IMA Doctors to sit on fast on 2nd October

IMA Doctors to sit on fast on 2^nd October

 30^th September, New Delhi: More than 3 lakh members from across the country have been asked to sit on a dawn-to-dusk fast, from 6 am to 6 pm, on 2^nd October.

The day has also been commemorated as the ‘International Day of Non Violence’ by the United Nations in memory of Mahatma Gandhi, who was born on this day.

This fast takes forward the "Dilli Chalo" movement of IMA held on the 6th of June and marks our continuing Satyagraha for a solution to the problems faced by the medical profession and further strengthen our demands through this peaceful protest for a strong Central Legislation against the continuing violence against doctors and clinical establishments, amendments in the CEA and PCPNDT Act, pay parity and uniform service conditions all across India, capping of the compensation amount awarded and not allowing non-MBBS and non-BDS doctors to prescribe medicines under the modern system of medicine

All State/UT branches of IMA will hold General body meetings today; resolutions will be passed and a letter will be sent to the Hon’ble Prime Minister requesting his intervention in the implementation of the demands of the medical profession.

On the occasion, Padma Shri Awardee Dr KK Aggarwal, National President Indian Medical Association (IMA) & President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA in a joint statement, said, “We demand immediate implementation of the recommendations of the Inter-Ministerial Committee and other demands. The Government had constituted the Inter-Ministerial Committee on 13th November, 2015, with IMA as a party, to examine the issues raised by IMA. As an outcome of persistent efforts of IMA for the past two years, the Inter-Ministerial Committee considered our demands. The Health ministry also recommended and forwarded the recommendations of the committee on all five major issues to the concerned Ministries for necessary action. But they are yet to be implemented.”

Dr R V Asoka Chairman Action Committee said “The Clinical Establishments Act is not state-friendly. CEA makes it mandatory for private clinical establishments to stabilize trauma victims. Similarly, in case of natural disasters, sexual abuse and other man-made disasters like fire, cracker explosions, spurious liquor tragedy etc., the private health sector is forced to give free treatment. Single doctor establishments should be exempted from the purview of the CEA. The Act is being implemented without taking into consideration the ground realities, which is pushing to medium-sized healthcare establishments to extinction.”

Dr Ravi Wankhedkar Incoming National President IMA said “Clerical errors in the maintenance of registers and minor noncompliance should not attract criminal provisions of the PCPNDT Act. Urgent amendments are needed in the PCPNDT Act to ensure that strict penalties are imposed only on actual acts of sex determination or female foeticide. It is the ultrasound machines that should be registered and not doctors doing pelvic ultrasound.”

Following are the demands of the medical fraternity.

• Stop criminal prosecution of medical negligence and clerical errors
• Stringent central act against violence on doctors
• Capping the compensation in Consumer Protection Act (CPA) on doctors
• Professional autonomy in treatment and prescriptions
• Amendments in PC PNDT, Central CEA, West Bengal CEA Acts
• No unscientific mixing of systems of medicine
• Empower MBBS graduates
• One drug - One company - One price
• Implement inter-ministerial committee recommendations in six weeks
• Single window accountability
• Single window registration of doctors and medical establishments
• No to National Medical Commission (NMC): Amend IMC act to maintain professional autonomy
• Uniform final MBBS exam instead of ‘NEXT’
• Uniform service conditions for service doctors & faculty
• Same work - Same pay - Pay parity - No to adhocism
• Fair conduction of NEET exam
• IMA member in every government health committee
• Central anti-quackery law
• Reimbursement of emergency services provided by private sector
• 25000 family medicine PG seats
• Aided hospitals and retainership in general practice
• Health budget of 5% of GDP for universal health coverage

Fight the inner demons through preventive health this Dussehra

Fight the inner demons through preventive health this Dussehra • The Perfect Health Mela 2017 will lay emphasis on preventive health among other things • Many diseases are an outcome of bad lifestyle habits such as lack of physical activity and eating unhealthy food, and should be done away with New Delhi, 29 September 2017: It is yet again that time of the year when the entire country rings in the festival season. Among the many festivals celebrated is Dussehra, which holds significance as it marks the triumph of good over evil. Symbolically, there are some modern-day demons in the form of diseases plaguing us today. In this festival season, the need of the hour is to triumph over these demons by embracing preventive health and adopting a healthy lifestyle. The Perfect Health Mela (PHM) 2017 to be held from 4th to 8th October at Talkatora Stadium, New Delhi which will be inaugurated by Honorable Chief Minister of Delhi, Shri Arvind Kejriwal, will provide the perfect platform to discuss and understand more about all aspects of preventive health. Some of the so-called demons include stress, smoking, alcohol, bad diet, lack of physical activity, and living in denial about our mental and physical health. The PHM aims at spreading mass health awareness using entertainment as a medium. The theme this year is “Digital Health” and will focus on ways to wellness, health awareness, roots of ancient Indian medicine, wellness through music, dancing and health, and saving the girl child, among other things. 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, "Taking steps towards preventive health assumes utmost significance in today’s times, also because the burden of non-communicable diseases is on the rise.PHM aims to tackle some of these issues, will offer health checkups to people at no cost, and create awareness on how to prevent these conditions through changes in their lifestyle. The theme this year is ‘Digital health’, which encompasses using technology to empower people in tracking, managing, and improving their own health and that of their near and dear ones. This will help them live better and more productive lives, and bring about improvements in the societal health at large.” The PHM caters to people from all age groups and all walks of life. It showcases activities across categories such as health education seminars, check-ups, entertainment programs, lifestyle exhibitions, lectures, workshops, and competitions. The Mela is attended by over 200 organizations each year including those from the state and central government, PSUs, and leading corporates. Adding further, Dr Aggarwal, said, “This Dusshera, we must take a pledge to eliminate evils like smoking and drinking from our lives. We must restrict the consumption of food containing high levels of trans fat, sodium, and refined sugar. It is important to deal with stress through a holistic approach and remove anger and negativity from our lives. Most lifestyle diseases are preventable and manageable only when necessary precautionary measures are taken. We must work towards beating obesity, heart disease, hypertension, and diabetes. Only when we do all this will the true meaning of victory of good over evil be achieved. Some preventive health tips one can follow are given below. • Avoid stress by taking short breaks at regular intervals whenever working at the office or even at home. Eat foods like brown bread for carbohydrates instead of white bread, oranges and lemons for vitamin C and spinach for magnesium. A healthy diet and sufficient sleep help in releasing chemicals like serotonin, which reduce stress. • Excessive smoking aggravates blood pressure, increases heart rate, and reduces the supply of the oxygen to the brain. You should immediately quit this habit for a disease-free life. • Quit alcohol as it can worsen heart problems and cause cirrhosis of the liver. It also triggers obesity and depression. • A balanced diet is key; consume healthy meals, which have the required nutritional benefits your body needs to function efficiently. Consuming small but frequent meals, which contain a sufficient quantity of fruits and vegetables, is important. One should also reduce the intake of high trans fat, sugar, and sodium laden food. • Exercise daily; include a 5-minute brisk walk and a 10-minute stretching in your things-to-do list whenever you get time. Regular exercise also helps keep a check on hypertension and obesity.

