All patients with TB should be tested for HIV as a routine

All patients with TB should be tested for HIV as a routine

IMA recommends HIV screening for all TB patients after the patient is notified unless the patient declines (opt-out screening) said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General IMA. This includes persons with TB disease and persons with latent TB infection.  Routine HIV testing is also recommended for persons suspected of having TB disease, persons diagnosed with latent TB infection, and contacts to TB patients.  Prevention counseling and separate written consent for HIV testing should no longer be required.

A resolution was passed by IMA during their annual national review meeting on TB held in the city here today. Additional DDG, Central TB Division, Ministry of health, Dr Niraj Kulsherestha and Dr K S Sachdeva, present on the occasion as guest of honors, said this is as per Govt of India guidelines.

Following was the main points of the discussion

1.       HIV infection is the most important known risk factor for progression from latent TB infection to TB disease.

2.       Progression to TB disease is often rapid among people infected with HIV and can be deadly.

3.        TB outbreaks can rapidly expand in patient groups infected with HIV.

4.        Targeted HIV testing based on provider assessment of patient risk behaviors fails to identify a substantial number of people who are infected with HIV.

5.        Many individuals may not perceive themselves to be at risk for HIV or do not disclose their risks.
6.        Routine HIV testing reduces the stigma associated with testing.

7.        When HIV is diagnosed early, appropriately timed interventions can lead to improved health outcomes, including slower progression and reduced mortality.

8.       Identifying TB patients, suspects, and contacts infected with HIV allows for optimal TB testing of these groups and provides opportunities to prevent TB in those without disease.

9.       Both TB and HIV treatments are available free from the government under one window.

10.      HIV testing can be done using the rapid card tests.

IMA hails smokeless tobacco ban Delhi: Will lead to less heart attacks

IMA hails smokeless tobacco ban Delhi: Will lead to less heart attacks

Banning smokeless tobacco in Delhi has been hailed by IMA. Complementing  Delhi Govt decision, Padma Shri Awardee Dr A. Marthanda Pillai National president and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General IMA, said that smokeless tobacco comes as chewing tobacco or snuff.

Electronic cigarettes (e-cigarettes) use a liquid nicotine cartridge, rather than tobacco.  In addition to cigarettes, tobacco is smoked in the form of cigars, pipes, and waterpipes.

Nicotine is the principal alkaloid found in smokeless tobacco products. The amount of total and free nicotine varies substantially. The concentrations of nicotine (milligrams per gram of tobacco) are similar in oral snuff and cigarette tobacco and somewhat lower in chewing tobacco.
Most smokeless tobacco products are held in the mouth, cheek, or lip or chewed to allow   absorption of nicotine across the buccal mucosa.Oral snuff is held in the cheek between the gum and tooth area.
1. Snuff is associated with a small but significant increase in the relative risk for hypertension.

2. Some smokeless tobacco products, such as loose snuff and chewing tobacco, contain large amounts of sodium, part of the sodium bicarbonate alkaline buffer, enhancing nicotine absorption. The sodium load (30 to 40 excess mEq per day) could potentially aggravate hypertension and heart failure

3. Some smokeless tobacco products contain significant amounts of licorice. Glycyrrhizinic acid, an active chemical in licorice, has mineralocorticoid activity, which may potentiate hypertension and potassium wasting

4. Among “one-time” users of snuff or chewing tobacco transient (30 to 60 minutes), increases in blood pressure and heart rate have been observed due to effects of nicotine

5. The acute effects of smokeless tobacco products include an increase in heart rate and no change or transient increases in blood pressure.

6. Data from INTERHEART showed that chewing tobacco alone was associated with significantly increased risk for heart attack

7. Most people are poorly informed about the dangers of smokeless tobacco, and some believe that it is a safe substitute for smoking cigarettes.

8. The health effects of smokeless tobacco include oral, pharyngeal, and esophageal cancer, oral leukoplakia (a premalignant lesion) and periodontal disease

9. Use of smokeless tobacco produces levels of nicotine that are similar to those produced by smoking, and are also addictive.

10. Smokeless tobacco use is associated with higher levels of current and subsequent cigarette smoking and lower rates of smoking cessation
[Uptodate]

IMA to sensitize 2.5 lac doctors on Food Safety, Dengue and Malaria

7th April is World Health Day and will be dedicated to Food Safety this year.

20th April is World Malaria Day and will be dedicated to invest in future, defeat malaria.

To earmark both the days, IMA will be sensitizing 2.5 lac doctors in the country through SMS and emails, about Food Safety and prevention of Vector Borne Diseases.

Giving the details, Padma Shri Awardee Dr  A Marthanda Pillai, National President & Padma Shri Awardee, Dr K K Aggarwal, Honorary Secretary General, IMA said that more than 3 lac children in the age group 0 to 5 years of age die every year because of food and water related diseases.

The core messages of the Five Keys to Safer Food are: (1) keep clean; (2) separate raw and cooked; (3) cook thoroughly; (4) keep food at safe temperatures; and (5) use safe water and raw materials.

One should not keep food in room temperature for  more than two hours.

Vector Borne Diseases specially Dengue are likely to increase this year. Therefore, mass sensitization of doctors is required to check the disease. IMA has decided to enter into an understanding with the NVBDCP, Govt. of India to work in this area.

Malaria mosquito is a night biter and a noise causing mosquito.

IMA distributes kitchen plants to create TB Awareness

IMA distributes kitchen plants to create TB Awareness

On the occasion of World TB Day, IMA in association with Heart Care Foundation of India distributed over 500 kitchen plants with TB Health Message : “TB Anywhere – TB Everywhere”.

Giving details, Padmashri Awardee , Prof  (Dr.) A. Marthanda Pillai,  National President and Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA & President, Heart Care Foundation of India said that one million TB cases in India are missing as either they are not get treated or during treatment they do not get notified.

IMA will get notify 50% of them in the next year.

