Every child has the right to immunization Estimates indicate that about 3 million deaths can be prevented annually with timely vaccination New Delhi, April 29, 2017: According to statistics, about 19.4 million children over the world are unvaccinated or under-vaccinated. Of these, about 11.5 million live in 10 countries: Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, the Philippines, and Ukraine. It is estimated that about 3 million deaths can be prevented annually through Immunization, which is one of the world's most successful and cost-effective health interventions. The theme for this year’s World Immunization Week focuses on the adage "Vaccines Work". The theme has been taken up to promote the use of vaccines in order to protect people of all ages from various diseases. As per the United Nations health agency, vaccinations helps in staving off 26 potentially deadly diseases. This year, the World Immunization Week also marks the halfway point of the UN's goal to stop millions of deaths from vaccine-preventable diseases. Speaking on this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr R N Tandon – Honorary Secretary General IMA in a joint statement, said "Immunization is the building block of a strong and sustainable primary health care system and universal health coverage. With the development of new vaccines today, more and more number of people, children in particular, can be protected against many debilitating diseases. However, the mere availability of vaccines does not mean that they are reaching every child in every part of the world. On this World Immunization Week, it is time to align ourselves to the larger goal of reaffirming our global commitment to children’s health and achieve the Sustainable Development Goals by 2030." According to WHO, the fact that the target of 194 countries which signed the global action plan to eliminate vaccine-preventable diseases by 2020, is running behind schedule, should serve as a wake-up call for immediate action. Among the preventable diseases are measles, rubella, and maternal and neonatal tetanus. A more concentrated effort is needed towards achieving the target. Adding further, Dr Aggarwal, said, "It is unfair to deny any child the right to immunization because of social or economic reasons. If the countries come together and act in unison towards achieving this goal, all barriers can be overcome." Thousands of events and activities are also being organized around the world as part of the World Immunization Week. WHO has also created a network of validated vaccine safety websites called Vaccine Safety Net, which provides accurate and reliable information about vaccines.
Sunday, 30 April 2017
Health Ministry launches a new ‘Test and Treat Policy for ,’ for India The Union Minister for Health & Family Welfare, Shri JP Nadda launched the ‘Test and Treat Policy for HIV’ yesterday. As per the policy, “as soon as a person is tested and found to be positive, he will be provided with anti-retroviral therapy (ART) irrespective of his CD count or clinical stage. This will be for all men, women, adolescents and children who have been diagnosed as a HIV + case. This will improve longevity, improve quality of life of those infected and will save them from many opportunistic infections, especially TB,” said the Health Minister. A National Strategic Plan for HIV for next seven years is under way. The Health Minister emphasized on the need to address stigma & discrimination towards HIV to enable persons infected and affected with HIV access health services. The long pending HIV/AIDS Act has been passed very recently to facilitate this. “Very few countries globally have such a law to protect rights of people infected with HIV,” Shri Nadda elaborated. The key provisions of HIV/AIDS Bill are prohibition of discrimination, informed consent, non-disclosure of HIV status, anti-retroviral therapy & opportunistic infection management, protection of property of affected children, safe working environment and appointment of ombudsman in every State. The Health Ministry has intensified its efforts to find all those that are estimated to be infected with HIV. “Out of 21 lakh estimated with HIV, we know only 14 lakh. To detect remaining we have revised national HIV testing guidelines and are aiming to reach out to people in community and test them where they are, of course with proper counseling and consent,” Shri Nadda mentioned. Shri Nadda further said that all those who are positive should get treatment and for that the Health Ministry is constantly expanding treatment delivery sites. “We have nearly 1600 ART and Link ART sites where treatment is provided across the country and recently we crossed the 1 million people on ART, second country in world to have such large numbers on free lifelong treatment. We have been able to avert 1.5 lakh deaths due to ART and we will be able to avert 4.5 lakh more deaths by expanding provision of ART,” Shri Nadda informed. Shri Nadda stated that the 90:90:90 strategy that the Ministry has adopted will help to identify 90% of those infected, place 90% of these on treatment and ensure 90% have their virus under control. “This strategy will offer us an opportunity to work towards our commitment during HLM and WHA on “ending AIDS by 2030” as a part of the Sustainable Development Goal (SDG).” (Source: Press Information Bureau, Ministry of Health and Family Welfare, April 28, 2017) Dr KK Aggarwal National President IMA & HCFI
Saturday, 29 April 2017
Waist circumference a better indicator of health than BMI A new study says that the waist circumference, and not body mass index (BMI), is a better indicator of increased risk of death from cardiovascular causes or any cause. In the study, normal weight individuals who had central obesity i.e. higher waist-to-hip ratio were at a 22% higher risk of death from any cause and a 25% higher risk for death from cardiovascular causes compared to these who are obese according to BMI but did not have central fat accumulation. The study jointly conducted by researchers from the University of Sydney in Australia and Loughborough University in England has been published April 26, 2017 in the Annals of Internal Medicine. The body mass index is the most commonly used measure of obesity, which is based on height and weight of a person. It is calculated as weight (in kg) divided by the height squared (in cm). But, it does not measure body fat. The correct method to measure obesity is to measure body fat, especially the fat around the abdomen. A high waist-to-hip ratio indicates high amounts of abdominal fat. A person can be obese even if the body weight is within the normal range. This is called normal weight obesity, where the BMI is normal as per the age and height, but the body fat percentage is high. Typically, such individuals have a potbelly but otherwise look normal. Abdominal obesity is more dangerous than generalized obesity. Abdominal girth or waist circumference of more than 90 cm in men and 80 cm in women indicates that the person is at a higher risk of future heart attacks, type 2 diabetes, hypertension, abnormal cholesterol (high TGs and low HDL or ‘good’ cholesterol) and metabolic syndrome. Lifestyle changes should be instituted immediately to ward off these chronic but potentially life-threatening diseases. Any weight gain after puberty is invariably due to fat as most organs also stop growing, once the height stops increasing. One should not gain weight of more than 5 kg after the age of 20 years in males and 18 years in females. And, after the age of 50, the weight should reduce and not increase. Potbelly obesity is linked to eating refined carbohydrates and not animal fats. General obesity is linked to eating animal fats. Refined carbohydrate includes white rice, white maida and white sugar. Brown sugar is better than white sugar. Some tips to reduce obesity • Skip carbohydrates once in a week. • Combine a sweet food with bitter food. • Include more green bitter items in foods. • Do not eat trans fats. • Do not consume more than 80 ml of soft drink in a day. • Do not consume sweets with more than 30% sugar. • Avoid maida, rice and white sugar. • Eat in moderation. • Walk, walk and walk… Remember, longer the waist line… shorter the lifeline… (Source: University of Sydney News, April 26, 2017) Dr KK Aggarwal National President IMA & HCFI
IMA lauds mandatory bioequivalence studies for drugs Move will ensure that the manufactured drugs are safe and effective New Delhi, April 28, 2017: In what can be called a long overdue move, the Ministry of Health and Family Welfare, has made bioequivalence studies compulsory for all drugs before they are launched in the Indian market. The draft amendments were first advertised in early February for public comment. Following this, the Drugs and Cosmetics Rules, 2017 were formally amended through a notification on April 3 to incorporate the change. Bioequivalence studies are conducted to establish that both the original patented drug and a generic version of it have the same biological equivalence. This means they should work the same way, to the same extent, and for the same purpose. Welcoming this move, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "For a long time, doctors have been prescribing generic drugs with no data on how these would perform. Until recently, only new drugs which have been in India for less than four years were required to undergo bioequivalence studies if they were in use in developed markets like the US and Europe. Many domestic manufacturers waited till the fifth year and got approval to manufacture and sell generics without conducting bioequivalence studies. However, IMA has always stood for conducting bioequivalence studies and the health ministry needs to be lauded for this decision." Bioequivalence studies are mostly conducted on a smaller group of healthy volunteers. On the other hand, clinical studies are conducted on patients who suffer from a said disease. The cost of a bioequivalence study is therefore only a small fraction of clinical trials. The amendment introduces a biopharmaceutical classification system, classifying drugs into categories based on solubility and permeability: i) category I- high solubility and high permeability; (ii) category II- low solubility and high permeability; (iii) category III- high solubility and low permeability; and (iv) category IV- low solubility and low permeability. Manufacturers will now need to conduct bio-equivalency studies on category II and IV drugs to obtain a manufacturing license from the state licensing authority. Adding further, Dr Aggarwal, said, "This decision is definitely a step in the right direction. It not only aligns the Indian framework with global standards but also ensures that the drugs manufactured are safe and effective. It assumes greater significance in light of the fact that doctors today are being asked to mandatorily prescribe generic drugs to consumers." The cornerstone for a vibrant public health framework is access to affordable and safe medicines. Future challenges may include ensuring that clinical research organizations conducting bioequivalence studies do not commit fraud.