An MBBS/MD degree must to sign lab reports

An MBBS/MD degree must to sign lab reports In a judgement in Association of Clinical Biochemists and Microbiologists ACBM (Regd) & Anr Vs Union of India & Ors delivered September 15, 2017, the Delhi High Court agreed with a Medical Council of India (MCI) notification that “all lab reports to be signed/countersigned by persons registered with MCI/State Medical Council”. The Medical Council of India (MCI) had issued a notification to this regard vide a letter No. MCI - 211(2))(Gen.)/2014-Ethics/ 118642 dated 14.06.2017, which had been contested by the Association of Clinical Biochemists and Microbiologists, who petitioned that “the said letter was without jurisdiction and deprived members of their association of their valuable right to conduct their trade and profession”. The Association of Clinical Biochemists and Microbiologists stated before the Court that “the members of the petitioner association are highly qualified persons and are engaged in the activity of laboratory testing. Since members of the petitioner association do not hold degree of MBBS and/or MD Degrees, they are not entered in the register maintained by the MCI or State Medical Councils. The petitioners state that the work of conducting laboratory test and submitting reports thereof is essentially a skilled task for which the members of the petitioner association are amply qualified and it is not necessary that the test report submitted by them be countersigned by a medical practitioner whose name is entered in the medical register. It is further stated that respondent no.3 (National Accreditation Board for Testing and Calibrating Laboratories) is competent to provide accreditation to pathology laboratories and no accreditation from MCI is required”. Referring to the Clinical Establishments (Registration and Regulation) Act, 2010, the Counsel appearing for MCI had submitted that “the said Act provides a comprehensive legal framework for registration of a clinical establishments. Section 3 of the said Act provides for establishment of a National Council which consists of representatives of various bodies including the Secretary General of Quality Council of India. The said National Council is inter alia charged with the function of prescribing the minimum standards of facilities and services; and (ii) minimum requirement of personnel, in a clinical establishment”. He also stated that the IMC Act did not provide for any framework for prescribing the standards for technicians engaged in a pathology laboratory. As per Clause (c) of Section 15(2) IMC Act, “No person other than a medical practitioner enrolled on a State Medical Register shall be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law to be signed or authenticated by a duly qualified medical practitioner.” Citing this, the MCI Counsel had further submitted, “the members of the petitioner association were not entitled to sign any medical fitness certificate and a pathology report would fall within the scope of a medical certificate, if there is any expression of opinion and/or indicative diagnosis… it is in this context that MCI had issued the impugned communication insisting that a pathology report be countersigned by a medical practitioner”. Section 15(3) IMC Act has defined punishment for violation of the above as follows: “Any person who acts in contravention of any provision of sub-section (2) shall be punished with imprisonment for a term which may extend to one year or with fine which may extend to one thousand rupees, or with both”. Court observations “It is apparent from the above that no person other than a duly qualified medical practitioner is entitled to sign any medical report. Thus, members of petitioner association cannot sign a medical report or a medical certificate. However, the same does not preclude the members of the petitioner association to give a technical report as to the tests conducted by them. Plainly, such report can only be for consumption of medical practitioners and pathologists. The said report cannot be treated as diagnosis of any medical condition. Thus, there can be no objection if the technical report submitted by the qualified technicians indicates the result of their tests or the technical analysis of the samples, as long as the members of the petitioner association refrain from expressing any medical opinion or holding out the technical result of the medical tests conducted by them as a diagnosis of any medical condition.” “This Court is also of the view that although members of the petitioner association are not precluded from acting as a laboratory technicians and submitting the result of tests conducted by them, adequate safeguard must be maintained to ensure that the reports submitted by them are not mistaken as medical certificates or diagnostic reports as that would, concededly, violate Section 15(2)(d) of the IMC Act, 1956. Thus, it would be apposite that all test reports must necessarily bear a disclaimer to the effect that the report are strictly for the use of medical practitioners and pathologists and the reports are not medical diagnostic results. Any pathological report which purports to record any opinion or to indicate any diagnosis must necessarily be co-signed by a qualified medical practitioner.” After examining three questions (as below), the Ethics Committee had decided that “All lab reports to be signed/countersigned by persons registered with MCI/State Medical Council.” 1. “Whether the M.Sc with PhD candidates who as a matter of fact are not registered with MCI are eligible to sign medical laboratory reports? 2. Can persons holding MBBS degree registered with MCI/State Medical Council sign the medical test reports? 3. Can PhD (Medical Microbiology, Medical Biochemistry, Life Sciences, Applied Biology, Cytogenetics, Biotechnology) in relevant discipline be allowed to sign medical test reports? If not, Can the same be allowed if they are co-authorised with a person registered with MCI/State Medical Council?” Taking note of this decision of the MCI Executive Committee, the Court said, “You are therefore requested to kindly abide the above said decision of the Council and widely publicise the above decision to all the concerned.” “The said decision of the Executive answers question nos.2 and 3 in the affirmative and there can be no dispute that MCI's decision in this regard is in conformity with the provisions of Section 15(2)(d) of the IMC Act and cannot be faulted.” “Insofar as the first question is concerned - that is, whether M.Sc/PHD candidates, who are not registered with MCI, are eligible to sign medical laboratory reports - the same must be answered in the negative as has been done by MCI. However, MCI decision in this regard must be read in the context. The expression "medical laboratory reports" as used in the first question cannot be misunderstood to mean test reports which merely indicate the result of tests and/or the manner in which, the tests are conducted.” “The expression "medical laboratory reports" must in the context of the impugned communication, be understood to mean reports that contain medical diagnostic results and/or an opinion with regard to the tests results. A technical report stating test results and indicating the analysis of samples without recording any opinion thereon, would not fall within the scope of medical laboratory reports as contemplated under the impugned communication.” The Court disposed of the petition stating that “The impugned communication, thus, cannot be understood in a wider sense as urged by the petitioner and must be read in the restrictive manner as indicated above. The petitioners can have no grievance if the impugned communication is read in the manner as indicated above and, therefore, no further orders are required to be passed in this petition.” IMA Viewpoint • Accurate interpretation of lab reports is very important as they affect clinical decision making. • Only a doctor can put a clinical context to the ‘numbers’ in the report and determine if the test result corresponds to the clinical situation of the patient or if the test needs to be repeated or the results are as expected if it is a follow-up test or if any additional test is required further to it. • Only doctors of modern medicine with MBBS/MD degree can sign medical lab reports. • Non MBBS can only write the values of the test results, BUT not the interpretation of those values. For instance, they can write result of a blood sugar test as 90 mg/dL, but cannot give the reference range as this would mean interpretation of the result. Another example can be, they can give the result of a Widal test, but cannot write positive or negative.

Perfect Health Mela to raise awareness on the need for mental support groups to fight substance addiction in youth

Perfect Health Mela to raise awareness on the need for mental support groups to fight substance addiction in youth The Mela will have inter-school competitions, youth festivals, and nukkadnataks to discuss the problem and possible solutions New Delhi, 28 September 2017: The Indian youth have an increasing addiction problem, so indicate statistics. About 75% of the youth in Punjab are severely addicted to drugs, which amounts to 3 of 4 children. Other cities such as Mumbai and Hyderabad are also quickly becoming popular for drug usage, with the number of addicted youth continuing to grow. The capital city if Delhi is not far with the youth addicted to tobacco, smoking, and substance abuse alike. About 75% of Indian homes house at least one drug user, often a male. Teenagers as young as 13 or 14 regularly experiment with intoxicants today. India today has about 500 rehab centres across cities, which will soon not be enough to tackle the increasing burden of addicted youth. Among the addictive substances are cannabis, alcohol, tobacco (in different forms), and more recently, fluid whiteners, which are used by teens to get a temporary high. This is one of the many issues that the Perfect Health Mela being organized by the HCFI this year will tackle and discuss. 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, "More Indian youngsters are struggling with addiction than ever before. The main factors responsible for this include peer pressure, depression, and adolescent immaturity. All this leads to a sense of dejection and depression and they resort to alternative ways to combat stress. Drugs and other addictive substances tend to give a temporary high making them forget the present situation and mental state. The Perfect Health Mela this year will address this issue, among many others. It will also focus on how the need of the hour is mental health support groups for youth and other ways to tackle addiction among youth.” Towards this end, the Mela will see events such as National inter-school competitions, Divya Jyoti Medical Masti Youth Festival, and Nukkad Natak, through which awareness will be generated on how this issue can be addressed. Adding further, Dr Aggarwal, said, “There is a need to empower the society and the community to deal with the problem of substance abuse. It should be recognized as a psycho-socio-medical problem. This can be done by: encouraging drug abstinence and alcohol moderation, at the family level first; recognizing the signs of trouble, counselling the youth, and offering early support; and finally, treatment, rehabilitation, and proper reintegration of recovering addicts into the mainstream. The Mela will focus on all of these.” The PHM is a mass health awareness module attracting over 2 to 3 lakh visitors every year. In its 24th edition, the event is being organized in association the NDMC, MCD, and IMA. MTNL is the title sponsor of the event. The theme this year is ‘Digital Health’. The Mela will be held from 4th to 8th October 2017 at the Talkatora Stadium, New Delhi. There are some basic tips one can follow at the personal level to discourage substance abuse and ensure good mental health among the youth. • Promote healthy lifestyles through personal and cultural practices. Set examples by following a healthy lifestyle. • Promote social interaction between the old and young. Create a conducive environment at home by organizing activities that involve both age groups. • Develop positive alternatives and keep in mind the interests of the younger generation. Do not ignore any warning signs of trouble and be a friend to them first. • Don’t shun those who are addicted. Understand that getting out of this habit takes time and effort. Encourage them at every step.

