Tuesday 30 August 2016

Myths and facts about the outbreak of Dengue in the National Capital

Myths and facts about the outbreak of Dengue in the National Capital New Delhi, August 29, 2016: Given the large-scale panic that the increasing incidence of dengue has created, it is essential that awareness is raised about the myths and facts of the disease. Clearing common misconceptions Padma Shri Awardee Dr. K K Aggarwal, President HCFI & Honorary Secretary General IMA said, “Dengue incidence will continue to exist in the coming one month and instead of creating unnecessary chaos and panic, it is essential that awareness is created about prevention and timely steps are taken towards disease management. One must remember that only 1% of the dengue cases are life-threatening. Most dengue cases can be handled on an outpatient basis and do not require hospitalization". Dengue Myths vs. Facts Myth: We are facing a dengue epidemic Fact: Delhi is at present going through a dengue outbreak, and it is not yet epidemic Myth: All dengue cases are the same and must be dealt with in the same manner Fact: Dengue can be classified as dengue fever and severe dengue. A person is said to be suffering from severe dengue when there is capillary leakage. Patients who have dengue fever do not have capillary leakage. Type 2 and type 4 dengue are more likely to cause capillary leakage. Myth: Everyone suffering from dengue must be hospitalized Fact: Dengue fever can be managed on an outpatient basis and patients who do not have severe abdominal pain or tenderness, persistent vomiting, abnormal mental status or extreme weakness, do not need hospitalization. Only patients suffering from severe dengue need hospitalization basis the discretion of their consulting doctor. One must always remember that 70% of the dengue fever cases can be cured just through the proper administration of oral fluids. Patients must be given 100-150 ml of safe water every hour, and it must be ensured that they must pass urine every 4-6 hours. Myth: Dengue can never re-occur if you have had it once in the past Fact: There are four types of dengue infections, which exist in our country. While dengue from the strain cannot re-occur, that from a different strain can. A second occurrence dengue (secondary) is more serious than first infection (primary). In the primary infection, IgM or NS1 will be positive and in secondary infection IgG will also be positive. Myth: Platelet transfusion is the primary treatment option for people suffering from dengue fever Fact: Platelet transfusion is only needed in cases where the patient's counts are less than 10,000, and there is active bleeding. Unnecessary platelet transfusion can cause more harm than good. The best treatment for dengue is to administer large amounts of oral fluids to patients. For patients who are unable to take oral fluids, intravenous administration may be necessary. Myth: Machine platelet count is accurate Fact: Machine platelet count reading may be less than the actual platelet count, and a difference of about 30,000 can occur Myth: Testing platelet levels alone accounts for complete and effective management of dengue Fact: A complete blood count (especially hematocrit) is needed to monitor prognosis and increased capillary permeability, which is the starting point of all complications. Falling platelet counts with rising hematocrit levels are most important

2-18 years age: Consume less than 6 teaspoons of added sugars in a day

2-18 years age: Consume less than 6 teaspoons of added sugars in a day

Dr K K Aggarwal Children aged 2-18 years should consume less than 6 teaspoons of added sugars a day and less than 8 ounces of sugar-sweetened drinks a week, an IMA-Heart Care Foundation of India statement advises. Table sugar, fructose and honey, sugar used in processing and preparing foods or beverages or sugars added to foods at the table, or eaten separately are added sugars. Children younger than 2 years should not consume added sugars at all. This advisory is in line with American Heart Association guidelines published August 22 in the journal Circulation. Regular consumption of foods and drinks high in added sugars can lead to high blood pressure, obesity and diabetes. Sugars remain a commonly added ingredient in foods and drinks. Starting in July 2018, food products sold in the United States will have to list the amount of added sugars on the Nutrition Facts Panel.

Mosquitoes Can Infect Their Eggs With Dengue


Mosquitoes Can Infect Their Eggs With Dengue

Dr K K Aggarwal


It’s hard to get rid of dengue as the mosquitoes can pass the virus to their offspring in their eggs. Mosquitoes infect their larvae with other viruses, too, including Zika virus.

It makes control harder. Spraying affects adults, but it does not usually kill the immature forms — the eggs and larvae. Spraying will reduce transmission, but it may not eliminate the virus.

Usually, it takes people plus mosquitoes to spread a virus. The mosquitoes bite actively infected people, incubate the virus for a while, and then bite other people to spread it. If no people in an area are infected, no virus spreads.

Sometimes an animal can act as a reservoir — birds can keep West Nile Virus spreading, for instance.

So-called vertical transmission allows the virus to spread even if all the adult mosquitoes in an area die out.

But that's not easy. Aedes are container breeders — they can lay their eggs in small containers and need just a tiny bit of water to hatch.

They live in and around houses and like crowded urban areas where spraying is difficult.

Spraying insecticides to kill adult mosquitoes cannot wipe out Aedes.

They lay their eggs right above the water line in a small container, a discarded tire or some trash.

So when that container is filled and the water covers the eggs, the eggs hatch.

YOU HAVE TO SCRUB THE INSIDE OF THE CONTAINER. THAT IS THE WAY TO GET RID OF THE EGGS.
The eggs can survive being dried out, and they stick really well. They're impervious to insecticides or other chemicals.

So simply emptying containers regularly does not necessarily get rid of the mosquitoes.

You have to scrub the inside of the container. That is the way to get rid of the eggs.

Aedes albopictus, the so-called Asian tiger mosquito that has a much broader ranges than Aedes aegypti, did not transmit Zika to its eggs. 

Mosquitoes Can Infect Their Eggs With Dengue
Dr K K Aggarwal


It’s hard to get rid of dengue as the mosquitoes can pass the virus to their offspring in their eggs. Mosquitoes infect their larvae with other viruses, too, including Zika virus.

It makes control harder. Spraying affects adults, but it does not usually kill the immature forms — the eggs and larvae. Spraying will reduce transmission, but it may not eliminate the virus.

Usually, it takes people plus mosquitoes to spread a virus. The mosquitoes bite actively infected people, incubate the virus for a while, and then bite other people to spread it. If no people in an area are infected, no virus spreads.

Sometimes an animal can act as a reservoir — birds can keep West Nile Virus spreading, for instance.

So-called vertical transmission allows the virus to spread even if all the adult mosquitoes in an area die out.

But that's not easy. Aedes are container breeders — they can lay their eggs in small containers and need just a tiny bit of water to hatch.

They live in and around houses and like crowded urban areas where spraying is difficult.

Spraying insecticides to kill adult mosquitoes cannot wipe out Aedes.

They lay their eggs right above the water line in a small container, a discarded tire or some trash.

So when that container is filled and the water covers the eggs, the eggs hatch.

YOU HAVE TO SCRUB THE INSIDE OF THE CONTAINER. THAT IS THE WAY TO GET RID OF THE EGGS.
The eggs can survive being dried out, and they stick really well. They're impervious to insecticides or other chemicals.

