October 31   2015, Saturday
Dr KK AggarwalDr KK Aggarwal
National Protest day & Satyagraha

Dear Leaders

On the basis of feedbacks received from across the country, the final program for our November 16 - National Protest day & Satyagraha will be as follows:

• Emergency services in hospitals will be maintained and emergency care will not be affected.

• The idea of conducting medical camps or road side clinic is abandoned.

• The timings of press conference can be relaxed depending upon the availability of journalists in local branch areas.

• Wherever possible, Doctors can congregate and go in a procession to the Satyagraha venue and hand over their representation to the local authority.

• The material that has been circulated may be translated to local language and given to peoples’ representatives right from ward member level to chief minister.

• The representation should be given to all MPs in person before Nov 16

• All local branches to share the details of online petition signing to all their members through Whatsapp or email and ensure that all members sign within next one week. The details are as follows:

o Kindly type the website address as: http://emedinexus.com/16novimasatyagraha/

o Enter the details requested and you will be signing the petition online

o In case of technical issues, please send us the details requested in the above web address on admin@emedinexus.com and we will fill the form for you.

• Every state branch should convene an emergency meeting of a state working committee or state council or executive committees and discuss the strategies to ensure max participation

• All the slogans and banners should convey people-oriented messages like

o Allow doctors to treat patients irrespective of patients’ income - If compensation is not capped, we can't do this

o Writing prescription drugs by anyone other than with an MBBS degree is injurious to peoples’ health.

o Please allow Doctors to treat poor and rich equally.

o More patients will die if doctors are not provided protection during duty hours.

o Death does not mean negligence.

o Save single clinic and small establishments - Exclude them from Clinical Establishment Act

• Printed banners regarding Nov 16 Satyagraha should be displayed in prominent places well in advance. Use people oriented slogans in the banners.
Breaking news
HCV Guideline Update

The American Association for the Study for Liver Diseases and the Infectious Disease Society of America (IDSA) have updated HCVguidelines.org so that it reflects the current understanding that virtually all individuals who are positive for the hepatitis C virus (HCV) should receive the newer HCV treatment. The site emphasizes that new sections have been added and that the recommendations are updated regularly as new information becomes available. The new guidance explains that the sustained virologic response that is characteristic of a successful HCV treatment would benefit almost everyone who is infected with HCV. Moreover, many of the highest-risk patients have already had the opportunity to receive treatment with the new medications. The IDSA notes that the cost of the new drugs and regional availability of the appropriate healthcare provider may still translate into a need to prioritize patients for treatment. (Medscape)
Dr Good Dr Bad
Specialty Updates
1. A policy statement released at the American Academy of Pediatrics (AAP) 2015 National Conference, and published online in Pediatrics has asked pediatricians to assess all patients for consistent access to adequate nutritious food.

2. In a cohort of middle-aged obese patients in Austria who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy, those who received high-dose vitamin D loading before surgery, then vitamin D, calcium, and protein supplements along with an individualized exercise program after surgery reported a decelerated loss of bone-mineral density and lean body mass and a less pronounced increase in bone-turnover makers than other patients (American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting).

3. Children and adolescents with migraine are more than three times as likely as those without headaches to have a mood disorder, such as depression, and almost three times more likely to have other neurologic conditions, such as epilepsy. The study results presented at the 44th Child Neurology Society (CNS) Annual Meeting highlight the need for neurologists to screen for such disorders.

4. Peggy S. Lai, senior author and ICU physician at Massachusetts General Hospital in Boston, and colleagues, write in an article online October 15 in JAMA Oncology that 1 to 4 days in the intensive care unit (ICU) may be enough for patients with poor-prognosis solid tumors, but longer stays may be better for those with hematologic malignancies or less-severe illness.

5. Antibiotic resistance continues to be high among ocular pathogens. Nearly half of staphylococcal isolates are resistant to methicillin, and most of those isolates are also resistant to multiple other commonly used ophthalmic antibiotics, according to data from the prospective surveillance Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study published in JAMA Ophthalmology.

6. Early findings from the aMASE ‘Advancing Migrant Access to Health Services in Europe’, presented at the 15th European AIDS Conference show that Migrants who have come to Europe from low- and middle-income countries who become infected with HIV start antiretroviral therapy later than native populations, and when their CD4 counts are lower.

