May 27 2015, Wednesday
Text of the speech delivered at Maharashtra University of Health Sciences, Nashik on 25th May, 2015 by Dr Jayshree Ben Mehta
Ladies and Gentleman

It gives me immense pleasure in participating in this notable inaugural session of Maharashtra University of Health Sciences, and UNESCO sponsored 3T Bioethics Training Programme, which in my opinion is a significant event of consequence and relevance alike.

In order to understand the concept of ‘Bioethics’ it is imperative that we are clear and loud about the core contours of ‘Ethics’. The dictionary definition of Ethics bring it out as ‘a set of principles of right conduct, or a theory or a system of moral values or the study of the general nature of morals or the rules or standards governing the conduct of a person or the members of a profession.

This brings us to a material question that if ethics are the study of morals and the philosophical process of considering what is moral and what is not then what exactly are the concrete ethical convictions underlying the bioethical evaluation process? The answer to the same is the objectivist view that ‘any action that willingly and directly benefits the well-being of a conscious human being is ethical, as long as it doesn’t willingly and directly harm any other conscious human being.

Society demands general respect for the human body and its parts. Human tissue should not be used at will or abused. Increasing public concern has been expressed over a number of ethical issues raised by the uses of human tissue ever since 1980s and continues till date. As such, it has turned out to be imperative that there is an important and urgent need to consider, clarify and where necessary, strengthen the ethical and legal framework within which the clinical and research usage of human tissue take place.

This is required to be evaluated in the context of the material fact that ethical question in medicine and life sciences are the subject of not one but two relatively new academic fields namely ‘bioethics’ and ‘health’ and human rights’. The growth of these fields has stimulated further attention to important moral questions in medicine and biology. Although this is to be welcomed there is also much to be regretted about the route bioethics has taken and about the very emergence of health and human rights as distinct academic field. More specifically, bioethics suffers from some serious quality control problems, while health and human rights seems to be in violation of a disciplinary version of Occam’s razor which proscribes the proliferation of discipline or fields beyond necessity. In other words, health and human rights, as an academic field does not seem to do anything that cannot be done either by bioethics, if the rights in questions are moral right, or by the law if the rights are legal rather than moral.

Bioethics per se can be understood in a broader or narrower way. Following the broader way, bioethics includes not only philosophical study of ethics of medicine, but also such areas as medical law, medical anthropology, medical sociology, health politics, health economics and even some areas of medicine itself. On the narrower side, it is limited to an area of philosophical enquiry.

The field of bioethics operationally has addressed a broad arena of human enquiry ranging from debates over the boundaries of life, surrogacy, the allocation of scarce health care resources to the right to refused medical care for religious or cultural reasons. However, the scope of bioethics has expanded with advancement in biotechnology including cloning, gene therapy, life extension, human genetic engineering, astroethics and life in space, and manipulation of basic biology through proteomics. These developments are bound to affect the future evolution and inevitably need new principles that address life at its score, such as biotic ethics that values life itself at its basic biological processes and structures and seeks their propagation.

One of the first areas addressed by modern bioethicists was that of human experimentation. The national commission for the protection of human subjects of biomedical and behavioural research was initially established in 1974 to identify the basic ethical principles that should underline the conduct of said research involving human subjects. However, the fundamental principles announced in the ‘Belmont Report’ in 1979 pertaining to autonomy beneficence and justice have influenced the thinking the world over across a wide range of issues.

In the context of multifaceted development an advancement worldwide and further as the 21st Century advances new and expanding areas of research will require increasing attention to their related ethical aspects. Neuroethics as one of the significant area pertaining to knowledge about human brain holds much promise and offers much needed hope to those who suffer from disorders of brain and mind. The relative accessibility of the brain through biochemical, electrical, and magnetic stimulation as well as surgery, makes neurological intervention tempting of knowledge as brain structure writing and chemistry grows. However, there has been very little systematic analysis of the ethical implications of the revolution in the brain sciences. So is the situation with reference to the ‘essence of personhood and identity’ in the context of relation between physiological structures and higher functioning in the domain of ‘mind or self’. Similar is the situation in the context of eugenics and also ‘when should a person die’.