So simply emptying containers regularly does not necessarily get rid of the mosquitoes.

You have to scrub the inside of the container. That is the way to get rid of the eggs.

Aedes albopictus, the so-called Asian tiger mosquito that has a much broader ranges than Aedes aegypti, did not transmit Zika to its eggs. 

Monday 29 August 2016

IMA’s viewpoint on the new draft Surrogacy (Regulation) Bill, 2016

IMA’s viewpoint on the new draft Surrogacy (Regulation) Bill, 2016 New Delhi, 26th August, 2016: Commercial surrogacy is banned in most developed countries, including Australia, UK, Canada, France, Germany, Sweden, New Zealand, Japan and Thailand. Now this bill bans it in India too. But the bill allows altruistic surrogacy, where near relatives can legally carry someone else’s child if no money (other than reasonable medical cost and insurance), favor or coercion is involved. Under the proposed law, only proven infertile Indian couples who have been married for at least five years can opt for surrogacy, while those who already have a child cannot do so. Only Indian nationals will be allowed for altruistic surrogacy. Foreign nationals or even NRI or OIC will not be allowed. Only married couples will allowed to opt of surrogacy. Gay, single, live-in couples are not allowed. The marriage should be minimum of five years and the age of the woman should be from 23-50 and for the man 26-55. The Bill has penalty provisions for those violating the law, when it comes into effect. The penalties include a huge monetary fine (ten lakh), and imprisonment (ten years) and even striking down the name from medical register. This will increase paper work. The records will have to be kept for five years and not 2 years. IMA welcomes the bill however the bill has many concern, said Dr. S.S Agarwal – National President and Padma Shri Awardee Dr. K K Aggarwal, Honorary Secretary General of IMA IMA’s viewpoints on the bill • There will be no role of brokers, agents or inter-mediators and the onus of proof in the case of negligence will be with the clinic and not surrogate or an egg donor. • Reasonable medical expenses are not clear. Does it include her man-hours away from work? • Proven infertility would be difficult to certify. Infertility is a relative term and would be difficult to define in absolute terms. • Close relative not defined. The law that insists that a surrogate woman has to be a close relative of the infertile couple would be "impractical" and may also raise the risk of the surrogacy industry, driven by demand, moving underground, spawning illegal transactions. People will start making fake documents that they are near relatives. • 5 years waiting after marriage is not scientific. It’s true that a girl marries at 18 and a boy at 21. But why should a couple wait for 5 years if they marry at 40. • Imprisonment clause is now coming in every new bill PCPNDT, CEA, Health Data Bill and now surrogacy bills. To err is human. Doctors are not criminals. 10 years of jail and 10-lakh penalty is unheard of. • There are more that 50 million infertile couples in the world and their desperation for a biological child has turned commercial surrogacy into a booming business. Thousands of infertile couples rent wombs from poor women for nine months so they can take a baby back home. India has estimated 12 million to 15 million infertile couples. Big market for sperm and ova banking, embryo implantation and surrogate womb services. Celebrities also rent wombs. An end to commercial surrogacy will be a big blow to many infertile couples. Infertile couples generally do not discuss in-vitro fertilization (IVF) or third-party reproduction (surrogacy) with close relatives. This is kept as secret as possible, particularly from their close family members - so how are they going to find altruistic close relatives. • Finding women from within the close family willing to be surrogates will not be easy. Many infertile couples are likely to find themselves in distress. • There are medical grounds where surrogacy is justified - imagine a woman who has lost her uterus during childbirth or a woman born without a uterus. • The proposed surrogacy law might even lead to break-up of marriages. This may lead to an increase in second marriages - if surrogacy is not allowed, some couples are likely to break up. • No surrogate till date has complained of ill treatment. The government could have defined reasonable compensation instead of a ban, which was the easy way out. • Parents who have their own child or have an adopted one will not be eligible to go for surrogacy. But India does not follow one child norm. Then why should a couple that has one baby not be allowed to go in for surrogacy? One’s parental need for the number of children cannot be defined in law. • Why ban NRIs or OICs • National surrogacy board will be constituted under the chairmanship of health minister. Three female MPs will be member of the board and two MPs will be form Lok Sabha. Why all females in the board. • There should be a medical certificate that the couple is not able to produce their own child. Who will issue the certificate?

IMA Points on The New Draft Surrogacy (Regulation) Bill, 2016

IMA Points on The New Draft Surrogacy (Regulation) Bill, 2016 Commercial surrogacy is banned in most developed countries, including Australia, UK, Canada, France, Germany, Sweden, New Zealand, Japan and Thailand. Now this bill bans it in India too. But the bill allows altruistic surrogacy, where women (near relative) can legally carry someone else’s child if no money (other than reasonable medical cost and insurance), favour or coercion is involved. Under the proposed law, only proven infertile Indian couples who have been married for at least five years can opt for surrogacy, while those who already have a child cannot do so. Only Indian nationals will be allowed for altruistic surrogacy. Foreign nationals or even NRI or OIC will not be allowed. Only married couples will be allowed to opt of surrogacy. Gay, single, live-in couples are not allowed. The marriage should be minimum of five years and the age of the woman should be from 23-50 and for the man 26-55. The Bill has penalty provisions for those violating the law, when it comes into effect. The penalties include a huge monetary fine (10 lakh), and imprisonment (10 years) and even striking down the name from medical register. This will increase paper work. The records will now have to be kept for 5 years and not 2 years. • There will be no role of brokers, agents or inter-mediators and the onus of proof in the case of negligence will be with the clinic and not the surrogate or egg donor. • Reasonable medical expenses not clear. Does it include her man hours away from work? • Proven infertility would be difficult to certify. Infertility is a relative term and would be difficult to define in absolute terms. • Close relative not defined. The law that insists that a surrogate woman has to be a close relative of the infertile couple would be "impractical" and may also raise the risk of the surrogacy industry, driven by demand, moving underground, spawning illegal transactions. People will start making fake documents that they are near relatives. • Five years waiting after marriage is not scientific. It’s true that a girl marries at 18 and a boy at 21. But why should a couple wait for 5 years if they marry at 40. • Imprisonment clause is now coming in every new bill PNDT, CEA, Health Data Bill and now surrogacy bills. To err is human. Doctors are not criminals… 10 years of jail and 10 lakh penalty unheard of. • There are more than 50 million infertile couples in the world and their desperation for a biological child has turned commercial surrogacy into a booming business. Thousands of infertile couples rent wombs from poor women for 9 months so they can take a baby back home. India has estimated 12-15 million infertile couples… a big market for sperm and ova banking, embryo implantation and surrogate womb services. Celebrities also rent wombs. An end to commercial surrogacy will be a big blow to many infertile couples. Infertile couples generally do not discuss in-vitro fertilisation (IVF) or third-party reproduction (surrogacy) with close relatives. This is kept as secret as possible, particularly from their close family members, so how are they going to find altruistic close relatives. Finding women from within the close family willing to be surrogates will not be easy. Many infertile couples are likely to find themselves in distress. • There are medical grounds where surrogacy is justified - imagine a woman who has lost her uterus during childbirth or a woman born without a uterus. • The proposed surrogacy law might even lead to break-up of marriages. This may lead to an increase in second marriages, if surrogacy is not allowed; some couples may break up. • No surrogate till date has complained of ill treatment. We had filed an RTI with the Govt. of India - No exploitation at all was found. They could have defined reasonable compensation instead of Ban, which was the easy way out. • Parents who have their own child or have an adopted one will not be eligible to go for surrogacy. But India does not follow one child norm. Then why should a couple who has one baby not allowed to try surrogacy? One’s parental need for the number of children cannot be defined in law. • Why ban NRIs or OICs? • National Surrogacy Board will be constituted under the chairmanship of health minister. Three female MPs will be members of the board and two MPs will be from Lok Sabha. Why only female members in the board? • There should be a medical certificate stating that the couple is not able to produce their own child. Who will issue the certificate?