7. The US Food and Drug Administration (FDA) has approved talimogene laherparepvec (Imlygic, Amgen), the first oncolytic viral therapy for the local treatment of unresectable cutaneous, subcutaneous, and nodal lesions in patients with melanoma that recurred after initial surgery. Talimogene laherparepvec is a genetically modified herpes simplex virus type 1 that is designed to replicate within tumors and produce the immunostimulatory protein granulocyte-macrophage colony-stimulating factor (GM-CSF). It is injected directly into the melanoma lesions causing cell lysis.

8. Patients with systemic lupus erythematosus have a very high burden of comorbidities ranging from end-stage renal failure to cancer, as reported in a study from UK published in Arthritis Care & Research. The incidence rate ratio for any type of cancer was 1.28, while increased risks also were seen for cardiovascular disease, stroke, osteoporosis, and infection.

9. A retrospective review of patient records presented at CHEST 2015 showed that aspirin prophylaxis during mechanical ventilation significantly lowered the risk of deep-vein thrombosis (DVT) vs patients on thromboprophylaxis but not aspirin. Patients on aspirin for cardiovascular prevention had a 61% lower risk of DVT as compared with all patients not on aspirin. Thromboprophylaxis without aspirin reduced the risk by 26%, which did not achieve statistical significance.

10. Older women who perform normally on a standard cognitive test but who have subjective memory complaints (SMCs) are significantly more likely to have a memory disorder almost two decades later, suggesting that SMCs are an early warning sign of future dementia. The study was published online October 28 in Neurology.
Best time to sign a deal is at 4 pm
As per Ayurveda 2–6 pm in the evening and 2–6 am in the morning are the periods of Vata or creativity. Most poets and writers do their creative work during these times of the day, especially 2–6 am in the morning.

Vata period is more creative and you are less likely to make mistakes. Four PM in the evening is considered the best time to make a deal, sign a document or to send a confession note.

Apart from the time of the day Vata age is old age and Vata month is rainy season. This is one reason that we always pay attention to the advice of the elderly.
The Proposed ART Regulation Bill

Dr Kaberi Banerjee, New Delhi

Millions of infertile couples are being gifted by a child through efforts of many clinicians and scientists. This work has been acknowledged in the western hemisphere. The Nobel Prize for science has been awarded to pioneers in this field. Today it seems necessary to pass a bill to regulate such clinicians and their facilities in India. The bill clearly highlights the duties and responsibilities of ART clinics which is essential, however the tone of the bill seems biased against them. Here are certain suggestions before the bill is accepted in this form.

Chapter 1 and 2: Constitution of the Board and Authorities to Regulate

• The Chairperson and other senior members of National and State Board and Registries must have significant exposure to the clinical or embryological aspect of ART. Any person with pure Biomedical Sciences and no ART experience will be incapable of heading or taking decisions on behalf ART bodies and organizations.

• A Vice Chairperson should be nominated. The working of the board in the absence of Chairperson should be entrusted to the vice chairperson and not to the senior-most member as there may be more capable members equipped to handle the same.

• The aim of the board/registry should not be to obstruct work of ART clinics but to help them function more efficiently.

Chapter 3: Procedure for Registration and Complaints

• Fair hearing and appeal time must be given to all doctors and ART clinics in case of complaints.

• A doctor/ clinic cannot be assumed to be guilty till proven otherwise. This clause is in very poor spirit against the medical fraternity. This is not the case in other medical or surgical fields and so should not be in ART. The board must ensure adequate protection of doctors and clinics and prevent unnecessary harassment. Fertility clinics and doctors must be protected against nonpayment, false identity of couples and misbehavior from patients.

Chapter 4: Duties and Responsibilities of ART Clinics and Banks

• The formation of ART Banks has to be clearer regarding who heads it and is responsible. It should be a person with adequate experience of ART, who is able to take care of all medical and other aspects of the donor and surrogate.

• Surrogacy must be allowed for recurrent implantation failures also.

• Age restrictions should be reconsidered. For e.g., a 21-year-old premature ovarian failure and a 56-year-old man may want ART. Prohibiting this is imposition on personal liberty.

