October 28   2015, Wednesday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
Riot Control Agents: The usage and implications of suppressing riots with lethal weapons

The World Medical Association (WMA) during its recent meeting held in Moscow urged all the governments to consider the fatal results that might occur post the usage of chemical agents often used to control riots. Governments across the world should understand that stockpiling and usage of such agents be done in a manner, which minimizes the chances of morbidity and mortality.

History has been a witness to political uprisings or riots in many parts of the world, some more severe than the other. The outcomes of these political and social feuds are an innumerable casualties, destruction and a simmering distrust or conflict between the two parties. In the past, various means were used for law enforcement in the event of such uprisings or riots. The use of poison gas during the First World War is one such example. This ultimately led to a call from the International Committee of the Red Cross (ICRC) in February 1918 for the cessation of its use. This led to the Geneva Protocol of 1925, the Biological and Toxin Weapons Convention of 1972 (BTWC) and the Chemical Weapons Convention of 1993 (CWC).

• These conventions prohibit the development, production and stockpiling of chemical weapons in addition to their usage in warfare and call for measures to decommission or destroy existing stores

• The CWC allows the use of specific chemicals in domestic law enforcement including riot control situations, which means that governments might hold stockpiles of certain agents and use only in domestic or national jurisdictions

• Although there is academic and military interest in what is often called non-lethal weapons, the incidence of morbidity and mortality caused by weapons are not criteria used in prohibition. A tiered approach based on degrees of lethality of specific weapons is contrary to the ethos of both conventions

• The use of riot control agents in situations of widespread public unrest and political or other uprisings may give rise to specific medical, legal and ethical challenges, despite not being in conflict with the principles of CWC

Riot control agents are still being used despite the long-standing concern regarding their safety and associated health hazards.

These riot control agents are not expected to directly cause any injuries or deaths. But they might impact the population based on determinants of age and health.

Release of chemical agents such as tear gas in a small enclosed space exposes individuals to concentrations far higher than those expected in normal deployment in riot situations, causing higher levels of serious morbidity and potentially death.

Their misuse can cause serious harm to the demonstrators and even death. Using chemical weapons for oppressing non-violent peaceful demonstrations, may lead to a breach of the human rights of the individuals concerned, in particular the right to life (Article 3), the right to freedom of expression (Article 19) and of peaceful assembly (Article 20) of the Universal Declaration of Human Rights.

WMA recommendations

• The decision of deploying such riot control agents be taken carefully as their inappropriate use endangers the lives of those targeted and exposes people around, amounting to a potential breach of human rights standards, in particular the right to life, the right to freedom of expression and of peaceful assembly as stated in the Universal Declaration of Human Rights.

• Riot control agents, if used, should be done in a manner designed to minimize the risk of serious harm to individuals, and to prohibit its use in the presence of vulnerable populations, such as children, older people or pregnant women.

• The riot control agents should never be used in enclosed spaces where chemical concentrations may reach dangerous levels, and where people cannot move away from areas with high concentrations of the agent.

• Police and other security forces should be trained in the safe and legal use of riot control agents to minimize the risk of harm when they are deployed such as rapid evacuation of any individual who is apparently suffering from a high level of exposure, not aiming people, and avoiding excessive use of the agent.

• States should penalize individuals who misuse riot control agents and who deliberately endanger human life and safety by using the agents.

• The governments should provide for unrestricted and protected access of healthcare personnel to allow them to fulfill their duty of attending to the injured as outlined in the "WMA Declaration on the protection of healthcare workers in situations of violence."

• Above all, their use in any circumstances should be refrained, considering risks to health and life associated with the use of such riot control agents.
Breaking news
CDC issues warning about fentanyl-related fatalities and seizures

The Centers for Disease Control and Prevention (CDC) has issued an alert about increases in fentanyl drug confiscations and fentanyl-related overdose fatalities. Reports from the National Forensic Laboratory Information System, a program of the Drug Enforcement Administration's (DEA's) Office of Diversion Control, indicate a significant increase in the total number of fentanyl drug seizures reported by forensic laboratories around the country from 2012 to 2014. There were 618 such seizures in 2012, 945 in 2013, and 4585 in 2014. The number of states reporting 20 or more fentanyl seizures every 6 months is also increasing, according to the CDC's Health Alert Network advisory. From July to December 2014, 18 states reported 20 or more fentanyl drug seizures. In contrast, six states reported 20 or more fentanyl drug seizures during the same period in 2013.