Friday, 28 April 2017
IMA-FOMA DELHI RESOLUTIONS From the desk of Dr KK Aggarwal, National Presidemt, IMA and Dr R N Tandon, HSG, IMA An emergency Action group meeting of IMA followed by an emergency meeting of Indian Medical Association - Federation of Medical Associations of India were held in IMA Headquarters Delhi from 11 am to 2 pm on Wednesday 26/04/2017 to discuss the emergent situation on generic drugs. (IMA- Federation of Medical Associations of India) Prescription of Generic Name of the Drugs by Medical Professionals IMA-FOMA appreciates Hon’ble Prime Minister, Shri Narendra Modi’s concern about the availability, accessibility and affordability of quality economical drugs to the society. 1. The judgement to choose a rational drug and its format vests only with the Registered Medical Practitioners. This right of the medical profession is sacrosanct. 2. IMA - FOMA also wants the Government to strengthen Quality control mechanisms to ensure adherence to Good Manufacturing Practices (GMP) for patient safety. 3. For a rational prescription, doctors should choose drugs generic-generic or generic - brand based on quality, efficacy and economy and write legibly and preferably in capital letters. 4. IMA-FOMA recommends that Government should ban differential pricing of a drug under different brand names (generic-generic, generic- trade or generic- brand) by one company. (one chemical drug, one company, one prise) 5. IMA FOMA will be meeting the President of MCI, Union Health Minister and Prime Minister of India about the views of the medical fraternity on this issue. All the constituent members of IMA-FOMA shall communicate these IMA-FOMA Delhi Resolutions to its members. Reference MCI Ethics Regulations Clause No. 1.5 states " All physicians SHOULD prescribe medicines with generic names, legibly and preferably in capital letters and he or she SHALL ensure rational prescription and use of drugs" List of Associations which attended the FOMA meeting Indian Medical Association, All India Ophthalmological Society, Urological Society of India, Geriatric Society of India, Indian Radiology & Imaging Association, Indian Academy of Echocardiography, Heart Care Foundation of India, Cardiological Society of India, Association of Surgeons of India, Indian Psychiatric Society, Delhi Psychiatrist Society, Indian Orthopaedic Association, The Federation of Obstetric & Gynaecological Societies of India, Indian Association of Dermatologists, Venereologists and Leprologists, Association of Physicians of India, Indian Academy of Echocardiography, FFPAIA,
IMA leaders attend the 206th WMA Council Meeting in Zambia Leaders from world over debate on key issues including medical tourism and organ trafficking, medical cannabis New Delhi, April 27, 2017: The 206th Council Meeting of the World Medical Association (WMA) was held in Zambia from 20th to 22nd April 2017 and was attended by almost 200 delegates from more than 30 national medical associations. Leading the discussions were Dr Ketan Desai, President WMA and Chairman International Wing IMA; Dr Arron, President, Zambia Medical Association; Dr Hoven Ardis, Chair, WMA; and Dr Otmar Kloiber Secretary General WMA. The IMA delegation from India was led by Dr KK Aggarwal National President along with council member Dr Ajay Kumar and Dr Ved Prakash Mishra. In his presidential report during the council meeting, Dr Ketan Desai, President World Medical Association said, “National Medical Associations play a significant and crucial role in shaping the health care delivery system of the respective countries in the larger interest of their citizens. The right to health is neither a luxury nor a charity. It must reach all and sundry including the weakest of the weak, poorest of the poor, and the remotest of the remote. It is our joint responsibility as leaders of the healthcare systems to ensure that every citizen from every part of the world is extended a meaningful right to health”. As part of the meeting, key documents readied under the leadership of Dr KK Aggarwal – National President IMA pertaining to Assisted Reproductive Technologies and HIV were presented, deliberated and finally adopted by the council. The creative contribution by the IMA towards quality assurance in medical education was acclaimed and appreciated. Speaking about the meeting and discussions, Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI), said, "The council meeting of WMA saw physician leaders from national medical associations around the world debating on a number of key issues. Policy proposals such as those on medical tourism, boxing, medical cannabis, and climate change hold national and international relevance. There is a need to allocate a larger role and responsibility to the African countries so that they are in the mainstream of global participation and this meeting held in Zambia is certainly the right step in that direction. It is heartening that the visibility of the IMA at the council meeting by virtue of well-articulated participation on all matters before the council meeting for consideration was noteworthy and well-recognized. I, along with Dr Vinay Aggarwal, also appreciate and acknowledge being re-nominated for another term on the ethics committee of WMA." IMA also interacted with other member countries on the side-lines of the council meeting on the matters of mutual concerns and interests and for evolving a roadmap for formal joint ventures. The event also saw the IMA and China Medical Association sign an MOU under the IMA-CMA initiative. Further to this, the general assembly of the WMA would be held at Chicago in October 2017 wherein Dr Ved Prakash Mishra will represent IMA in the WMA advocacy group as also chair a session on medical education in Chicago.
Thursday, 27 April 2017
IMA condemns the West Bengal Clinical Establishment ACT 201 Urges 3 lakh members to observe a National Black Day on 27th April. New Delhi, 26 April, 2017: Following the deaths of few patients in alleged cases of medical negligence against private hospitals in West Bengal, the West Bengal Clinical Establishments (registration regulations transparency) Bill, 2017 was recently passed in the state assembly with full support. The Indian Medical Association, the largest conglomeration of doctors of modern medicine has, however, condemned and opposed the Act. They feel that it is unjust towards the medical fraternity and will only increase the cases of violence against doctors. At IMA’s recent National Conference in Kolkata – the 217th CWC – it was unanimously decided that 27th April would be observed as National Black Day across the country. Over 3 lakh members of the IMA have been asked to join the peaceful demonstration of solidarity by wearing black badges and displaying a black cloth on their notice board with explanation. Speaking about the Act and its repercussions, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "The passing of this Act is indeed an issue of grave concern for the medical fraternity as it can hamper the relationship between the doctor and patient and affect the nobility of the profession. Treatment failures don't amount to negligence on the part of doctors and a 5% death rate during treatment is unavoidable. It is impossible for doctors to do their job effectively if they fear imprisonment and violence at every instance. Instead of passing such an Act, it is expected of the Indian judicial system and the law enforcement agencies to provide doctors with protection against such violence failing which the medical community will be unable to practice and fulfill their basic duties without any apprehensions." The IMA has opined that the provisions of the Act are unjust and impose an inspector raj. As a result of this Act, the licenses of the hospitals can be cancelled every time there is a death to satisfy some or other authority. The decision to include medical negligence under criminal jurisprudence is completely unjust as at no time, during a treatment, is there an intention to kill the patient. Adding further, Dr R V Asokan, Chairman, Action Committee IMA," As per the Act, a doctor can be put behind bars even for a clerical error. This is unjust as is the law that for every complaint made against a doctor, he/she has to get an advance bail. We wish to understand why this difference exists between doctors in private and government facilities. Many other points in the law are not in accordance with IMA's stands and hence we wish to seek amendments to the same. This silent protest is a step towards that." IMA has also initiated a signature campaign wherein each state has been asked to mobilize the maximum number of signatures from doctors. This petition is addressed to the Chief Minister of West Bengal.
Walk up and down the stairs to boost energy Walking up and down the stairs is more energizing than low-dose caffeine in sleep deprived individuals. In a new study published March 14, 2017 in the journal Physiology and Behavior, researchers from the University of Georgia compared the effects of 10 minutes of low-to-moderate intensity stair walking to low-dose caffeine (50 mg equivalent to that in one can of soda) capsules on energy and motivation to work in women with chronically inadequate sleep. They found that compared to women who took 50 mg caffeine, those who walked up and down stairs for 10 minutes at a regular pace had greater increase in vigor or feeling of energy. They were also more motivated to complete cognitive tasks. However, no effect on attention or memory was observed. Office workers often rely on a cup of coffee to reduce fatigue and stay alert to enhance their productivity. Instead, they can now skip their caffeine and instead walk up and down the stairs. It is also a healthier option to keep fit, particularly for the desk-bound office worker, and requires no special facilities or equipment. Any person who can climb two flights of stairs or walk 2 km without any discomfort or breathlessness usually requires no cardiac investigations. Dr KK Aggarwal National President IMA & HCFI
Wednesday, 26 April 2017
Mosquito menace likely to be back Time to learn from mistakes made last year and take steps to take preventive measures early on this year, including a community driven approach New Delhi, 25 April, 2017: According to statistics, the mosquito container index (the percentage of water-holding containers infested with larvae or pupae) in Delhi is over 5% and had crossed 40% last year. Any index above 5% requires a community integrated cluster approach to reduce mosquito density together with effective anti-larval measures. Cases of dengue and chikungunya have started in the capital already. Unfortunately, no alert has been issued and in sporadic cases, no surgical strikes have been attempted openly in selected breeding places. It is a fact that we have collectively failed last year in controlling the mosquito menace and consequently, the mosquito menace is back this year. Speaking on the issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "There is a need for a paradigm shift in our thinking. We need to over report and act in time. There is no point acting when the cases have started. However, even this year, cases have started without alerts and involvement of private sector. This is again a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and private sector. It’s time for all of us to convert last year's biggest failure of controlling the mosquito menace into success this year." Another point to consider is that last year, about 3 lakh mosquito repellent impregnated mosquito nets were distributed by MCD but most were not available to actual patients. The very purpose of notification is lost if the disease is not notified within hours of even suspecting a diagnosis of Chikungunya. Therefore, all suspected cases must be reported without waiting to confirm the diagnosis. Adding further, Dr K K Aggarwal, said, "This problem requires a community approach involving 100% of the society speaking about dengue. Every premise must write that their premises are mosquito-free. When you are invited to somebody’s place, you should ask 'I hope your premises are mosquito-free' and when you invite somebody, write 'Welcome to my house and it is mosquito-free. One should be alert every day. It should be a part of your routine. You do not clean your premises once a week. Make it a habit to look for the breeding places." The outdoor Aedes mosquito cannot be ignored. The entire campaign up till now has been focused on a day biter, wearing long sleeves shirt and pants during the day, and using night mosquito nets. However, precautions need to be taken throughout the day as the mosquitoes only recognize the light and not whether it is day or night. The fact that the mosquitoes only breed in clear water also needs to be re-learnt. It is true that disease spreading mosquitoes do not make noise but the ‘noise-producing’ nuisance mosquitoes unless addressed will not create a public movement.