Urgent need to create social awareness on mosquito borne diseases!

Urgent need to create social awareness on mosquito borne diseases! Prevention measures essential to curb the ongoing dengue and chikungunya menace in the city Despite the best efforts from doctors, the illnesses will continue to exist over the next one month New Delhi, August 28, 2016: Dengue and chikungunya cases are rampant in Delhi and raising preventive awareness crucial. Chikungunya is not life-threatning and symptoms typically exist for 7-10 days. Dengue on the other hand can be easily managed and does not always require hospitilization. Mass public awareness campaigns are essential. Speaking about this issue, Padma Shri Awardee Dr. KK Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India said, “The misconceptions that people have about the mosquito-borne tropical disease has contributed towards making India the ‘Dengue capital’ of the world. Nowadays, individuals ignore the fact that the disease is manageable and preventable. Also, it can be effectively treated with the right kind of first aid, medication, and precautions. In addition to this, people forget that surviving dengue the first time doesn’t make us immune to reinfection with another strain, so one should always take precautions after recovering from the infection. The need of the hour is to raise awareness about prevention, treatment options and busy common myths about the disease. Instead of panicking and spreading panic, we must all work together towards solving the problem and preventing as many cases as possible.“ It is extremely important to note that platelet transfusion is only needed in dengue cases where the platelet count is less than 10,000, and there is active bleeding. Unnecessary platelet count can cause more harm than good. Adequate hydration is the best management approach to dengue while monitoring crucial signs. In most cases, hospitalization is not required, and families must not insist towards this as it deprives seriously ill patients from getting hospital beds. Only severe dengue cases must be admitted basis the treating physicians discretion. One must always remember that 70% of the dengue fever cases can be cured just through the proper administration of oral fluids. Patients must be given 100-150 ml of safe water every hour and it must be ensured that they must pass urine every 4-6 hours. What are symptoms of severe dengue fever? • Abdominal pain or tenderness • Persistent vomiting • Clinical fluid accumulation (pleural effusion/ascites) • Active mucosal bleeding • Severe restlessness or lethargy • Tender enlarged liver How to identify dengue fever by applying the Formula of 20: • If there is rise in pulse by 20 • If there is fall in upper BP by 20 • If the difference between upper and lower blood pressure is less than 20 • If there is rise in hematocrit by 20 percent • If the platelet counts are less than 20,000 • If the petechial count in one inch of the arm is more than 20 after tourniquet test • If all of this happens then it is essential to take 20 ml of fluid per kg body weight in a span of 20 minutes and then approach the doctor. First aid for Dengue patients: • If a person has warning signs of dengue with normal blood pressure 10ml of fluid per kg body weight must be administered in the next 20 minutes (oral or IV). Then the dose should be reduced by 50% in the next hour. If they have low blood pressure than the quantity should be 20ml per body weight • A patient should drink as much fluids as he can • Best oral fluid is one litre of safe water added with six spoons sugar and half spoon salt • Anyone who is ill with dengue shouldn’t cut down on food. Consuming nutritious food in sufficient quantities is important. • Best treatment for dengue is 100 ml of fluids per hour for 48 hours from when the symptoms are noted in patients with normal BP patients and 150 ml per hour in patients with a low BP Dangerous Parameters: When you should be worried? • While first aid will help you control the situation so that it doesn’t reach the extreme. But a patient is advised to consult a doctor in situations like: • When there is an absence of baseline hematocrit value. If hematocrit value is less than 40 percent in adult female and less than 46 percent in the adult male, then a doctor should be consulted, as it might be a case of plasma leakage. • When the platelet counts are rapidly falling. • When the difference between the upper and lower blood pressure is falling. • When liver enzymes SGOT levels are more than SGPT levels. Liver enzyme levels more than 1000 can lead to severe plasma leakage and less than 400 can cause moderate plasma leakage. • When there is a progressive increase in hematocrit with a progressive reduction of platelet count

Sepsis is a Medical Emergency

Sepsis is a Medical Emergency Dr KK Aggarwal [IMA White paper] 1. 72% of patients with sepsis, a fast-moving deadly illness, are seen by doctors in recent past representing missed opportunities to catch it early or prevent it. 2. Common conditions leading to sepsis are pneumonia and infections of the urinary tract, skin and gut 3. There is no specific test for sepsis and symptoms can vary, which means it is often missed. Three is no standard definition also. 4. Preventive Flu, meningococcal & pneumonia vaccines and washing hands can help 5. As over CDC over 258,000 Americans die of sepsis annually more than deaths from heart attack. 6. Sepsis is most common among older people, the very young and those with compromised immune systems 7. The condition can rapidly advance to septic shock 8. In 2011, sepsis was the No. 2 reason for readmissions, following congestive heart failure. {BMJ] 9. When sepsis is caught early, prognosis is very good, but mortality climbs to 25 to 30 percent for severe sepsis and 40 to 70 percent if septic shock occurs. 10. “Early” can mean within a matter of hours. 11. In septic shock chances for survival decrease 7.6 percent for every hour that it goes untreated. 12. Warning signals are fever, elevated heart rate, elevated respiration, low blood pressure and mental confusion that worsens within a few hours 13. Once in sepsis address low blood pressure by administering fluids or by IV drugs to constrict blood vessels and raise blood pressure. 14. Start broad-spectrum antibiotics till cultures are available 15. Outcome depends on fluids, blood pressure, antibiotics, source control and underlying health status.