• Total number of positive cases along with clinical pregnancy and take home must be reported. Board must have a system to ensure that supplied data is authentic (like HFEA in UK)

Chapter 5: Sourcing, storage and handling of gametes, embryos and surrogates

• Known donation must be allowed as is allowed elsewhere in the world. Couple may want to retain some genetic linkage and prohibiting this would be imposition on legitimate personal choice.

• Embryo donation of surplus embryos must be allowed if consented to by the couple. This is acceptable universally. This gives a chance of many couples to get a child at low cost and must be encouraged. Total number of patients to whom it should be transferred should be restricted as is for sperm and egg donor.

• Oocyte donor must be allowed to donate more than once as is prevalent all over the world.

• We can retrieve as many oocytes as the follicles and there is no rationale of restricting number. However attempt always should be to minimize hyperstimulation and keep stimulation as safe as possible.

• Death of donor or surrogate cannot be assumed to be due to negligence. It has to be proven, like is with any death in any other circumstance.

• If couple wants to continue to store the embryos beyond 5 years or donate it to any other infertile couple, it should be allowed.

Chapter 7: Rights and duties of patients, donors, surrogates

• The Board/ Registry must ensure proper functioning of banks. The amount promised to donor/surrogate must be duly given.

• The surrogate must be allowed twice.

• It has to be seen whether insurers are willing to ensure for complications like diabetes and hypertension.

• Surrogacy for foreigners must be allowed. By not allowing we are only given chance to Eastern European and American markets to flourish. This will be a very wrong economic decision for the country. There is absolutely no reason why this should not be allowed. Checks and counter checks can be put in place but banning is a very regressive step.

• Bank should not be obliged to fight legal battle free of charge on behalf of surrogate or her husband if they have not fulfilled their obligations.

Chapter 10: Miscellaneous

• For any conflict or dispute, appropriate hearing and appeal must be allowed.

• The provision for search and seizure of documents etc. is a harsh step. The bill is meant for doctors who are one of the most respected members of the community. They cannot be treated as culprits. They should be given fair hearing like any person in a democratic society. The doctors should be free to practice what is correct under the code of MCI.

• Legal proceeding should be allowed against centre, state or board by any citizen if deemed appropriate under democratic rules of the country.

• All funds with the board/registry must undergo proper audit.

(No suggestion is meant to offend the Government or anybody intentionally)
Legal Quote
Martin F. D'Souza vs Mohd. Ishfaq, 3541 of 2002, dated 17.02.2009

“… It has been stated that simple negligence may result only in civil liability, but gross negligence or recklessness may result in criminal liability as well. For civil liability only damages can be imposed by the court but for criminal liability the doctor can also be sent to jail (apart from damages which may be imposed on him in a civil suit or by the consumer fora). However, what is simple negligence and what is gross negligence may be a matter of dispute even among experts.”
Estate planning: Wills

A Will is a legal document that lays out the fate of one’s property after his death. It states who receives the property and in what proportion. To make it sure that most of estate is transferred to the beneficiaries in the manner one desires, will plays a very significant role.

(Source: IJCP)
Industry News
Govt to introduce Euro-VI fuel by 2020 to reduce pollution: India plans to shift to Euro-VI emission compliant petrol and diesel by 2020 to cut carbon pollution. Addressing a workshop on ‘Carbon Emission Management’, oil minister Dharmendra Pradhan said the fuels meeting Euro-IV or Bharat Stage (BS)-IV specifications are to be supplied throughout the country by April 2017 and BS-V or Euro-V grade fuel by 1 April 2020. But now instead of stepwise upgradation from BS-IV to BS-V and then from BS-V to BS-VI, the government is planning to switch over directly from BS-IV to BS-VI auto fuels by 1 April 2020. BS-IV fuels contain 50 parts per million (ppm) sulphur, while BS-V and BS-VI grade fuel will have 10 ppm sulphur. (Livemint – PTI)

Easier to start business in India, difficult to get credit: According to World Bank’s Doing Business Report 2016World Bank report, India improved its performance on three parameters—starting a business, getting construction permits and accessing electricity—in the World Bank Ease of Doing Business Index 2016, as compared with last year, but saw its performance deteriorate with regard to two parameters—getting loans and paying taxes. (Livemint)