New AAN-AES guidelines on sudden unexpected death in epilepsy The American Academy of Neurology (AAN) and the American Epilepsy Society (AES) have jointly developed a new guideline on SUDEP or sudden unexpected death in epilepsy. SUDEP is the term used when a patient with epilepsy, who is otherwise healthy, dies suddenly without any known cause. • SUDEP is rare in children, affecting just one in 4,500 children every year. It is also uncommon in adults, typically affecting one in 1,000 adults every year. • Generalized tonic-clonic seizures are a major risk factor for SUDEP. • SUDEP is more likely in patient with frequent generalized tonic-clonic seizures. People with ≥ 3 episodes of generalized tonic-clonic seizures in a year are 15 times more likely to die suddenly vs people who have ≤ 3 generalized tonic-clonic seizures per year. • The guidelines stress on education about the condition for both physicians and patients with epilepsy. Patients should be informed that controlling seizures, especially tonic-clonic seizures, may reduce the risk of SUDEP. They should be encouraged to take their medications on time, not miss a dose and to learn and manage their seizure triggers to reduce frequency of seizures. • The guideline shows that being free of seizures, particularly tonic-clonic seizures, is strongly associated with a decreased risk of SUDEP. These guidelines were presented at the ongoing 69th AAN Annual Meeting in Boston and simultaneously published online April 24, 2017 in the journal Neurology. (Source: AAN, Press Release, April 24, 2017) Dr KK Aggarwal National President IMA & HCFI
Tuesday, 25 April 2017
206th WMA Council Meeting Report: Salient points • Dr Ketan Desai, President World Medical Association (WMA) and Chairman International Wing IMA, addressed a press conference on 18th April along with Dr Arron President Zambia Medical Association, Dr Hoven Ardis Chair WMA and Dr Otmar Kloiber Secretary General WMA. • The African initiative undertaken by WMA towards empowering National Medical Association of South African countries so as to play important role in the policy making by the respective governments pertaining to health professionals and health acre. • Dr Desai, led the deliberations at the executive committee meeting on 19th April 2017. • Dr Desai was at the head table in the 206th council meeting of WMA held on 20-22nd April 2017. • In his Presidential report, Dr Desai brought out various initiatives and dispensations by him on behalf of WMA during the impending period from October 2016 till date were adopted. • At the said council meeting, key documents readied under the leadership of IMA pertaining to Assisted Reproductive Technologies and HIV-AIDS and the medical profession were presented and deliberated by Dr KK Aggarwal National President IMA and were adopted by the council and were to assembly for acceptance. • The creative contribution by the IMA towards these two document was acclaimed and appreciated by the council. • The document readied and presented by Dr KK Aggarwal on TB is being circulated to member countries for their inputs. • The observations given on behalf of IMA on documents pertaining to medical education and quality assurance in medical education were also taken note off by the council. • Dr Ajay Kumar deliberated on all issues of WMA as the council member putting forth the views of IMA. • Dr Desai, in the reception function hosted by ZMA in honor of HE Mr Edgar President of ZMA, in his address emphasized allocation of greater role and responsibility to the African countries so that they are in the main stream of global participation. • The speech delivered by Dr Desai as President WMA was very well received by all. • IMA and China Medical Association also signed an MOU under IMA-CMA initiative. • Dr Ved Prakash Mishra will be representing IMA in the WMA advocacy group and will also chair a session on medical education in Chicago. • Dr KK Aggarwal and Dr Vinay Aggarwal were re-nominated for another term on the ethics committee of WMA. • The visibility of the IMA at the council meeting by virtue of well-articulated participation on all matters before the council meeting for consideration was noteworthy and well-recognized. • IMA interacted with other member countries on the side-lines of the council meeting on the matters of mutual concerns and interests and for evolving a roadmap for formal joint ventures. • With Spain Medical Association, a formal round of talks on forging a common associated group with like-minded NMAs on the issue of organ trafficking and transplantation was also discussed. • The general assembly of the WMA would be held at Chicago in October 2017.
IMA to organize centenary conference to debate on key issues Conference being organized 100 years after the first one in 1970 New Delhi, 24 April 2017: The Indian Medical Association is organizing a Centenary Conference on 23 and 24 September 2017. The centenary conference is being organized 100 years after the 1st Medical Conference in India in 1970 in Kolkata. Over 400 top doctors and policy makers in the country will be deliberating on various issues as part of the proceedings. The conference will deliberate on the history and advancement of medicine in India. State-of-the-art centenary lectures will also be held as part of the event. Giving details about the event Padma Shri Awardee Dr K K Aggarwal, National President, IMA and Dr R N Tandon, Honorary Secretary General, IMA said, "It is a moment of pride to be organizing this conference after 100 years. Medicine as a field has seen many changes since the time the first conference was held and this will be a platform for thought leaders and doctors to discuss and debate on issues facing the medical fraternity today. IMA is committed to solving six major issues: protection of MCI autonomy; capping of compensation; insulation against violence by way of a central act; amendments in CEA and PC PNDT act; and ban on non-MBBS, non-BDS doctors prescribing modern medicine drugs. The medical profession is facing a paradigm shift in public behavior and needs insulation against any violation. There has been a marked shift in public expectations. A central act against violence is the need of the hour." A coffee book on 100 top achievers in medical field in the last Centenary will be released during the conference. The event which was declared in the recently held Central Working Committee of IMA will be attended by all presidents and secretaries of IMA State Branches and Presidents and secretaries of all specialist organizations in India. Adding further, Dr K K Aggarwal, said," The true strength of IMA lies in our unity and common commitment to the betterment of the medical profession. We propose to work hand in hand to help establish ourselves as the voice of the medical fraternity globally." IMA represents the collective consciousness of 2.7 lakh doctors across 1700 local branches and 31 state branches. It is the largest non-government organization of doctors of modern medicine in the world. It connects the medical fraternity to one another on a daily basis. Its strength is its troop of more than 35,000 IMA leaders / office bearers, who live and breathe IMA.
Monday, 24 April 2017
Syncope increases risk of occupational accidents and job termination Syncope, or fainting episode, increases the risk of occupational accidents and loss of employment, says a new Danish study published April 18, 2017 in the journal Circulation: Cardiovascular Quality and Outcomes. Those who had syncope were at a 1.4-fold increased risk of occupational accidents compared with the employed general population. The 2-year risk of termination of employment after syncope was 31.3%, which was twice the risk compared with the control. Patients with recurrent syncope, who were younger than 40 years, belonged to poor socioeconomic status or had comorbid cardiovascular disease or depression, were particularly at high risk of workplace accidents or loss of employment. In addition to the direct clinical impact of syncope on morbidity and mortality, the findings of this study highlight an indirect effect of the condition. Although the study did not establish a cause-effect relationship, it showed a significant association between syncope and work-related adverse outcomes, including occupational accidents and termination of employment. Syncope is not life threatening, but it can be worrying to the patient and interfere with quality of life. Patients who have recurrent episodes should undergo thorough evaluation as recommended in the latest 'ACC/AHA/HRS Guideline for the Evaluation and Management of Syncope' published this year and helped to reduce occupational risks and maintain their employment. (Source: AHA News Release, April 18, 2017) Dr KK Aggarwal National President IMA & HCFI
Timely diagnosis and treatment imperative during a heart attack ‘Heart attack guidance for physicians: When to suspect, how to diagnose, what to do?’ a comprehensive guidebook by Dr KK Aggarwal and Dr Sundeep Mishra published in the Indian Heart Journal New Delhi, April 23, 2017: Cerebrovascular diseases have become the number one cause of mortality and morbidity in India. Among these, heart attack is one of the most serious conditions associated with very high morbidity and death rate. General practitioners must recognize the signs early on in order to bring down the high complication rate and follow it up with proper treatment by certified cardiologists. An instructive document titled ‘Heart attack guidance for physicians: When to suspect, how to diagnose, what to do?’ has been published by Dr KK Aggarwal, National President of the Indian Medical Association and Prof. Sundeep Mishra, Professor of Cardiology at AIIMS in the special STEMI Supplement of the Indian Heart Journal. It provides simple guidance on how to suspect and diagnose a heart attack, early treatment, and when to refer a patient with this condition. This information is important not only clinically but from the medico-legal standpoint as well because any delay can worsen survival and even result in death. Speaking on the subject, Padma Shri Awardee Dr KK Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) said, "Heart attack, particularly STEMI, can be totally reversible if diagnosed and treated early. The adage 'Time is Muscle' is extremely relevant in the diagnosis and treatment of this disease. The door-to-balloon time when a heart attack patient arrives in the emergency room until percutaneous coronary intervention is performed to restore blood flow also needs to be considered by physicians. It is therefore important that physicians be trained to recognize any such symptoms right at the onset such that the appropriate guidance can be given without losing out on precious time." There is severe chest discomfort during a heart attack. Deaths occur due to abnormal heart rhythm (ventricular fibrillation) due to electrical instability of the heart or heart failure due to massive heart attack. Occasionally, a heart attack can cause a heart muscle to rupture and this can prove fatal. Adding to this, Prof. Sundeep Mishra, Professor of Cardiology at AIIMS and Editor, Indian Heart Journal said, " It is very important for the first-contact physicians to suspect a heart attack early on, confirm it through an ECG as soon as possible, and refer the patient for revascularization to a center that is better equipped. This is where clear cut guidance for physicians regarding when to suspect a heart attack, how to confirm it, and how to proceed when a diagnosis is made assumes utmost importance and the instructive document will be like a comprehensive guide to this and more." Following are the signs and symptoms of a heart attack. • Pain areas: in the area between shoulder blades, arm, chest, chest, jaw, left arm, or upper abdomen • Pain types: can be crushing, like a clenched fist in the chest, radiating from the chest, sudden in the chest, or mild • Pain circumstances: can occur during rest • Whole body: dizziness, fatigue, light-headedness, clammy skin, cold sweat, or sweating • Gastrointestinal: heartburn, indigestion, nausea, or vomiting • Chest: discomfort, fullness, or tightness • Neck: discomfort or tightness • Arm: discomfort or tightness • Also common are anxiety, feeling of impending doom, sensation of an abnormal heartbeat, shortness of breath, or shoulder discomfort. Physicians must also raise awareness about the preventable aspect of heart disease. Simple lifestyle modifications such as consuming a healthy diet, exercising regularly, cessation of alcohol consumption and smoking and effective stress management techniques can go a long way in helping reduce the risk of heart attacks.