Fentanyl, a synthetic and short-acting opioid analgesic, is 50 to 100 times more potent than morphine. It is approved for managing acute or chronic pain associated with advanced cancer. (Medscape)
Dr Good Dr Bad
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Specialty Updates
• Eating a diet rich in fruits and vegetables as a young adult may help lower coronary artery calcium (CAC), a known predictor of CV events, up to two decades later, suggests new research published online October 26 in Circulation.

• The US Food and Drug Administration (FDA) has approved a buprenorphine buccal film product for the treatment of chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment, for whom alternative treatment options are not sufficient.

• Nearly 40% of patients who presented with idiopathic acute anterior uveitis (AAU) had undiagnosed spondyloarthritis (SpA), reported two cohort studies, which evaluated a newly developed algorithm called the Dublin Uveitis Evaluation Tool (DUET). The findings were published in Annals of the Rheumatic Diseases.

• Chronic constipation in adults could be a sign of more serious gastrointestinal (GI) disorders, including ischemic colitis, colorectal cancer, gastric cancer, and diverticulitis, suggested a new study presented at the American College of Gastroenterology 2015 Annual Meeting.

• A new systematic review and meta-analysis has found that the currently available tests with urine-based biomarkers may not be accurate enough to replace standard methods for diagnosis of bladder cancer. The findings were published online October 27 in the Annals of Internal Medicine.

• A world-first study by Queensland University of Technology’s Sleep in Early Childhood Research Group has revealed that pre-schoolers exposed to more light earlier in day tend to weigh more. Researchers noted that moderate intensity light exposure earlier in the day was associated with increased body mass index (BMI) while children who received their biggest dose of light in the afternoon were slimmer. The data were presented at the ASA Sleep Downunder Conference.

• An eight-item questionnaire, called the STOPBang questionnaire, might be used in the primary care setting to help identify patients who have obstructive sleep apnea (OSA), suggests new research presented at the annual CHEST meeting.

• Early magnetic resonance imaging (MRI) bone marrow lesions in knees at high-risk of knee osteoarthritis (OA) seemed to represent early radiographic OA, reported an observational study published online in Annals of the Rheumatic Diseases.

• The risk of developing gout was up to 60% higher among patients with sleep apnea vs individuals without sleep apnea, Yuqing Zhang, MD, DSc, from the Boston University Clinical Epidemiology Research and Training Unit and the Department of Medicine at Boston Medical Center in Massachusetts, and colleagues write. They report their findings online October 19 in Arthritis & Rheumatology.

• "Cannabis users were significantly younger, more frequently men, and consumed tobacco and alcohol more frequently than non-cannabis users," researcher Valerie Wolff, MD, PhD, of the University Hospital Strasbourg, and colleagues wrote in the Journal of the American College of Cardiology, published online Oct. 26.
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Media
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eSPIRITUAL
Dealing with Stress
Stress may be broadly defined as comprising of three components, namely a "known situation, interpretation of a situation and the physical and mental reaction to that interpretation of the situation".

Stress is a situation: There cannot be a stress without a situation. One cannot be stressed about some event occurring in USA without knowing the person or the situation. The situation requires familiarity with the particular sensory object (known situation).

Stress is an interpretation of a situation: Without interpretation, stress is not possible. The same situation can be interpreted differently by different people. A stimulus may be stressful to one but not to the other.

Stress is a physical and mental response to the interpretation of the situation: Stress manifests because of a chemical imbalance resulting due to sympathetic over-activity, which manifests as mental and or physical symptoms.

Stress is the body’s physical and mental response to the interpretation of a situation. Management of stress, therefore, involves either changing the situation, changing the interpretation of the situation or making the body resistant to physical and mental changes in the situation.