India growth for 2015-16forecast at 7.5%: The latest India Development Update expects India’s economic growth to be at 7.5 per cent in 2015-16, followed by a further acceleration to 7.8 per cent in 2016-17 and 7.9 per cent in 2017-18. Speaking at the launch of a report by the World Bank, Senior Country Economist Frederico Gil Sander said India has taken advantage of the sharp decline in global oil and commodity prices to eliminate petrol and diesel subsidies and increase excise taxes. (Financial Express – PTI)

A 'Make in India Week 2016' in Mumbai: The government is planning to organize 'Make in India Week 2016' from February 13 in Mumbai with an aim to promote India as an investment destination and increase its share in global FDI. "The objective of the Make in India Week is to showcase opportunities to promote India as a preferred investment destination in the source markets overseas and to increase India's share of global FDIC besides highlighting India's manufacturing capability," the Department of Industrial Policy and Promotion (DIPP) said. (Economic Times – PTI)
Inspirational Story
Hiding their weaknesses and highlighting their strength

There was a King who had only one eye and one leg. He asked all the painters to draw a beautiful portrait of him. But none of them could because how could they paint him beautifully with the defects in 1 eye and 1 leg. Eventually one of them agreed and drew a classic picture of the King. It was a fantastic picture and surprised everyone.

He painted the King aiming for a hunt. Targeting with one eye closed and one leg bent

Moral: Why can’t we all paint pictures like this for others… Hiding their weaknesses and highlighting their strength....!!!!
A mix of exercise protocol is better

A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease. Only aerobic exercise is also as good as it reduces weight and takes inches off the waistlines. Just weight lifting alone has very little benefit.

According to a study published in the American Journal of Cardiology, people in the weight–training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists. Those who did both weight and aerobic training dropped about 4 pounds and 1 inch from the waistline. This group also saw a decrease in diastolic lower blood pressure and in a metabolic syndrome score. Both the aerobic–only group and the combined-exercise group also lowered their levels of bad triglycerides.
A press conference was organized to announce the dates of the 22nd Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India. The Mela will take place from Nov 4-8, 2015 at the Talkatora Stadium in New Delhi
At the end of a balanced anaesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1. Pancuronium.
2. Gallamine.
3. Atracurium.
4. Vecuronium.

Yesterday’s Mind Teaser: An increase in which of the following parameters will shift the O2 dissociation curve to the left.

1. Temperature.
2. Partial pressure of CO2
3. 2,3 DPG concentration.
4. Oxygen affinity of hemoglobin.

Answer for Yesterday’s Mind Teaser: 4. Oxygen affinity of hemoglobin.
Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Raju Kuppusamy, Daivadheenam Jella, Dr Avtar Krishan.
Answer for 28th October Mind Teaser: 1. Criterion validity.
Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Daivadheenam Jella, Raghavendra Chakurkar, Dr K Raju, Dr Avtar Krishan.
MTNL Perfect Health Mela 2015.
Pls click here for details
IMA Digital TV

There were these two friends, Bill and Bob, and they both loved baseball. So, they made a promise to each other, the first one to die, will come back and let the other know if there’s baseball in heaven. Well, the day comes and Bob passes. Weeks turn to months while Bill is still waiting to hear from his friend.

Then one day, Bill is walking down the street, and Bob appears. Bill all excited says: "I’ve been waiting forever! So tell me, is there or isn’t there Baseball in heaven?" Bob kinda perks up and says: "I’ve got good news and bad news." "1st, there is Baseball in heaven! The bad news is you’re pitching Friday!"
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!
Breaking news
WCD Ministry launches a new initiative to spread awareness about Beti Bachao Beti Padhao Scheme

The Union Ministry of Women and Child Developmenthas launched a new initiative to spread awareness about the Beti Bachao Beti Padhao (BBBP-Save the girl child, Educate the girl child) Scheme of the Ministry. The initiative has been launched in partnership with Celltick Mobile Media India Pvt. Ltd. to generate awareness about BBBP Scheme to an estimated 100 million mobile users in India. This campaign is aimed at promoting gender equality and the significance of educating girls.

