, container, statement, design or device which makes any false claim; or
 
(d) does not comply with the prescribed colour additives
 
7D. For the purposes of this Chapter, a medical device shall be deemed to be adulterated if it,-
 
(a) consists, in whole or in part, of rusted or corroded or filthy or putrid or decomposed substance; or
 
(b) is not prepared or stored in such manner and conditions as may be prescribed; or
 
(c) contains any harmful or toxic substance or component or software or parts thereof which may render it dangerous to use or injurious to health; or
 
(d) is having any substance or component or software or part thereof mixed or added thereto or substituted or removed therefrom so as to reduce its quality or strength or performance or safety which may render it dangerous to use or injurious to health; or
 
(e) is having a pack or container composed, in whole or in part, of any deleterious substance which may render it dangerous to use or injurious to health.
Spurious medical device.
7E. For the purposes of this Chapter, a medical device shall be deemed to be spurious if it,-
 
(a) is having the label or pack or the container bearing the name of an individual or firm or company purporting to be the manufacturer of the device, which individual or a firm or a company is fictitious or does not exist; or
 
(b) purports to be the product of a manufacturer of product whom it is not actually a product
Prohibition of import or manufacture and sale of medical devices
7F. (1) save as otherwise provided in sub-section (4), no person shall himself or by any other person on his behalf import or manufacture for sale for distribution or for marketing, sell, stock, exhibit, offer for sale or distribute any notified category of medical device,-
 
(i) which does not conform to such standards of quality, safety and performance as may be prescribed;
 
(ii) which is misbranded, adulterated or spurious;
 
(iii) software, part, component or instrument accompanying to which is not having details displayed in such manner as may be prescribed;
 
(iv) which by means of any statement, design or accessory accompanying it or by any other means, purports or claims to cure any such disease or ailment, or to have any such other effect as may be prescribed;
 
(v) which is containing any component that may render it unsafe or harmful beyond what is declared, for use under the directions indicated therein or recommended therefor;
 
(vi) which is in contravention of any of the provisions of this Chapter or rules made there under
 
except under and in accordance with a licence issued under this Chapter by the Central Licensing Authority or the State Licensing Authority, as the case may be:
 
Provided that nothing contained in clause (i) to (vi) shall apply to import or manufacture of any notified category of medical device in small numbers for the purposes of examination, test, analysis, demonstration, not on human beings, or for personal use subject to such conditions as may be prescribed:
 
Provided further that the Central Government may, in consultation with the Medical Devices Technical Advisory Board, by notification permit, subject to any conditions specified therein, the import or manufacture of any notified category of medical device not approved by the Central Government or not of standard quality for sale or for distribution.
 
(2) No person shall himself or by any other person on his behalf sell or stock or distribute or exhibit or offer for sale any notified category of medical device referred to in sub-section (1) which has been imported or manufactured in contravention of any of the provisions of this Act or any rule made there under
 
3) No person shall himself or by any other person on his behalf sell, or stock or exhibit or offer for sale, or distribution any notified category of medical device,
 
except under and in accordance with a licence issued under this Chapter by the State Licensing Authority:
 
(4) On and from the commencement of the Drugs and Cosmetics (Amendment) Act, 2014, the Central Licensing Authority shall have exclusive power to issue a licence for the manufacture for sale or distribution or marketing of any medical device in such manner as may be prescribed.
Application of law relating to sea customs and powers of Customs Officers.
7G. (1) The law for the time being in force relating to customs and goods, the import of which is prohibited by the Customs Act, 1962 or rules made or notifications issued there under or any other law for the time being in force shall, subject to the provisions of section 7J, section 7K and section 7L of this Act, apply in respect of notified category of medical device, the import of which is prohibited under this Chapter, and officers of Customs and officers empowered under that Act or law to perform the duties imposed thereby on a Customs Collector and other officers of Customs, shall have the same powers in respect of such notified category of medical device as they have for the time being in respect of such goods as aforesaid.
 
(2) Without prejudice to the provisions of sub-section (1), the Commissioner of Customs or any officer of the Government authorised by the Central Government in this behalf, may detain any imported package which he suspects to contain any notified category of medical device, the import of which is prohibited under this Chapter or any other law for the time being in force and shall forthwith report such detention to the Drugs Controller General of India and, if necessary, forward the package or sample of any suspected medical device found therein to the Laboratory prescribed for the purpose:
 
Provided that in the event of that package or sample of that notified category of medical device found in contravention of any of the provisions of this Chapter or any rule made thereunder, the same shall not be allowed to be imported from that or any other port of entry in the country.
 
