November 2   2015, Monday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
Laws applicable on Quacks

The Hon’ble Supreme Court of India in the matter titled as “Poonam Verma versus Ashwin Patel, CA No. 8856/1994 dated 10.05.1996 has held that:

“A person who does not have knowledge of a particular System of Medicine but practices in that System is a Quack and a mere pretender to medical knowledge or skill, or to put it differently, a Charlatan.”

In view of the above landmark judgment, it is stated that the person who possesses recognized qualification / knowledge of a particular system of medicine is only authorized to practice in that particular system of medicine. If a person practices in any other system of medicine of which he does not possesses recognized qualification / knowledge, then that person would be considered as a quack i.e. a mere pretender to medical knowledge or skill, or a charlatan.

There are majorly three systems of medicines in India i.e. (1) allopathic or modern system of medicine (2) Ayurvedic, Siddha or Unani Tibb system of medicine and (3) Homeopathic system of medicine. Different central and state legislations, laws and acts have enacted for all the three system of medicine. It is pertinent to mention herein that all the three system of medicines do not allow cross pathy i.e. a person who has obtained a recognized qualification / knowledge of a particular system of medicine is only authorized to practice that particular system of medicine and not the other. Further, penal actions are also there if a person practices some other system of medicine of which he has not obtained a recognized qualification.

The various laws / legislations which are applicable on quack i.e. a person who practices that system of medicine of which he has not obtained qualification are as follows: Indian Medicine System also known as Ayurvedic, Unani & Tibbs System

The Indian Medicine Central Council Act, 1970 (hereinafter referred to as “IMCC Act) has been framed to provide for the constitution of a Central Council of Indian Medicine and the maintenance of a Central Register of Indian Medicine and for matters connected therewith.

According to Section 2(d) of the IMCC Act, 'Central Register of Indian Medicine' means the register maintained by the Central Council under this Act.

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

According to Section 2(g) of IMCC Act, 'recognised medical qualification' means any of the medical qualifications, including Post-graduate medical qualification, of Indian medicine included in the Second, Third or Fourth Schedule of IMCC Act.

According to Section 2(j) of the IMCC Act, 'State Register of Indian Medicine' means a register or registers maintained under any law for the time being in force in any State regulating the registration of practitioners of Indian Medicine.

Section 17 of IMCC Act lays down the Rights of persons possessing qualifications included in Second, Third and Fourth Schedules of the Act to be enrolled
(1) Subject to the other provisions contained in this Act, any medical qualification included in the Second, Third or Fourth Schedule shall be sufficient qualification for enrolment on any State Register of Indian Medicine.
(2) Save as provided in section 28, no person other than a practitioner of Indian medicine who possesses a recognised medical qualification and is enrolled on a State Register or the Central Register of Indian Medicine, -
(a) shall hold office as Vaid, Siddha, Hakim or physician or any other office (by whatever designation called) in Government or in any institution maintained by a local or other authority;
(b) shall practice Indian medicine in any State;
(c) shall be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law to be signed or authenticated by a duly qualified medical practitioner;
(d) shall be entitled to give evidence at any inquest or in any court of law as an expert under section 45 of the Indian Evidence Act, 1872 (1 of 1872) on any matter relating to Indian medicine.

(3) Nothing contained in sub-section (2) shall affect, -
(a) the right of a practitioner of Indian Medicine enrolled on a State Register of Indian Medicine to practise Indian medicine in any State merely on the ground that, on the commencement of this Act, he does not possess a recognised medical qualification;
(b) the privileges (including the right to practise any system of medicine) conferred by or under any law relating to registration of practitioners of Indian medicine for the time being in force in any State on a practitioner of Indian Medicine enrolled on a State Register of Indian medicine;
(c) the right of a person to practise Indian medicine in a State in which, on the commencement of this Act, a State Register of Indian Medicine is not maintained if, on such commencement, he has been practising Indian medicine for not less than five years;
(d) the rights conferred by or under the Indian Medical Council Act, 1956 (102 of 1956) [including the right to practise medicine as defined in clause (f) of section 2 of the said Act], on persons possessing any qualifications included in the Schedules to the said Act.