Sunday 28 August 2016

Early diagnosis and treatment of inflammatory arthritis key

Early diagnosis and treatment of inflammatory arthritis key New Delhi, 27th August, 2016: Inflammatory arthritis is a term used to describe a group of conditions that affect your immune system. This means that your body’s defense system starts attacking your own tissues instead of germs, viruses and other foreign substances, which can cause pain, stiffness and joint damage. They’re also known as autoimmune diseases. The three most common forms of inflammatory arthritis are Rheumatoid arthritis, Ankylosing spondylitis and Psoriatic arthritis These conditions are also called systemic diseases because they can affect your whole body. They can happen at any age. There’s no cure for these diseases at the moment, but the outlook for those diagnosed with inflammatory arthritis is significantly better than it was 20–30 years ago. Effective treatment begins much earlier and new drugs are available, which means less joint damage, less need for surgery and fewer complications. Inflammatory arthritis isn’t the same as osteoarthritis, which happens when the cartilage in your joint wears away. Stressing on the need to raise awareness about the symptoms of inflammatory arthritis to encourage early diagnosis, the IMA and Heart Care Foundation of India organised a webcast for both doctors and the public. The expert faculty for the same consisted of Dr. Mrs Vishal Kaura Aggarwal, Visiting Consultant in Rheumatology department at BLK Super Speciality Hospital and Max Smart Super Specialty Hospital, Saket New Delhi and Padma Shri Awardee Dr KK Aggarwal – President HCFI & Honorary Secretary General IMA. Raising awareness Dr KK Aggarwal said, "Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is triggered by a faulty immune system (the body’s defense system) and affects the wrist and small joints of the hand, including the knuckles and the middle joints of the fingers. Early diagnosis and treatment can control joint pain and swelling, and lessen joint damage. A person suffering from RA can perform low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. This will help improve overall health and reduce pressure on the joints”. The following points on Inflammatory Arthritis were discussed: 1. Do not ignore arthritis in children 2. Do not ignore Joint pain, stiffness, back pain, which worsen on rest & improves with exercise or movement 3. Do not ignore high ESR, Positive CRP or high platelet count 4. Inflammatory arthritis is an acute medical emergency 5. Skin, Joint & Kidney involvement suggests auto immune disease 6. Squeeze test: squeeze mid carpel or mid tarsal (Mid palm or mid foot) & if Painful suggest Inflammatory poly arthritis 7. Back pain, stiffness responsive to NSAID- pain killers suggest inflammatory arthritis 8. Dry eyes can be a sign of underline autoimmune disorder 9. Chikungunya can precipitate underlying joint disease 10. Do not ignore Reynaud’s phenomenon 11. High uric acid is a marker of metabolic syndrome or early kidney disease 12. Asymptomatic high uric acid (<10) needs no treatment 13. Gout is uncommon in women 14. Alternating buttock pains, heel pains, chest pains may be markers of inflammatory arthritis

RTA Fund, this is what IMA has been asking all throughout

RTA Fund, this is what IMA has been asking all throughout • The Ministry of Road Transport and Highways in its proposed amendments to the Motor Vehicles Act has provisioned for a fund that will ensure free treatment of grievously injured victims. • The amendment bill introduced in Lok Sabha earlier this month has proposed setting up a motor vehicle accident fund, which will be used for medical expenses of grievous hurt persons till they stabilize. • The fund can be created by collecting certain cess or tax, any grant or loan made by the central government or any other source of finance as may be prescribed by the government. • The fund shall be constituted for the purpose of providing compulsory insurance cover to all road users in the territory of India. • The fund shall be utilised for treatment of grievously hurt persons, for paying compensation to representatives of persons killed or seriously hurt in hit and run motor crashes. • Government would come out with the maximum liability amount that shall be paid in each case. • People who have medical or life insurance cover, the payment made by government shall be deducted from the claim they receive from the insurance companies. • The central government shall launch a scheme for cashless treatment of victims of the road crashes during the golden hour (first hour of crashes).

Friday 26 August 2016

Timely immunisation key for both children and adults: HCFI

Timely immunisation key for both children and adults: HCFI New Delhi August 25, 2016: Immunisations, also known as vaccinations, help protect you from getting an infectious disease. When you get vaccinated, you help protect others as well. Vaccines are very safe. It is much safer to get the vaccine than an infectious disease. Raising awareness Dr KK Aggarwal – President HCFI & Honorary Secretary General IMA said, “Immunization can protect against 25 different infectious agents or diseases, from infancy to old age. The most common diseases include measles, polio, and tetanus amongst others. However the level of awareness about the need for immunisation is low in India. While majority of the people are aware that children need regular vaccinations, there exists a high level of ignorance about the importance of adult vaccinations. Vaccines can help protect a person from serious and sometimes deadly diseases and timely vaccination is extremely important especially for all those above the age of 65 years of age.” A few tips • It is recommended that all individuals above the age of 18 get a yearly flu vaccine. This is a crucial requirement for those above the age of 65, diabetics and heart patients. • Tetanus Toxoid vaccination must be administered every 10 years in adults with an extra dose to be given after five years. • Elderly people after the age of 60 years may require Herpes zoster vaccination. • All adults irrespective of their age should be given full coverage from hepatitis B • Most adult vaccinations are administered intra-muscular on the shoulder muscle • Pneumonia and flu vaccines can be given at the same sitting. • Most vaccination are safe and cause only minor side effects • Research shows that administering the flu vaccination to heart patients and diabetics helps reduce morbidity and mortality • Replacing trivalent OPV with bivalent OPV is a significant step that has been made in polio eradication and that the IMA has been supporting. The currently used OPV contains all thee polio serotypes – type 1, 2 and 3 and its use has led to the eradication of wild poliovirus type 2. The switch from tOPV to bOPV removes the type 2 component (OPV2) from the vaccine. The switch from trivalent to bivalent vaccine has to be globally synchronised to minimise the risk of new cVDPV type 2 emergence.

The New Draft Surrogacy (Regulations) Bill, 2016

The New Draft Surrogacy (Regulations) Bill, 2016 Dr K K Aggarwal 1. Commercial surrogacy is banned in most developed countries, including Australia, UK, Canada, France, Germany, Sweden, New Zealand, Japan and Thailand 2. Now the new bill bas it in India too 3. But the bill allows altruistic surrogacy, where women (near relative) can legally carry someone else’s child if no money (other than medical cost and insurance), favour or coercion is involved. 4. Under the proposed law, only infertile Indian couples who have been married for at least five years can opt for surrogacy, while those who already have a child cannot do so. 5. The law that insists that a surrogate woman has to be a close relative of the infertile couple would be "impractical" and may also raise the risk of the surrogacy industry, driven by demand, moving underground, spawning illegal transactions. People will start making fake documents that they are near relatives. 6. The Bill has penalty provisions for those violating the law, when it comes into effect. The penalties include a huge monetary fine (ten lac), and imprisonment (ten years) and even striking down the name from medical register. This will increase paper work. The records will have to be kept for five years and not 2 years. 7. Imprisonment clause is now coming in every new bill PNDT, CEA, Health Data Bill and now surrogacy bills. To err is human. Doctors are not criminals. 8. There will be no role of brokers, agents or inter-mediators and the onus of proof in the case of negligence will be with the clinic and not surrogate or an egg donor. 9. It will effect medical tourism 10. There are more that 50 million infertile couples in the world and their desperation for a biological child has turned commercial surrogacy into a booming business. Thousands of infertile couples rent wombs from poor women for nine months so they can take a baby back home. 11. India has estimated 12 million to 15 million infertile couples 12. Big market for sperm and ova banking, embryo implantation and surrogate womb services. 13. Celebrities also rent wombs 14. An end to commercial surrogacy will be a big blow to many infertile couples. Infertile couples generally do not discuss in-vitro fertilisation (IVF) or third-party reproduction (surrogacy) with close relatives. This is kept as secret as possible, particularly from their close family members - so how are they going to find altruistic close relatives. 15. Finding women from within the close family willing to be surrogates will not be easy. Many infertile couples are likely to find themselves in distress. 16. There are medical grounds where surrogacy is justified - imagine a woman who has lost her uterus during childbirth or a woman born without a uterus 17. The proposed surrogacy law might even lead to break-up of marriages. This may lead to an increase in second marriages - if surrogacy is not allowed, some couples are likely to break up.