7H. (1) The Central Government or a State Government may, by notification, for the purposes of this Chapter, appoint such persons, as it thinks fit, having such qualifications and experience as may be prescribed to be the Drugs Control Officers for such areas as may be assigned to them.
 
(2) The powers and duties of the Drugs Control Officer shall be such as may be Prescribed
 
(3) No person who has any financial interest in the import, manufacture or sale or distribution of notified category of medical devices shall be appointed to be a Drugs Control Officer under this section.
45 of 1860.
(4) Every Drugs Control Officer shall be subordinate to such authority having the prescribed qualifications and experience and deemed to be a public servant within the meaning of section 21 of the Indian Penal Code.
eMedinewS Humor
Organized Crime
No matter how much the government fights it, organized crime just seems to get more organized every day. The police pulled in a Mob kingpin recently and reminded him he had the right to make a phone call.
"Just fax the arrest report to my lawyer," the mobster said calmly.
Media
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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
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The Year in Medicine 2014: News That Made a Difference
12. Morcellation
Laparoscopic power morcellators should no longer be used for hysterectomy or myomectomy in most women with uterine fibroids because of the risk of spreading unsuspected cancerous tissue, the US Food and Drug Administration (FDA) warned on April 17. At the end of July, Johnson & Johnson announced a global withdrawal of its laparoscopic power morcellators. In November, the FDA issued a tougher warning against using laparoscopic power morcellators in hysterectomy and myomectomy to remove uterine fibroid tumors, saying surgeons should avoid them in the vast majority of women. Two days later, HCA Holdings Inc, the largest for-profit hospital operator in the United States, said power morcellation for removing uterine fibroids will no longer be performed at its facilities. The issue has received attention because of publicity around the upstaging of leiomyosarcoma in Amy Reed, MD (above left), an anesthesiologist who had undergone power morcellation at Brigham & Women's Hospital in Boston. Her husband, Hooman Noorchashm, MD, PhD (above right), a cardiothoracic surgeon, helped publicize the issue beginning last fall, and the two physicians are now "on a mission to ban the practice of morcellation in any form. (Source: Medscape)
News around the Globe
  • A new study from the Dana-Farber Cancer Institute has shown that vitamin D can help the body fight against colorectal cancer by boosting the immune system. The study is published in Gut.
  • One of the most important elements of improving physical function in patients with chronic fatigue syndrome is using therapy to reduce fear that exercise will worsen rather than improve symptoms, suggests a new trial published in the journal The Lancet Psychiatry.
  • Thermo-ablative fractional CO2 laser is a safe, well tolerated, and effective treatment option for relieving severe symptoms of vulvo-vaginal atrophy in post-menopausal women, suggests a recent study published online in Maturitas.
  • A new larger-reservoir insulin pump has been approved by the US Food and Drug Administration for use in patients aged 12 and over with both type 1 and type 2 diabetes.
  • Needle biopsies of the pancreas are not associated with an increased risk for death in patients with pancreatic cancer, suggests a retrospective study published online in Gut.
Sub-Standard Drugs
Shri Anant Gupte inquired about the sub-standard/fake and spurious drugs in the country which threatens public health system and the effective steps taken by the government in tackling this problem. The Minister of State for Health and Family Welfare replied saying that as per reports from the State Drug Licensing Authorities during the period 1993-96, 10-12% samples of drugs tested were found to be substandard, whereas 0.2% samples were found to be of spurious origin. The State licensing authorities have been advised from time to time, to strengthen their enforcement staff and drugs testing facilities to curb the menace of manufacture and sale of sub-standard drugs. However, under the public health capacity building project being negotiated with the World Bank, Government proposes to augment the drug testing facilities and drug inspectorate staff in the centre and the states. (LS USQ 20 23-7-1997) http://www.thehindubusinessline.com/opinion/merchants-of-death-in-indian-pharma/article6618600.ece
Salim Yusuf is the World Heart Federation’s New President
The World Heart Federation is delighted to announce that Dr Salim Yusuf has begun his tenure as the new President of the organisation, following on from immediate Past-President, Prof. K. Srinath Reddy. Dr Yusuf will hold the role of President for the next two years, supported by Kingsley K Akinroye as Vice-President, replacing outgoing Vice-President Deborah Chen.
Dr KK Spiritual Blog
Positive Attitudes