Practicing Patanjali’s eight limbs of yoga via living a yogic lifestyle, adhering to the various Dos and Don’ts in life as taught in various religious teachings, and learning to meditate helps our body to resist these sympathetic–activating changes and handle the stressful situation. These involve proper diet, exercise, meditation and relaxation exercises. Changing the interpretation of a situation involves counseling. Cognitive behavior therapy used in counseling is one such example. Change in interpretation requires deeper understanding of the problem and removal of the obstacles. This can be done by using Ganesha’s principles of stress management, Rosenburg’s Principle of Non–Violent Communication, or the principles of counseling from Bhagwad Gita. Change of the situation is the final resort for solving the problem, even though this may not be always possible. For example, in a dispute between husband and wife, divorce should be the last choice, after all counseling efforts have failed to resolve the issue.
Legal Quote
Dr. Suresh Gupta vs. Government of N.C.T. of Delhi and another AIR 2004 SC 4091 Appeal (crl.) 778 of 2004

“For conviction of a doctor for alleged criminal offence, the standard should be proof of recklessness and deliberate wrong doing i.e. a higher degree of morally blameworthy conduct.”
Medicofinance
Power of Attorney

Power of attorney gives a person or an organization the legal power to deal with your affairs when your self are not able to do so. The person or organization you appoint is referred to as ‘attorney’ or ‘agent’. The person so appointed can act on your behalf in a manner you require. This route entitles one to do certain acts without his presence and according to the directions given. The power of attorney may be general, to do all acts and deal with all issues relating to all assets or it may be specific, to deal with a particular asset or matter. Power of Attorney is a good delegation of authority but is not the best tool of estate planning.

(Source: IJCP)
Industry News
Women’s insurance segment predicted to be worth $22-35 billion by 2030: In its report, SheforShield: Insure Women to Better Protect All, insurance company Bharti AXA has predicted that by the year 2030, the annual women’s insurance market in India would be worth $22–35 billion. This amount is about 2 to 4 times the estimated premium of $10 billion spent by women in 2013. The report is the India chapter of the global research report by AXA and International Finance Corp. (Livemint - Pradeep Gaur)

Finding the right people the biggest worry for startups: A survey shows that the startup boom in the country is now faced with the challenge of finding the right skilled manpower as most entrepreneurs find mismatch in the talent with the required skill set. According to Bhavishya Sharma, Managing Director, Athena, the executive search and consulting firm, 61% of startups feel that embracing the startup culture is the biggest issue even after finding the right hire. Around 44.4% of startups face the problem of ensuring whether the right talent has the right skills; stability concerns and budget constraints constitute 38.9% and 27.8%, respectively (The Times of India- PTI)

Innovation hub to boost life science startups in Bengaluru: Centre for Cellular and Molecular Platforms (C-CAMP) has tied up with the California Institute for Quantitative Biosciences (QB3) to set up an innovation hub in Bengaluru. This will provide Indian scientists the opportunity to collaborate with labs in the US, while the scientists there will be able to leverage the huge opportunities in India. C-CAMP, a premier technology and innovation initiative of the Centre, has been mentoring around 45 startups from across India - 10 of them in Bengaluru. (The Times of India - Chetan Kumar)

Planning a startup? If you are planning a startup, keep in mind four basic factors, which will help make your venture a success. These are: Founding and management team, valuation of a company - very important at every stage of its life cycle, choosing the right investors and customer acquisition - cost of customer acquisition should be lesser than the lifetime value of the customer. (Business Insider - Purba Das)
Inspirational Story
Are you a potato, an egg, or a coffee bean?

Once a daughter complained to her father that her life was miserable and full of problems. She was tired of fighting and struggling all the time. It seemed just as one problem was solved, another one soon followed. Her father, a Chef, took her to the kitchen. He filled three pots with water and placed each on a high fire. Once the three pots began to boil, he placed potatoes in one pot, eggs in the second pot and ground coffee beans in the third pot.