Dr  Aggarwal further said that irrespective of specialty of doctors in the country, all hould join the TB movement.

Multi drug resistance TB is not in the interest of the country.  If the spread of multi drug resistance TB is not stopped, it can take an epidemic shape and will not spare people from any walks of life. 

It is a misnomer that TB is a disease of the poor. Dr Aggarwal said  that “forget about rich class, even 5% of health care professionals develop TB over their life time".

All the workers (drivers, security man, attendants and maids etc) before they are inducted in the job, they should be screened for TB.

It is also a myth that TB is a disease of adults.  A large number of children today are being diagnosed with TB.

In the last one year IMSA has sensitized over one lac poem, trained 16000 GP's and notified over one lac TB patients.

In the last one week, IMA sensitized over 100 nursing teachers, over 300 school principals, over 100 general practitioners, over 1000 medical college students, over 250 college students and over 500 school children.

PADMA Celebrities to join for a social cause

World TB Day on 24th March

 PADMA Celebrities to join for a social cause

 IMA saved government over 30 crores by preventing development of drug resistant TB

 Padma Awardees of the country will join hands for social causes of National Interest. Addressing a press conference here, Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General INA and Padma Shri Awardee Ashok Chakradhar, Noted Kavi said that efforts are being made to have Padma Awardees meet regularly and do something collectively for the society. The first on the line will be endorsing the health concern about drug resistant TB. The duo said that the best treatment of drug resistant TB is its prevention. If TB is partially or wrongly treated 3% of them will become drug resistant requiring more than 2 years of treatment  and more than 2 lac worth drugs.

Padma Awardes, Birju Maharaj, Sonal Man Singh, Purshottal Lal,  , Uma Sharma, Amjad Ali Khan, Naresh Trehan, Ambrish Mithal, Ashok Seth, T S klair, Neelam Klair, Arvind Lal, Sudhir Tailang, Sovna Narayan, Geeta Chandran, Satpal, Surinder Sharma, Ashok Chakradhar and many others will support the combined social campaign, said Dr Aggarwal and Dr Chakradhar.

All patients of TB needs to be notified and followed up till they are cured, added Padma Shri Awardee Dr AM Pillai National President IMA.

Patients notified in private sector if lost in follow up could result in multi drug resistant TB, added Dr Suresh Gutta National Coordinator TB IMA.

Efforts of IMA have helped in identifying, follow , treat and cure one lakh ( 104000  to be exact) out of one million missing TB cases in India.   Out of these 33913 cases were sputum positive and infectious to the community. Each sputum positive case spreads infection to 15 other healthy persons and ten percent of all TB infected persons develop clinical disease.

IMA has been able to avert about 508695 new TB infections due to reduction of TB transmission by treating infective TB cases. Out of these ten percent, 50870 cases could have developed clinical TB disease. Three percent of them, 1526 cases could have become drug resistant over time.

 Treatment of 1526 drug resistant cases could have caused the government extra cost of over 30.52 crores ( Rs 2 lac per treatment). Apart IMA's contribution has been able to check impending Drug resistant TB epidemic.

Apart IMA has also trained and provided a TB faculty cum experts of over 16000 doctors in the country and has been able to sensitize over one lac private doctors.  All these doctors follow one TB treatment protocol adhering to Standards of TB Care in India. This itself further checks the development of MDR TB.

IMA has brought the private sector to the forefront to shoulder the efforts of Government in TB Control, said Dr Aggarwal.

IMA activity has helped linking the Government machinery to private sector doctors and hospitals of these one lakh patients. Patients are benefitted as they get an opportunity for free drugs and facilities for Drug susceptibility testing. These patients are not just being referred to Government sector for treatment, but gets managed by the private sector following standards of TB care in India.

IMA also released it slogan for the general practitioners" I have notified a TB patient today: have you. Do it today

IMA is also linking private doctors and private doctors owned clinical establishments into the loop of DOTS centers by way of establishing peripheral health institutes. A PHI is a center in private sector linked to government DOTS and provided confidential and free treatment to the public. Over 1700 such centers have been established by IMA so far. IMA hospital Board of India has been rope in by IMA to expand its scope of PHI centers. HBI has over 10000 member.

Talks are also on with National Accreditation Board of Hospitals to accreditate PHI in regards to quality and safety.

IMA GFATM RNTCP Project

 IMA is the largest NGO of the works with a membership of over two lac spared over 1700 branches and 30 state branches. IMA communicates to its members daily though emails and or SMS apart from its regular publications.

Under the IMA GFATM RNTCP Project and IMA TB initiative IMA has been engaged in the following activities

1.      Sensitization of doctors in Standards of TB care

2.       Need for notification - follow up and cure

3.      Training of general practitioners in standards of TB care

4.      Institution of Peripheral Health Institution

5.      IEC activities

6.      Media Advocacy

7.      Celebrity endorsement

Sensitization of doctors in Standards of TB care: IMA has been able to sensitize over one lac private doctors. 

Sensitization of doctors in Standards of TB care: Patients notified in private sector if lost in follow up could result in multi drug resistant TB

Need for notification - follow up and cure: All patients of TB needs to be notified and followed up till they are cured. IMA has helped in identifying, follow, treat and cure one lakh ( 104000  to be exact) out of one million missing TB cases in India.  Out of these 33913 cases were sputum positive and infectious to the community. Each sputum positive case spreads infection to 15 other healthy persons and ten percent of all TB infected persons develop clinical disease. IMA has been able to avert about 508695 new TB infections due to reduction of TB transmission by treating infective TB cases. Out of these ten percent, 50870 cases could have developed clinical TB disease. Three percent of them, 1526 cases could have become drug resistant over time.

Treatment of 1526 drug resistant cases could have caused the government extra cost of over 30.52 crores ( Rs 2 lac per treatment). Apart IMA's contribution has been able to check impending Drug resistant TB epidemic.