Sunday, 23 April 2017
New WHO ‘Global Hepatitis’ report highlights the impact of viral hepatitis While the world focused on tackling the HIV/AIDS epidemic, another viral infection, viral hepatitis, has slowly gained foothold and has now become a major public health problem. This week, the World Health Organization (WHO) released a ‘Global Hepatitis’ report, which elaborates on the global burden of viral hepatitis and for the first time includes global and regional estimates on viral hepatitis in 2015. According to the report, globally, about 325 million people worldwide have chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Many among these are at risk of progression to chronic liver disease, cancer, and eventually death as they lack access to diagnostic tests and treatment. Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. Of the five types of viral hepatitis, hepatitis B and C together account for 96% of overall mortality due to hepatitis. While deaths due to TB and HIV are declining, those due to viral hepatitis are increasing. Globally, countries in the WHO African and the Western Pacific Regions have the highest prevalence of hepatitis B. The WHO Eastern Mediterranean and the European Regions have the highest reported prevalence of hepatitis C. Here are some key points about viral hepatitis: • Hepatitis B is the most infectious of the three blood-borne viruses: Hepatitis B, hepatitis C and HIV. • Absence of jaundice does not rule out acute hepatitis infection, can just present with constitutional symptoms such as fever, vomiting, poor appetite, lethargy with high liver enzymes. • Because of their shared routes of transmission - infected body fluids such as blood, semen and vaginal fluid, or from a mother to her baby during pregnancy or delivery - people at risk for HIV infection are also at risk for HBV or HCV infection. • All people with HIV infection should be tested for hepatitis B and C infections. • Progression of liver disease is faster in viral hepatitis and HIV coinfection, which also increases the risk of serious, life-threatening health complications. • Hepatitis B can also be transmitted by fomites such as such as finger-stick devices used to obtain blood for glucose measurements, multi-dose medication vials, jet gun injectors, and endoscopes. • Hepatitis B is 10 times more infectious than HCV and 50–100 times more infectious than HIV. The HBV can survive in dried blood for up to 7 days and remains capable of causing infection. This makes hepatitis B a more dangerous infection than HIV. • Hence, any blood spills from a person with hepatitis B should be cleaned up with appropriate infection control procedures e.g. wearing gloves, and using an appropriate cleaning product for the surface, such as diluted bleach or detergent and warm water • The first step after being exposed to blood or bodily fluids is to wash the area well with soap and water and covered with a waterproof dressing or plaster. Expressing fluid by squeezing the wound will not reduce the risk of blood-borne infection. All unvaccinated persons should be administered hepatitis B vaccine after exposure to blood. If the exposed blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immune globulin is recommended. • Hepatitis C virus can survive on environmental surfaces for up to 16 hours. It can also spread from infected fluid splashes to the conjunctiva. Dr KK Aggarwal National President IMA & HCFI
Heart Care Foundation of India (HCFI) celebrates World Earth Day 2017 Inter-school activities hosted for over 200 students jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India and Ramjas Public School (Day Boarding), Anand Parbat New Delhi, April 22, 2017: The Heart Care Foundation of India (HCFI), a leading national non-profit organization, in association with the Indian Medical Association and Ramjas Public School (Day boarding) celebrated World Earth Day on 22nd April 2017 from 8 a.m. to 11 a.m. The theme for the event was Sustainable Earth. The Ministry of Earth Sciences, Government of India, supported the program. On the occasion, various inter-school activities such as elocution, slogan writing, and painting were organised in the host school with participation by more than 200 students. The underlying message of the event was the importance of preserving one’s environment and its close link with living a healthy life. Dr R N Tandon, Honorary Secretary General, Indian Medical Association, graced the occasion as the Chief Guest. Padma Shri Awardee Dr K K Aggarwal, National President, Indian Medical Association (IMA) and President, Heart Care Foundation of India (HCFI) in his message said, “HCFI has been celebrating World Earth Day since several years. The theme this year is about making earth and our activities sustainable. Among the many global climatic emergencies, climate change poses the biggest challenge. Temperatures are higher than ever and there is an increase in the occurrence of natural disasters. To cope with and counter this challenge, we need to work towards a more sustainable earth by adopting many sustainable practices such as walking and cycling instead of using cars to move around when possible, using public modes of transport and reducing pollution which is the leading cause of lifestyle diseases in today’s date and age. We are thankful to the Ministry of Earth Sciences, Government of India for offering their support to this event as also Ramjas School for being a part of this cause.” Co-host of the event Ms. Sarika Arora, Principal, Ramjas Public School (Day Boarding), Anand Parbat, said, “It is our privilege to be associated with the Heart Care Foundation of India for this event on the occasion of World Earth Day. There is an urgent need to create awareness about environmental issues among children as they are the future of our country. Our school believes in helping enable futuristic thinking in all our students. We hope that this event will be another step for us in achieving this objective. Many competitions were held for middle and senior classes (9th to 12th standard) as part of this day. The young artists displayed imagination at its best and their paintings were also displayed around the school for others to see and learn. Winners from each category were awarded and participation certificates were handed over to each and every participant. On this Earth Day, Heart Care Foundation of India shares tips for a sustainable earth: • Reduce, reuse, and recycle • Turn off water when not in use • Start a home garden and cultivate your own fruits and vegetables • Save electricity and turn off appliances when not in use
Saturday, 22 April 2017
Health benefits of implementing taxes on sugar sweetened beverages A new study published in the journal PLoS Medicine on Tuesday this week has shown that implementing sugar sweetened beverage (SSB) tax works as intended. In November 2014, Berkeley in California passed the first large (one cent per fluid ounce of sugary drinks paid by beverage distributors) tax on SSBs in the United States. Revenues from the tax were put in the general fund with an advisory committee recommending on how to spend the resources to improve health. This ‘before-and-after’ study by the Public Health Institute and the University of North Carolina evaluated changes in prices, sales, consumer spending and beverage consumption one year after implementation of tax on SSBs in Berkeley, California. The study covered 15.5 million supermarket checkouts plus a before-and-after representative telephone survey of 957 adult residents of Berkeley. The key findings were: • The sales (in ounces per transaction) of taxed SSBs significantly declined by 9.6% in the year following implementation in Berkeley, while they rose by 6% in other Bay Area stores without a tax. • No negative impact on overall beverage sales at studied local businesses was observed as people spent more on healthier beverages (increase of 3.5%).Sales of water rose by 15.6% (more in ounces than the decline in SSBs); untaxed fruit, vegetable or tea drink sales increased by 4.37%; and sales of plain milk rose by 0.63%. On the other hand, sales of diet soft drinks and diet energy drinks declined by 9.2%. • The average grocery checkout bill did not increase, nor did the store revenue decrease. • Investments in health increased. The revenue from the first year of the SSB tax was $1,416,973or $12 per capita despite reduced consumption of SSBs. Funds raised went to nutrition and obesity prevention activities in schools, childcare and other community settings. In 2012, researchers from the University of California, San Francisco wrote in the journal Nature that like alcohol and tobacco, sugar is a toxic, addictive substance that should be highly regulated with taxes, laws on where and to whom it can be advertised, and even age–restricted sales. When consumed in excessive amounts, sugar poses dangers similar to those of alcohol. Fructose, specifically, can harm the liver just like alcohol and overconsumption of sugar has been linked with all the diseases involved with metabolic syndrome - hypertension, high triglycerides insulin resistance, diabetes. The Indian Medical Association (IMA) supports introduction of sugar tax along with high alcohol tax, 85% pictorial warning on tobacco packs and high tobacco taxes as an intervention strategy to curb the rising incidence of non communicable diseases (NCDs). Lifestyle disorders like diabetes, obesity, hypertension, heart disease, stroke, COPD are escalating in our country mainly due to an unhealthy lifestyle. What is of more concern is that these diseases are now affecting people at a younger age. It is very important therefore to raise awareness among the public about the lifestyle diseases prevalent in our country and how they can be prevented. In June 2016, the Government of Fiji increased taxes on tobacco, alcohol and SSBs as all of these increase risk of developing NCDs. Excise duty on alcohol and tobacco and alcohol were increased by 18.5%, which included 12.5% excise duty and 6% health levy. A health levy of 5 cents per liter on SSBs was also introduced. A similar tax implementation in Mexico in 2014 reduced sales of sugary drinks by 12% within a year of the tax being implemented. When will India follow suit? (Source: Public Health Institute Press release, PLoS Medicine April 18, 2017) Dr KK Aggarwal National President IMA & HCFI
The Indian Medical Association calls for stronger laws to eliminate the circulation of spurious and substandard medicines in the country
The Indian Medical Association calls for stronger laws to eliminate the circulation of spurious and substandard medicines in the country Writes to its 3 lakh members asking them to extend support towards the Prime Ministers push for Generic Drugs New Delhi, 21st April, 2017: The Indian Medical Association, the oldest and largest representative organisation of doctors of modern scientific medicine is committed to helping the government in making low price medicines available to the masses. It welcomed Prime Minister Narender Modi’s push for generic drugs at a press conference held at the IMA headquarters today. IMA feels that to make this a reality, there is a need to address key issues such as increased penetration of spurious and substandard medicines in our country, unauthorized dispensing of generics by chemists as well as lack of dedicated fair price medical shops by the government. IMA is for promotion of drugs in the National List of Essential Medicines NLEM, which are price capped and cheaper. Its policy is to write NLEM and non-NLEM drugs with consent of the patient, promote Jan Aushadhi drugs and take strict action against drug stores that do not keep NLEM drugs. Speaking about the subject, Padma Shri Awardee Dr KK Aggarwal, National President IMA, President of HCFI, & Dr R.N. Tandon, Honorary Secretary General IMA said, “For doctors to prescribe generic drugs, it is crucial that the laws regarding drug testing and quality assurance are strengthened. IMA is for writing the generic name of the drug alone, and also recognizes the need to mention the name of the company of whose generic the patient is going to buy. The same should also be freely available. IMA also believes that CGHS, PSUs and IRDA should mandate reimbursement of only NLEM drugs unless reasoned out. The recent inclusion of stents under the NLEM has reduced prices. All other devices and disposables should also be brought under NLEM”. Very often, generic prescribing is misconceived as writing a drug’s generic name or non-proprietary name. All Generic drugs have a brand name as well as a non- proprietary name but all drugs having a non- proprietary name (generic name) may not be generic drugs. The patent for Paracetamol expired in 2007 after which numerous generic versions have been developed and sold under various “brand names”. If one were to prescribe it only by the name “Paracetamol”(generic name), it is up to the pharmacist to select and dispense a particular brand, which may either be the costliest brand or it could be the cheapest brand at somewhere in between (Med Guide India, 2013). A simpler and better alternative for cost reduction would be to prescribe the cheapest “brand” of Paracetamol or a NLEM drug. The price difference of “branded” and branded-generic equivalents of commonly used medicines manufactured by the same pharmaceutical company in India is substantial considered. For instance if retailer margin for branded medicines was in the range of 25-30%, that their branded-generics version was in the range of 201-1016%. IMA feels that there is a need to bring the department responsible for generic drug quality control under the Ministry of Health rather than Ministry of Chemical and Petroleum affairs. Quality assurance laboratories should be urgently installed in every state. A few points: 1. No one will be able to get Jan Aushadhi drugs if the words ‘Jan Aushadhi’ are not written on the prescription. Jan Aushadhi therefore is also a brand 2. All NLEM drugs should be available under one window pharmacy. 3. Not keeping NLEM drugs should be considered a crime. 4. The answer is to ‘Write generic name of the drug, Choose from NLEM, Write Jan Aushadhi or a standard company name’.