In the quagmire of the said scenario, the initiative undertaken by Maharashtra Universities of Health Sciences, Nashik and UNESCO is laudable which is bound to give a new fillip to the face and facet of this vital arena in all its dimensions and manifestations.

I record my appreciation for the laudable initiative and hope and expect that it will definitely generate its own imprints on the stands of time.

Thank you,
Jai Hind

Dr Jayshree Ben Mehta
President
MCI
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IMA-USV Vitamin D Deficiency CME held on 24-5-2015 at IMA House, New Delhi
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News
  • Cancer patients with brain metastases who develop venous thromboembolism can safely receive anticoagulant therapy without increasing their risk for intracranial hemorrhage, suggests new research published online in Blood.
  • A drug aimed at preventing osteoporosis appears to help the cognitive deficits associated with schizophrenia, suggested new research presented at the annual meeting of the American Psychiatric Association. Researchers noted that daily raloxifene improved working memory and attention/processing speed.
  • Drinking 2 to 3 cups of coffee every day could lower a man's risk of erectile dysfunction, suggests a new study published in the journal PLos One.
  • Gastroesophageal reflux disease (GERD), being female and certain scores on the St. George's Respiratory Questionnaire (SGRQ) were associated with exacerbations of chronic obstructive pulmonary disease (COPD) in subjects using long-acting controller medication, reported a study presented at the 2015 American Thoracic Society International Conference.
  • A new study suggests people who work shifts are more likely to have sleep problems than people who follow conventional work schedules, and this may raise their risk of metabolic disorders such as obesity and diabetes. The findings are published in Sleep Health.
Dr KK Spiritual Blog
Spiritual Prescription: Who am I? Know Your Soul Profile

"I am not my physical body, as I know, once my body dies, nobody wants to touch it." (Adi Shankaracharya in the Bhaja Govindam)

"I am not my mind as I know whenever I am in trouble; the mind asks the heart for help" (Deepak Chopra in the Seven Spiritual Laws of Success).

"I am my consciousness which is residing in the core of my heart" (Svetasvatara Upanisad 5.8).

"This consciousness is nothing but a web of energized information situated in the void" (Chandogya Upanishad Chapter XII — the Birth of the Gross from the Subtle)

"the consciousness is timeless, has no beginning, no end, weapons cannot cut it, air cannot dry it, water cannot wet it and fire cannot burn it" (Bhagavad Gita 2.23, 24).

Each one of us has a physical profile (as defined by our height, complexion, collar number, waist size, etc.) and has a mental or ego profile. A few examples of ego profile: my bank balance, car, job designation, locality of residence, size of house, contacts, power, clothes’, etc.

Similarly each one of us also has a soul profile. We should give sometime to ourselves for knowing our soul profile and revisit it at least once in a week.

According to Deepak Chopra, to know the soul profile one should ask seven questions to his or her consciousness while sitting in a meditative poise or in state of relaxation. The answer to each question should be either in three words or three phrases.
  1. What is my purpose of life?
  2. What is my contribution going to be for my friends and family?
  3. Three instances in my life when I had my peak experiences.
  4. Names of three people who inspire me the most.
  5. Three qualities which I admire in others the most.
  6. Three of my unique talents.
  7. Three qualities I best express in my relationship.
These twenty one answers will characterize your soul profile or will be your passport for every action you perform in your life.

In day–to–day’s life, one should act from the soul profile and not from the ego profile. Soul profile cannot be manipulated while the ego profile can be.