An Open Letter to the Prime Minister

An Open Letter to the Prime Minister It’s time for you to intervene; surgical strike needed to solve the issues of doctors Indian Medical Association (IMA) representing over three lakhs modern medicine doctors spread across 1700 local branches and thirty-one state and territorial branches, requests the Prime Minister to solve the problems of the health sector. The Health Sector including health care delivery, health parameters and medical education is far behind other sectors like agriculture, Information technology, Space technology and Economic sector due to a faulty Health Policy over the years. Our health parameters have a long way to go to reach the status of even developing countries like Sri Lanka, Bangladesh, Thailand, leave alone developed countries. Doctor-Population ratio, Health Care spending, Private Health Sector and Medical Education are the issues, which are to be solved to make health care accessible and affordable. We lack evidence-based, data-based Health Care Policy. Health care is not addressed from a public health point of view and emphasis is given to curative medicine only. The social determinants of health like safe water, sanitation, nutrition and environmental factors are not addressed. Wherever the health parameters have improved, it is due to better health worker-population ratio rather than doctor-population ratio. The policy makers feel that by deploying more Doctors including Ayush doctors to prescribe modern medicine, will improve health of the public, which on the contrary will be counterproductive and will leave public health and preventive aspect of health care unaddressed. Government of India spending on health is hardly 1.1% of GDP, which is one of the lowest in the world. Instead of Government spending more on health care, the burden of free health care is forced on the private medical sector. The Clinical Establishments Act and even Supreme Court Judgement make it mandatory for private clinical establishments to stabilize trauma victims. Similarly, in case of natural disasters, sexual abuse and other man-made disasters like fire, cracker explosions, spurious liquor tragedy etc., the private health sector is forced to give free treatment. At the same time, road safety fund collected through Vehicle Tax and Road Cess remains underutilized. The small and medium level hospitals, which cater to 40% of the population are facing closure due to financial non-viability and Government’s lopsided Health Policy. Government should promote the segment of health care providers by a policy of AIDED HOSPITALS. These small institutions run by doctors are situated in the neighbourhood and are present in villages and remote areas. They are friendly and easily accessible 24 x 7 at an affordable cost. The violence and plethora of laws are pushing them to extinction. They are national assets providing primary and secondary care. They help to keep the healthcare cost down. They deserve a special status and promotion. Only Doctor-friendly Acts and Rules and Judgements can be Patient-friendly. A doctor should work in an environment, which is friendly, relaxed, confidence building and free of violence to deliver his best to the patient, which is ensured even in the theatre of war. Now incidents of violence against Doctors and clinical establishments are the order of the day and in spite of IMA’s demand for a Central Act against violence, this issue remains unaddressed by the Government. Another proof of Government’s lopsided policy is the PCPNDT Act. Female feticide occurs because of social and economic reasons. To reduce female feticide, not only sex determination and female feticide, but even clerical errors attract criminal provisions as per PCPNDT Act. Clerical errors and minor noncompliance should not attract criminal provisions of the PCPNDT Act. IMA demands amendment of the Act to this extent. IMA even suggests that sex of the foetus should be determined and tracked so that the real issues and persons behind female feticide can be identified and appropriate action taken. IMA strongly feels that without solving the social and economic reasons behind female feticide/infanticide, the proper male-female ratio cannot be maintained. PCPNDT Act is a medical solution for a socio-economic problem, which cannot solve the issue. There is a double standard in award of compensation in cases of medical negligence /accidental deaths. There is capping of compensation for accidental death like flood, fire, road – rail and air accidents, the amount of compensation range from Rs. 2,00,000/- to Rs. 10,00,000/-. There is also capping for drug trial-related mortality and tubectomy failure or death. But in the case of medical negligence / treatment-related mishaps the compensation awarded is now alarmingly increasing to crores. IMA demands that the double standard in award of compensation should be eliminated and compensation on medical negligence should also be capped. The government is debating the need to abolish the Medical Council of India (MCI) and replace it with a 29-member National Medical Commission. If NMC is enacted, it will allow non MBBS doctors to practise modern medicine, a step which may be detrimental to the society. Schedule-IV of NMC which allows lateral entry of other medical practitioners into the modern medical registry will be detrimental to the health of the people. Medical students are against being asked to appear for an exit exam after passing MBBS. The Indian Medical Association is also not in favour of “NEXT”. An Inter-Ministerial Committee was constituted by the Government to examine the issues raised by IMA on 13th November, 2015. The committee consisted of: 1. Joint Secretary (subject expert), Ministry of Health & Family Welfare 2. Joint Secretary, Ministry of Law & Justice 3. Joint Secretary, Department of Consumer Affairs 4. Joint Secretary, Ministry of Home Affairs 5. A representative from MCI 6. Three representatives from IMA The terms of reference of the Committee were as follows: 1. Frequent instances of assault on doctors and Clinical Establishments across the country and the need for a strong Central Legislation to prevent it. 2. Urgent amendments in the PC & PNDT Act to ensure that strict penalties are imposed only on actual acts of sex determination or female feticide and not for clerical errors in the maintenance of registers. The IMA is also of the view that registration should be of ultrasound machine and not of doctors not doing pelvic ultrasound. 3. Single doctor establishments should be exempted from the purview of the Clinical Establishments Act. Establishments that already have entry level NABH accreditation should be exempted from the mandatory pre-registration inspection. 4. Suitable amendments should be made in the Consumer Protection Act for capping the compensation amount as the current compensation practice, apart from being very high at times, is also in favour of people falling under a higher income bracket. 5. Non-MBBS and non-BDS doctors should not be allowed to prescribe medicines under the modern system of medicine. The inter-ministerial committee had several sittings and arrived at mutually agreed formula. The health ministry also recommended and forwarded the committee’s recommendations on the 5 issues mentioned above to concerned ministries for action. We are thankful to Shri JP Nadda, Hon’ble Minister of Health & Family Welfare, Government of India, Shri CK Mishra, Secretary and Shri Sanjeeva Kumar, Additional Secretary for favourably listening to our demands and putting them in process. IMA has been on agitation path for implementation of the recommendations of the inter-ministerial committee and other demands for the past one year. As an outburst of anger and frustration more than 10,000 doctors marched from Rajghat on 06.06.2017 and over 90,000 participated digitally in Dilli Chalo Protest. We request you that our issues be resolved in a time-bound manner. The increasing violence against doctors, criminal prosecution of doctors and uncapped compensation are serious issues and need your immediate intervention. We ask your help to restore the nobility of the profession to serve the society better. We also request you to evolve an evidence-based health policy to solve the issues mentioned above to protect the health of the public. With warm regards Yours sincerely Dr KK Aggarwal Dr RN Tandon National President IMA Hony Secretary General IMA