(4) Any person who acts in contravention of any provision of sub-section (2) shall be punished with imprisonment for a term which may extend to one year, or with fine which may extend to one thousand rupees, or with both.

According to Section 28 of IMCC Act, if the course of study to be undergone for obtaining a recognised medical qualification in Indian Medicine include a period of training after a person has passed the qualifying examination and before such qualification is conferred on him, any such person shall, on application made by him in this behalf, be granted provisional registration in a State Register of Indian medicine by the Board concerned in order to enable him to practice Indian Medicine in an approved institution for the purpose of such training and for no other purpose for the period aforesaid.

Section 29 of IMCC Act lays down Privileges of persons who are enrolled on the Central Register of Indian Medicine:

Subject to the conditions and restrictions laid down in this Act regarding practice of Indian medicine by persons possessing certain recognised medical qualifications, every person whose name is for the time being borne on the Central Register of Indian Medicine shall be entitled according to his qualification to practice Indian medicine in any part of India and to recover in due course of law in respect of such practice any expenses, charges in respect of medicaments or other appliances or any fees to which he may be entitled.

THE SECOND SCHEDULE deals with Recognized medical qualifications in Indian medicine granted by Universities, Boards or other medical institutions in India

THE THIRD SCHEDULE deals with Qualifications granted by certain medical institutions before 15th August, 1947 in areas which comprised within India as defined in the Government of India Act, 1935.

THE FOURTH SCHEDULE deals with Qualifications granted by medical institutions in countries with which there is a scheme of reciprocity.

As per the provisions of Indian Medicine Central Council Act, 1970, it is opined that only the that person can practice Indian medicine who possesses a recognized medical qualification as per the Schedule Annexed with the IMCC Act, 1970 and is enrolled on a State Register or the Central Register of Indian Medicine. If any other person practices Indian Medicine in contravention to the provisions of IMCC, then that person shall be punishment with imprisonment and / or with fine.
(to be continued... )
Breaking news
Breakthrough in phototherapy system to fight cancer

Researchers have developed a new approach that uses a single chemical compound to make cancer cells glow when exposed to near-infrared light, which can help a surgeon identify the cancer and remove it more effectively. The compound, silicon naphthalocyanine, also creates heat and reactive oxygen species within any remaining cancer cells, killing them. In tests completed with laboratory animals, tumours were completely eradicated without side effects, and did not return. When perfected, researchers believe that the evolving field of phototherapy may become a new and promising addition to the three primary ways that most cancer is treated today - surgery, radiation and/or chemotherapy. Phototherapy clearly has the potential to make some of those approaches more effective than they already are, researchers said.
Dr Good Dr Bad
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Specialty Updates
• When compared to their married counterparts, patients 50 years of age and older who were divorced, separated, or widowed had about 40% greater odds of dying or developing a new functional disability during the first 2 years after cardiac surgery, Mark D. Neuman, MD, MSc, and Rachel M. Werner, MD, PhD, reported online in JAMA Surgery.

• According to HCVguidelines.org, approximately 3 to 4 million individuals in the United States are chronically infected with HCV, and half of them are unaware of their status.

• Individuals who live at higher altitudes may have a 50% lower risk of dying of Alzheimer's disease (AD) compared with their counterparts living at lower altitudes (JAMA Psychiatry)

• In relatively unfit adults, 12 weeks of aerobic exercise significantly improved asthma control, according to preliminary results from the randomized Impact of Aerobic Exercise on Asthma Morbidity (Ex-Asthma) study.

• Breast cancer rates among black women increased from 2008 to 2012 in the United States, eliminating a gap that had existed for decades between black and white women, according to a study from the American Cancer Society (ACS).

• A new study in mice by researchers at Fred Hutchinson Cancer Research Center has found that a specialized type of immunotherapy -- even when used without chemotherapy or radiation -- can boost survival from pancreatic cancer, a nearly almost-lethal disease, by more than 75 percent. The findings are so promising, human clinical trials are planned within the next year.

• The October issue of the Journal of Urology carries a pro and con couplet of articles. The point of view in favor of focal therapy is from Mark Emberton, MD, who argues that focal therapy is "a legitimate and necessary response to a changing world." The opposing view is from Mark L. Gonzalgo, MD, PhD, who counters that focal therapy "aims to kill cancer while minimizing side effects" but that, on the basis of current data, "the hype...outweighs the hope."