There are only three ways of improving one’s soul profile and these are:
  1. The choices one makes should be soul–profile oriented and not ego–profile oriented. Whenever there is an opportunity for an action, ask the head for choices, then ask the heart to choose one, and finally order the hand to take action. A soul–based action is the one which is based on the truth, is necessary, and which makes the person and the people around him or her, both happy.
  2. Total clarity of vision of "What do I want" and also "What I don’t want".
  3. Learn to enter into discontinuity of thought processes using "beej mantra" or doing primordial sound meditation 20 minutes in the morning and 20 minutes in the evening.
These can also be equated to the eight limbs of Yoga Sutras of Patanjali, where the "choices I make" represents Yama and Niyama, "what do I want" represents Dharma and the "entering into discontinuity" represents Dhyana and Samadhi.
Cardiology eMedinewS
  • Percutaneous coronary intervention (PCI) patients have a high prevalence of obstructive sleep apnea (OSA) with nontypical presentations, suggested a large international study presented at the American Thoracic Society annual meeting.
  • Cognitive impairment could predict worse outcomes such as readmission to hospital or death in older heart failure patients, suggests a new study presented at Heart Failure 2015, the main annual meeting of the Heart Failure Association of the European Society of Cardiology (ESC).
Pediatrics eMedinewS
  • Urinalysis (UA) in young infants with bacteremic urinary tract infection (UTI) is more sensitive than previous research suggested it was in infants with UTI in general, reported new research published online May 25 and in the June issue of Pediatrics.
  • Healthy mothers and children are frequently colonized with pathogenic Escherichia coli that are resistant to ciprofloxacin as well as multiple additional antibiotics, suggests new research published online in the Journal of Infectious Diseases
Make Sure
Situation: A patient on ACE inhibitor developed angioedema.
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 in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
Dr Good Dr Bad
Situation: A 24-year-old male was on nimesulide
Dr Bad: Stop it. It is banned all over the world
Dr Good: Continue it
Lesson: Nimesulide is not banned in India for use in adults.
(Copyright IJCP)
Legal
Can MCI take over the case if state medical council does not decide it in six months?

Yes, as per MCI Ethics Regulations 8.7, which states as follows: “Where either on a request or otherwise the Medical Council of India is informed that any complaint against a delinquent physician has not been decided by a State Medical Council within a period of six months from the date of receipt of complaint by it and further the MCI has reason to believe that there is no justified reason for not deciding the complaint within the said prescribed period, the Medical Council of India may-

(i) Impress upon the concerned State Medical council to conclude and decide the complaint within a time bound schedule;

(ii) May decide to withdraw the said complaint pending with the concerned State Medical Council straightaway or after the expiry of the period which had been stipulated by the MCI in accordance with para(i) above, to itself and refer the same to the Ethical Committee of the Council for its expeditious disposal in a period of not more than six months from the receipt of the complaint in the office of the Medical Council of India.”

If the MCI has taken over the case, can the State Medical Council continue its investigations?

No

If MCI has taken the decision can State Medical Council refuse to follow the same on the grounds that it is looking on it independently?

No.

Reference: Kolkata High Court Judgment 12 5.5.2015, CAN 4073 of 2015, in MAT 634 of 2015, (Joydib Basu vs. Medical Council of India & Ors.)
  • The appellant has approached this Court challenging the impugned order passed by a learned single Judge of this Court. By the said order, the learned Judge has directed the respondent Authorities to place on record affidavit in opposition.
  • According to the appellant, there was no justification for such direction since the appellant is being put to hardship and inconvenience as the proceeding initiated before the Medical Council of India had reached its logical conclusion and at the same time the State Council is simultaneously proceeding against the appellant. So far as the decision of the Medical Council of India to proceed with the matter, when the West Bengal Medical Council did not complete the enquiry within six months’ time frame given by Medical Council of India, is the subject matter of challenge before the learned single Judge. On the very same complaint after the decision by the Medical Council of India was taken, the State Medical Council seems to be proceeding with the matter which is nothing but double jeopardy. As the subject matter of writ petition is the final decision of the Medical Council of India on the complaint of the husband of the deceased, we direct the West Bengal Medical Council not to proceed with the enquiry now sought to be reopened by them.
  • Learned counsel for the private respondent makes it clear that he is not pursuing any action so far as West Bengal State Medical Council is concerned.
  • Hence we direct the State Medical Council not to proceed with the matter so far as the impugned order is concerned. We find at this stage since discretionary power was exercised by the learned single Judge, we need not consider the matter on merits. Accordingly, the appeal is dismissed.
  • However, the State Medical Council in terms of the final decision of the Medical Council of India is required to proceed with the matter in accordance with the procedure so far as suspension registration of the appellant unless appropriate direction staying such action comes from the Court of law.
  • In view of the dismissal of the appeal, the application for stay being CAN 4073 of the 2015 is dismissed.