IMA welcomes the decision of Govt. to increase retirement age of doctors to 65 years

IMA welcomes the decision of Govt. to increase retirement age of doctors to 65 years The Union Cabinet chaired by the Prime Minister Shri Narendra Modi, yesterday approved the enhancement of superannuation age of doctors other than doctors of the Central Health Services (CHS) falling under various Departments/Ministries/autonomous organisations, to 65 years. “According to the Cabinet decision, the superannuation age of doctors under the administrative control of the respective Ministries/Departments [M/o AYUSH (AYUSH Doctors), Dept. of Defence (civilian doctors under Directorate General of Armed Forces Medical Service), Dept. of Defence Production (Indian Ordnance Factories Health Service Medical Officers), Dental Doctors under D/o Health & Family Welfare, Dental doctors under Ministry of Railways and of doctors working in Higher Education and Technical Institutions under Department of Higher Education) has been enhanced to 65 years. The Union Cabinet has approved ex-post facto, the enhancement of superannuation age of doctors working in Central Universities and IITs (Autonomous Bodies) under Dept. of Higher Education to 65 years; and approved enhancement of superannuation age of doctors in Major Port Trusts (Autonomous Bodies) under Ministry of Shipping to 65 years. The Union Cabinet has approved that doctors shall hold the administrative posts till the date of attaining the age of 62 years and thereafter their services shall be placed in non-administrative positions.” The Indian Medical Association (IMA) has been pursuing this issue with the Health ministry since long on behalf of all these organizations. IMA welcomes this decision of the government taken in the interest of the society and congratulates both the Prime Minister and Health Minister for this momentous decision. We also hope for a similar decision on uniform service conditions and pay scales for all residents, service doctors and faculty. “Same work - Same pay - Pay parity - No to adhocism” has been one of our major demands, which we hope the government would accede to. (Source: Press Information Bureau, Ministry of Health & Welfare, Sept.27, 2017)

HCFI releases health sutras ahead of the Perfect Health Mela

HCFI releases health sutras ahead of the Perfect Health Mela • Veteran Bollywood actors Manoj Bakshi and Inderpal Singh grace the occasion as chief guests • The release commemorates 25 years of the Mela New Delhi, 27 September 2017: Heart Care Foundation of India (HCFI), a National NGO working in the healthcare sector, organized a press conference on September 27th, 2017 at the NDMC Convention Centre, Jai Singh Marg, New Delhi. The event focused on the key areas of HCFI’s annual flagship event, the Perfect Health Mela (PHM). Bollywood actors Mr Manoj Bakshi and Mr Inderpal Singh were the chief guests for the day. Commemorating 25 years of the Mela, the HCFI also released health sutras, in the form of playing cards, along with the two veteran actors.
The health sutras are aimed at educating people about preventive health. They are one-line messages with a complete meaning, are field tested, and prepared by experts. The PHM is a mass health awareness module attracting over 2 to 3 lakh visitors every year. In its 24th edition, the event is being organized in association the NDMC, MCD, and IMA. MTNL is the title sponsor of the event. Speaking during the press conference, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI), said, “The PHM completes its 24th year this year, celebrating the start of its silver jubilee. All programmes launched at the Mela will be continued for one year and conclude with the 25th PHM next year. With the burden of non-communicable diseases on the rise around the world, this is the perfect time to release these one-line talismans called health sutras. Many diseases can be prevented by making some necessary lifestyle changes and these health sutras are aimed at educating people about what these changes are and how they can be done.”
The Mela was started in 1993 by the HCFI. The first ever event was earmarked by the Government of India through the release of a National Postal Commemorative stamp. The theme this year is ‘Health Sutras’. Lauding the event, Mr Manoj Bakshi, actor, said, “I am happy to be a part of this launch and thank the HCFI for inviting me. In our busy lives today, we do not take a moment to look back and check on our health. We forget how important it is to follow a disciplined lifestyle which will be beneficial for the body and mind. Many people today have some disease or the other, and most of them are due to erratic eating and living. This initiative is a great way to make people aware of the changes they need to bring about in their lives and I congratulate the HCFI for this.”
Adding his views, Mr Inderpal Singh, actor, said, “I have been a part of a movie that talks about one of the issues faced by men today, that of infertility. There are many similar problems and diseases which have become rampant in people today. What is sad is that there is lack of awareness on what needs to be done and how. These health sutras being released today are like mantras for people on the lifestyle they should adopt. I am happy to be a part of this event and wish HCFI all success in the future endeavours.” The PHM caters to people from all age groups and walks of life. It showcases activities across categories such as health education seminars, check-ups, entertainment programs, lifestyle exhibitions, lectures, workshops, and competitions. Speaking on the occasion, Sh Sunil Kumar Director (HE & EB) MTNL Corporate office, said, “We are happy to be sponsoring this event, like every year, and are sure that this year will also see participation in huge numbers. We encourage one and all to take advantage of the various health care programmes during the Mela.” Adding further, Dr P K Sharma, MOH, NDMC, said, “This is an event that many people look forward to every year. From tips on matters concerning health to checkups, there is something for everyone. We will continue extending our support in the future too.” Among the various events being organized this year are the Harmony & Ecofest National inter-school competitions, Youth Rock Band/Orchestra Festival, Divya Jyoti Medical Masti Youth Festival, All Pathy Conference, All Religious Conference, and Nukkad Natak. The Perfect Health Mela is a great opportunity to for students to have fun while learning. Dr RN Tandon, Honorary Secretary General, IMA, opined, “The PHM focuses on the betterment of societal health and creating awareness on health issues. The health sutras being released today are one of the ways in which this is being achieved. IMA being the knowledge partner urges everyone to follows these sutras for a better and disease-free life.”
The health sutras released include the following. • High blood pressure, blood sugar and blood cholesterol can remain silent for up to a decade. • A pulse rate of less than 60 or more than 100 is abnormal. • Weight loss of 10kg can reduce upper blood pressure by 5-20 mmHg. • Restricting salt intake to less than 6gm per day can reduce upper blood pressure by 2-8 mmHg. • A 1% increase in cholesterol increases chances of heart attack by 2%. • A 1% increase in good HDL cholesterol decreases chances of heart attack by 3%. • Any chest pain, which lasts for less than 30 minutes duration is not a heart pain. • Keep air pollution (particulate matter PM 2.5 and PM 10 levels) below 80 µg per cubic meter • To revive a cardiac arrest victim, compress the center of the chest of the victim within 10 minutes of death (earlier the better) at least for the next 10 minutes (longer the better), with a speed of at least 10x10=100 per minute.