After 20 minutes he turned off the burners and put the potatoes and eggs in separate bowls and poured the coffee in a cup. Turning to her he asked “Daughter, what do you see?” “Potatoes, eggs and coffee,” she hastily replied.

“Look closer,” he said, “and touch the potatoes.” She did and noticed that they were soft. He then asked her to take an egg and break it. After pulling off the shell, she observed the hard-boiled egg. Finally, he asked her to sip the coffee. Its rich aroma brought a smile to her face.

“Father, what does this mean?” she asked.

He then explained that the potatoes, the eggs and coffee beans had each faced the same adversity – the boiling water. However, each one reacted differently to the situation.

The potato went in strong, hard but in boiling water, it became soft and weak.

The egg was fragile, with the thin outer shell protecting its liquid interior until it was put in the boiling water. Then the inside of the egg became hard.

However, the ground coffee beans were unique. After they were exposed to the boiling water, they changed the water itself and created a new liquid.

“Which are you,” he asked his daughter. “When adversity knocks on your door, how do you respond? Are you a potato, an egg, or a coffee bean?“

Attitude to face the problem matters. You can either let the problem change you completely or you can change the problematic situation into a favorable opportunity
eWELLNESS
Diet is linked to the diabetes epidemic

A study published in the journal Diabetes Care, has highlighted the importance of the whole diet rather than focusing on certain foods or food groups that might be beneficial. A diet rich in whole grains, fruits and vegetables (leafy green), nuts and low-fat dairy may help people lower their risk of type 2 diabetes by 15% over 5 years than those who ate the lowest amounts of these foods. Also, a diet which contains high amounts of red meat, high-fat dairy and refined grains like white bread may boost the odds of diabetes development by 18%.

Type 2 diabetes is closely linked to obesity and it is well-known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.
eMEDIPICS
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Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
MTNL Perfect Health Mela 2015.

Pls click here for details
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eMEDI QUIZ
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.

Yesterday’s Mind Teaser: Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionization of the drug in the stomach. Which of the following statements is not a correct example:

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

Answer for Yesterday’s Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.
Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Raju Kuppusamy, Daivadheenam Jella, Dr Avtar Krishan.
Answer for 25th October Mind Teaser: 3. Gelfiltration chromatography.
Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Raghavendra Chakurkar, Dr Avtar Krishan.
BIOETHICAL ISSUES IN MEDICAL PRACTICE
Defensive Medicine

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
New Delhi

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
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Breaking news
A National Registry of ART clinics and banks

The Union health ministry will establish a National Registry of Assisted Reproductive Technology (ART) clinics and banks which will act as a central data-base in the country and through which details of all the ART clinics and ART banks of the country including nature and types of services provided by them, outcome of the services and other relevant information can be obtained on regular basis. The Registry will be maintained at Indian Council of Medical Research (ICMR), New Delhi.

As per the draft Assisted Reproductive Technology (Regulation) Bill, 2014, which has been issued by the Union health ministry recently, the Registry will assist all the State Boards for Assisted Reproductive Technology in the country in accreditation, supervision and regulation of the ART clinics and ART banks in their respective states. It will also assist the National Board for Assisted Reproductive Technology in its functioning by providing the data generated from the central database of the Registry…The draft Assisted Reproductive Technology (Regulation) Bill, 2014 which aims at proper regulation and supervision of Assisted Reproductive Technology (ART) clinics and banks in the country, and for prevention of misuse of this technology, including surrogacy, and for safe and ethical practice of ART services in the country. (Health Technology)
MAKE SURE
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Indian Medical Association National Satyagraha for a Healthy India
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IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.

• Writing prescription drugs by unqualified people can be dangerous.

• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)

• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?

• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?

• Allow us to treat poor and rich equally.

• Non pelvic ultrasound providers should be out of PCPNDT Act.

• Unless caught doing sex determination, no criminal offence shall be registered.

• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.

• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.

• Money spent does not mean you will get a cure.

• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.

• How can we treat patients using outdated standard treatment guidelines made by government?