Thursday 25 August 2016

Never administer Asprin or Ibuprofen to patients suffering from dengue fever

Never administer Asprin or Ibuprofen to patients suffering from dengue fever All heart patients suspected of dengue fever who are on regular low-dose aspirin should stop its consumption immediately and contact their treating doctor New Delhi August 24, 2016: The cases of dengue are rampant especially in New Delhi. While most people are seen scouting through journals and articles looking for dengue symptoms and its treatment, they often miss one of the most crucial pieces of information. One must never administer aspirin or ibuprofen to a patient suffering from or suspected to suffer from dengue since it can cause internal bleeding. In addition to this, all heart patients who are on regular low-dose Aspirin and associated drugs must stop its consumption immediately and contact their treating doctor Since dengue presents as a fever with body ache in the beginning, most people mistake it as a case of viral fever caused due to a change in season. They in-turn self-medicate themselves with either Aspirin or Ibuprofen to get relief from the symptoms. This is extremely dangerous for if the patient actually has dengue, their chances of severe bleeding and complications go up drastically. Most heart patients also continue taking Aspirin as a regular feature not realizing that this can be life threatening for them. Creating awareness is the need of the hour. Speaking about the issue, Padma Shri Awardee, Dr K K Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India said, “Delhi is presently going through a dengue and chikungunya outbreak and not an epidemic, and the cases will continue to come in for the next one month. Common symptoms of dengue include fever along with headache, body ache, fatigue, nausea, and vomiting. Because of the adverse effects ibuprofen and aspirin can have on dengue patients, their administration to all patients must be avoided. Instead, Paracetamol should be used to treat common symptoms such as fever and body aches." Dengue fever is transmitted by female Aedes Aegypti mosquitoes, which acquire the virus while feeding on the blood of an infected person. Dengue occurs in two forms: Dengue fever and dengue hemorrhagic fever or severe dengue. A person is said to be suffering from severe dengue when there is capillary leakage. Patients who have dengue fever do not have capillary leakage. Dengue fever is marked by the onset of sudden high fever, severe headache and pain behind the eyes, muscles, and joints. There is no specific treatment for dengue fever apart from early recognition and adequate hydration. Use of aspirin during dengue fever is not recommended owing to increased bleeding tendency. The infecting organism in dengue affects the platelets, which are responsible for clotting (stopping bleeding) increasing the tendency of the person to bleed. Aspirin and Ibuprofen also have similar action. Both of them together could cause the person to bleed excessively pushing the patient into what is called the ‘Dengue Shock Syndrome.' And once in this stage, medical treatment is needed in an emergency basis, and hospitalization becomes necessary because of its life-threatening nature. One must, however, remember that platelet transfusion is not the solution in the majority of the dengue cases unless the counts are less than 10,000, and there is active bleeding. Unnecessary transfusions can cause more harm than good. Instead, one must keep a tab on the hematocrit levels as their count decides the adequate requirement of fluids required by the body. Here is a simple formula of 20 that can be followed to identify dengue patients: • Rise in pulse by 20 • Fall in upper blood pressure by more than 20 • Rise in hematocrit by more than 20 percent • Rapid fall in platelets to less than 20,000 • More than 20 hemorrhagic spots on the arm in one inch after tourniquet test • Difference between upper and lower blood pressure is less than 20 • Start fluid replacement at 20 ml/kg/hour immediately in such patients, and shift to nearest medical center for observation.

Commercial donors in the disguise of a near relative or the spouse

Commercial donors in the disguise of a near relative or the spouse Many cases of kidney racket are being reported in the media. The new Transplantation of Human Organs and Tissues Rules, 2014 has been notified and is applicable to the medical practice. People bring commercial donors in the disguise of a near relative or the spouse in most instances. There are loopholes in the organ transplant rules, which may make it difficult for the treating doctors to suspect them. Any way the treating doctors cannot be involved in any such scam as they have nothing to do with the committees constituted under the new rules and the law. Procedure in case of near relatives Who is a near relative? When transplant of organs is between near relatives related genetically, namely, grandmother, grandfather, mother, father, brother, sister, son, daughter, grandson and granddaughter, above the age of eighteen years Who can give permission? The competent authority as defined at rule 2(c) or Authorisation Committee (in case donor or recipient is a foreigner) Who is a ‘competent authority’? (c) “Competent authority” means the Head of the institution or hospital carrying out transplantation or committee constituted by the head of the institution or hospital for the purpose; What does this mean? It can be a single window clearance by the head of the institution. What is the role of the competent authority? To evaluate conclusively 1. Documentary evidence of relationship e.g. relevant birth certificates, marriage certificate, other relationship certificate from Tehsildar or Sub-divisional magistrate or Metropolitan Magistrate or Sarpanch of the Panchayat, or similar other identity certificates like Electors Photo Identity Card or Aadhaar card. 2. Documentary evidence of identity and residence of the proposed donor, ration card or voters identity card or passport or driving license or PAN card or bank account and family photograph depicting the proposed donor and the proposed recipient along with another near relative, or similar other identity certificates like Aadhaar Card (issued by Unique Identification Authority of India). What are the loopholes? The certificates can easily be fabricated. What if the evaluation is inconclusive? If in the opinion of the competent authority, the relationship is not conclusively established after evaluating the above evidence, it may in its discretion direct further medical test, namely, Deoxyribonucleic Acid (DNA) Profiling. The test shall be got done from a laboratory accredited with National Accreditation Board for Testing and Calibration Laboratories and certificate shall be given in Form 5. If the documentary evidences and test referred to do not establish a genetic relationship between the donor and the recipient, the same procedure be adopted on preferably both or at least one parent, and if parents are not available, the same procedure be adopted on such relatives of donor and recipient as are available and are willing to be tested, failing which, genetic relationship between the donor and the recipient will be deemed to have not been established. What about husband and wife? Where the proposed transplant is between a married couple the competent authority or Authorisation Committee (in case donor or recipient is a foreigner) must evaluate the factum and duration of marriage and ensure that documents such as marriage certificate, marriage photograph etc. are kept for records along with the information on the number and age of children and a family photograph depicting the entire family, birth certificate of children containing the particulars of parents and issue a certificate in Form 6 (for spousal donor). What is the loophole? People can show that they are married only for the purpose of transplant. How to block the loopholes? Any document with regard to the proof of residence or domicile and particulars of parentage should be relatable to the photo identity of the applicant in order to ensure that the documents pertain to the same person, who is the proposed donor and in the event of any inadequate or doubtful information to this effect, the Competent Authority or Authorisation Committee as the case may be, may in its discretion seek such other information or evidence as may be expedient and desirable in the peculiar facts of the case. Can the treating doctor be the competent authority? No. The medical practitioner who will be part of the organ transplantation team for carrying out transplantation operation shall not be a competent authority of the transplant hospital. What is another way of reducing the gaps? The competent authority may seek the assistance of the Authorisation Committee in its decision making, if required.