There has been a steady decline in the Child Sex Ratio (CSR) across India, with 918 females born per 1000 males as per the Census of 2011. Through the Celltick managed mobile services based on its patented Live Screen platform, available to over 100 million users in India, the user is able to get messages that they can interact with on the homescreen of their device, enabling ease of use in accessing information about BBBP. The platform provides a means to reach users based on their location as well as their language of preference. Working with all the major mobile operators across India, the Beti Bachao, Beti Padhao campaign will be executed to reach over a 100 million users in India. The service will direct users to access more information about it…. “We are happy that Celltick is committed to the cause of improving the Child Sex Ratio in India and therefore, contributing to promote the issue of gender equality and significance of educating our daughters to mobile users in India,” said Shri V. Somasundaran, Secretary, Ministry of Women and Child Development. “The Beti Bachao, Beti Padhao campaign is very important to us and we are happy to work with the Government to create wide awareness of such an important initiative in promoting gender equality in India,” said Abraham Punnoose, Managing Director, Celltick India. “We are always keen to use the power of our next generation mobile platforms for the greater good of people around the world and shall endeavor to make this a great success in India.”

The Ministry of Women and Child Development is the nodal ministry for the Beti Bachao Beti Padhao Scheme being implemented jointly with the Ministry of Health and Family Welfare and Ministry of Human Resource Development. The Scheme is targeted at improving the Child Sex Ratio through multi sectoral interventions including prevention of gender biased sex selection and promoting girls’ education and her holistic empowerment. (PIB)
Respected Dr. K. K. Aggarwal,
Honorary Sec. Gen. IMA

Dear Sir,
I was very pleased and also reassured to talk to you over the telephone about the proposed ART bill 2014 (Regulation).

The Bill in its present form is a matter of grave concern for all Obstetricians and Gynaecologists, FOGSI and the women of the country who we serve. We feel this will adversely affect the care of women in our country already reeling from the deprivation of healthcare due to the non-uniform and draconian implementation and interpretation of the PC PNDT Act

Although the problems with the bill are so many that a complete redrafting of the bill may be needed we would like to highlight a few areas which stand out for the unfettered access it entails to the authority to trample upon the dignity, livelihood and right to practice under a reasonable framework that any professional should have in a civilised society.

The bill seems to reflect the ethos and spirit of the PC PNDT act and indeed has language in two sections which seem to be a “Copy - Paste” job. This has been pointed out by Dr Sanjay Gupte a keen legal mind who is also a Past President of FOGSI.

Chapter 8 section 64 (1) has the similar wording as PCPNDT Act section 23 (1) so also section 69 is the same as section 25 of the PCPNDT Act. The presumed Guilt of the Physician in the matter is not only appalling but we believe also goes against the basic spirit of the Constitution and violates our rights as citizens of a free and democratic India.

The Bill not only sanctions, but also seems to encourage “Authorities” to visit any Infertility Clinic /Centre/ Hospital / any Gynaecologists practicing Infertility (Basic/ Advanced) without any prior information. Moreover it gives them unprecedented access to the Hospital records. IVF and Infertility treatment is a serious and emotional matter even in the best of circumstances. The infertile couple is surely not asking for too much when they ask for confidentiality. The authority can without any questions divest the couple of this right. There is no mechanism to address the break in confidentiality and this is a real problem.

The bill further invests the authorities - (Experience with the PC PNDT act has shown that the training of the authorities and the understanding they have of the Act is driven more by their desire to show action rather than following the spirit of the Act) - with completely unreasonable powers. It is our stand that regulation although welcome must not act as deterrent. If there is error in record keeping it is presumptuous to assume that there is an underhanded motive behind the lapse. Equating an error in record keeping with a heinous crime is unprecedented in any civilised part of the world and to base penalties on this is something which is completely out of line.

The authorities can on finding error - even without any trial / hearing of the physician seal the clinic/ centre/ hospital, imprison the Physician for upto 7 years and impose a fine upto 15 lacs. This is grossly unfair and should not be allowed to stand.