Friday, 21 April 2017
Trust makes patients adhere to prescribed treatment Study finds lack of communication as a major cause for dispute between doctors and patients New Delhi, 20 April 2017: According to a new study of 101 Hispanics and 100 non-Hispanics from the University of California, patients with high blood pressure who had more trust in the medical profession were more likely to take their high blood pressure medicine than those with less trust. The study was presented at the recent American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2017 in Arlington, Virginia. The doctor–patient relationship is the foundation in the practice of medicine. It is a fiduciary relationship; the word "fiduciary" derives from the Latin word for "confidence" or "trust", which forms the basis of an effective doctor–patient relationship. The study conducted also showed that mutual trust is important for positive treatment outcomes. However, in recent times, it is being seen that this trust is slowly eroding away and a doctor–patient relationship is no longer held sacrosanct as it once was. Speaking on this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "A patient who does not trust his doctor will not confide in him nor will he be motivated to adhere to the prescribed treatment plan. Modern medicine today is patient-centric and based on partnership. The patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, and therefore, it is important that patients trust their doctors. Doctors must be courteous with their patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent. Patients must in turn show respect towards their doctors and trust their judgment." The study also concluded that patients who had higher levels of trust in their doctor, and the treatment plan, took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. Additionally, placing trust in the medical profession was linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life. It also deduced that trust had an equally protective effect on the health of both groups studied regardless of race or ethnic origin. Dr K K Aggarwal further opined, "Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication, and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor and if the same is ‘Communicated’ to the patient, ‘Documented’ and then implemented, there can never be a dispute. Any disparity between your plan and the outcome leads to a dispute." The following points are key to a successful doctor–patient relationship. • Do what you say. For example, if you have told the patient that you would be late by one hour, make sure that it is only one hour and not later than that. • Document what you speak • Preserve what you document
National Black Day on April 27 Dear Colleague The 217th CWC at Kolkata has condemned and opposed the West Bengal Clinical Establishment (Registration, Regulation and Transparency) Act 2017. The hostility displayed by this Act on doctors, health care workers and the hospitals is unacceptable. All the state branches unanimously decided to voice their concern regarding the national repercussions of the Act. The Central Working Committee dedicated the major part of its sitting to this issue and closed sine die hours before schedule in protest. The CWC also decided to observe a National Black Day on Thursday 27.04 .2017. Accordingly, all the state branches are hereby directed to inform all their members through their local branches to observe the National Black Day on 27. 04. 2017 against the West Bengal CEA. The observation shall be a peaceful demonstration of our solidarity with the suffering doctors of West Bengal. The following actions may be taken up at state and local branches level: - 1. Black badges to be worn by all members. 2. All hospitals and clinics to display black cloth in their notice board with explanation. 3. All state branches to send uniformly formatted email opposing the Act to the Chief Minister of West Bengal. 4. The details of the Act to be communicated to all members during a protest meeting/executive of the local branch. 5. Signature campaign: An All India signature campaign to be started. Each State to mobilise maximum number of signatures with credible e mail IDs and address details. The petition must be addressed to the Chief Minister of West Bengal. A copy may be retained at the state branch. A Xerox copy may be sent to IMA HQs. 6. A social media signature campaign is to be initiated from IMA HQs. The state branches may facilitate this initiative. 7. A state level press conference should be conducted by all state branches giving details and repercussions of this Act on the Health of the Nation.
Thursday, 20 April 2017
AHA Scientific Statement on diagnosis and management of Kawasaki disease The American Heart Association (AHA) has published an updated scientific statement for health professionals on diagnosis, treatment, and long-term management of Kawasaki disease. The statement published online March 29, 2017 in Circulation recommends that clinical decision making in patients with Kawasaki disease should be individualized to specific patient circumstances. Recognizing that prompt diagnosis is essential, these guidelines include an updated algorithm to aid the clinician in diagnosis of patients with suspected incomplete Kawasaki disease. The diagnosis of incomplete or atypical Kawasaki disease should be considered in any infant or child with prolonged unexplained fever, fewer than 4 of the classical clinical findings, and compatible laboratory or echocardiographic findings. The guidelines recommend intravenous immunoglobulin (IVIG) as the primary treatment to be administered as soon as the diagnosis can be established within the first 10 days of illness. Treatment should not be delayed for lack of echocardiography. However, the guidelines recommend against IVIG administration to patients beyond the 10th day of illness in the absence of fever, raised inflammatory markers, or coronary artery abnormalities. Adjunctive therapies - corticosteroids, infliximab, etanercept – may benefit patients at high risk for development of coronary artery aneurysms. For patients at increased risk of thrombosis, for example, with large or giant aneurysms (≥8 mm or Z score ≥10) and a recent history of coronary artery thrombosis, “triple therapy” with ASA, a second antiplatelet agent, and anticoagulation with warfarin or LMWH may be considered. The goal of therapy is to prevent thrombosis and myocardial ischemia while maintaining optimal cardiovascular health. Risk-stratification of patients for effective long-term evaluation and management should be done according to the relative risk of myocardial ischemia, either related to coronary artery thrombosis or stenoses/occlusions. The guidelines also recommend development of effective and collaborative programs between pediatric and adult cardiology providers for effective long-term management of the patient. (Source: Medscape, Circulation March 2017) Dr KK Aggarwal National President IMA & HCFI
A World Liver Day Initiative Excess alcohol bad for the liver • On World Liver Day, IMA warns that excess alcohol is responsible for fatty liver disease in a majority of people • Lifestyle changes key to a healthy liver New Delhi, 19th April 2017: Recent WHO (World Health Organization) statistics indicate that every year, about 2 lakh people die of liver ailments around the world. As per data, fatty liver disease is the third most common cause of chronic liver disease and affects 1 in 6 individuals. Just like the brain and heart, the liver is also a crucial organ that needs to be taken care of, more so if you are a heavy drinker. It has been found that about 25,000 lives can be saved by a liver transplant. However, data shows that at present, only 1,800 liver transplants happen every year globally. As in every year, 19th April is being celebrated as the World Liver Day this year as well. The liver has a very important role in the body’s digestive system. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Anything that we eat or drink, including medication, must pass through the liver. It is the second-largest organ in the body and helps filter chemicals like drugs and alcohol from the blood; regulates hormones and blood sugar levels; stores energy from the nutrients and makes blood proteins, bile and several enzymes that the body needs. Keeping the liver healthy therefore is all about a healthy lifestyle. The basic thing about taking care of the liver is to avoid what’s bad rather than eat or drink something that nourishes this organ. Alcohol does more damage to the liver cells than one can imagine. It leads to swelling or scarring, later turning into cirrhosis, and can prove fatal to life." Alcoholic cirrhosis is the most common cause of cirrhosis, accounting for 40% of liver deaths from cirrhosis. The liver helps to remove alcohol from the blood through oxidation. However, once too much alcohol has been ingested for the liver to process in a well-timed manner, the toxic substance begins to turn into 'fatty liver'. This then is the early stage of alcoholic liver disease and can be seen in about 90% of people who drink more than two ounces (60 ml) of alcohol per day. Continuing to drink similar quantities of alcohol can lead to liver fibrosis and ultimately cirrhosis. Dr K K Aggarwal adds, "Fatty liver is reversible with timely medical intervention. However, it is also important to bring about certain lifestyle changes. If ignored, this condition can cause irreversible damage with liver transplant as the only end option. Therefore, it is important to avoid intake of alcohol, eat healthy, and get regular exercise. Timely hepatitis vaccines should also be considered to avoid any sort of complications to the liver." It is important to take care of the following points to keep the liver healthy. • Eat a healthy balanced diet and exercise regularly. • Eat out of all food groups, for instance, grains, protein, dairy products, fruits, vegetables, and fats. Eat fibrous food such as fresh fruits and vegetables, whole grain breads, rice, and cereals. • Avoid consuming alcohol, smoking, and drugs. They can permanently damage the liver cells. • Always make sure to consult your doctor before starting a new medication. Taking incorrect combinations of medicines can lead to liver damage. • Chemicals like aerosols and cleaning products can injure liver cells and therefore it is better to avoid extensive contact with these. • Keep a check on your weight as obesity can cause non-alcoholic fatty liver disease.