The following Delhi Government Departments will be participating in this year's Perfect Health Mela: Directorate of Health Services, Directorate Family Welfare GNCT Delhi, AYUSH (ISM&H), NCT Delhi:, Delhi State Aids Control Society (DSACS), Department of Food Safety, Drug Controller, Director, Delhi State Cancer Society, Chaudhary Brahm Prakash Charakh Sansthan, Institute of Human Behaviour & Allied Sciences (IHBAS), Institute of Liver & Biliary Sciences, Chacha Nehru Bal Chikitsalaya, Centralized Accident & Trauma Services (CATS), Dean Maulana Azad Medical College, MAMC, Dean/Principal UCMS. Deen Dayal Upadhyay Hospital, DIPSAR, Chacha Nehru Bala Chikitsalaya and Maulana Azad Institute of Dental Sciences: Other Departments: South Delhi Municipal Corporation/ North Delhi Municipal Corporation/ East Delhi Municipal Corporation, WCD (Prohibition) Government of NCT Delhi, Department of Environment and Forests GNCT Delhi, Secretary, Department of Art, Language & Culture (All Academies,)Department of Transport GNCT Delhi, Delhi Transport Corporation, NCT Delhi, Delhi Commission for women NCT Delhi, Directorate of Education Delhi Govt, DIP (Directorate of Information and Publicity),Delhi SC/ST/OBC/Min.& Handicapped Finance & Development Corp. Ltd, Labour Commissioner, Delhi Jal Board, Delhi Tourism, Controller Weights & Measures GNCTD, Commissioner Food Supplies & Consumer Affairs, Director Social Welfare Dept. Delhi Govt. Dept. of Power, Development Commissioner, Delhi Khadi Village Industries Commission:

GTN: IMA TB Initiative

GTN: IMA TB Initiative New WHO report highlights TB as a global priority for research and development A recently released new report from the World Health Organization (WHO) “Antibacterial Agents in Clinical Development An analysis of the antibacterial clinical development pipeline, including tuberculosis” portrays a grim scenario by highlighting the lack of new antibiotics under development to combat the growing threat of antimicrobial resistance, which has emerged as a serious global public health concern. Along with other priority antibiotic-resistant pathogens and Clostridium difficile, the report also focuses on Tuberculosis (TB) as a global priority for research and development. It draws attention to the fact that only seven new agents for TB are currently in clinical trials. Of these, four are in phase-1, and only one compound is in phase-3. This means that physicians have limited or no options for multidrug-resistant Mycobacterium tuberculosis (MDR-TB), particularly extensively drug-resistant M. tuberculosis (XDR-TB). Perhaps, in acknowledgement of this lack of therapeutic options, the Report also says, “This is especially problematic because treatment of TB infections requires a combination of at least three antibiotics. Novel treatment regimens of short duration that are assembling non-toxic drugs are desperately needed.” The seven agents being developed specifically for treatment of TB include pretomanid (nitroimidazole), delpazolid (oxazolidinone), SQ-109 (diamine), GSK-3036656 (Leu RS inhibitor[oxaborole]), Q-203 (imidazopyridine amide), PBTZ-169 (DprE1 inhibitor [benzothiazinone]) and OPC-167832 (DPrEq inhibitor). Only two new antibiotics for treatment of MDR-TB, bedaquiline and delamanid, have reached the market in more than seven decades. Bedaquiline has been introduced in India under Conditional Access Programme (CAP) to as treatment for MDR-TB as part of RNTCP at six identified tertiary centers. India has highest burden of both TB and MDR TB in the world. According to the Global Tuberculosis Report 2016, six countries, including India accounted for 60% of the new cases of TB in the world. The number of new tuberculosis cases in a year went up to 2.8 million in 2015. Along with China and the Russian Federation, India accounted for 45% of the combined total of 580,000 cases of MDR-TB globally, including rifampicin-resistant TB (RR-TB). About 1.3 lakh incident MDR-TB cases occur annually in India (TB India 2017 Report). TB is therefore a national public health emergency in India. Given the lack of innovative treatment options, as highlighted in the latest WHO report, there is a need for a concerted effort from all stakeholders including health care providers and policy makers, to check the emergence and spread of MDR-TB. Inaccurate diagnosis and/or delayed diagnosis, especially detection of latent TB (infected but asymptomatic patients) and incomplete treatment are factors propagating the epidemic of MDR TB in the country. Control of infection by timely diagnosis and treatment will prevent further transmission of TB. This is why, Indian Medical Association (IMA) has launched a campaign “IMA TB Initiative: GTN” to control this preventable and curable disease, where G stands for diagnosis of TB using GeneXpert test, T is for tracing the contacts and treating them and N stands for Notifying (mandatory) TB patients. All of us should actively support this initiative. Because, it is only through a united and collaborative effort that this public health threat can be controlled.

Vitamin D supplementation should be started early to prevent osteoporosis

Vitamin D supplementation should be started early to prevent osteoporosis This is silent disease as it does not have any symptoms New Delhi, 26 September 2017: From a research conducted recently, scientists have been able to identify what leads to bone loss in older adults. According to this, a protein called Cbf-beta plays a critical role in maintaining the bone-producing cells. When the mechanism producing this protein malfunctions, the progenitor cells stop creating bone-producing cells and instead create fat cells. It is, therefore, important to maintain this Cbf-beta to prevent human age-associated osteoporosis, which is caused due to excessive creation of fat cells. Osteoporosis is condition in which the bones become weak, and even a simple fall or bump can cause a bone to break. The most common bones to break or fracture are those of the spine, hip and the wrist. This is often known as a “silent disease’’ because one cannot feel or see the bones becoming weaker. Women are more affected by this condition than men. 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, “The normal bone-remodeling cycle is a balance of two special cells that work together to keep the bones strong. While osteoclast cells break down old bones causing pits; osteoblasts work to fill in these pits with new bone. When a person grows older, the bone-remodeling cycle changes and more bone is broken down than that formed. Osteoclasts start breaking down the bone faster. The osteoblasts cannot keep up with this to fill in the pits that are being formed. The bones thus become thin and fragile, leading to an increased risk of fractures. Apart from this, a low BMI is a risk factor for osteoporosis and high BMI is a risk factor for osteoarthritis. Therefore, a balance must be maintained.” Apart from age and gender certain other factors such as an inactive lifestyle, excessive alcohol and tobacco intake, and smoking can also lead to osteoporosis. It is important to get a bone density test done in those above the age of 50 to assess the risk of acquiring this disorder. Adding further, Dr Aggarwal, said, “If a female is postmenopausal, she needs an osteoporosis evaluation. In premenopausal women, in presence of risk factors, osteoporosis evaluation should be done; more the risk factors, more the chances of developing osteoporosis in future. To overcome osteoporosis, one must remember the following mnemonic, ABCDE: A means adequate sunlight, B means avoiding bone toxins, C means adequate calcium, D means fortification or supplementation of Vitamin D and E means exercise.” The upcoming Perfect Health Mela being organized by HCFI, to be held from 4th to 8th October 2017 at the Talkatora Stadium in New Delhi will provide a platform to discuss many of these health issues. IMA is the knowledge partner for the event. It is a must visit for those interested in learning more about preventive health and well-being. The Mela will also have free health camps for checking various health parameters. The following tips can help prevent the risk of osteoporosis at an early age. • Avoid bone toxins, namely, alcohol and smoking. Smoking is dangerous as it accelerates bone destruction. Excess of 80 ml of alcohol or 80 gm of alcohol can accelerate bone destruction. • Start Vitamin D supplementation right from when boys and girls are in the school going age. Remember, osteoporosis begins in the school going age but manifests later in life. • Three yoga exercises namely, Surya Namaskar, Tadasana and Vrakshasana, which involve standing on your toes or weight bearing on your toes, are good to avoid osteoporosis. • An adequate intake of protein in diet, combined with an adequate intake of calcium helps increase bone density. One should aim for about 12% of calories to come from proteins such as legumes, poultry, seafood, meat, dairy products, nuts and seeds.