Training of general practitioners in standards of TB care: IMA has trained and provided a TB faculty cum experts of over 16000 doctors in the country. All these doctors follow one TB treatment protocol adhering to Standards of TB Care in India. This itself further checks the development of MDR TB.

Start of Peripheral Health Institutions: IMA is also linking private doctors and private doctors owned clinical establishments into the loop of DOTS centers by way of establishing peripheral health institutes. A PHI is a center in private sector linked to government DOTS and provided confidential and free treatment to the public. Over 1700 such centers have been established by IMA so far. IMA hospital Board of India has been rope in by IMA to expand its scope of PHI centers. HBI has over 10000 member.

Talks are also on with National Accreditation Board of Hospitals to accreditate PHI in regards to quality and safety.

·         IEC activities: At National, State and Branch levels include

·         Sensitization of School and College Principals

·         Sensitization of medical college students

·         Sensitization of Nursing School and Colleges

·         CME for general practitioners

·         Rally, Walks, Run, Exhibitions etc events

·         Fairs, Melas etc

·         Competitions: Poster, slogan, painting, dances, music etc etc

Media Advocacy: IMA regularly organizes media sensitization programs for the benefits of the public, at National, State and Branch levels

Celebrity endorsement: Padma Awardees of the country have joined hands for social causes of National Interest. They include Birju Maharaj, Sonal Man Singh, Purshottal Lal,  , Uma Sharma, Amjad Ali Khan, Naresh Trehan, Ambrish Mithal, Ashok Seth, T S klair, Neelam Klair, Arvind Lal, Sudhir Tailang, Sovna Narayan, Geeta Chandran, Satpal, Surinder Sharma, Ashok Chakradhar and many others.

IMA slogan for the general practitioners" I have notified a TB patient today: have you. Do it today

Rally to create awareness on TB

Rally to create awareness on TB

Dr Jagdish Prasad DGHS and DR KK Aggarwal Honorary Secretary General IMA today released TB messages to earmark World TB day falling on 24rth March. Addresing a gathering of hundreds of health care professionals coordinated by IMA, Dr Prasad said that the slogan this year is " TB Harega, desh Jitega".

Dr AM Pillai National President and Dr Sursh Gutta National coordinator TB said that it is important to notify TB in every case to stop the spread.

Over 40 Principals from various schools were also sensitized on TB prevention and respiratory hygiene.

Following messages were released

1. TB is curable

2. Not notifying a TB patient is violation of MCI act

3. Not only notify but also follow notified patients till they are cured

4. Patients notified in private sector and are lost in follow up could result in MDR TB, which costs a huge sum of money (Rs. 2 laks / patient)

5. Swach Bharat, Swsathya Bharat, TB Mukt Bharat

6. TB harega desh jeetega

7. Two weeks cough can be TB. Consult a Doctor

8. World cup lao, TB ko harao

9. 2 hafte se jyada khansi, wajan ghatna, bukhaar aana, balgam mein khoon aane par turant doctor se salaah karein. Ye TB ho sakti hai

10. Notify all TB cases and make TB free India.

11. Notify all TB cases in Nikshay and make TB Mukt Bharat

12. Diagnose and treat TB every case as per the Standards for TB Care in India

13. Kshay rog ka nidaan v ilaaj bhartiye kshay rog manakon ke anusaar hi karaye

14. TB anywhere is TB everywhere.

15. TB sab ko nahin hoti; par kisi ko bhi ho sakti hai

16. TB isn’t just somebody else’s problem, it could be yours. Coughing for more than 2 weeks, test for TB

17. 9 million new TB cases are detected every year globally

18. 1.5 million people die every year from TB globally

19. Do not ignore cough of more than 2 weeks, it may be TB.

20. Serological tests for diagnosis of TB are banned and not recommended

21. Follow the standard IMA Protocol for TB

22. Not notifying TB is a violation of IMC Act under Section 5.2 and 7.14.

23. 2 consecutive negative sputum samples for AFB at the end of treatment means TB is cured

24. DOTs provides free treatment to TB patients and their confidentiality is maintained

25. MDR TB means TB that is resistant to INH, Rifampicin.

26. MDR TB requires treatment for 24-27 months

27. "Reach the 3 Million: Reach, Treat, Cure Everyone"

28. All diagnosed TB patients should be offered HIV counselling & Testing.

29. TST and IGRA should not be used for diagnosing active TB.

30. TB patients should be given dosages of the drugs depending upon body weight.

31. Patients with pulmonary tuberculosis  should be monitored by follow-up sputum

32. microscopy at defined intervals.

33. TB patients living with HIV should receive the same duration of TB treatment with daily regimen

34. ART must be offered to all patients with HIV  & TB at the earliest.

35. People living with HIV should be screened for TB

36. Ensure pura course for pakka ilaj

37. Ensure all contacts of TB patients are screened for TB

38. <6 yrs contacts of  TB patients after excluding active TB, should  get INH for 6 months

39. Counsel all TB patients for cough hygiene, nutrition & treatment adherence

40. Hate TB,  not the patient, treat with dignity and confidentiality.

The new Health Budget… Healthy in long run

The new Health Budget… Healthy in long run

Dr K K Aggarwal

The pro-manufacturing and pro-infrastructure budget focuses on a long-term road map for the economy and health and lays down short-term strategies to achieve them. The budget will ultimately benefit the common folk and generate jobs for the strong and young. Rising transparency levels in governance would ultimately generate more revenues and improve targeted spending. Make in India, Digital India, Housing for all, 24x7 power and water will help health care spending in long run.

Only 33,152 crores have been earmarked for health sector, but there are other avenues. This amount must not lapse and reach every house hold.

Jan Dhan, Aadhar and Mobile will allow transfer of benefits in a leakage-proof, well-targeted and cashless manner. Incentives for card transactions with the aim of making India a cashless society will make healthcare system more transparent.

Jan Dhan Yojana, with over 12.5 crore families brought into the financial mainstream will raise education standards and reach of health care. 