Wednesday 24 August 2016

Dengue fever is harder to treat in obese and overweight patients

Dengue fever is harder to treat in obese and overweight patients
Individuals who have a high body mass index are more likely to suffer severe capillary leakage and even worse Dengue infection.
New Delhi, 23rd August 2016: The National Capital city is going through a lot of chaos and disorder amid the prevailing medical crisis because of Dengue and Chikungunya outbreak. People living with other lifestyle diseases like obesity, diabetes and heart disease must be more careful since they can develop complications.

Dengue and Chikungunya are flu-like viral diseases that are transmitted through the bite of infected Aedes mosquitoes. The Aedes mosquito often breeds in standing water, discarded tires, flowerpots and vases, oil drums and water storage containers. One must remember that the adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. To protect oneself, it is important to use mosquito repellents while indoors or out. When possible, people must wear long sleeve shirts and long pants for additional protection.   Also, they must make sure that the window and door screens are secure and without holes. Sitting in air-conditioned rooms can reduce the incidence of the disease.
Symptoms of Dengue Fever:
·       Sudden onset of fever
·       A severe headache and pain behind the eyes
·       Muscle and Joint pain  
·       Red rashes spreading on lower limbs and chest
·       Nausea and vomiting
·       Loss of appetite
·       Unusual abdominal pain

Symptoms of Dengue Hemorrhagic Fever:
·       Blood vessels start leaking/ capillary leakage
·       Unusual bleeding from the nose, mouth and gums
·       Massive bleeding due to disseminated intravascular coagulation
·       Blood vessels may collapse
·       High fever may cause shock (Dengue shock syndrome)


According to Padma Shri Awardee, Dr K K Aggarwal – Honorary Secretary General IMA and President HCFI, “Individuals who are obese or have a high mass body index tend to suffer from a severe symptom known as capillary leakage after contacting dengue infection. In such condition, body fluid leaks from blood vessels into the surrounding tissues. This permeability is likely to cause major complications in organs like liver, brain and kidneys. When lots of fluids are present in the lungs, obese patients often face breathing difficulties. The chances of catching Dengue infection can’t be eliminated entirely, but one can create a safer environment by taking immediate precautions. Additionally, individuals who are already suffering from one or the other co morbidities need to be kept in close observation and should be given medical assistance whenever the symptoms are reported. “
In the case of obese patients, there can be complications with the fluctuations in the blood pressure levels. Also, sometimes the patient’s current medication schedule might clash with prescribed medicines during Dengue infection. This can lead to adverse effects on an individual’s health and his organs. The best way to reduce chances of acquiring the illness is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, one must regularly clean water containers like pet and animal water containers, flower planter dishes and keep water storage barrels covered.

An easy to apply ‘formula 20’ that can be used to identify Dengue fever: 
·           If there is a rise in pulse by 20
·           Fall in upper blood pressure by 20
·           Rise in hematocrit by 20 percent
·           Rapid fall in platelets to less than 20,000
·           Platelets count of more than 20 in one inch after tourniquet test
·           If the difference between upper and lower blood pressure is less than 20, then such cases should be given 20 ml of fluid per kg immediately and then shifted to nearest medical centre for medical assistance
Over the past few years, Dengue infection has become one of the most prevalent infectious diseases affecting children and adults. But there’s something more alarming about this infection; Dengue is proving to be fatal in case of individuals who have any other major health impairment like a heart disease, diabetes or any existing liver issues. The best way to get rid of this mosquito-borne disease is maintaining a hygienic environment and adopting a health lifestyle.

Tuesday 23 August 2016

Do not ignore a sore throat in children

Do not ignore a sore throat in children New Delhi, August 22, 2016: Viral infections continue to plague Delhi with more and more people becoming victims of high fever, cough and nasal discharge. Mosquito borne diseases such as chikungunya and dengue are also on the rise. “At such times it is important to remember a few basic guidelines. Firstly there is no need to take antibiotics when an adult patient has symptoms such as high fever, a cough and a cold. In patients with suspected dengue, NSAIDs barring Paracetamol must not be taken as they run the risk of capillary leakage. One must remember that Chikungunya though painful is not a life-threatening disease and takes about a week ten days for the symptoms to disappear”. said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. It is however impirtant to remember that a sore throat in school children should not be ignored and shown to a local family doctor. This should be done to rule out bacterial sore throat infection, which if goes undetected, can cause rheumatic involvement of the valves of the heart, a condition known as rheumatic fever. Such children invariably will complain of throat pain while swallowing, red angry–looking tonsils and painful enlargement of lymph nodes at the angle of the mouth. Immediate antibiotics are needed to treat this to avoid future heart disease. In such patients no cough and nasal discharge will be present. Children also should not be given aspirin indiscriminately as it is known to be associated with fatal liver disease, in susceptible children. The first attack of rheumatic fever is rare after the age of 35.

Study suggests possible airborne Hepatitis B virus transmission

Study suggests possible airborne Hepatitis B virus transmission A study from Korea has reported that the hepatitis B virus (HBV) can be detected in surgical smoke from laparoscopic surgeries on patients with hepatitis B. Eleven 11 patients who underwent laparoscopic or robotic abdominal surgeries between October 2014 and February 2015 at Korea University Anam Hospital were included in the study. A high efficiency collector was used to obtain surgical smoke in the form of hydrosol. The smoke was analyzed by using nested PCR. All 11 patients had positive hepatitis B surface antigen (HBsAg) prior to the surgery, while two had detectable HB surface antibody (HBsAb), two were positive for hepatitis B e antigen, and three were on anti-HBV medications. The hepatitis B virus was detected in surgical smoke in 10 of the 11 cases. Although preliminary, these findings highlight the need to recognize and understand the risk when treating patients with HBV and take steps to control surgical smoke during laparoscopic procedures to protect doctors and other healthcare workers from exposure to the virus. The study is reported online August 2, 2016 in the journal Occupational & Environmental Medicine.