Move, Move & Move: Non-recreational physical activity also reduces CVD and mortality risk

Move, Move & Move: Non-recreational physical activity also reduces CVD and mortality risk Dr KK Aggarwal The Prospective Urban Rural Epidemiology (PURE) study has shown that any kind of physical activity lowers the risk of heart disease and death. The prospective cohort study led by the Population Health Research Institute of McMaster University and Hamilton Health Sciences recruited more than 130,000 subjects from 17 countries - Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, Pakistan and Zimbabwe, including India. The PURE study, published September 22, 2017 in The Lancet, not only examined leisure time physical activity, it also evaluated non-recreational activities such as active commuting, having an active job or even doing housework, which are more prevalent in low and middle-income countries. And, any activity was found to meet the current recommendations of 30 minutes of activity a day, or 150 minutes a week. By meeting the activity guidelines, the risk for death from any cause was reduced by 28%, while heart disease was reduced by 20%; these results were not influenced by the type of physical activity the person did. Those who recorded more than 750 minutes of brisk walking per week had a 36% reduction in risk of death. But, a large percentage of participants (38%) were able to achieve this level of activity from activities such as commuting, being active at work or doing household chores compared to only 3% of those who achieved this level from leisure time activity. Although often used interchangeably, ‘exercise’ is not synonymous with ‘physical activity’. Exercise is a part of physical activity, which includes activities done at leisure, done at work, commuting or household tasks or chores. Increasing physical activity is a strategy that requires no investment, no special training to reduce the burden of non communicable diseases. Everybody should move around more often all through the day in addition to regular exercise. Promoting physical activity is also the objective of the “Move, Move and Move” campaign of IMA. (Source: McMaster University, Sept 22, 2017)

Severe jawbone disorder can worsen migraine pain

Severe jawbone disorder can worsen migraine pain
• TMD can increase the frequency and severity of the migraine • Lifestyle changes can help in preventing migraine symptoms from becoming worse New Delhi, 25 September 2017: As per a recent study, those with a severe jawbone disorder (known as temporomandibular disorder (TMD)) are more likely to suffer from chronic migraine. Although TMD does not directly cause migraine, it can increase the severity and frequency of the condition. Migraine is the third most prevalent illness in the world and affects about 1 billion people worldwide. While most sufferers experience attacks once or twice a month, more than 4 million people have chronic daily migraine, with at least 15 migraine days per month. Migraine, is a severe throbbing recurring pain, usually on one side of the head. However, both sides are affected in about one-third of the attacks. Migraine is a primary headache. This is because the pain is not due to an underlying condition such as a brain tumor or injury. Those with migraine suffer from moderate to severe pain. This makes it difficult for them to carry out even normal activities and therefore, they retreat to a quiet and dark room. 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, “Migraine can also have an enormous impact on a person’s work, family and social life due to the debilitating pain it causes. Migraine occurs in children also but largely goes undiagnosed. Migraines can be episodic or chronic. The difference lies in how frequently the migraines occur. Those who suffer from episodic migraine have fewer than 14 headaches per month for three months. Whereas, those with chronic migraine have headaches for 15 days or more per month. Episodic migraines can increase and turn into chronic migraines over the course of few years or months. Familial Hemiplegic Migraine (FHM) is a type of migraine that runs in families. It is a rare, genetically inherited condition. Women are affected thrice as much as men by migraine.” Some common disabling symptoms of migraine include visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. However, the symptoms can vary from person to person. Adding further, Dr Aggarwal, said, “Prevention and treatment of migraine centers around reducing the frequency, stopping the symptoms, or making them less severe. While some medications provide pain relief, others attack the underlying symptoms. It is also a good idea to keep a migraine journal, which will help in figuring out what treatment works best for you. An accurate and complete account of migraine attacks can help track the triggers and frequency of attacks and decide on the right treatment option for you.” The upcoming Perfect Health Mela being organized by HCFI, to be held from 4th to 8th October 2017 at the Talkatora Stadium in New Delhi will provide a platform to discuss many of these health issues. IMA is the knowledge partner for the event. It is a must visit for those interested in learning more about preventive health and well-being. The Mela will also have free health camps for checking various health parameters. Certain lifestyle changes and eating habits can help prevent migraine from getting worse. • Avoid certain foods such as alcohol and chocolate. • Quit smoking as it has been proven to increase head pain and other symptoms. • A diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats is best to avoid migraines. One should also avoid skipping meals. • It is important to stick to a regular sleep schedule to keep the immune system strong, ward off depression and anxiety, and help the body and mind relax. • Indulge in aerobic, strengthening, and flexibility exercises for about 30 minutes every day. Avoid stress through meditation and yoga can help in significantly reducing the frequency and severity of migraines.

IMA CWC demands urgent implementation of their demands

IMA CWC demands urgent implementation of their demands Dr KK Aggarwal Taking the Dilli Chalo movement forward, the Central Working Committee meeting ratified the decision of the Indian Medical Association (IMA) to hold a dawn-to-dusk fast throughout the country on October 2, 2017, the birthday of Mahatma Gandhi. The day is also observed by the United Nations as the International Day of Non-Violence. The fast will be held in Delhi, Sabarmati and Wardha. The fast is a move towards drawing the attention of the government and the general public to violence in hospitals. Through this peaceful protest, the IMA also aims to reinforce its demand for a Central Hospital Protection Act and the implementation of the inter-ministerial committee recommendations, which were a result of persistent efforts of IMA with the ministry for two years. The Dilli Chalo movement in June this year was a huge success, where more than 100,000 doctors, both in person and through digital media, participated. We also initiated a signature campaign on the issues at hand on social media for doctors, to demand justice from the government. We further discussed the status of the demands raised by the IMA as part of the Dilli Chalo campaign at the 218th meeting of IMA's Central Working Committee (CWC) in New Delhi. Many issues were raised during the Dilli Chalo movement. Our major demands are as follows: • Criminal prosecution of medical negligence and clerical errors • Stringent central act against violence on doctors • Capping the compensation in CPA on doctors • Professional autonomy in treatment and prescriptions • Amendments in PC PNDT, Central CEA, West Bengal CEA Acts • No unscientific mixing of systems of medicine • Empower MBBS graduates • One drug - One company - One price • Implement inter-ministerial committee recommendations in six weeks • Single window accountability • Single window registration of doctors and medical establishments • No to NMC: Amend IMC act to maintain professional autonomy • Uniform final MBBS exam instead of ‘NEXT’ • Uniform service conditions for service doctors & faculty • Same work - Same pay - Pay parity - No to adhocism • Fair conduction of NEET exam • IMA member in every government health committee • Central anti-quackery law • Reimbursement of emergency services provided by private sector • 25000 family medicine PG seats • Aided hospitals and retainer ship in general practice • Health budget of 5 % of GDP for universal health coverage This CWC meeting, in particular, is significant as it is a landmark year for the Association and also because it is time to work further to uphold the dignity of this noble profession. In medical profession, actions need to be implemented without waiting. Violence against doctors continues, rights of the medical fraternity are trampled upon, and there is no action taken towards modifying draconian acts. Hence, all doctors of modern medicine in the country will undertake a dawn to dusk fast on 2nd October.