Swachh Bharat campaign with its target of 6 crore toilets will promote hygiene and cleanliness; it is a program for preventive health care and reduce communicable diseases; 100% tax deduction for contributions under this, other than by CSR contributions, will make available more money. Swachh Bharat Cess of 2% on all or certain services will finance and promote initiatives towards this campaign.

By 2022, as a part of Amrut Mahotsav (75th year of independence), India will have 6 crore new houses each with 24x7 power supply, clean drinking water, a toilet, road connection and at least one earning member; electrification of remaining 20,000 villages; 1,78,000 connected habitations by all-weather roads; provision for medical services in each village and city; avenues for education and skill development of youth; a senior secondary school within 5 km reach of each child. Increase in overall agricultural productivity and connectivity to all villages will help general economy leading to a healthy society. India will become the manufacturing hub of the world through Skill India and Make in India programs.

Any spending in the rural area will include health spending. Rs 25,000 crore to the corpus of Rural Infrastructure Development Fund set up in NABARD; 15,000 crore for Long Term Rural Credit Fund; 1500 crore in Deen Dayal Upadhyay Gramin Kaushal Yojana, 45,000 crore for Short Term Cooperative Rural Credit Refinance Fund and 15,000 crore for Short Term RRB Refinance Fund will promote rural health; 34,699 crore for MGNREGA will provide employment to the poor. A universal social security system for all, especially the poor and underprivileged, will also help create health security.

For the welfare of SCs, STs and women, 30851, 19,980 and 79258 crores respectively have been earmarked; 3738 crore has been allocated for welfare of minorities.

Pradhan Mantri Suraksha Bima Yojana will cover accidental death risk of 2 lakh for a premium of just 12 per year; Atal Pension Yojana will provide a defined pension with government contributing 50% of beneficiaries’ premium limited to 1,000 each year, for 5 years. Pradhan Mantri Jeevan Jyoti Bima Yojana will cover both natural and accidental death risk of 2 lakhs at a premium of 330 per year for the age group 18-50.

Unclaimed deposits of 3,000 crore in PPF and 6,000 crore in EPF corpus will be converted into Senior Citizen Welfare Fund. A new scheme for the elderly with age-related disabilities will provide Physical Aids and Assisted Living Devices for those living below the poverty line. Life insurance service provided through Varishtha Pension Bima Yojana is exempt from service tax.

In nutrition, 68968 crore for education and mid day meal will cover deficiencies in children. 5,300 crore towards microirrigation, watershed development and Pradhan Mantri Krishi Sinchai Yojana will increase production of health-friendly food. Exemption of service tax in cold storage services and in transportation of food stuff by rail/road will make available healthy food at a cheaper cost.

Rs 10,351 crore has been allocated for women and children with another 1,000 crore towards the Nirbhaya Fund for women safety; 1500 crore has been earmarked for Integrated Child Development Scheme and 500 crore for Child Protection Scheme.

A defence budget of 2,46,727 crore will cover health of all Army personnel and related units.

MUDRA (Micro Units Development Refinance Agency) bank with a corpus of 20,000 crore, and credit guarantee corpus of 3,000 crore can fund small health business houses.  

Family gold, under Gold Monetisation Scheme can earn interest. With transparent coal auction, coal bearing States will get additional several lakhs of crore of rupees towards betterment of society.

Infrastructure development will help build safe roads and railways; 22,407 crore for housing, 4,173 crore for water resources, 14031 crore for road development, 10050 for railways and + 70,000 crore towards infrastructure development with provision for tax-free infrastructure bonds will reduce disease burden. Plug-and-play projects in infrastructure projects will aid road safety.

National Investment and Infrastructure Fund will have additional 20,0000 crores. Excise duty on petrol and diesel at 4 per liter into Road Cess will additionally fund 40000 crore investment in roads and other infrastructure.

Five Ultra Mega projects of 4000 MW each to make electricity available across the country will indirectly also help the medical profession.

In insurance, the employee will have the option of choosing either ESI or a Health Insurance product; the employee may opt for EPF or the New Pension Scheme. Increase in the limit of deduction in respect of health insurance premium from 15,000 to 25,000 (for senior citizens 30,000 from existing 20,000; for 80 plus people who are not covered by health insurance, deduction of 30,000 towards expenditure incurred on their treatment; deduction limit of  60,000 towards expenditure on account of specified diseases of serious nature enhanced to 80,000 in 80 plus; additional deduction of 25,000 allowed for differently abled persons under Section 80DD and Section 80U of the Income-tax Act.

Rs 150 crore under Atal Innovation Mission, will promote scientific research in India.

India will have six new AIIMS, three National Institutes of Pharmaceutical Education and Research, two Institutes of Science and Education Research and one University of Disability Studies and Rehabilitation. All ambulance services will be exempt from service tax. Donation made to National Fund for Control of Drug Abuse will be 100% exempt from deduction under 80G. Artificial hearts (left ventricular assist device) and flexible medical video endoscopes will become cheaper with reduction in custom duty.

Visa on arrival for 150 countries will promote Medical tourism.

Rs 750 core allocated towards Faster Adoption and manufacturing of Electric Vehicles will reduce pollution. Renewable energy capacity to 1,75,000 MW will reduce pollution. Clean Energy Cess from 100-200 per metric tons of coal will help clean environment initiatives.

Self-Employment and Talent Utilization with 1000 crore, will promote IT. National Optical Fiber Network Programme of 7.5 lakh km, will help digitize 2.5 lakh villages. Fully IT based Student Financial Aid Authority through Pradhan Mantri Vidya Lakshmi Karyakram will ensure that no student misses out on higher health education for lack of funds.

Reduction in Corporate Tax from 30% to 25% over 4 years may make corporate health services cheaper.  Making quoting of PAN mandatory for any billing of over 1 lakh will maintain transparency. Wealth tax has been replaced with an additional surcharge of 2% on the super-rich with a taxable income of over 1 crore. Service tax now will be consolidated rate of 14%. The tax does not involve medical services.