Despite the fact of adequate consent the bill imparts the responsibility of even known complications solely to the physician. Even complications which have nothing to do with the treatment e.g. development of Gestational diabetes or even the presence of chromosomal anomalies are laid at the door step of the ART clinic.

Not only that the ART Bank - a new entity created solely to introduce middlemen into the system and further push up costs - also relinquishes responsibility in the patients eyes to the Physician. Thus a Donor either male or female, or surrogate almost has no responsibilities and yet has all possible rights at the expense of the Physician.

This is pushing the limits of tolerability and credence.

Perhaps what is most damaging is that the clinic / centre which are sealed can be so sealed, for upto three months whilst the appeal is being heard. Let’s keep in mind that this act does not purport to cover only the Advanced / IVF centres. It also aims to bring under its ambit regular Gynecologists all 32000 and more who are members of FOGSI who even give Clomiphene and do Insemination. The same physician also provides Maternity services, Family Welfare Services and Gynecological care. In a scenario where there are limited resources, imagine the disastrous consequences for women’s health in our country. A clinic may be the only one of one of two in a given area. If for a flimsy lapse in record keeping this clinic is shut down, that population of that area is deprived of even basic health care for its women.

We are also taken aback at the arrogance of the drafting committee to unleash a poorly thought out bill which impacts so much of our population without consulting the professional associations who represent the health care providers. We are unaware that IMA or even FOGSI was involved in the decision making and drafting of the contentious sections of the proposed law.

The proposed ART Bill 2014 Regulation which is kept for opinion till 10th Nov’15 and then will be tabled in the Parliament to become an Act.

We from FOGSI are keen to make reasonable the provisions of the proposed ART Bill 2014 Regulation and believe that IMA’s endorsement of our views for this matter is a deserving cause for not only the over 250, 000 IMA members who provide women’s health but also for the women of our country.

With regards,

Dr. Prakash Trivedi, President FOGSI
Dr. H.D.Pai, Secretary General
Dr Jaydeep Tank, Dy Sec General
Indian Medical Association National Satyagraha for a Healthy India
IMA Digital TV
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?
India recorded largest number of TB cases in 2014

India recorded the largest number of Tuberculosis cases in the world last year, according to a report by the WHO that said 1.5 million people died in 2014 from the disease which ranks alongside HIV as a leading killer worldwide. The Global Tuberculosis Report 2015 by WHO said that of the 9.6 million new TB cases in 2014, 58% were in the South-East Asia and Western Pacific regions. India, Indonesia and China had the largest number of cases at 23%, 10% and 10% respectively of the global total in 2014. Nigeria, Pakistan and South Africa also had high numbers of TB cases last year. Nearly 1.5 million people died from the disease last year, including 140,000 children, according to the report. “Most of these deaths could have been prevented. The disease ranks alongside HIV as a leading killer worldwide,” it said…The annual total of new TB cases, which had been about 5.7 million until 2013, rose to slightly more than 6 million in 2014, mostly due to a 29 per cent increase in notifications in India, which followed the introduction of a policy of mandatory notification in May 2012, creation of a national web—based reporting system in June 2012 and intensified efforts to engage the private health sector… (The Hindu – PTI)
The Bombay high court on Thursday directed state to regulate sale of medicines online till a law is made and constitutes a committee to be headed by FDA chairman Harshdeep Kamble. The high court had on Wednesday asked the state government to spell out the steps it planned to take to prevent online sale of drugs without a proper prescription from a doctor. The bench of Justices Naresh Patil and S B Shukre was hearing a plea to tackle these online sales where students were buying the drugs based on fake medical prescriptions. (Times of India – Swati Deshpande)
The Ministry of Health & Family Welfare has sanctioned grants amounting to more than Rs. 17 crore towards upgradation and strengthening of trauma care facilities in Government Hospitals in the state of Himachal Pradesh. This is as part of the centrally sponsored scheme of “Capacity Development for Developing Trauma Care Facilities in Government Hospitals located on National Highways” of the Ministry of Health & Family Welfare. (PIB)
CDC releases its first national data on e-Cigarette use in adults

Current smokers and former smokers who quit only recently, as well as smokers who tried to quit in the recent past, are more likely to use e-cigarettes compared with former smokers who quit smoking more than a year ago, new data from the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS) suggest.