• How can government decide the charges of a clinical establishment?
Govt hospitals will now be able to give BPL patients Rs 5L aid

Hospitals under the central government will now be able to provide financial assistance of Rs 5 lakh to BPL patients suffering from life-threatening diseases as the Centre has decided to enhance the financial powers delegated to them. Earlier, under the Rashtriya Arogya Nidhi (RAN), an assistance of Rs two lakh was given to BPL patients so that they could avail medical treatment at any of the super specialty government hospitals in case of emergencies. As per a statement from the Health ministry - To further ease access to financial assistance under RAN, the government has decided to enhance the financial powers delegated to designated central government hospitals and institutes from Rs two lakh to Rs five lakh for providing financial assistance in cases where emergency surgery is to be conducted. This would also enable to curtail the procedural delay for treatment, which would bring relief to thousands of patients annually ... Financial assistance is also available under the Health Minister's Discretionary Grant (HMDG) to patients having family annual income up to Rs one lakh and below to defray a part of the expenditure on hospitalization and treatment in government hospitals. These schemes have benefited 37,063 poor patients so far, the statement said. (ET Healthworld – PTI)
The number of stillbirths to be calculated in the country

Marking a first, India has decided to systematically count the exact number of children dying in their mother's womb. Dr Ajay Khera, deputy commissioner in the ministry of health, said, “We recently set up the India Newborn Action Plan, under which we have decided to map the actual rate of stillbirths in India. Stillbirth has remained invisible till now and never been accurately calculated." Currently, the estimated stillbirth rate in the country is 22 per 1000 live births and India targets to achieve a stillbirth rate of less than 10 per 1,000 live births by 2030. According to Dr Khera, the aim is to find out the causes of stillbirths in the country, whether it was medical failure or the mother's disease that led to the stillbirth. The program also intends to monitor every stillbirth at around 50 medical colleges, where a verbal and medical autopsy will be done to see why the stillbirth took place. India is among 10 countries, which, though they contribute 54% of the worldwide live births, make up for 66% or 1.8 million of all stillbirths. Around 2.6 million stillbirths occur worldwide each year during the last trimester - 98% of them in low- and middle-income countries… (ET Healthworld – Kounteya Sinha)
Breast cancer may become the leading cause of death in women

Breast cancer is the most common cancer among women in urban areas and constitutes more than 30% of all cancers in females. According to the Indian Council of Medical Research, breast cancer is the second most common cancer in women in rural areas also, next to uterine cervix cancer. ICMR has projected that one in every 10 Indians will be at risk of developing one or the other type of cancer by the middle of this century and that cancer will become the number one killer by then… (The Indian Express)
Uttarakhand to introduce injectable polio vaccine

With Uttarakhand registering zero polio cases over the past nine years in a row, the state is now all set to introduce for the first time 'Injectable Polio Vaccine (IPV) that will further ensure that any possibility of susceptibility of children to polio virus is completely erased. According to state government data, the last polio case was registered in Udham Singh Nagar in 2006. Thereafter, state has put into place an Acute Flaccid Paralysis (AFP) surveillance. It is being conducted to find traces of traumatic neuritis, Guillain-barre syndrome and transverse myelitis which are actually pre-determiners of Poliomyelitis. All the infants will now be given IPV along with third dose of Oral Polio Vaccine (OPV), which is given on 14th week after birth. The first two dosage which are given after six weeks and 10 weeks of birth would comprise only OPV not IPV as the injected dosage is heavy and can be given only after certain age and stage of child, said State's SMO Arijit Kumar. (Times of India – Shivani Azad)
WHO highlights cancer risks from processed and red meat

The International Agency for Research on Cancer (IARC), the cancer research agency of WHO, has evaluated the carcinogenicity of the consumption of red meat and processed meat. A Working Group of 22 experts from 10 countries convened by IARC classified the consumption of red meat as ‘probably carcinogenic’ to humans and processed meat as ‘carcinogenic’ to humans. (WHO)

The consumption of red meat was classified as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect. This association was observed mainly for colorectal cancer, but associations were also seen for pancreatic cancer and prostate cancer. Processed meat was classified as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer.