IMA CWC demands urgent implementation of their demands

IMA CWC demands urgent implementation of their demands · Taking forward from the Dilli Chalo movement, there will be a mass fasting by doctors in India on 2nd October New Delhi, 24 September, 2017: As an outcome of an Action Group meeting, and later ratified by the Central Working Committee meeting the IMA will organize a dawn-to-dusk fast throughout the country on 2 October 2017. The fast is a move towards drawing the government and people's attention to the violence in hospitals. Through this peaceful protest, the IMA also aims to reinforce its demand for Central Hospital Protection Act and the implementation of the inter-ministerial committee recommendations, which were a result of two years persistent efforts of IMA with the ministry. Earlier the Dilli Chalo movement in June this year saw participation by over 100,000 both in person and through digital media. The IMA also initiated a signature campaign on the issues at hand on social media for doctors, to demand justice from the government. The 218th meeting of IMA's Central Working Committee (CWC) in New Delhi, on the sidelines of the Centenary Celebrations of Medical Conferences held at The Grand Vasant Kunj, New Delhi, also discussed the status of the demands raised by the IMA as part of the Dilli Chalo campaign. 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, "The IMA is the only national voluntary organization representing the collective consciousness of doctors of modern scientific system of medicine in the country, with its Headquarters in New Delhi. In line with our resolution of upholding the interest of the medical profession, many issues were raised during the Dilli Chalo movement. The inter-ministerial committee considered our demands. However, the fact is that in medical profession the actions need to be implemented without wait. Violence against doctors continues, rights of the medical fraternity are trampled upon, and there is no action taken towards modifying draconian acts. This meeting is an urgent call for action, and till such time our efforts will not subside.” The concept of IMA was born out of these conferences in response to a need of a national organization of doctors. A resolution adopted at the 5th All India Medical conference held at Calcutta in the year 1928 led to the formation of an All India Medical Association. The objectives were to improve medical education, promote medical and allied sciences in their different branches and safeguard interests of the medical profession. Adding further, Dr Aggarwal, said, “This CWC meeting assumes importance as it is a landmark year for the Association and also because it is time to work further to uphold the dignity of this profession. Towards this, on2nd October, all doctors of modern medicine in the country will undertake a dawn to dusk fast in continuation of our Dilli Chalo movement. The fast will be held in Delhi; Sabarmati, Gujarat; and Wardha, Maharashtra.” Following are the demands of the medical fraternity. • Criminal prosecution of medical negligence and clerical errors • Stringent central act against violence on doctors • Capping the compensation in CPA on doctors • Professional autonomy in treatment and prescriptions • Amendments in PC PNDT, Central CEA, West Bengal CEA Acts • No unscientific mixing of systems of medicine • Empower MBBS graduates • One drug - One company - One price • Implement inter-ministerial committee recommendations in six weeks • Single window accountability • Single window registration of doctors and medical establishments • No to NMC: Amend IMC act to maintain professional autonomy • Uniform final MBBS exam instead of ‘NEXT’ • Uniform service conditions for service doctors & faculty • Same work - Same pay - Pay parity - No to adhocism • Fair conduction of NEET exam • IMA member in every government health committee • Central anti-quackery law • Reimbursement of emergency services provided by private sector • 25000 family medicine PG seats • Aided hospitals and retainer ship in general practice • Health budget of 5 % of GDP for universal health coverage

Medical Errors: “I am sorry”

Medical Errors: “I am sorry” Adverse events and medical errors are a part of clinical practice. A report from the Institute of Medicine “To Err is Human: Building a Safer Health System” published in the year 1999 has defined medical error as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim”. Some examples of errors as mentioned in the IOM report include transfusions, surgical injuries and wrong-site surgery, restraint-related injuries or death, falls, burns, pressure ulcers and mistaken patient identities. The IOM report also noted that errors occur more commonly due to faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. According to the Journal of the American Medical Association (JAMA), medical negligence is the third leading cause of death in the US, behind heart disease and cancer. In 2012, over $3 billion was spent in medical malpractice pay-outs, averaging one pay-out every 43 minutes. Every year, 200,000 patients in the US die due to medical errors. Should a doctor apologize for his/her mistake? A very common, perhaps natural, apprehension is that acknowledging a mistake before the patient may leave one vulnerable to litigation. Admitting to a mistake may also undermine the doctor-patient relationship. Doctors are often counselled not to apologize to patients. A common view is that if you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened; in other words, saying sorry is an admission of guilt. But, apologizing after a medical error is the humane thing to do. Often, patients sue simply because it’s the only way to find out what went wrong. Physicians should inform patients, no matter what caused the events, of the facts and the nature and circumstances of the problem while expressing regret and showing sympathy for the situation (Can Fam Physician. 2007 Feb; 53(2): 201). Doctors should always communicate with their patients. A two-way communication is the key to a strong doctor-patient relationship. Remaining silent and not communicating to the patient may sometimes result in distrust and an angry patient, who is only too willing to sue the doctor. Apologizing at this point of time may not work to defuse the situation. Many states in the US have passed ‘Apology laws’ that do not permit apologies to be used against doctors in malpractice court Apology the spiritual answer • The word ‘sorry’ is synonymous with apology. • To err is human and to admit one’s error is superhuman. • Sorry should be heartfelt and not ego felt. You should not only say sorry, but you should also mean it. An insincere apology may only complicate matters further. • It requires tremendous courage to face the victim of our wrong doing and apologize. • It is generally seen that those who are in harmony with their life and consequently with themselves, find it easier to say ‘I’m sorry’. They are the positive, conscientious ones who are at peace only after making amends for their misdeeds. • The word ‘sorry’ in itself is imbued with so much potential and power. Within a fraction of a second, grave mistakes are diluted, tepid and estranged relations are brought alive, animosity and rancour are dissolved, misunderstandings resolved and tense situations ease out resulting in harmony and rapprochement. • To forgive and forget is a common spiritual saying. • Remember we all do mistakes and seek forgiveness from God every day. No doctor practices medicine with an intention to harm the patient. Beneficence and non-maleficence are the guiding ethics of clinical practice. But, despite all care, sometimes errors may happen inadvertently. To err is human and every doctor is likely to make mistakes. Difference of opinion, error of judgment, medical errors and medical accidents are not medical negligence. Experiencing a bad outcome does not always mean medical negligence. This has also been the position of the Supreme Court of India in its various judgements. For medical negligence, there is always an element of wilful omission and commission, which causes injury or damages to a patient. Such an act is liable for medical negligence or malpractice claim. Disclaimer: The views expressed in this write up are entirely my own.

IMA organizes Centenary Celebrations of Medical Conferences

IMA organizes Centenary Celebrations of Medical Conferences • Awards announced on Doctors Day presented on the occasion • The event also entailed discussions on key issues, recommendations on the same, and a promise to keep fighting for the cause of the medical fraternity New Delhi, 23 September 2017: As a follow-up to the awards under various categories announced on Doctor’s Day in July this year, an award ceremony was held in The Grand, Vasant Kunj on the 23rd of September 2017. The ceremony was organized as part of the Centenary Celebrations of Medical Conferences in India by the IMA. The doctors were honored for their contribution in the field of medicine and for their work towards the betterment of the medical fraternity at large. The event saw the coming together of the medical fraternity to discuss and debate on, among other things, the various issues plaguing the medical profession today. Discussions also focused on the revised fluid intake recommendations, among pediatricians, surgeons and physicians. Speaking about the awards, 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 fraternity is at a crossroads today. While on the one hand, this award ceremony is being held to honor those who are consistently striving to uphold the integrity of the medical profession, on the other, the fact that many issues still remain unaddressed cannot be ignored. These awards are an encouragement for all concerned to continue working towards restoring the nobility of this profession. They will also inspire others work harder to reach this level. I congratulate all the winners and urge them to carry on the good work being done by them.” Apart from the awards, consensus meetings were also held which discussed various guidelines, one of them being the revised fluid intake recommendations. The revised recommendations indicate that hydrating a patient should entail a mix of energy and electrolytes. Apart from this, different levels of physical activity need different levels of hydration. As a general rule, the fluid intake should be low-sodium, low-sugar, non-caffeinated, and non-alcoholic. However, fitness activities of one hour or more may require additional hydration. Adding further, Dr Aggarwal, said, “Fluid balance is essential for life. The daily liquid requirement can be calculated as 30 ml /kg body weight. Fluid is not only in the liquid form but also solid. For example, all vegetables and fruits are weighed equal. When a person is normally hydrated, they will have no thirst, their armpits will be wet, and they will pass urine every 3 to 6 hours. Hydration requirements increase in summer, after exercise, and in fever. About 5% of fluid loss is symptomatic. To find out whether a person is adequately hydrated, a comparison of their body weight during morning and evening can be done.” The following days of this event will entail a meeting of the Central Working Committee, wherein pertinent issues will be discussed along with the way forward. The recipients of the IMA awards are as follows. Women Empowerment Award • Dr Jayshree B. Mehta and Dr Soumya Swaminathan (2016) • Dr Rishma Pai (2017) Doctor of the Decade Award • Dr A Marthanda Pillai and Dr Shashank Joshi (2016) • Dr Randeep Guleria (2017) Centenary Awards • Dr Ketan Desai • Dr Ajay Kumar • Dr Vinay Aggarwal • Dr KK Aggarwal Life Time Achievement Award • Dr Ved Prakash Mishra (2017) Doctor of the Year Award • Dr R N Tandon, Dr Girish Tyagi, Dr R V Asokan, Dr Hrishikesh D Pai, and Dr K K Kalra (2016) • Dr Shiv Kumar Mishra, Dr Bhupender Ahuja, Dr Saumitra Rawat, Dr H P Saraf, and Dr Mona Desai (2017) Medical Eminent Teacher Award • Dr Georgi Abraham, Dr C G Bahuleyan, Dr M C Mishra, and Dr J A Jayalal (2016) , Dr Swati Bhave IMA Eminent Nurse Award • Ms Anita Deodhar and Ms Evelyn P Kannan