All those out there who feel you are at your wits end wondering how things don’t ever work out for you, can now relax and dwell on all those failures that life has taken you through and turn failure into success.
  1. Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
  2. Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
  3. Failure doesn’t mean you have been foolish. It does mean you had a lot of faith.
  4. Failure doesn’t mean you’ve been discouraged. It does mean you were willing to try.
  5. Failure doesn’t mean you don’t know how to do it. It does mean you have to do it in a different way.
  6. Failure doesn’t mean you are inferior. It does mean you are not perfect.
  7. Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
  8. Failure doesn’t mean you should give up. It does mean you must try harder.
  9. Failure doesn’t mean you’ll never make it. It does mean it will take a little longer.
  10. Failure doesn’t mean God has abandoned you. It does mean God has a better idea.
Inspirational Story
Planting Potatoes

When I was a boy growing up we had several gardens around our old house. The largest one of all was used just for growing potatoes.

I can still remember those potato planting days. The whole family helped. After my Dad had tilled the soil, my Mom, brothers, and I went to work. It was my job to drop the little seed potatoes in the rows while my Mom dropped handfuls of fertilizer beside them. My brothers then covered them all with the freshly turned earth.

For months afterward I would glance over at the garden while I played outside and wonder what was going on underneath the ground. When the harvest time came I was amazed at the huge size of the potatoes my Dad pulled out of the soil. Those little seedlings had grown into bushels and bushels of sweet sustenance. They would be turned into meal after meal of baked potatoes, mashed potatoes, fried potatoes, and my personal favorite: potatoes slowed cooked in spaghetti sauce. They would keep the entire family well fed throughout the whole year. It truly was a miracle to behold.

Thinking back on those special times makes me wonder how many other seeds I have planted in this life that have grown unseen in the hearts and minds of others. How many times has God used some little thing that I said or did to grow something beautiful? How many times has Heaven used these little seedlings to provide another’s soul with sweet sustenance?

Every single day of our lives we step out into the garden of this world. Every single day we plant seeds that can grow into something wonderful. We may never see the growth that comes from the kind words or loving acts we share but God does. I hope then that you always tend the garden around you with care. I hope that you plant only goodness, peace, and compassion in the lives of everyone you meet. I hope that every day you help miracles to grow.
Rabies News (Dr A K Gupta)
Can a rabies vaccine be given to a pregnant woman?
Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.
Cardiology eMedinewS
  • Women with a history of pre-eclampsia - particularly severe pre-eclampsia or multiple episodes - are at increased risk for developing atherosclerotic disease, suggests a population-based study published online in Heart.
  • A new post-marketing study evaluating the safety of once-daily rivaroxaban shows, in patients with non-valvular atrial fibrillation (NVAF), rates and patterns of major bleeding in routine clinical practice are generally consistent with those observed in Phase 3 clinical trials used to approve the medicine for this indication. The results are published in Clinical Cardiology.
Pediatrics eMedinewS
  • Pooled data suggest that fish oil-containing lipid emulsion is effective for reversing parenteral nutrition-associated cholestasis (PNAC) in neonates, suggests new research published online in The Journal of Nutrition.
  • Kids who ride home from school, whether in a car or on a bus, eat more snacks and candy during that window of opportunity than those who get home under their own steam, suggests a new study published online in the Journal of Preventive Medicine.
Wellness Blog
Cycling can cause erectile dysfunction

Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. Those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term "impotent" is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.
Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.
Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.
Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.
Bicycling: Less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.
Cycling-induced impotence is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.
The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.
Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting ten minutes.
eMedi Quiz
The buffering capacity of a buffer is maximum at pH equal to:
1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa
Yesterday’s Mind Teaser: In a patient with a tumor in superior mediastinum compressing the superior vena cava, all the following veins would serve as alternate pathways for the blood to return to the right atrium, except:
1. Lateral thoracic vein.
2. Internal thoracic vein.
3. Hemiazygos vein.
4. Vertebral venous plexus.
Answer for yesterday’s Mind Teaser: 4.Vertebral venous plexus.
Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan.
Answer for 17th Jan Mind Teaser: 2.Propionyl CoA.
Correct Answers receives: Daivadheenam Jella, Dr Avtar Krishan.
Events
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Medicolegal
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Dr Good Dr Bad
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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.
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
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
Press Release of the Day
Tobacco Spiting at public places will now be an offence – IMA

IMA has welcomed the new Tobacco Amendment Bill 2015 (COTPA) where Govt. of India has proposed banning spiting tobacco in the public place.