• Individuals who live at higher altitudes may have a 50% lower risk of dying of Alzheimer's disease (AD) compared with their counterparts living at lower altitudes as reported in in JAMA Psychiatry.

• Researchers in Canada and China have developed eight cancer hallmark-based gene signature sets (CSS sets) that may help to decide if patients with stage II colorectal cancer (CRC) should be treated with adjuvant chemotherapy after surgery.

• Despite increasing access to HIV treatment in Europe, in a significant proportion of countries, one in six people who need treatment don't receive it, according to a recent report from the European Centre for Disease Prevention and Control.
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Media
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eSPIRITUAL
Is it necessary to take a dip in Ganga to remove your sins?
Ganga, Jamuna and Saraswati, the trio sangam in Allahabad is believed to be the holiest place in the country where taking a dip can wash away all past sins. After death, ashes are also submerged in Ganga water with an assumption that the past sins will be removed.

In Vedic era what was the intention of the rishis and munis while making this ritual?

In mythology, moon represents cool mind and Ganga represents the positive flow of thoughts. And sea turmoil indicates the disturbed state of mind. Hanuman ki samudra yatra indicates the meditative journey through the flow of thoughts. Samudra manthan represents the journey of the mind during meditation.

Taking a dip can be equated to shifting your mind towards your consciousness which can happen when you introspect in a relaxed state of mind or when you practice meditation. Meditation is defined as a journey from sympathetic and parasympathetic state of mind or a journey from disturbed state of consciousness to undisturbed state of consciousness. Every time you meditate, you dip into your consciousness and clean your guilt and negative thoughts. It is something like reformatting your hard disk and removing the bad sectors and viruses in your software. It is, therefore, possible for you to do Ganga snan (bath) at your house in the morning while meditating or during pooja by drifting away from disturbed state of mind to non disturbed relaxed state of mind clearing your guilt and negative thoughts.
The proposed ART Regulation Bill: Some suggestions

• This bill is to decrease the commercialization of IVF.
• But the committee formed has many non medicos and especially those who do not know about IVF and this will curb the growth of research and development in this field
• It should not become another PCPNDT act

Dr Anita Kant
Director, Gynaecology & Obstetrics
Asian Institute of Medical Sciences, Faridabad
Legal Quote
Martin F. D'Souza vs Mohd. Ishfaq, SCI: 3541 of 2002, dated 17.02.2009

“The Courts and Consumer Fora are not experts in medical science, and must not substitute their own views over that of specialists.”
Medicofinance
Estate planning: Succession

Succession is another tool of estate planning wherein the legal heirs inherit the property from their ancestors. In this tool although there is an exemption of property tax but generally this tool results in dispute between family members. But, if same is adopted amicably, it can work out as a very useful tool of estate planning.

(Source: IJCP)
Industry News
Flipkart eyes national logistics network: Flipkart Ltd, the country’s largest e-commerce company, is making its biggest investment push by far by investing about $2.5 billion over the next few years to establish a country-wide network of back-end infrastructure as it fortifies its position in the rapidly growing e-commerce market. “Logistics network is the biggest differentiator,” Flipkart chief operating officer Binny Bansal said on Friday. A logistics network presents “strong competitive advantages”, which is why it will be the “biggest investment area” for the company, he said. (Live Mint - Yogendra Kalavalapalli)

New aviation policy to make air travel affordable: The government on Friday outlined its proposed aviation policy that seeks to make millions more fly by limiting airfares to Rs 2,500 through subsidies and tax cuts for flights lasting an hour or less. A 2% cess proposed on tickets to part fund the subsidy, however, could add to the cost of travelling abroad and between metro cities. The draft policy, unveiled by the civil aviation minister, has been put up for consultations for three weeks. The final policy is expected to be announced by the end of the year. (Economic Times)

Entrepreneurship is challenging in India, but growth is equally faster: Being an entrepreneur anywhere in the world is not an easy task. It's filled with potholes, roadblocks and massive mountains to cross everyday. It's even more challenging in India as we are faced with several restrictions. But success is equally faster here when you find a way to work around the kinks. Staying agile, flexible, and focusing on building a great culture, a great team and great product is key to making it big, said Vinod Muthukrishnan CEO of CloudCherry, in an interview with SME Times. (Smetimes.in)