Monday 22 August 2016

IMA congratulates the Medical Council of India on the launch of its Digital Mission Mode Project

IMA congratulates the Medical Council of India on the launch of its Digital Mission Mode Project
IMA extended its support to the Medical Council of India’s Digital Mission Mode Project (DMMP). New Delhi, August 20, 2016: “The DMMP is a commendable initiative by the MCI aimed at creating a digital network facilitating data exchange across all medical colleges in the country and converting the Indian Medical Register in the digital mode. The project is in line with the Honorable Prime Minister’s Digital India initiative and is a much-needed development in helping make the Indian Medical Education system more transparent and effective. We at IMA welcome the initiative and will support the MCI in its implementation in any way we can,” said Dr SS Agarwal – National President IMA & Padma Shri Awardee Dr KK Aggarwal – Honorary Secretary General IMA. The DMMP solution shall enable online submission of applications for opening of new medical colleges or seat enhancement; creating a national data base of faculty in medical colleges which shall be linked with their Aadhar Card and have bio-metric verification. Every faculty will be issued a RFID enabled identity card and the attendance, salary and work status of the faculty shall be submitted to the MCI on a real time basis by all medical colleges, besides other data and information required for regulatory compliance. The applicant medical college can also track the application processing status through this online application. The existing records of MCI shall be completely digitalized and the Indian Medical Register shall be made a live Register. The above referred solution shall be backed by a Robust Call Centre Support and “Samadhan” the Grievance Management System of MCI. According to a statement issued by Prof. Jayshree Mehta, President, Medical Council of India, the long standing demand of the medical profession, civil society and Govt. of India about having a real time medical register shall be accomplished through this project in the next 6 months. The status of medical practitioners of the country shall be updated and the same could be tracked electronically, their current status especially about their Good Standing or any proceedings under the ethics regulations shall be available for view by general public in the online DMMP application at all times.

With price cap, 22 drugs get cheaper

With price cap, 22 drugs get cheaper In a move that would make some commonly used cancer drugs, anti-retrovirals and medicines to treat malaria cheaper by up to 45%, the central drug regulator has capped prices of 22 essential medicines with immediate effect. The price cap announced by National Pharmaceutical Pricing Authority (NPPA) would bring down maximum retail price or MRP of these medicines down by 10-45%. It is likely to impact prices of nearly 220 medicine brands containing 22 formulations. For instance, the price of 1ml Doxorubicin HCl Pegylated Liposomal Injection — used in the treatment of different types of cancer including blood, breast, stomach, lungs, ovaries and kidneys — has been fixed at Rs 723.93, whereas a pack of Zoledronic Acid infusion — used with cancer chemotherapy to treat bone problems — will now cost Rs 3,609.13. "The average price reduction on these drugs would be at least 25% after the latest order," an official told TOI. The NPPA caps prices of essential drugs at the simple average of all medicines in a particular therapeutic segment with sales of more than 1%. [TOI]

IN DEFENCE OF A PROFESSION: A Doctor’s perspective

IN DEFENCE OF A PROFESSION
                                               

…………………………A Doctor’s perspective
                                                         
Dr. Dharamvira Gandhi, MD   (Medicine)
                                                          Member Parliament, Patiala.
                                                          M:-91-90138-69336
                                                          Email:-dvgandhi1951@yahoo.com

It is very disturbing and frustrating to read and watch almost daily, the painful stories of fast deteriorating patient-doctor relationship, in print and electronic media. The increasing incidents of patient’s relatives attacking doctors, ransacking hospitals and doctors retaliating with scuffles and strikes are bound to cause irreparable damage to ages—old historical sacred relationship and bring it to the lowest ebb in near future, if remedial measures are not taken quickly.

Our people and we the doctors can’t afford this tense relationship for long.  There is an urgent need for the medical fraternity and the society at large, (the community leaders and opinion makers in particular) to discuss thread bare, analyze and sort out the problem at both ends.  Moved by recent unfortunate happenings across the country, I am writing this article from a doctor’s perspective with a hope that all concerned will also respond and initiate a healthy debate, best in the interest of ailing humanity and society as a whole.  Let us put in sincere efforts and try hard not only to save, but take this sacred relationship to new heights of mutual understanding, confidence and glory.

During my medical career spread over 40 years, I have attended to and served my patients to the best of my knowledge and capability, with total devotion and professionalism, surely like my own family members. During these four decades, I have interacted with and treated lacs of people and have enjoyed their great affection, respect and gratitude, which continues to be and will always remain till my last breath, the greatest and richest treasure of my life.  I have never been and in fact, can never think of being negligent towards my patients.  Even at 63 today, I wake up at the first telephone or doorbell ring, not that I need to earn more money, but because of my professional commitment and sensitivity, I love to preserve. 

For me, my patient was never and neither will ever be a “consumer”. Patient doctor relationship is a sacred relationship bases on absolute and immense faith which patient reposes in his doctor, and offers his life or that of his beloved ones to a person, with whom he has no blood relations and at times, has met him (the doctor) for the first time.  I firmly believe that this faith has no parallel, in known human behavior.  As a doctor, I have always felt small, in front of this faith of the patient and it is this feeling which keeps me working day in and day out, for the welfare of my patients.  It is this faith which compels me to spend tiring and sleepless nights for my patients, swimming and sinking with their clinical state, reflecting upon and affecting not only my own mind and body, but that of my whole family.  No amount of money, no court, law or legislation can compensate my 30years of physical and more importantly my mental and psychological involvement of my wife, my daughter and my son.  Money, if at all is and always was, too small, rather too un-important part of this whole relationship.  I hereby declare that my patients can never ‘pay’ me for my exhaustive involvement in them. They are rather too poor to do that.  They can feel indebted and express gratitude to me throughout their life, as I feel indebted to them for the faith they put in me. It is this superb relationship which differentiates medical profession from any other profession.

Doctors who relish profession at this emotional and spiritual plane are now being made believe that their patients are now the ‘consumers’,. One cannot imagine how much this new definition of sacred patient-doctors relationship has tortured  and discouraged people like me during the recent years.  I express honestly and frankly, that his ‘patient as consumer’ concept, will adversely affect patients more, that the doctors.  It is the public large, which is going to be at the receiving end in this game and not the doctors, who will become smart enough over time ,to escape or guard themselves against legal aspects of increasing litigations, of course with high-tech investigative plans, taking insurance covers and ensuring bit of more legal formalities. Let somebody convince me as to, how one can do justice to his profession and provide scientific, rational and yet affordable treatment to great majority of patients in this poor country, when every patient one starts conceiving, as a potential litigator.