Income Tax Savings will be for every doctor with proper planning. [Deduction u/s 80C `1,50,000/  Deduction u/s 80CCD `50,000/  Deduction on account of interest / On house property loan (Self occupied property) `2,00,000/  Deduction u/s 80D on health insurance premium `25,000/ Exemption of transport allowance `19,200 = Total `4,44,200]. Transport allowance exemption from 800 to 1600 per month will help the middle class to earn money.

National Skills Mission, a skill-building initiative with 31 Sector Skill Councils will help develop skills including health skill manpower.

Income tax rate on royalty and fees for technical services has been reduced from 25% to 10%; increase in  excise duty on cigarettes, cigars, cheroots and cigarillos by 15-25% will reduce some smoking related illnesses.

More investments will create Jobs with rationalized conditions for FDI in medical devices sectors.

Inclusion of Yoga within the ambit of charitable purpose under Section 2(15) of the IT will see more Yoga Centers.

The Govt. is envisaging a national database of NGOs, which will promote transparency.

[Dr K K Aggarwal is Padma Shri, National Science Communication and Dr B C Roy National Awardee. He is Honorary Secretary General IMA and President Heart Care Foundation of India]

The Vedic science behind a divorce

The Vedic science behind a divorce

Dr K K Aggarwal

Padma Shri Awardee, Honorary Secretary General IMA and President Heart care Foundation of India

I was asked by  Ms. Vandana Shah, a practicing divorce lawyer in Mumbai to be the Guest of Honour for the release of her book “ The Ex Files – the story of my divorce”.

I started wondering, what I should speak. In the night, I closed my eyes and reviewed my Vedic knowledge and I got my insight into my possible dialogues:

1. Seven years itch is a known phenomenon. Many people even remarry after seven years. It is based on a scientific phenomenon of euphoria, reaction, adjustment, liking and loving.

Euphoria is the first phase of getting engaged to the period of honeymoon. The chemical reactions are based on release of adrenaline and nor adrenaline and amphetamine like chemicals. Both partners feel great, light and on the air.

 

This phase of euphoria ends with the next phase of reaction where both the partners start reacting to each other’s behavior and life style. The duration of this period may last for few years. 

The main cause of fight between two couples is this phase. This phase is followed with the phase of adjustment.

Both phases of & reaction and adjustment may carry on for upto 7 years.  During this period, both partners are compelled to stay with each other and start adjusting to their needs and life style. By 7^th year, the phase of liking start and this is the phase when you start feeling depending on each other. The misunderstandings may end and people may stop thinking about divorce and fight.

The last phase is phase of love which is sole to sole relationship and this phase may start decades after the marriage and that forms the basis of 25^th , 50^th & 75^thmarriage anniversary.  People in this phase of marriage are totally dependent on each other and cannot face separation.  If one person dies, the other may go to depression and also die within a short period of time. The chemical involved in this phase is endorphins.

2. Phase of reaction is dependent on our needs.  Every person has five types of needs and they are Physical, Mental,  Intellectual,  Egoistic and  Spiritual Needs.

Physical needs are needs for physical and sexual intimacy; mental needs are to share one’s emotions and need for a shoulder at the time of a cry; intellectual needs are the needs to discuss about future, decision making etc.; egoistic needs are the needs to acquire power and spiritual needs are the needs to acquire inner happiness.

Husband & wife who fulfill all the above needs of each other are called “made for each other’s”; which happens only rarely.

In a joint family concept, marriages are often successful because of one of the partners is not able to fulfill the non physical needs the same can be taken over by others in the family. In a single family, if one start looking for fulfilling non sexual needs from other friend the same may be the start of a conflict between husband and wife.

3. The phase of reaction always needs proper counseling which is based on the principal of Bhagavad Gita where Lord Krishna gives 18 counseling sessions to Arjuna.  In the first Counseling session, Lord Krishna only listens to Arjuna and in 2^nd counseling he briefs Arjuns in detail. From 3^rd to 17^th counseling Sessions, Lord Krishna answers each and every query, frightens and as well as consoles Arjuna. Ans in last 18th session Krishna revises all what has been counseled.

Unfortunately, in today’s divorce matters, such type of 18 Sessions are missing. Even Courts recognizes only 3 sessions.

4. In India, sexual preference are often not discussed or counted for.  People who have preference of the same sex or both the sexes may end up with conflicts unless proper counseling is done.

5. The concept of Ayurvedic matching is also missing in the country.  As per Ayurveda, a person can be Vata, Pitta or Kapha personality. Vata people are thin built with cold and dry hands, emotional and impulsive.  Pitta people are medium built with moist and warm hands and are egoistic.  Kapha people are heavy weight, with moist and cold hands, and they are calculative and manipulative.

Best marriages are between two kapha partners and worst marriages are between two pitta partners. Vata with Vata marriages are also a ground for divorce but can be easily salvaged with proper counseling.

India is a Vata-Pita society and hence most of the marriages can be saved if Ayurveda match making principles are used. 

6. If the disputes in husband and wife continues, over a period of time husband may suffer from erectile dysfunction with wife but not with other partner. 

TB infection is different from TB disease?

In most people who breathe in TB bacteria, the body's immune system is able to fight the TB bacteria and stop them from multiplying. This is called TB infection. People who are infected with TB do not feel sick, do not have any symptoms and cannot spread TB.

But on the other hand if the infected person's immune system cannot stop the bacteria from multiplying, the bacteria eventually cause symptoms of active TB, which is called TB disease.

Only 10% of all people with TB infection may suffer from the TB disease, said Padma Shri Awardee Dr A M Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary general Indian Medical Association.

Dr Aggarwal said that people with conditions like HIV, diabetes mellitus, malnutrition and those on treatment with immunosuppressant drugs (anti-cancer, corticosteroids etc) are at a greater risk of developing TB disease once infected.

TB is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in a year.