Wednesday, 19 April 2017
IMA welcomes PM’s push for Generic Drugs with a caveat The Indian Medical Association (IMA) has welcomed the push for generic drugs coming from the Prime Minister himself. It is the policy of IMA to help the Government to make available all drugs at an affordable cost. For years IMA had been demanding dedicated fair price medical shops under the Government. IMA had welcomed the Jan Aushadhi scheme of the Prime Minister and has adopted the scheme. A Jan Aushadhi generic drugs outlet runs from IMA HQs in New Delhi. IMA has also been promoting Jan Aushadhi centers in private hospitals. IMA feels that no new legislation is required to ask the doctors to prescribe generic drugs. The MCI Etiquette for doctors has already stipulated this. The concern of the medical profession regarding spurious and substandard drugs is yet to be addressed. The Government has around 1800 Drug Inspectors for the entire country, a number which is grossly inadequate. Indiscriminate dispensing of antibiotics and other prescription drugs by doctors not qualified in Modern Medicine, Quacks and by over-the-counter sales has led to emergence of serious resistant microorganisms. Strict implementation of the existing laws should suffice in this regard. The Government itself admits that less than 0.01 percent of the drugs produced in the country are tested for quality. It will not be fair on the part of the Government to expect doctors to prescribe substandard drugs. The Government should urgently improve the administration regarding drugs by bringing the department under Ministry of Health rather than Ministry of Chemical and Petroleum affairs. Quality assurance laboratories should be urgently installed in every state. The loopholes in governance between the Central and State Governments should be cemented. IMA on behalf of the Modern medicine doctors requests the Prime Minister that his Government should follow up with all the substantial measures to facilitate widespread usage of generic drugs. Points 1. IMA is for promotion of drugs in National List of essential medicines, which are price capped and cheaper. 2. IMA policy is to write NLEM and non-NLEM drugs with consent of the patient 3. .IMA policy is to promote Jan Aushadhi drugs 4. No one will be able to get Jan Aushadhi drugs if the words ‘Jan Aushadhi’ are not written on the prescription. Jan Aushadhi therefore is also a brand 5. All NLEM drugs should be available under one window pharmacy. 6. Not keeping NLEM drugs should be considered a crime. 7. CGHS, PSUs and IRDA should mandate reimbursement of only NLEM drugs unless reasoned out. 8. IMA is for writing the generic name of the drug alone, but also recognizes the need to mention the name of the company of whose generic the patient is going to buy. The same should also be freely available. 9. Stents have become cheaper because they have been now included in NLEM. All other devices and disposables should also be brought under NLEM. 10. The answer therefore is ‘Write generic name of the drug, Choose from NLEM, Write Jan Aushadhi or a standard company name’. Dr K K Aggarwal National President IMA With contributions from Dr R N Tandon Hony. Secretary General, IMA
The Indian Medical Association welcomes the Prime Ministers push for Generic Drugs Urges the government to address the key issue of spurious and substandard drugs, a matter that remains unaddressed New Delhi, 18 April 2017: The Indian Medical Association, the oldest and largest representative organisation of doctors of modern scientific medicine welcomed Prime Minister Narender Modi’s push for generic drugs. IMA strives to work towards making healthcare more affordable and accessible to all and has been demanding dedicated fair price medical shops by the government since years. IMA in committed to helping the government in making low price medicines available to the masses and not only welcomed but also adopted the Jan Aushadhi scheme. IMA headquarters in New Delhi has a fully functional Jan Aushadhi outlet. IMA has also been promoting Jan Aushadhi centres in private hospitals. The IMA leadership opines that no new legislation is required to get doctors to prescribe generic drugs since the MCI code of ethics already details the associated rules and regulations. IMA is however concerned regarding the lack of legislations and initiatives towards curbing the use of spurious and substandard drugs in our country. This is a matter of great concern to the medical fraternity and remains unaddressed. “The Government presently only has around 1800 Drug Inspectors who are responsible for quality control of drugs being sold across the country. This number is grossly inadequate. Indiscriminate dispensing of antibiotics and other prescription drugs by doctors, who are not certified to practice under modern medicine, quacks and by over the counter sales executives has led to the emergence of a new strain of resistant microorganisms. Strict implementation of the existing laws in required in this regard” said Padma Shri Awardee Dr KK Aggarwal, National President IMA & HCFI, and Dr RN Tandon, Honorary Secretary General IMA. The Government itself admits that less than 0.01 percent of the drugs produced in the country are tested for quality. “For doctors to prescribe generic drugs, it is crucial that the laws regarding drug testing and quality assurance are strengthened”, added Dr KK Aggarwal. IMA feels that a good way to do this is by bringing the department responsible for generic drug quality control under the Ministry of Health rather than Ministry of Chemical and Petroleum affairs. Quality assurance laboratories should be urgently installed in every state. The loopholes in governance between the Central and State Governments should be cemented. IMA on behalf of 3 lakh practising modern medicine doctors assures our Prime Minister that it will do it’s best in helping facilitate widespread usage of generic drugs. Key Points: 1. IMA is for the promotion of drugs in the National List of essential medicines which, are prize capped and cheaper 2. IMA’s policy for its members is to write NLEM and non NLEM drugs with the patient’s consent 3. IMA is in favour of Jan Aushidhi drugs 4. No one will get Jan Aushidhi drugs if the word Jan Aushidhi is not written on the prescription. Jan Aushidhi, therefore, is also a brand 5. All NLEM drugs should be available through one window pharmacies 6. It should be a crime for a chemist to not keep NLEM drugs 7. CGHS. PSUs and IRDA should mandate reimbursement of only NLEM drugs unless reasoned out 8. IMA is in favour of prescribing the generic name of the drug alone but doctors need to mention the name of the company whose generic the patient is going to buy. The same should also be available freely 9. The answer, therefore, is to write the Generic Name of the drug, choose from the NLEM, write Jan Aushidhi or the name of a standard company 10. Stents have become cheaper because they are now in NLEM. All other devises and disposables should also be brought under NLEM.
Tuesday, 18 April 2017
Air pollution increases risk of heart disease by lowering the good cholesterol Air pollution is a reality today and has been a subject of much discussion recently. Several studies have demonstrated the association of poor air quality with diseases such as respiratory and heart diseases, global warming making it a major public health problem of concern. Yet another new study reported in the journal Arteriosclerosis, Thrombosis, and Vascular Biology has highlighted the increased risk of cardiovascular diseases due to traffic-related air pollution and proposed an explanation for the relationship between air pollution and cardiovascular disease. The study says that traffic-related air pollution may increase risk of developing heart diseases via its effects on the good high-density lipoprotein cholesterol (HDL-C). The study involving more than 6000 middle-aged and older adults in the United States found that people who live in areas with high levels of air pollution, especially traffic-related air pollution, have lower levels of the good HDL-C. Over a period of one year, those with higher exposure to black carbon, emitted from vehicles, had considerably lower levels of HDL-C compared to those with lower exposure to black carbon. Higher particulate matter exposure over three months was associated with a lower HDL particle number. Compared to men, women had much lower levels of HDL-C. Keep your total cholesterol lower than 160mg/dL. HDL is good cholesterol, keep it more than 40mg/dL. LDL is bad cholesterol and should be kept as low as possible; keep it lower than 80 mg/dL. A 1% rise in bad cholesterol increases the chances of heart attack by 2% and 1% reduction in good HDL-C reduces the chances of heart attack by 3%. (Source: AHA news release, April 13, 2017) Dr KK Aggarwal National President IMA & HCFI
IMA calls for ending violence against doctors The 217th meeting of IMA Central Working Committee discusses taking united action against pressing issues New Delhi, 17 April 2017: Over 300 IMA leaders gathered to deliberate on key issues affecting the medical profession at the 217th Meeting of the Central Working Committee of IMA, the oldest and largest representative organization of doctors of modern scientific medicine. The meeting was held in Kolkata on 15th and 16th April 2017. The main agenda of the Central Working Committee is to evaluate and discuss issues of National importance affecting the functioning and efficacy of the medical community in the country. Many prominent thought leaders attended the meeting which saw discussions and deliberations on some pressing issues facing the medical fraternity today such as violence against doctors, redundant laws the medical fraternity is being subjected, unjustified compensation for any medical negligence, etc. Speaking on the occasion, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The medical profession today faces many challenges than ever before and this is the time when the IMA must stand together as a united voice against these. Restoring the nobility, honesty and integrity of the medical profession in India is in our hands and as the key stakeholders in this respect we must act with immediate urgency. The IMA stands for accountability and regulation of practice. We need to oppose quackery at all levels and also pave way for self-regulation”. The primary issue discussed in the meeting was the increasing violence against doctors. While the IMA is not against accountability, it was discussed that the medical fraternity will have zero tolerance for violence against doctors and medical establishments. Speaking further on this, Dr K K Aggarwal opined, "This meeting has raised some very relevant issues, the primary one being cases of violence against doctors. This is a matter of grave concern, which affects the nobility of the profession. Treatment failures don't amount to negligence on the part of doctors and a 5% death rate during treatment is unavoidable. The Indian judicial system and the law enforcement agencies need to provide the doctors with protection against such violence failing which the medical community will be unable to practice and fulfill their basic duties without any apprehensions." It was also decided that the IMA would appoint health-keeping forces. A need was felt to bring back trust in the medical profession as also strengthen doctor-patient relationships. The leaders also felt that just as government officials and members of parliament have immunity at work, doctors should also get similar provisions. The members present in the meeting hoped that as a result of the discussions in this meeting, the fight for the rights of the medical fraternity in India would gain new ground.