          We the doctors, working in developing countries like India, have to deal with vast majority to patient population which is took sick and too poor at the same time, to afford anything.  In a country, where govt. is totally apathetic, insensitive irresponsible towards the health of its people, where health insurance is still a distant dream, where religious heads instead of building health institutions are busy in making more and more of temples and gurudwaras, where NGO sector is weak and public at large gullible,  it is we the doctors, who are left to carry the burden of providing health care to the helpless majority. While   dealing with the semi-starved patient of course now a ‘consumer’, we the doctors often have to act as social activists, as social scientists and many times have to make compromises with our knowledge and tailor our science with the sole idea of helping the patient best, with the available resource in that given situation.  It is irony of the situation, that if such patient turned ‘consumer’ incited by smart ‘friend’s files a case against the doctor, the law wants us to have acted and performed according to the western standards.  This attitude and approach is totally divorced from the hard socio-economic realities, existing in the country today.

This attitude, of the law, state and society will certainly sap the already fast eluding spirit of sympathy and compassion from doctor’s community.  It will kill their remaining sensitivities and make them ‘full businessmen’ for whom patients will be the objects and just “consumers” as they are being made to believe today.

Now let me talk of medical science itself and plight of doctors thereof, from whom the law and “consumers” expect to deliver with mathematical precision and perfection.

The law makers and our ‘consumers’ are perhaps ignorant of the fact that medical sciences is an ever evolving and completely complete science.  The entire medical literature is full of its and buts, conflict and controversies, still grappling with thousands of unresolved questions and mysteries.  Till date, it is an imperfect science and probably will continue to remain so, for the times to come and may be for indefinite period. 

One would appreciate the fact that human body behavior is yet far from being completely understood.  Numerous, mysteries regarding functioning and ‘mal functioning’ of various human organ systems are still unsolved and continue to challenge the available global medical wisdom.

Harrison book on internal medicine, often quoted as the ‘Bible of medicine’ in chapter 125 of its latest edition, on ‘Fever of unknown origin’ clearly mentions that in spite of best available diagnostic tools and best input of medical knowledge,19%  cases of fever remain undiagnosed and this number  is not negligible

Let people clearly understand that medical science as it stands today, lays only broad guidelines regarding diagnostics and modalities of treatment and does not claim them to be mathematic-specific.  These guidelines are based on group data and not on individual data.  This simply means that while generalities may hold good, yet certain subsets of patients can behave and in-fact do behave in a totally unpredictable manner, which is beyond the comprehension of available medical knowledge, at lease today. Moreover, solutions to medical challenges are sought from animal models, while humans are much more advanced and complicated species that their ancestors.  You cannot extrapolate results of animal experimental  models with that level of precision, as required in  humans.  For any science to be perfect, it is mandatory that in order to understand the possible “wrongs”  with the machine, one wants to master, one should be free to dismantle it step by step and throw it into the dustbin, at the end of the day.  But the medical science is “tied down” science, on the account.  You cannot experiment on humans, not even those, going to be hanged the other day and now, not even on animals (“Thanks” to Ms. Menka Gandhi, who went to stop research on animals, at out prestigious All India Institute of Medical Sciences New Delhi)
          It is because of these historical handicaps and limitations that every test, every tablet, every injects, every procedure and every modality of treatment is fraught with some serious implications and complication.  No treatment, modality is absolutely safe.  Entire Medical Literature, each chapter of it, make special mention of some potential dangers, side effects, complications and even morbidity and mortality, associated with every that procedure or  modality of treatment, which otherwise provides relief and mitigates suffering of many.  I can quote several examples where the doctors themselves have suffered and even lost their lives, because of these uncertainties of medical science.  Whatsoever complication is mentioned in medical literature, it is incidence may be one amongst one lac, it does happen in one case or the other.  For some “smart”  and some ignorant people, it can well be  a case of ‘negligence’

          Moreover, sicker the patient more are the chances of facing problems during the procedure/treatment, Nowhere in the world not even in advanced economics a surgical  procedure ensure 100% success.  Nowhere in the world, an investigative procedure or treatment modality guarantees 100% success and safety.  If that be the case, no rich man should ever die, and why rich man, no doctor in first place, should ever dies.  But this is not true.

          Out of thousands of patient one treats in month, some may not do well in spite of one’s best professional judgment and input and occasionally one may even loss a patient, because of advances nature of disease.  It is not fair, at all, rather it is utter injustice, to label these unfortunate mishaps as “doctor’s negligence”, without taking into consideration the limitations of medical science and particularities of that case.

`It may look misplaced argument here, but I can’t help adding new dimensions to much hyped concept of ‘negligence’.  I can quote several instances, where wards of many patients ignored may advice for getting  their  seriously sick, old and helpless parents admitted  to hospital and instead let them die at home for want of required medical care, as they were busy with their school going children’s exams.  Will any law ever book these selfish and insensitive ‘educated’ and ‘not to ignorant’ consumers? In fact, such are the perfect cases of negligence.

          Let me emphasize the fact that it is with these historical limitations that medical science and we the doctors, who practice this science are expected to perform and deliver.  It is against these odds and handicaps that we the doctors are destined to work.  We the doctors and our families carry daily, the burden of this sickly poor and poorly sick society.  In a recent survey conducted in Ahmedabad, researches could find only two octogenarian doctors in a city with over 30 lac population.  This finding speaks volumes of the burdening and sickening nature of our job and the price, we the doctors are paying for the pursuance of  our duty and profession/

          Unmindful of our problems, hardships and contributions made by us towards the health of the society, the promptness shown by police in registering case against ‘erring’ doctors without seeking opinion from some independent body of medical professionals and ‘Masala’ stories flashed/published by electronic and print media, without ascertaining the facts and taking doctor’s version, only adds to our agony.  I firmly believe that our journalist  friends and the custodians of law  and order and the law itself, are well aware of the fact that such charges of ‘negligence’ are merely a ploy to extort money from doctors and hospitals,  in majority of cases.  This is evident from the fact that hardly and hulla-balloo is raised over such mishaps occurring in govt. hospitals.

In the entire west, it is on the record now that serious students long back stopped  opting  for medical profession, partly because of sickening nature of profession and mainly because their patients were made ‘consumers’ in mid seventies, by their capitalists  states, driven by laws of capital and profit in every sphere of human and social activity.  Health services there, are being largely managed today, by doctors from India, China, Latin America and other South East Asian countries.  With the advent of globalization, new economic  policy, structural reforms and privatization drive with resultant consumerism,  India is  shortly following suit.  In fact, the trend has  already started,

It is because of this attitude of some ‘smart’ and some ‘ignorant’ people that we the doctors now feel hesitant to treat lawyers, journalists, court people and VIPs, who we think are potential litigators.In case something goes wrong even in a natural way.  We prefer now, to avoid such ‘consumers’ even if we feel competent enough to treat them.


After expressing my heartfelt feelings on the plight of my once great and now ‘not so great’ profession, let me conclude saying that no doctor, how so ever ‘bad’ or ‘greedy’ (As some people complain about) he or she may be, will ever like to end up with this case in the post mortem room.  This sweeping statement I make universal truth for all my professional colleagues, even enough I differ with most of them on the issues of professional ethics and morality.

Place :- Patiala

Date: 08.08.2016