Indian Medical Association has been able to notify over one lac TB patients in last one year which has resulted prevention of atleast ten lac TB infections in the country.

All contact of TB cases should be identified at the earliest

24th World TB day

One sputum positive case of TB can spread the infection to ten others said Padma Shri Awardee Dr A M Pillai national President and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General IMA. A person who is sputum positive for TB is considered to have been contagious beginning three months prior to the first smear-positive sputum or the onset of symptoms, whichever is earlier. For individuals with AFB smear-negative TB, the contagious period is considered to have begun one month prior to onset of symptoms.

IMA release said that in the last one year IMA has been able to notify one lac additional new cases of TB in the society and thus has been able to stop the spread of TB to atleast ten lac persons in the society.

Al contacts of TB patients should also be investigated promptly to identify secondary cases of active and latent tuberculosis. Contacts should include family members and other close contacts in the community.

Within a healthcare facility, contact investigation should also be done if a patient with active TB received care prior to prompt institution of infection control measures. Contact investigation is also warranted if a healthcare worker who has had exposure to others in a healthcare setting is diagnosed with active TB.

Person-to-person transmission of TB occurs via inhalation of droplet nuclei. Individuals with active untreated pulmonary or laryngeal disease are contagious, particularly when cavitary disease is present or when the sputum is TB smear positive. Patients with sputum smear-negative, culture-positive pulmonary TB can also transmit infection.

Suspected or confirmed cases of TB should be reported promptly to the local public health department in order to expedite contact investigation and plan outpatient follow-up.

Infectious patients (eg, patients with AFB smear-positive sputum) may be discharged to home, provided there are no household members who are immuno-compromised or younger than four years of age.

Infectious patients should remain at home as much as possible; when receiving visitors or leaving home, patients should wear a surgical mask (not an N95 mask; surgical masks are designed to prevent the respiratory secretions of the person wearing the mask from entering the environment).

Sputum Disposal Guidelines

 Sputum Disposal Guidelines

One sputum positive case can infect ten more cases if sputum disposal guidelines are not followed by the patients said Padma Shri Awardee Dr A M Pullai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.

IMA is observing TB awareness fortnight to reduce the menace of TB in the country.  As per IMA, patients should be provided with individual container with lid, containing 5% phenol, for collection of sputum.  Patients should be instructed on spitting the sputum directly in the container or in a tissue paper which is then thrown in the container.  The container should be emptied daily and the sputum should be disposed of.

Disposal of sputum at health settings need to be considered. All health care settings should make available tissue papers, and make bins with disinfectants accessible to patients for disposal of sputum.

In OPD segregation of patients with respiratory symptoms should be achieved by having a separate waiting area for chest symptomatic patients.

One should implement a patient flow control mechanism at the entry point of the waiting area, so that chest symptomatic patients (who have been screened earlier and are carrying priority slips or other similar identification) are diverted to this special area rather than the common waiting area. The outpatient area, more so this segregated area, should be well ventilated to reduce overall risk of airborne transmission.

One should minimize hospitalization of TB patients and establish separate rooms, wards, or areas within wards for patients with infectious respiratory diseases.

The best choice for infectious or potentially-infectious patients is to house and manage them in airborne precaution rooms. Where such airborne precaution rooms are not feasible, other options for physical separation include: Having a few small ‘airborne precautions rooms’ for patients with infectious respiratory disease patients, having a separate ward designated for patients with infectious respiratory disease; keeping a designated area with better ventilation available for the placement of potentially-infectious patients; having a “No Immune-Compromised Patient Area”

IMA Stand why Ayush cannot prescribe modern medicine drugs

Background note on Government Stand

1. Central Government is envisaging starting one year course for AYUSH doctors and allowing them to practice modern medicine. IMA attended a meeting convened by the Secretary, Ministry of Health and Family Welfare, Govt. of India on 22nd January, 2015 in his office at 6.00 P.M.

2. Mainstreaming of AYUSH doctors: Back Ground Note by the ministry

The Doctor Population Ratio as per WHO norms should be 1:1000, in India it is 1:1674. Thus, there is overall shortage of doctors in the country which is more pronounced in rural areas. As per MCI, the total number of doctors in India as on 30.09.2014 is 9.32 lakhs. There are 6,86319 AYUSH practitioners in the country out of which 4,46,051 are ASU doctors.

Section 15 of the Indian Medical Council Act, 1956 states that no person other than a medical practitioner enrolled on a State Medical Register shall practice medicine in any State. Any person who acts in contravention of this shall be punished with imprisonment of 1 year or fine of Rs 1,000 or both.

In the case of Dr. Mukhtiyar Chand us State of Punjab, the Hon’ble Supreme Court held that practice of modern system of medicine by ISM qualified professionals is possible provided such professionals are enrolled in the State Medical Register for practitioners of modern medicine maintained by the State medical Council. The respective State Government can notify and give recognition to qualifications eligible for registration in the State medical Register.

The Ministry requested all the State governments vide letters dated 29th May,2013 and reminders dated 20th Novembers, 2013 and 19th March,2014 to consider amending their respective State laws relating to registration of practitioners of modern scientific medicine and provide an enabling provision to allow the enrolment of an ISM professional in the State medical Register maintained for registration of the practitioners of modern medicine by the respective State Medical Councils. Comments were received from some of the States, which are as follows:

S.No.	State/UT	Comments
I.	Kerala	Govt. of Kerala doesn’t face any shortage of doctors of modern medicine for posting in PHCs as a large number of medical graduates will be passing out from the colleges in the state in the next few years.
II.	Daman & Diu and Dadra & Nagar Haveli	There is no State/UT Medical Council and, hence, no enrolment of practitioners of modern medicine.
III.	Goa	They strongly opposed the matter.
IV.	Rajasthan	Initiating registration of AYUSH doctors in State medical Register will complicate matters and will dilute the efforts of brining them into the mainstream.