Monday, 17 April 2017
Patients who trust their doctors are more likely to adhere to prescribed treatment A new study of 101 Hispanics and 100 non-Hispanics from the University of California presented at the recent American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2017 in Arlington, Virginia has shown that patients with high blood pressure who had more trust in the medical profession were more likely to take their high blood pressure medicine than those with less trust. • Patients who had higher levels of trust took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. • Additionally, having trust in the medical profession was linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life. • Trust had an equally protective effect on the health of both groups regardless of race or ethnic origin. The doctor-patient relationship is the foundation of the practice of medicine. It is a fiduciary relationship; fiduciary derives from the Latin word for "confidence" or "trust", which forms the basis of an effective doctor-patient relationship. Mutual trust is important for positive treatment outcomes as was shown in the above study. But, this trust is slowly eroding away and a doctor-patient relationship is no longer held sacrosanct as it once was. Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor and if the same is ‘Communicated’ to the patient, ‘Documented’ and then implemented, there can never be a dispute. Any disparity between your plan and the outcome leads to a dispute. A patient who does not trust his doctor will not confide in him nor will he be motivated to adhere to the prescribed treatment plan. Modern medicine today is patient-centric based on partnership, where the patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, so it is important that patients trust their doctors. Be courteous with the patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent To build a successful doctor-patient relationship: • Do what you say: For example, if you have told your patient that you would be late by one hour, make sure that it is only one hour and not later than that • Document what you speak and • Preserve what you document Dr KK Aggarwal National President IMA & HCFI
All you need to know about radiations from mobile towers: IMA New Delhi, 16th April 2017: There has been plenty of research about radiation and how it affects the human body. The recent ruling by the Supreme Court, where it directed to shut down a mobile phone tower after a man claimed that the radiations emitted by the tower were the cause of his cancer, has rekindled the debate about cell phone towers and the electromagnetic radiation emitted by them. Many organizations and activists have been campaigning against mobile towers near residential areas or otherwise, but the government maintains that low Electro Magnetic Frequency (EMF) from mobile towers does not pose any major health hazards. Speaking about this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA in a joint statement, said," Many studies have been conducted over the years that refute the connection between non-ionizing radiations given out by cell phone towers, and cancer. Many oncologists are also of the view that these radiations are not carcinogenic. We, at IMA, feel that although the radiations may not be the primary cause of cancer, some precautions certainly need to be taken to rule out any long-term health effects as a result of these radiations." Radiations are of two types: ionizing and non-ionizing. X-rays fall into the former kind, are harmful to the body, and can cause cancer. Non-ionizing radiation is a low-energy radiation and generates heat and mobile tower radiation falls into this category. As per a report, in India, the safety standards followed are 10 times more stringent than a majority of other countries. There is a certain limit for radiation that is prescribed and mobile handsets emitting over 1.6 watt/kilogram radiation are not allowed in India. This limit is called the Specific Absorption Rate or SAR. Dr Aggarwal further said," Many studies have been conducted over a long period of time to assess whether mobile phones pose a potential health risk and some have concluded that the health effects caused by mobile towers are not adverse in nature and are not likely to cause cancer. Studies also indicate that it is the antenna from which we should keep distance and not from tower and that too if we are positioned facing antenna at comparable height. Despite all the claims, it remains a fact that some health hazards do exist and therefore taking precautions to avoid constant exposure to cell phones and towers is key." While it is still being debated as to whether mobile towers and cell phones increase the risk of cancer or not, there are certain safety measures one can take. • Hold the cell phone away from the body to the extent possible. • Do not press the phone handset against your head. Radiation level is proportional to the square of the distance from the source and therefore, being very close increases energy absorption much more. The farther your brain is from the handset the better it is. • Limit the length of mobile calls. • If the radio signal is weak, a mobile phone will increase its transmission power. Find a strong signal and avoid movement. Use your phone where reception is good. • Metal and water are good conductors of radio waves so avoid using a mobile phone while wearing metal-framed glasses or having wet hair. • Let the call connect before putting the handset on your ear or start speaking and listening – A mobile phone first makes the communication at higher power and then reduces power to an adequate level. More power is radiated during call connecting time • Reduce mobile phone use by children as a younger person will likely have a longer lifetime exposure to radiation from cell phones • While purchasing a Mobile Handset, check the SAR value of the mobile phone. This can be searched on internet, if the model number and make is known. Dial *#07# to know the SAR value. • To lower exposure to radiation, close additional transmissions in the phone like WiFi, Bluetooth, GPS or Data connections when not needed. Additional connections not only drain battery but also dramatically increased device radiation emissions. • Keep the phone away from areas of the body such as eyes, testicles, breasts and internal organs. • The phone antenna has to perform extra work to arrange communication with the cell tower that increases RF exposure when the battery is lower than 20% the RF exposure increases. • Alternate your ear while talking. • While sleeping, keep the phone at a distance of 6 ft (2 meter). • Do not use a metal case as your phone cover.
Sunday, 16 April 2017
Refer all insurance queries of your patients to the ombudsman An ombudsman or public advocate is an official, usually appointed by the government or by parliament, but with a significant degree of independence, who is charged with representing the interests of the public by investigating and addressing complaints of maladministration or a violation of rights. The typical duties of an ombudsman are to investigate complaints and attempt to resolve them, usually through recommendations (binding or not) or mediation. The Insurance Ombudsman scheme was created by Government of India for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way. There are 17 Insurance Ombudsman in different locations and one can approach the one having jurisdiction over the location of the insurance company office that you have a complaint against. You can approach the Ombudsman with complaint if: • You have first approached your insurance company with the complaint and o They have not resolved it o Not resolved it to your satisfaction or o Not responded to it at all for 30 days • Your complaint pertains to any policy you have taken in your capacity as an individual and • The value of the claim including expenses claimed is not above Rs 20 lakh Your complaint to the Ombudsman can be about: • Any partial or total repudiation of claims by an insurer • Any dispute about premium paid or payable in terms of the policy • Any dispute on the legal construction of the policies as far as it relates to claims • Delay in settlement of claims • Non-issue of any insurance document to you after you pay your premium The settlement process Recommendations • The Ombudsman will act as counsellor and mediator and • Arrive at a fair recommendation based on the facts of the dispute • If you accept this as a full and final settlement, the Ombudsman will Inform the company which should comply with the terms in 15 days Award • If a settlement by recommendation does not work, the Ombudsman will: • Pass an award within 3 months of receiving the complaint and which will be • A speaking award with the detailed reasoning • Binding on the insurance company but • Not binding on the policyholder • The Ombudsman can also award an ex-gratia payment Once the Award is passed • You have to accept the award in writing and the insurance company has to be informed of it within 30 days. • The Insurance Company has to comply with the award in 15 days after that. Dr KK Aggarwal National President IMA & HCFI
IMA committed to improving insurance policy in India Calls for stringent examination at the time of joining an insurance policy, among other suggestions New Delhi, April 15, 2017: The IMA (Indian Medical Association) organized an Insurance Workshop along with the Hospital Board of India for deliberations on Improving Insurance Policy in the country. It came out with many suggestions for the Insurance Regulatory and Development Authority (IRDA) and has written to them for the changes. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, " One of the main reasons for the low penetration and coverage of health insurance in India is the lack of competition in the sector. There is also a need to include more stringent measures at the time of a person joining an insurance policy. Once the policy is issued, no claim should be rejected on any account whatsoever. Currently, insurance policies are issued upon declaration by the patient. This can lead to errors as the most of the time; the patient may not possess the requisite medical knowledge. This workshop was organized with a view to addressing these and many other policy changes needed at various levels." It was concluded that in most settings, it was mandatory to provide treatment during hospitalization to claim insurance. However, this should not be mandatory. IMA's policy and the international approach today is to say no to intravenous and intramuscular drugs and focus on shifting intravenous drugs to oral route. It is also a strange fact that a doctor cannot treat his relation himself when it is true that they can provide the best treatment to them out of their own specialty. The MCI also mandates that a doctor should consider waiving of charges of other colleagues and according to the IMA policy, a doctor cannot charge his/her near relations any consultation fee. Dr Aggarwal also said, "Issuing a bill for surgery should be made mandatory irrespective of whether a person is under Mediclaim or not. There is a need to create awareness at every level and one of the first steps towards this is to print the insurance. We also believe that there should be a concept of monthly insurance. Here, an employer will pay insurance of the employees and the government will pay the insurance of all those who cannot afford it." It was also noted that the TPA has the tendency to cancel a cashless claim if the investigations do not reveal any diagnosis. Denied claims are not in the interest of a community policy. Another point that came out was the agreement on deployment of Ayush doctors to judge the claim of modern medicine. Not only will this open new avenues for medicine but also encourage people to adopt alternative modes of treatment.