    (Manjula Chellur, Chief Justice)

    (Joymalya Bagchi, J.)
Events
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eMedinewS Humor
During their silver anniversary, a wife reminded her husband: Do you remember when you proposed to me, I was so overwhelmed that I didn’t talk for an hour?" The hubby replied: "Yes, honey, that was the happiest hour of my life."
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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
Rabies News (Dr A K Gupta)
Can the IM and ID routes of vaccination be used interchangeably?
 

Many internationally reputed experts recommend that the phenomenon of mixing of IM and ID schedules is not to be practiced and must be avoided as far as possible.

eIMA News
IMA Swachch Bharat Swastha Bharat
Observe IMA Hygiene Hour Every Friday 4-5 p.m. Do one hour cleanliness awareness drive.

A doctor with a state-run hospital in Jammu was suspended on Monday for alleged negligence that led to the death of a patient, an official said. The resident doctors' association, however, contested the suspension and alleged not the doctor's negligence but reaction from the drip caused the patient's death. (IMA has asked for details)

Defying his own hospital’s report, which showed complications in one of the kidneys of a six-year-old girl, a doctor at AIIMS allegedly removed both the kidneys and later claimed that the patient had just one. The hospital has denied having knowledge of the incident. (No excuse, before surgery you need to confirm that the kidney is present and is functioning)
Private Hospital in a Fix Over 'Negligence'
By Express News Service

Bengaluru: Two young mothers, Aruna (22) and Chitra (20), have filed complaints with Yelahanka Old Town police that their newborn babies died due to the negligence of the authorities of a private hospital.

According to police sources, Chitra, a resident of Sabrehalli near Devanahalli toll gate, was admitted to the hospital a few days ago. On Sunday, she gave birth to a baby girl. But while she was being discharged on Monday, the hospital authorities allegedly gave the baby an injection that led to a health complication, and eventually her death.

Aruna, a resident of Chikkajala, complained that her baby was given BCG and Polio injection around 3 pm on Monday, but the baby developed a health complication soon after and passed away.

Yelahanka Old Town police inspector Rajeev said, “Based on the complaint, we have registered a case of medical negligence and the bodies have been sent to Ambedkar Medical College (for autopsy). We are waiting for the test results.”

(IMA has asked the state branch to follow and send all reports)

There have been only 24 cases of polio worldwide this year as of May 20 according to the Global Polio Eradication Initiative, a public-private partnership led by national governments and spearheaded by the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention and the United Nations Children’s Fund.

Last year at April 20 there were 82 cases reported and ten more from vaccine derived doses.

See more at: http://www.waterloorotary.org/ Stories/more-good-news-about- polio-eradication#sthash. 5bJVdj4e.dpuf

The California Medical Association (CMA) officially adopted a neutral stance on physician-assisted suicide last week, ushering California closer to legalizing euthanasia.
Panel tells cardiac stent makers to provide price details
Tuesday, 26 May 2015, DNA Correspondent

In order to check over pricing of cardiac stents, the National Pharmaceutical Pricing Authority has written to all manufacturers of orthopaedic implants asking them for product details and prices. The development comes within a week of Food and Drug Administration (FDA) writing a letter to the authority on over pricing issues.

In its letter, the NPPA has reminded the companies that since medical devices like orthopaedic implants fall under non-scheduled drug category, their prices can be increased only up to 10% of MRP annually.

The letter added that in addition to the penalty, manufacturers/importers/ distributors shall be liable to deposit the overcharged amount along with interest thereon from the date of increase in price.

Dr Dilip Nadkarni, orthopaedic surgeon at Lilavati Hospital, called this as a good move by NPPA. "It will not only bring uniformity but make the process very transparent and standardised," said Dr Nadkarni.

Apart from NPPA, the state government is also closely following the over pricing issue in cardiac stents and orthopaedic implants. Doctors say that like in cardiac stents, where there is a huge disparity in manufacturing and selling prices, orthopaedic implants are also priced exorbitantly. Dr Shubhranshu Mohanty, orthopaedic surgeon attached to KEM Hospital and a member of Indian Orthopaedic Association, said, "In private hospitals, they charge their profit margin too which is from 10-20%. The pricing of the implants in different hospitals differs too. In public hospitals, where the demand is huge, the manufacturers give heavy discount."