Under NRHM, services of AYUSH practitioners are utilized for providing essential new-born care services, managing common childhood illness, counseling on family planning methods and most importantly, they render their services as Skilled Birth Attendants (SBA).

Department of AYUSH in consultation with National Board of Examination (NBE) prepared one year curriculum, for bridge course to provide competency to ISM doctors to practice modern medicines in a limited way in rural areas. Ministry requested the MCI to vet the draft curriculum; MCI has vehemently opposed the move.

A meeting was convened to discuss the introduction of a bridge course for AYUSH Doctors on 10th September, 2014 in which it was decided that a bridge course may be prepared keeping in consideration the course curriculum of B.Sc.(CH). It was agreed that a 9 months course (6 months regular and 3 months internship) duration may be developed for this purpose.

Department of AYUSH vides their D.O. letter dated 23.09.2014 made the following objections:

a)  The proposal to allow ASU doctors to only dispense and not prescribe modern medicines is not agreeable to them.

b)  It will make ASU doctors subservient to Allopathic doctors.

c) The decision to develop a Bridge Course of 9 months on the lines of B.Sc. (CH) is a unilateral stand of DoHFW.

Now, on 10th November, 2014, Department of AYUSH has been made a separate Ministry with Sh. Shripad Naik, Minister of State (Independent Charge).

Discussion and IMA Point of view

Government wants that Ayush Graduates with a bridging course should be

1. entitled to practice and prescribe Modern Medicine Drugs

2. Also be entitled to be included in the State Register as registered medical practitioner upon incorporation of necessary enabling provisions in the governing State Act, in the light of pronouncement made by the Hon'ble Supreme Court in Muktiyarchand case.

3. Rajya Sabha Question on Ayush practicing modern medicine

AYUSH practitioners prescribing allopathic medicines: Rajya Sabha, information given by the Minister for Health & Family Welfare, Dr. Anbumani Ramadoss in a written reply to a question in the Rajya Sabha.

The matter regarding qualified practitioners of Ayurveda, Unani, Siddha and Homoeopathy systems prescribing allopathic medicines has been examined in depth by the Hon'ble Supreme Court of India in Civil Appeal No.89 of 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others.

Representations have been received from time to time on this matter and accordingly Department of AYUSH entrusted the study of the contemporary acts on medical practice in the light of judgement of Hon'ble Supreme Court in 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others and other similar judgements. Drugs can be sold and supplied by a Pharmacist or a Druggist only on a prescription of a Registered Medical Practitioner and who can also store them for treatment of patients.

According to Section 2 (ee) of the Drugs and Cosmetics Rules, 1995, Registered Medical Practitioner means a person -

(i)  holding a qualification granted by an authority specified or notified under Section 3 of the Indian Medical Degrees Act, 1916 (7 of 1916), or specified in the Schedules to the Indian Medical Council Act, 1956 (102 of 1956); or

(ii) registered or eligible for registration in a medical register of a State meant for the registration of persons practicing the modern scientific system of medicine (excluding the Homoeopathy system of medicine); or

(iii)  registered in a medical register (other than a register for the registration of Homoeopathic practitioners) of a State, who although not falling within sub-clause (i) or sub-clause (ii) is declared by a general or special order made by the State Government in this behalf as a person practicing the modern scientific system of medicine for the purposes of this Act.

Hon'ble Supreme Court upheld the validity of Rule 2 (ee) (iii) as well as the notifications issued by various State Governments there under allowing Ayurveda, Siddha, Unani and Homoeopathy practitioners to prescribe allopathic medicines.

In view of the above judgment, Ayurveda, Siddha, Unani and Homoeopathy practitioners can prescribe allopathic medicines under Rule 2 (ee) (iii) only in those States where they are authorized to do so by a general or special order made by the concerned State Government in that regard. Practitioners of Indian Medicine holding the degrees in integrated courses can also prescribe allopathic medicines if any State act in the State in which they are practicing recognizes their qualification as sufficient for registration in the State Medical Register.  KR/SK/95 – RS :

http://pib.nic.in/newsite/erelease.aspx?relid=30117, 20th August 2007

IMA Stand

•  In the agenda item No. A-2 (a) : MENACE OF QUACKERY , the issue was discussed in the  75th Meeting of the Central Council of IMA held  on December 27-28 December, 2014 on Govt. Sponsored Quackery. It was discussed that the Maharashtra Govt. has promulgated an Ordinance permitting AYUSH doctors to practice modern medicine.  It was decided that IMA should publicize this as a social evil, malpractice and should take it as a very serious issue. At the same time IMA, along with MCI, should give stringent directions to hospitals and doctors not to appoint AYUSH doctors as RMO / Assistants  and strong action taken against those violating the directions”.
• 
  
•  Following MCI Code of Medical Ethics and Regulations 2002 dis-allow such practices

1.        “7.9 Performing or enabling unqualified person to perform an abortion or any illegal operation for which there is no medical, surgical or psychological indication”. The regulations clearly prohibits taking assistance from any un qualified person for  surgery, especially abortions. 

2.        "7.10 A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non-medical person”: The regulation again clearly talks about that any allopathic doctor shall not appoint any non-allopathic doctor for any allopathic services.  As appointing him/her, would amount  to issuing a certificate of efficiency in modern medicine. 

3.        “2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care”: The regulation clearly talks about that if there is any emergency, we have to take care of our patients ourselves.  We cannot pass on this responsibility to a unqualified persons.

4.        “7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch”: The above regulation clarifies that because Ayush Doctors do not have special  qualification in allopathy they cannot be treated as allopathic practitioner.

5.        “7.19 A Physician shall not use touts or agents for procuring patients”: As this regulation we should not use touts or agents for procuring patients.  Any non allopathic doctor, if assist us in procuring patients, the same will be a violation of the above clause.

6.        “7.18 In the case of running of a nursing home by a physician and employing assistants to help him / her, the ultimate responsibility rests on the physician.”: This regulation clearly mentions that if any MBBS doctor, appoints any Ayush Doctor, the responsibility will be of an MBBS doctor and not that of Ayush Doctor.