• In 2014, 12.6% of adults had ever tried an e-cigarette even one time, with use differing by sex, age, and race and Hispanic or Latino origin.
• About 3.7% of adults currently used e-cigarettes, with use differing by age and race and Hispanic or Latino origin.
• Current cigarette smokers and former smokers who quit smoking within the past year were more likely to use e-cigarettes than former smokers who quit smoking more than 1 year ago and those who had never smoked.
• Among current cigarette smokers who had tried to quit smoking in the past year, more than one-half had ever tried an e-cigarette and 20.3% were current e-cigarette users.
• Among adults who had never smoked cigarettes, 3.2% had ever tried an e-cigarette. Ever having used an e-cigarette was highest among never smokers aged 18–24 (9.7%) and declined with age.

The NCHS Data Brief published online October 28, highlights the first estimates of e-cigarette use among US adults. (Medscape, CDC)
DGCA drafts a new set of rules for air ambulance services

India's aviation regulatory body has drafted a new set of rules for air ambulance services that can potentially improve the country's medical emergency services up to global standards. The new regulations from the Directorate General of Civil Aviation will enable players such as Aviators Air Rescue, which is set to launch India's first dedicated air ambulance operator next year… India has a fleet of 140 commercial helicopters but no not even one is a dedicated air ambulance… (Economic Times – Anirban Chowdhury)
IMA Digital TV
GP Tip: Closed eyes sign

The examiner observes the patient’s eyes before and during the abdominal examination. Those with specific intraabdominal disease keep their eyes open, fearful that the examining hand will cause even more pain. Those with less serious, non-specific abdominal pain problems tend to keep their eyes closed.

(Source: IJCP)
Readers column
Dear Sir, Very informative newspaper. Regards: Dr KP Sharma
IMA Digital TV
Press Release
The dangers of excessive alcohol consumption especially during the festive season

Awareness generation and adequate checks are crucial in order to save lives

Excessive alcohol consumption and underage drinking are common issues, which almost all countries globally continue to struggle with. India witnesses a sudden spike in the sale and consumption of alcohol, especially during the festive Diwali season. This particularly can prove to be extremely dangerous for those with existing lifestyle diseases, the elderly and young adults. It is extremely important that awareness is raised, and adequate checks are put in place to prevent the festivities from turning into disasters.

Increased alcohol consumption is directly proportional to a rise in the number of road accidents, obesity and hypertension levels and risk of heart disease. People often take to the wheel when under the influence of alcohol and often end up risking their lives and that of others due to decisions made under an impaired judgment. Similarly, the high-calorie levels of alcohol cause obesity put additional pressure on the heart and cause a spike in blood pressure. A few moments of fun can turn to be fatal if adequate precautions are not taken.

Speaking about this, Padma Shri Awardee, Dr A Marthanda Pillai – National President IMA and Padma Shri Awardee – Dr K K Aggarwal – Honorary Secretary General IMA and President HCFI in a joint statement said, “Alcohol consumption is a critical challenge that contributes to various social and economic problems. 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. Awareness needs to be raised about the evils of alcohol consumption and the dangers of over-consumption especially during the festive month of Diwali. Parents need to be made aware of the problems of under-age drinking and the need to counsel their children, and patients about the consequences it can have on their overall health and well-being. In addition to this, the government must take stringent steps to curb the menace of drinking and driving."

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. 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. The Indian Medical Association and the Heart Care Foundation of India endorse their points and believe that a problem such as this can only be tackled when collective steps are taken by all medical associations.

A few ways in which the Governments can help tackle the menace of alcohol consumption that plagues societies include

• 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 minimize 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. Practicing social marketing campaigns to educate the public about harmful alcohol use. Encouraging drink driving policies and regulating health-warning labels on alcohol products, mandated by an independent authorized body
• Key drink-driving deterrents should be implemented like strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions
• The problem of excessive alcohol consumption is plaguing the entire country, and if appropriate measures are not implemented, the number of deaths caused due to alcohol-related causes will continue to rise at a high pace. In a country like India, which is home to 1.27 billion people and records one of the highest drinking and driving deaths yearly, stringent laws and checks are a must.
Digital IMA