Surprisingly, this isn't the first move by the NPPA to regulate the prices of stents and implants. In 2011, the state's FDA had written to the Drug Controller of India that life-saving medical devices like stents, pacemakers, orthopedic implants among other things should be included in the Drug Price Control Order (DPCO). In 2014, the NPPA had sought pricing data from the manufacturers, importers and distributors of cardiac stents, drug-eluting stents and orthopaedic implants.

"This is a good move. If the state government really looks into the pricing of plant, then it will definitely help patients," said Dr Jayesh Lele, president-elect of Indian Medical Association, Maharashtra.
World No Tobacco Day
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Inspirational Story
The Story of a Woodcutter

Once upon a time, a very strong woodcutter asked for a job in a timber merchant and he got it. The pay was really good and so was the work condition. For those reasons, the woodcutter was determined to do his best.

His boss gave him an axe and showed him the area where he supposed to work. The first day, the woodcutter brought 18 trees. "Congratulations," the boss said. "Go on that way!"

Very motivated by the boss words, the woodcutter tried harder the next day, but he could only bring 15 trees. The third day he tried even harder, but he could only bring 10 trees. Day after day he was bringing less and less trees.

"I must be losing my strength", the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on. "When was the last time you sharpened your axe?" the boss asked. "Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut trees…"

Reflection: Our lives are like that. We sometimes get so busy that we don’t take time to sharpen the "axe". In today’s world, it seems that everyone is busier than ever, but less happy that ever.

Why is that? Could it be that we have forgotten how to stay "sharp"? There’s nothing wrong with activity and hard work. But we should not get so busy that we neglect the truly important things in life, like our personal life, taking time to get close to our Creator, giving more time for our family, taking time to read etc.

We all need time to relax, to think and meditate, to learn and grow. If we don’t take the time to sharpen the "axe", we will become dull and lose our effectiveness.
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
IMA in Social Media
Reader Response
  • Dear Sir, It's a good piece of guideline to prevent the consumption of tobacco as well tackling smokers to quit smoking on this World No Tobacco day. As a first step in this direction of NO TOBACCO, let us start from ourselves. There are many doctors who are smokers and I know some smoking in front of patients. It is essential to advice our medical community to quit smoking as a role model for others, the patients in particular. Without quitting smoking ourselves, we have no moral authority to advice others. All gatherings of IMA and other sister associations and all CME programs, seminars and other medical conferences must be strictly made smoking-free. All the staff of the clinics and hospitals must be instructed not to consume tobacco in any form and this should be basic qualification for all new recruits. Hope everyone realizes the importance of no tobacco in one's life as it is a slow poison in one's life. Thanking you, yours sincerely: Dr Jaya Prakash Reddy
Wellness Blog
Three simple ways for a restful sleep
  • Cut down on caffeine: Caffeine drinkers may find it harder to fall asleep. Even a single cup of coffee in the morning may lead to a sleepless night. Caffeine blocks the effects of adenosine, a neurotransmitter thought to promote sleep. Caffeine can also interrupt sleep by increasing the need to urinate during the night. Because caffeine withdrawal can cause headaches, irritability, and extreme fatigue, it may be easier to cut back gradually rather than to go cold turkey. Those who can’t or don’t want to give up caffeine should avoid it after 2 p.m., or noon if they are especially caffeine–sensitive.
  • Stop smoking or chewing tobacco: Nicotine is a central nervous system stimulant that can cause insomnia. If you continue to use tobacco, avoid smoking or chewing it for at least 1 to 2 hours before bedtime.
  • Limit alcohol intake: Alcohol depresses the nervous system, so a nightcap may seem to help some people fall asleep. Alcohol suppresses REM sleep, and the soporific effects disappear after a few hours. Alcohol also worsens snoring and other sleep breathing problems.
eMedi Quiz
The parameters of sensitivity and specificity are used to assess:

1. Criterion validity.
2. Construct validity.
3. Discriminant validity.
4. Content validity.

Yesterday’s Mind Teaser: The substances present in the gallbladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X-ray diffraction.