7.        The Maharashtra FDA has recently issued guidelines regarding prescription where it clearly mentions that another doctor cannot sign on the prescription paper of treating doctor.

Provisions in Indian Medical Council Act, 1956

1.       Section 2 (f) defines the word ‘medicine’ as ‘medicine means modern scientific medicine in all its branches and includes surgery and obstetrics but does not include veterinary medicine and surgery’.

2.         Section 2(a) defines the word ‘approved institution’ as ‘a hospital, health centre or other such institution recognized by a University as an institution in which a person may undergo the training, if any, required by his course of study, before the award of any medical qualification to him’.

3.         Section 2 (d) defines the word ‘Indian Medical Register’ as ‘Indian medical registers means the medical register maintained by the council’.

4.         Section 2 (h) defines the word ‘recognized medical qualification’ as ‘recognized medical qualification means any of the medical qualifications included in the schedules’.

5.        Section 2 (j) defines the word  ‘State Medical Council’ which reads ‘State Medical Council means a medical council constituted under any law for the time being in force in any State regulating the registration of practitioners of medicine’.

6.        Section 2 (k) defines State Medical register’ as ‘State Medical Registers means a register maintained under any law for the time being in force in any state regulating the registration of practitioners of medicine’.

7.        Section 11 of the concerned Act deals with the ‘recognition of medical qualifications granted by Universities or medical institutions in India’ and that ‘MBBS qualification recognized by the Medical Council of India with reference to a concerned institution and examining University thereto duly incorporated in schedule A amounts to the registering medical qualification for the purposes of enrolment in the appropriate register maintained by a State medical council or the Medical Council of India as the case may be’.

8.         Section 15 of the Act, deals with ‘Right of person possessing qualifications in the schedules to be enrolled’ and section 15(2)(d) clearly prescribes that “no person other than a medical practitioner enrolled on a State Medical Register shall practice medicine in any State”.

9.        Vide provision included at section 21 the council is duty bound to maintain Indian Medical Register in a prescribed manner which shall contain the names of all persons who are for the time being enrolled in any State Medical register and who possess any of the recognized medical qualifications. The said provision has to be harmoniously read with the provisions incorporated at section23 of the very Act, which deals with ‘registration in the Indian Medical Register and mandates that the Registrar of the council may, on receipt of the report or registration of a person in a State Medical Register or on application made in the prescribed manner by any such person, enter his name in the Indian Medical register, provided that the registrar is satisfied that the person concerned possessed a recognized medical qualification’.

10.     Resultantly, section 27 of the Act, provides for the ‘privileges of the persons who are enrolled in the Indian medical register’ to the effect ‘that every person whose name is for the time being borne on the Indian medical register shall be entitled according to his qualifications to practice as a medical practitioner 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’.

11.     Modern medicine can be practiced exclusively by a person who possess recognized medical qualifications included in the appropriate schedule appended to the Indian Medical Council Act and is duly registered with a concerned State Medical Council and resultantly is included in the State Medical Register in terms of the explicit embargo as has been brought out in Section 15(2)(b) of the IMC Act, 1956. The said position has been fortified in several pronouncements made by the various judicial forums including the one brought out in Poonam Varma Vs. Ashwin Patel case by the Hon'ble Supreme Court in 1992.

12.     The entitlement of the Ayush Graduates in the State medical register will have another problem. Who shall govern the disciplinary jurisdiction on them in regard to enforcement of ethical conduct and practice as contemplated in the code of medical ethics which is applicable to every registered medical practitioner possessing registering medical qualification in modern medicine.

Supreme Court and CPA Judgments that Ayush Doctors cannot prescribe allopathic drugs

1.       NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI ORIGINAL PETITION  NO.214  OF  1997,  " When a patient is admitted in a hospital, it is done with the belief that the treatment given in the hospital is being given by qualified doctors under the Indian Medical Council Act, 1956.  It is not within the knowledge of the relatives of the patient that the patient is being treated by a Unani Specialist.  We hold that it is clear deficiency in service and negligence by the hospital for leaving the patient in the hands of Unani doctor.

" As laid down by Apex Court in the above case (Jacob Mathew case) , we feel it is high time that hospital authorities realize that the practice of employing non-medical practitioners such as Doctors specialized in Unani system and who do not possess the required skill and competence to give allopathic treatment and to let an emergency patient be treated in their hands is a gross negligence.We do not wish to attribute negligence on the part of Dr. Rehan alone while the patient was in his charge in terms of directing to pay compensation but solely on the hospital authorities for leaving the patient in his complete care knowing he is not qualified to treat such cases."

"Supreme Court came down heavily in cases where Homeopathic Doctors treated  the patients with allopathic medicines.  In Poonam Verma Vs. Ashwin Patel and  Others  (1996) 4 SCC 332 where a doctor holding Diploma in Homeopathic Medicine and Surgery  (DHMS) and registered under Bombay Homeopathic Practitioners Act, caused the death of a patient due to administration of Allopathic medicine, the Supreme Court    held him being not qualified to practice Allopathy, was a quake or pretender to the medical knowledge and skill as a  charlatan and hence guilty of negligence per se. The facts being similar in this case, we hold that there is total negligence in treating  the deceased patient."

 "Thus, we feel that an amount of Rs.7,50,000/- would be appropriate amount of  compensation in face of peculiar facts and circumstances. "

2. Dr. Mukhtiar Chand & Ors. Vs.State Of Punjab & Ors., decided by the Supreme Court on 08/10/1998, reported as AIR 1999, SC 468, (1998 (7) SCC 579) K.T. Thomas, Syed Shah Mohammed Quadri," A harmonious reading of Section 15 of 1956 Act and Section 17 of 1970 Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian medicine or Central Register of Indian Medicine to practise modern scientific medicine in any of its branches unless that person is also enrolled on a State Medical Register within the meaning of 1956 Act."