The experts concluded that each 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%. According to IARC, processed meat refers to meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation. Hot dogs (frankfurters), ham, sausages, corned beef, and biltong or beef jerky as well as canned meat and meat-based preparations and sauces are examples of processed meat. (WHO)
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IMA Digital TV
GP Tip: Detecting saturated fat

A common question in clinical practice is to know which fat is saturated and which is unsaturated. The formula is very simple. Fats that are liquid at room temperature are unsaturated and those that are solid at room temperature are saturated fats. Hydrogenated oils are solid fats and have the same harmful effects as that of saturated fats.

(Source: IJCP)
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Readers column
Dear Sir, Nice Updates. Regards: Dr Tarun
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Humor
Teacher: Billy, stop making ugly faces at other students!

Billy: Why, ma’am!

Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!

Billy: Well, I can see you didn’t listen then!
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Press Release
Excessive alcohol consumption continues to damage the society, economy and the health of the individuals

It is the cause of death of over 2.5 million individuals every year (almost 4% of all deaths worldwide), and the third leading risk factor for poor health globally, accounting for 5.5% of disability-adjusted life years lost

Excessive alcohol consumption and under-age drinking are common issues, which all countries globally continue to struggle with. The urgent need to raise awareness about the evils of alcohol consumption has been brought up by most National and International bodies during their annual meetings. However, till now, no strict action has been taken to curb the menace of alcohol.

In a developing country like India, there’s an immediate need for framing a new set of policies, which will focus on reducing excessive alcohol consumption and framing new policies for harm reduction.

Speaking on the issue, Padam Shri Awardees Dr A Marthanda Pillai National President Indian Medical Association and Dr K K Aggarwal – Honorary Secretary General IMA and President HCFI said, “The government should start with formulating new policies, which will focus on reducing the harm caused by excessive alcohol consumption. They should also impose some staunch legal and regulatory measures to limit the access to alcohol in cases of individuals who are below the certain age. The focus should be laid on creating new healthy and social policy interventions regarding alcohol, consumption by targeting vulnerable groups like high-risk drinkers. At present, the country already has some existing policies but they are not being properly implemented in the required areas. Bringing in international public health advocacy and partnerships to educate individuals about the ills can definitely help to free society from the shackles of alcohol consumption.”

As far as our health is concerned, alcohol weakens the communication pathways of the brain, which causes sudden mood shifts, changes behavior and weakens the ability to coordinate. Excessive drinking can aggravate severe cardiovascular issues like cardiomyopathy – stretching and drooping of heart muscle, arrhythmias – irregular heartbeat, heart stroke and high blood pressure. Not only this, excessive consumption can cause liver inflammation problems like steatosis, or fatty liver, alcoholic hepatitis, fibrosis and cirrhosis. It is also a leading cause of obesity.

Towards the cause of a reduction in the alcohol consumption worldwide, the World Medical Association recently during its General Assembly launched a declaration, which focuses on reducing excessive alcohol consumption and framing new policies for harm reduction.

According to it, the following steps that should be taken in this regard:

• Increase alcohol prices, through volumetric taxation of products based on their alcohol strength, and other proven pricing mechanisms, to reduce alcohol consumption

• Regulate access and availability of alcohol by limiting the hours and days of sale, the number and location of alcohol outlets and licensed premises, and the imposition of a minimum legal drinking age

• Governments should tax and control the production and consumption of alcohol, with licensing that emphasizes public health and safety and empowers licensing authorities to control the total availability of alcohol in their jurisdictions

• Public authorities must strengthen the prohibition of selling to minors and must systematically request proof of age before alcohol can be purchased in shops or bars

• Practicing alcohol marketing in a restricted way, so as to prevent the early adoption of drinking by young people and to minimise their alcohol consumption

• Imposing regulatory measures ranging from wholesale bans and restrictions on measures that promote excessive consumption, to restrictions on the placement and content of alcohol advertising that is attractive to young people

• Increase public awareness of harmful alcohol consumption through product labeling and public awareness campaigns.

• Key drink-driving deterrents should be implemented like strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml.
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