SEC wants to make it easier for startups to raise money: The Securities and Exchange Commission is about to vote on a proposal that should it easier for small startups to raise funds. The regulation, called Title III of the JOBS act, will allow companies to raise up to $1 million by selling stock to small investors. These so-called unaccredited investors will be able to buy $2000 of a startups shares through crowdfunding platforms. Right now, the SEC restricts those kinds of investments only to high-net worth investors, and crowdfunding has instead worked more like advance sales of a startups product or service. (Business Insider- Jonathan Marino)
eWELLNESS
Don’t ignore women’ health

Women are not diagnosed or treated as aggressively as men. Even though more women than men die of heart disease each year, women receive only 33% of all angioplasties, stents and bypass surgeries; 28% of implantable defibrillators and 36% of open-heart surgeries, according to the National Coalition for Women with Heart Disease. Although the traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — have a detrimental impact in men and women, certain factors play a bigger role in the development of heart disease in women.

1. Metabolic syndrome — a combination of increased blood pressure, elevated blood glucose and triglycerides — has a greater impact on women than men.

2. Mental stress and depression affect women's hearts more than they do men's.

3. Smoking is much worse for women than men.

4. A low level of estrogen before menopause is a significant risk factor for developing microvascular disease.

5. Though women will often have some chest pain or discomfort, it may not be the most prominent symptom. Diffuse plaques build-up and diseased smaller arteries are two reasons why symptoms can be different in women.

6. In addition to chest pain, pressure or discomfort, signs and symptoms of heart attack in women include: Neck, shoulder, upper back or abdominal discomfort, Shortness of breath, Nausea or vomiting, Sweating, Light-headedness or dizziness and unusual fatigue.

7. Endothelial dysfunction is more common in women. In this the lining of the artery does not expand (dilate) properly to boost blood flow during activity, which increases the risk of coronary artery spasm and sudden death.

8. WISE study results suggest that the commonly used treatments for coronary artery disease — angioplasty and stenting — are not the best option for women with more diffuse plaques.

9. Typical tests for coronary artery disease — angiogram, treadmill testing and others — are not reliable in women.

10. The WISE study showed that in some women, plaques accumulate as an evenly spread layer along artery walls, which is not visible using traditional testing methods.
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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BIOETHICAL ISSUES IN MEDICAL PRACTICE
Right to refuse treatment

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

In India, going on protest fasts is a recognized method of registering opposition to several public issues- from AFSPA to reservations and pensions. Indian law permits force feeding of protesters.

a) While correct in law, is this ethically proper?

b) What alternatives should the State follow, if force feeding is not permissible?

Do write in with views and your solutions!
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Breaking news
Union Health Minister holds high level review meeting on Seasonal Influenza (H1N1)

The Union Health and Family Welfare Minister Shri J P Nadda has issued necessary directions related to procurement, training, issuing of advisories and guidelines for the state government in a high level meeting which took place earlier this week to review the preparedness for tackling seasonal Influenza (H1N1).

“We are monitoring the situation on real time basis. A control room has already been set up and is fully functional now. We have also rolled out a nationwide awareness campaign on Seasonal Influenza (H1N1),” said the Union Health Minister. “We have assured full support to the state governments. In fact, the Ministry has already issued three advisories to the state governments over the last one month and held a video conference with them to review their strategy and plans,” he added.
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?
The Union Health Ministry on Friday said that India had shown an overall reduction of 57 per cent in new HIV infections in the past decade and expressed confidence that the AIDS epidemic as a public health threat could be tackled by 2030. (Express News service)
Prevent Carbon Monoxide (CO) Poisoning
Do

• Have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Install a battery-operated CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.
• Seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.