In a joint statement, Padma Shri Awardee Prof Dr A Marthanda Pillai, National President, and Padma Shri Awardee Prof Dr K K Aggarwal, Hony Secretary General Indian Medical association and President, Heart Care Foundation, said “the tobacco spiting in public place is one of the biggest cause of spread of infection such as TB, Pneumonia, H1N1 Flu, Avian Flu and other ear, nose and throat infections. TB bacilli can survive in spit for an entire day. TB kill over two lakhs Indians every year.

IMA however wanted instead of banning tobacco spit, the Govt. of India should have banned spiting in public place as an offence.

IMA also welcomed
  • that now tobacco industry control will no more be with a State government but taken over by the Union Government.
  • That indirect tobacco (surrogate) advertisements and promotions will be included as a violation of the act
  • That the word Advertisement now has been broadened to include marketing, promotion or advertising through goods, services and events
  • That apart from print, Radio, TV the ban will include, Mobile internet and any other new technologies.
  • That banning the sale- purchase of tobacco products will now be applicable to all people below 21 years. It is known that if a person is kept away from tobacco for first 21 years of life there is very high probability that he/she would not start tobacco consumption. Government is likely to increase this age from 21 years to 25 years for a period of time.
  • That on the packets of tobacco products apart from bold warning one would also have to disclose constituents and emissions of tobacco products instead of mentioning only nicotine and tar contents
  • That there will be designated courts for trial of tobacco related offences
  • That no loose cigarette or tobacco products will be sold in the market.
  • That the sale of tobacco products will not be allowed within a radius of 100 yards of educational institutions. (earlier it was 100 meters.)
  • That Government will set up National Tobacco Control Organization ( NTCO)
  • That except for some designated areas in airports no non smoking areas will be built up in areas like hotels, restaurants etc.
IMA suggestions
  1. That all offence under the act should be non bailable.
  2. Infact IMa stand is to ban tobacco products all together and till, they are banned to make them available with a chemist as a drug
  3. Any form of spiting should be banned in public places not only tobacco spiting
  4. Doctors and celebrities should be prohibited to consume tobacco products in public
  5. Proposed fines/punishment u/s 20 to be raised as under:-
    1. Any person who products or manufactures cigarettes or any other tobacco products, which do not contain either on the package or on their label, the specified warning shall in the case of first conviction be punishable with imprisonment for a term which may extend to three years, or with both, and for the second or subsequent conviction, with imprisonment for term which may extend to five years and with fine which may extend to 10 lakhs rupees
    2. Any person who sells or distributes cigarettes or any other tobacco products which do not contain on the package or on their label, the specified warning shall in the case of first conviction be punishable with imprisonment of a term, which may extend to three years, or with fine which may extend to one lac rupees, or with both, and, for the second or subsequent conviction. With imprisonment for a term which may extend to five years and with fine which may extend to ten lak rupees
    3. Any person who produces or manufactures cigarettes or any other tobacco products, does not disclose to the government the constituents and emissions of cigarettes or any tobacco products shall in the case of first conviction be punishable with imprisonment for a term which may extend to five year or with fine which may extend one lac subsequent conviction, with imprisonment for a term which may extend to 10 years and with find which may extend to 5 lakhs rupees
    4. Any person who produces or manufactures cigarettes or any other tobacco products, which do not contain either on the package or on their label, the constituents and emissions, shall in the case of first conviction be punishable with imprisonment for a term which may extend to five year or with fine which may extend one lac rupees or with both, and for the second or subsequent conviction, with imprisonment for a term which may extend to five years and with find which may extend to five lakh rupees
Reader Response
  • Thank you for the e-journal. I hope I can suggest something: The unguarded advice on HRT for women above 65 years seems contrary to the conclusions of large scale clinical trials and one would not recommend HRT for improving general health. There was increased cardiovascular risk with large scale use of HRT. Rather HRT is recommended only for specific symptoms and not for prevention of heart disease, though in a subset, only ERT may be beneficial, hence individualized recommendation is expected. Hormone analogues also can be used for prevention of osteoporosis. Regards, Dr Jayashree Joshi, MD, PhD, Mumbai
  • Dear Dr KK Aggarwal, it is v informative in r/o vit D/Heart risk, artificial sweeteners & salt, asthma & OSA, obesity & VBLOC etc. Thanks, keep it up: Dr VK Agarwal