Answer for yesterday’s Mind Teaser: 4. X-ray diffraction.
Correct Answers received from: Dr A K (Jain) Diwaker, Dr K Raju, Satish Gulati, Dr G Madhusudhan, Dr Avtar Krishan, Dr K V Sarma.
Answer for 25th May Mind Teaser: 3. Gelfiltration chromatography
Correct Answers received: Dr Shangarpawar, Dr K Raju, Dr Poonam Chablani, Dr Avtar Krishan.
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Press Release
Abundant sunshine available in the Capital during peak summer months, yet 80 – 90% of the city’s population remains Vitamin D deficient

Indian Medical Association trains doctors in New Delhi on the urgent need to raise awareness about Vitamin D deficiency under its Rise & Shine campaign

A CME was organized in New Delhi today by the Indian Medical Association to discuss the growing concern about the rise of Vitamin D deficiency cases amongst the Indian population. Lately, studies have revealed that in addition to the known skeletal effects of Vitamin D deficiency, it can also have serious long-term impact on the health of people making them vulnerable to diseases such as heart attacks, cognitive disorders, type 2 diabetes and cancer. The CME was an initiative under IMA’s Rise and Shine campaign and was attended by around 70 doctors.

The IMA Rise and Shine campaign is a National movement initiated by the Indian Medical Association under an unconditional educational grant from leading pharmaceutical company USV. It is aimed at sensitizing its 2.5-lakh members across 30 states and 1700 branches over the next two years about the need to raise awareness of Vitamin D deficiency. The campaign also aims to provide essential soft skills training to all doctors on topics such as public speaking, managing patient records online, adapting to the new mobile app culture, how to break the news of death to a patient's family.

Addressing the media, Padma Shri Awardees Dr. A Marthanda Pillai – National President and Dr. KK Aggarwal – Honorary Secretary General of the Indian Medical Association in a joint statement said, “For the next two years, the IMA Rise & Shine campaign will raise awareness about Vitamin D deficiency and address the skill gap that exists in the healthcare sector. A serious concern for the medical fraternity is that most people in our country are unaware that they are Vitamin D deficient. The onus lies on the doctors to recognize common signs of vitamin D deficiency in their patients such as tiredness, vague aches, and pains and advise them the right diet plans and supplementation to cure it. In the long run, a National policy on Vitamin D food fortification similar to that being practiced in the US and some European countries is needed to help eradicate the problem from its root itself.”

Adding to this, Dr. Ambrish Mithal, Chairman, Division of Endocrinology & Diabetes, Medanta – The Medicity and Dr. Ajay K Ajmani, Senior Consultant Endocrinologist, BLK Super Specialty Hospital in a joint statement said, “Vitamin D deficiency is rapidly gaining epidemic proportions yet it is the most under diagnosed and under treated nutritional deficiency in the world. Vitamin D, which can be synthesized in the body by sun exposure, is essential to maintain calcium homeostasis in the body for good bone health and for overall disease prevention. Supplementation is required when adequate levels are not met from natural sources. Indians are more prone to Vitamin D deficiency for several reasons including long and stressful working hours in a closed office space, consumption of a predominantly vegetarian diet and obesity amongst others. The need of the hour is to raise awareness about this problem and possible prevention measures.”

The IMA Rise and Shine campaign, in addition to conducting CMEs and soft skill training workshops across 128 cities, also comprises of a National daily SMS campaign for doctors, awareness through an active Facebook page, regular State and National Body meetings and public sensitization events.

IMA released certain guidelines for doctors during the CME. These include:
  • Indians require higher levels of vitamin D supplementation than their Western counterparts.
  • The typical dose of Vitamin D supplementation in Indian adults is about 2000 International units per day.
  • Doses up to 4000 IU daily are considered safe and do not require monitoring. Toxicity has not been reported below intakes of 10000 IU/day.
  • The optimum serum 25(OH)D level for patients with bone disorders like osteoporosis is 30 ng/dL (International Osteoporosis Foundation 2010, Endocrine Society 2011)
  • A serum 25(OH)D level of 30 ng/ml is also preferable for older adults (>50 years), who are at risk for osteoporosis (IOF). For other patient groups or population, 25(OH)D values of 20 ng/ml may be considered adequate. Most Indians may require supplementation to achieve this level (International Osteoporosis Foundation 2010)
  • Vitamin D toxicity is most commonly caused by overdose of vitamin D supplements
  • There is no specific antidote for vitamin D toxicity. Hydration, judicious use of loop diuretics, calcitonin, bisphosphonates, and glucocorticoids are mainstay of management