Saturday, 15 April 2017
IMA Stand on Mobile Towers Radiations: Some key facts • Cell phones emit radiofrequency energy (radio waves), a form of non-ionizing radiation. Tissues nearest to where the phone is held can absorb this energy. • Radiofrequency energy is a form of electromagnetic radiation. • Electromagnetic radiation can be categorized into two types: ionizing (e.g., x-rays, radon, and cosmic rays) and non-ionizing (e.g., radiofrequency and extremely low-frequency or power frequency). • In September 2013, WHO in online question and answers, have mentioned that "Studies to date provide no indication that environmental exposure to RF fields, such as from base stations, increases the risk of cancer or any other disease." • In respect of EMF radiations from mobile handsets, WHO in Fact Sheet 193 published in June 2011 has concluded that “A large number of studies have been performed over the last two decades to assess whether mobile phones pose a potential health risk. To date, no adverse health effects have been established as being caused by mobile phone use”. • In 2012 WHO declared Radio frequency radiation as a possible carcinogen in human Group (2B). • SAR is Specific Absorption Rate. It is an indication of the amount of radiation absorbed into the head while using a cellular phone. • The higher the SAR rating greater radiation is absorbed into the head. • SAR value is a measure of maximum energy absorbed by a Unit of mass -exposed tissue of a person using a mobile phone over given a time. It is simply the power absorbed per unit mass. • SAR values are usually expressed in units of watts per kilogram in one gram of tissue. • As per NICRP, the SAR value in India is 1.6 watt per kg in one g of tissue. • Low SAR rating is no guarantee of your health. Safety Measures • Reduce electromagnetic radiation from a source spreads in electromagnetic Field (EMF becomes weaker and weaker as distance increases. Thus, the distance plays a vital role. Mobile hand set • Keep distance: Hold the cell phone away from the body to the extent possible. • Use a headset (or ear bud) to keep the handset farther from your head. • Do not press the phone handset against your head. Radiation level is proportional to the square of the distance from the source- being very close increases energy absorption much more. The farther your brain is from the handset the better it is. • Use a wired headset. • Limit the length of mobile calls. • Use text as compared to voice wherever possible. • Put the cell phone on speaker mode. • Use a wireless Bluetooth headset. • If the radio signal is weak, a mobile phone will increase its transmission power. Find a strong signal and avoid movement. Use your phone where reception is good. • Use the mobile on a speaker mode. • Metal and water are good conductors of radio waves so avoid using a mobile phone while wearing metal-framed glasses or having wet hair. • Let the call connect before putting the handset on your ear or start speaking and listening – A mobile phone first makes the communication at higher power and then reduces power to an adequate level. More power is radiated during call connecting time • If you have a choice, use a landline (wired) phone, not a mobile phone. • Use mobile when mobile and use stationary phone, when stationary. • When your phone is ON, don't carry it in a breast or pants pocket. When a mobile phone is on, it automatically transmits at high power every 1 to 2 minutes to check (poll) the network. • Reduce mobile phone use by children as a younger person will likely have a longer lifetime exposure to radiation from cell phones • People having active medical implants should preferably keep the cell phone at least 15 cm away from the implant. • While purchasing a Mobile Handset, check the SAR value of the mobile phone. This can be searched on internet, if the model number & make is known. Dial *#07# to know the SAR value. • To lower exposure to radiation, close additional transmissions in the phone like WiFi, Bluetooth, GPS or Data connections when not needed. Additional connections not only drain battery but also dramatically increased device radiation emissions. • In iphone 6, SAR value can reach 1.59 watt per kg with their transmitters enabled. • Multiple transmission increase SAR value by up to 40%. • Try to use the phone outdoors rather than inside. Try move close to a window to make a call. • Avoid touching the aerial while the phone is turned on • Keep the phone away from areas of the body such as eyes, testicles, breasts and internal organs. • Limit the usage if you are pregnant. • The phone antenna has to perform extra work to arrange communication with the cell tower which increases RF exposure when the battery is lower than 20% the RF exposure increases. • The RF radiation is increased by mobile phones when used in a car to overcome the shielding. • Avoid using the phone when you are tired or sleepy. • Alternate your ear while talking. • Try not keep your phone in your pocket when you are in the office. • While sleeping, keep the phone at a distance of 6 ft (2 meter). • Do not use a metal case as your phone cover. • RF energy is inversely proportional to the square of the distance from the source. • India has adopted one of the most stringent electromagnetic field (EMF) exposure norms in the world. EMF exposure limit (Base Station Emissions) is lowered to 1/10th of the existing ICNIRP exposure level effective from 1st Sept. 2012. • At very high levels, RF waves can heat up body tissues. (This is the basis for how microwave ovens work.) But the levels of energy used by cell phones and towers are much lower. Mobile stations • Radio waves from base stations in India comply with international health and safety guidelines. • The prescribed safe RF exposure limit is f/2000 (in India), where f is in mHz. • Exposure limits in India are: At 900 MHz, power density is 0.45 watt/m2 & at 1800 MHz, power density is 0.9 watt/m2. • It is the antenna from which we should keep distance not from tower and that too if we are positioned facing antenna at comparable height. At the ground level, the intensity of RF radiation from base station is much lesser than that of from Antenna. Phone vs tower · • A mobile handset or a cellular phone is a low-power, two way radio. It contains a transmitter and a receiver. It emits electromagnetic / RF radiation to transmit information to the base station and it also acts like a receiver of information. Radio signals in a mobile phone are generated in the transmitter and emitted through its antenna. The radiation emitted by the antenna is not sufficient to cause any significant heating of tissues in the ear or head, although a rise in skin temperature may occur as a result of placing the mobile phone too close against the ear or head for a long time. This is due to insulation of the phone, contact with the screen, lack of ventilation between the ear and the phone, and the energy generated by electronic components. • Mobile phone base stations, which are also known BTS, work as multi-channel two-way radios. Antennas, which produce RF radiation, are mounted on either transmission towers or roof-mounted structures. These structures are to be of a certain height so that coverage could be wider. When you communicate on a mobile phone, you are connected to a nearby base station. From that base station your phone call goes into the regular fixed-line phone system. • Since the mobile phone and its base stations communicate using a two way radio communication, they produce RF radiation to communicate and therefore expose the people near them to RF radiation. • Radiation emitted from cell phone is of a short-term, repeated nature (coherent) at a relatively high intensity, whereas Radiation emitted from BTS (mobile towers) is of long duration but is of a very low intensity. • Safety distance to mobile tower antennas or masts: There is a recommended safe distance (i.e. compliance boundary) from the antenna. It ranges from 30 to 75 meters right in front at height comparable to the lowest mobile tower antenna depending upon the number of antennas deployed. Power The analog phones are being phased out. The major difference is that analog phones use more power than digital. Analog mobile phone uses up to 2 watt, while a digital mobile phone has an average power level of 0.25 watt. Phones typically operate at much lower levels during normal use as the phone power is automatically adjusted to the minimum radio signal level needed for call quality. This extends battery life. Cellular phone tower & Radio waves Mobile phone base stations are radio transmitter with antennas mounted on either transmission towers or roof tops on buildings. The antennas need to be located at optimum locations and heights so they can adequately cover the area. Antenna position usually range in height from 50-200 feet. When a person makes a cell phone call, a signal is sent from the mobile phone's antenna to the nearest base station antenna. The base station responds to this signal by assigning it an available radiofrequency channel. RF waves transfer the information to the base station. The voice/data signals are then sent to a switching center, which transfers the call to its destination. The voice signals are then relayed back and forth during the call. In India mobile phones operate in the frequency range of: 869 - 890 MHz (CDMA) 935 - 960 MHz (GSM900) 1805 – 1880 MHz (GSM1800) 2110 – 2170 MHz (3G) Cell phones connect with the base station as frequently as every minute so as to relay information about your location which generates a near-field by the cell phone even when you are not making a call. When you make a call on a mobile phone, the phone transmits radio waves to the antenna of a nearby base station. The base station then transmits the call using the mobile telecommunications network to the phone of the person you are calling. In town and cities where there are many phone users, more base stations are needed than in rural areas. The antenna of the base stations are mounted on mast, buildings or towers. The intensity of the radio waves emitted from base stations in places where the public have access are generally found to be hundreds of times below the health and safety guidelines. The intensity of electro-magnetic wave (power density) weakens very quickly as it moves away from the antenna. It is reduced to ¼ when the distance from the antenna doubles and to 1/9 when the distance is three times. Do cellular phone towers cause cancer? Some people have expressed concern that living, working, or going to school near a cell phone tower might increase the risk of cancer or other health problems. At this time, there is very little evidence to support this idea. In theory, there are some important points that would argue against cellular phone towers being able to cause cancer. • First, the energy level of RF waves is relatively low, especially when compared with the types of radiation that are known to increase cancer risk, such as gamma rays, x-rays, and ultraviolet (UV) light. The energy of RF waves given off by cell phone towers is not enough to break chemical bonds in DNA molecules, which is how these stronger forms of radiation may lead to cancer. • A second issue has to do with wavelength. RF waves have long wavelengths, which can only be concentrated to about an inch or two in size. This makes it unlikely that the energy from RF waves could be concentrated enough to affect individual cells in the body. • Third, even if RF waves were somehow able to affect cells in the body at higher doses, the level of RF waves present at ground level is very low – well below the recommended limits. Levels of energy from RF waves near cell phone towers are not significantly different from the background levels of RF radiation in urban areas from other sources, such as radio and television broadcast stations. For these reasons, most scientists agree that cell phone antennas or towers are unlikely to cause cancer. How are people exposed to the energy from cellular phone towers? As people use cell phones to make calls, signals are transmitted back and forth to the base station. The RF waves produced at the base station are given off into the environment, where people can be exposed to them. The energy from a cellular phone tower antenna, like that of other telecommunication antennas, is directed toward the horizon (parallel to the ground), with some downward scatter. Base station antennas use higher power levels than other types of land-mobile antennas, but much lower levels than those from radio and television broadcast stations. The amount of energy decreases rapidly as the distance from the antenna increases. As a result, the level of exposure to radio waves at ground level is very low compared to the level close to the antenna. Public exposure to radio waves from cell phone tower antennas is slight for several reasons. The power levels are relatively low, the antennas are mounted high above ground level, and the signals are transmitted intermittently, rather than constantly. At ground level near typical cellular base stations, the amount of RF energy is thousands of times less than the limits for safe exposure set by the US Federal Communication Commission (FCC) and other regulatory authorities. It is very unlikely that a person could be exposed to RF levels in excess of these limits just by being near a cell phone tower. When a cellular antenna is mounted on a roof, it is possible that a person on the roof could be exposed to RF levels greater than those typically encountered on the ground. But even then, exposure levels approaching or exceeding the FCC safety guidelines are only likely to be found very close to and directly in front of the antennas. If this is the case, access to these areas should be limited. The level of RF energy inside buildings where a base station is mounted is typically much lower than the level outside, depending on the construction materials of the building. Wood or cement block reduces the exposure level of RF radiation by a factor of about 10. The energy level behind an antenna is hundreds to thousands of times lower than in front. Therefore, if an antenna is mounted on the side of a building, the exposure level in the room directly behind the wall is typically well below the recommended exposure limits.