Don't

• Run a car or truck inside a garage attached to your house, even if you leave the door open.
• Burn anything in a stove or fireplace that isn't vented.
• Heat your house with a gas oven.
• Use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or outside less than 20 feet from a window, door, or vent. (Source: CDC)
CDC resumes weekly flu activity reports

Information about influenza activity in the United States is collected, compiled and analyzed by the Centers for Disease Control and Prevention (CDC) and published in a report called FluView. CDC has resumed full FluView reporting for the 2015-2016 U.S. flu season and has made a number of refinements to the report this season. (CDC)

Flu View includes information on:

• when and where influenza activity is occurring in the United States,
• what influenza viruses are circulating, and
• the impact of influenza disease in the United States, including flu-related illness, hospitalizations and deaths.
'Toxic cocktail' makes Delhi world's most polluted city

Delhi, the world’s most polluted city, suffers a toxic blend of geography, growth, poor energy sources and unfavourable weather, which boosts its dangerously high levels of air pollution, scientists, including one of Indian-origin, have found.

A team of researchers led by the University of Surrey in the UK assessed how Delhi’s landscape, weather, energy consumption culture, and growing urban population combines to elevate concentrations of air pollutants, including ultra-fine particles, the most harmful to human health. “Air pollution has been placed in the top 10 health risks faced by human beings globally. Delhi has the dubious distinction of being regularly cited as the most polluted city in the world, with air pollution causing thousands of deaths in a year in this growing megacity,” said Dr Prashant Kumar of the University of Surrey. “Whilst it might be easy to blame this on increased use of vehicles, industrial production or a growing population, the truth is Delhi is a toxic pollutant punchbowl with myriad ingredients, all which need addressing in the round,” said Kumar…(Deccan Herald)
Inspirational Story
A most important lesson

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions, until I read the last one: "What is the first name of the woman who cleans the school?"

Surely, this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark-haired and in her 50s, but how would I know her name? I handed in my paper, leaving the last question blank.

Just before class ended, one student asked if the last question would count toward our quiz grade."Absolutely," said the professor. "In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say 'hello'."

I've never forgotten that lesson. I also learned her name was Dorothy.
Sree Balaji Medical College conducts walkathon in Chennai

The management, staff and students of Sree Balaji Medical College conducted a walkathon in Chennai to mark the 11th World Psoriasis Day October 29. This was part of the International Psoriasis Conference (IPC) held at the college and was partnered by the Indian Society of Teledermatology (INSTED)… (Times of India – Divya Chandrababu)
India needs database of blood stem cell donors

Kolkata: With only one in two million Indians finding a genetically matched donor, the country needs a database of willing blood stem cell donors to help the cause, a senior haematologist said. "Surprisingly it's not difficult to get blood donors in our country, but we do not have enough donors for blood stem cells," haematologist and director of Tata Medical Centre in Kolkata Dr Mammen Chandy said. "A large number of Indian patients with blood cancer and bone marrow failure who have failed standard treatments, can be cured with a haematopoietic stem cell transplant if only they had matched donors. For other patients, if a donor is found to be genetically matched from the registry, a transplant can be done and it can be life-saving… (DNA - PTI)
Himachal would be the first State to start Rotavirus vaccination from next month, to be started from district Kangra, which is leading cause of severe diarrhea among infants and young children.
IMA JIMA
IMA Digital TV
GP Tip: Occult wheezing

When evaluating a cough, ask the patient to perform a forced expiration, which often reveals occult end-expiratory wheezing. In small children ask them to blow as if they are trying to extinguish the candles on their birthday cake.

(Source: IJCP)
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Readers column
Dear Sir, Thanks for the updates. Regards: Dr Kartik
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eMEDI QUIZ
A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

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

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

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

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

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Raju Kuppusamy, Daivadheenam Jella , Dr Avtar Krishan

Answer for 1st November Mind Teaser: 3. Atracurium.

Answers received from: Dr Rajesh S. Joshi, Dr Poonam Chablani, Dr K Raju, Raghavendra Chakurkar, Dr K V Sarma, Daivadheenam Jella, Dr Avtar Krishan.
Humor
The phone bill was exceptionally high. Man called a family meeting to discuss.

Dad: This is unacceptable. I don't use home phone, I use my work phone.

Mum: Me too. I hardly use home phone. I use my company phone.

Son: I use my office mobile, I never use the home phone.

All of them shocked and together look at the maid who's patiently listening to them.

Maid: "What? So we all use our work phones. What's the Big deal??
Digital IMA