A must-watch IMA event

A must-watch IMA event The Central Working Committee (CWC) of IMA is meeting today at Hotel The Grand, Vasant Kunj in New Delhi. It is a residential event for members of CWC with a continuous live webcast on IMA website for non CWC members at http://ima-india.org/imalive/ 2-5 PM Saturday and 10-2 PM Sunday. Celebrations of centenary year of medical conferences in India will be observed simultaneously with the 218th CWC Meeting. One of the issues that will be discussed among other such issues of concern to the medical fraternity is “Is the time ripe to shift from non-violence way of protest?” Drafting of Restoration guidelines is another issue on the agenda. For every 1000 members there is one CWC member elected by the IMA state branch. They form the lower house of IMA and recommends all the policies. The CWC forms the IMA upper house. Local branches select one CC member for every 100 members. This is the supreme body of IMA. Though policy suggestions can be sent by individual members, it is always better to bring resolutions through the states via state CWC members. All suggestions of states and branches should be routed through CWC.

Endometriosis may cause complications during pregnancy

Endometriosis may cause complications during pregnancy The disease has symptoms which can be confused with other conditions New Delhi, 22 September 2017: Endometriosis in pregnant women can cause many complications during pregnancy and delivery, including preterm birth and cesarean section. The findings come from a recently conducted study, which also indicates that such women should be closely monitored during the course of their pregnancy for any complications. Endometriosis can cause problems such as inflammation of the endometrium and inhibit the action of progesterone during implantation and throughout the pregnancy, as per the IMA. Endometriosis is a painful condition in which the tissue lining the inside of the uterus, grows outside it. It is estimated to affect about 10% to 15% of the women in the reproductive age. The condition mostly involves the ovaries, fallopian tubes, and the tissue lining the pelvis; but can spread beyond the pelvic organs as well. 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, “Although there has been much progress on various issues related to women’s health, endometriosis is a condition marred by lack of awareness in the country. In this condition, displaced endometrial tissue has no way to exit the body and becomes trapped. When endometriosis involves the ovaries, it can cause formation of cysts. This can lead to an irritation in the surrounding tissue and eventually scar tissue and adhesions. Endometriosis can be mistaken for other conditions that can cause pelvic pain. Some of these include pelvic inflammatory disease (PID) or ovarian cysts and irritable bowel syndrome (IBS). However, in some cases endometriosis may be accompanied by IBS, which can complicate the diagnosis.” While the primary symptom of this condition is increased pelvic pain associated with menstruation, the other symptoms include pain during intercourse and bowel movement, excessive bleeding, fatigue, diarrhea, constipation, and bloating or nausea, especially during menstrual period. Adding further, Dr Aggarwal, said, “Healthy diet and physical activity improve immunity which in turn can help reduce inflammation to some extent. It is imperative to look for heart disease in women with endometriosis. Women with endometriosis are known to have systemic, chronic inflammation, an atherogenic lipid profile, heightened oxidative stress and several overlapping risk factors for cardiovascular disease.” The upcoming Perfect Health Mela being organized by HCFI, to be held from 4th to 8th October 2017 at the Talkatora Stadium in New Delhi will provide a platform to discuss many of these health issues. IMA is the knowledge partner for the event. It is a must visit for those interested in learning more about preventive health and well-being. The Mela will also have free health camps for checking various health parameters. Here are some tips to prevent the risk of endometriosis in women. • Hormonal birth control methods such as pills, patches or rings with lower doses of estrogen can help in preventing this condition. • It is good to indulge in regular exercise regularly. This will help in reducing body fat and decrease the amount of estrogen circulating through the body. • Avoid over consumption of alcohol as it can cause an increase in estrogen levels. Women should limit alcohol intake to one drink per day. • Avoid large amount of drinks with caffeine as more than one caffeinated drink a day, especially sodas and green tea, can raise estrogen levels.

Scientific System of Medicine

Scientific System of Medicine The practice of medicine is an art based on science. Today, evidence-based medicine has become the norm in clinical practice. Application of evidence-based medicine in day to day practice means relating individual clinical signs, individual clinical experience with the best scientific evidences obtained by the clinical research. Scientific system of medicine evaluates any health practice, product, based on the scientific evidence available. Scientific system of medicine takes into consideration all of the scientific evidence in their entirety. It also takes into consideration prior scientific plausibility or prior likelihood, whether that treatment is a valid treatment and is effective, when evaluating health or scientific claims or assertions, which evidence-based medicine does not. Any pathy can have treatment at any level of evidence. • Level I: Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results. • Level II: Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT). • Level III: Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental). • Level IV: Evidence from well-designed case-control or cohort studies. • Level V: Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis). • Level VI: Evidence from a single descriptive or qualitative study. • Level VII: Evidence from the opinion of authorities and/or reports of expert committees. Randomized controlled trials (RCTs) are regarded as Level 1 evidence and have been ranked highest. Observational studies, generally regarded as Level II or level III evidence, have been shown to be comparable to RCTs. Therefore, observational studies are also important as evidence for a said practice or treatment or product. The word ‘observation’ is defined in the English dictionary as “an act of noting and recording any event”. In terms of science, this can be likened to recording any data generated out of an experiment. Any observation therefore is potential evidence (JAMA. 2000;284(10):1290-1296). There should be only one system of medicine, the scientific system of medicine. And, all pathies must validate their effectiveness through scientific evidence. Disclaimer: The views expressed in this write up are entirely my own.

Elderly with Type-2 diabetes at high risk of fractures

Elderly with Type-2 diabetes at high risk of fractures
• Poor lifestyle habits can exacerbate this disease • A healthy diet is key in managing the symptoms in those with Type-2 diabetes New Delhi, 21st September 2017: A study conducted recently has indicated that older adults with Type-2 diabetes have deficits in their cortical bone, which can increase their susceptibility to fractures. Cortical bone is the dense outer surface of bone that forms a protective layer around the internal cavity. Type-2 diabetes can alter the micro-architecture of this bone in the elderly and increase the risk of fracture. The IMA added that Type-2 diabetes is a serious public health problem. With the population of the elderly on an upward trend, this is only likely to increase further. Diabetes is a life-long disease that affects the way the body handles glucose in the blood. Most people with diabetes have Type-2 diabetes. People with Type-2 diabetes make insulin, but the cells are unable to use it as well as they should. This is known as insulin resistance. 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, “Type 2 diabetes is typically brought on by poor eating habits, too much body weight and too little exercise. As the body cannot effectively use insulin to bring glucose into cells, it relies on alternative energy sources in the tissues, muscles, and organs. This is a chain reaction that follows up with many symptoms. Type-2 diabetes tends to develop slowly over time and the symptoms are very mild in the beginning. Apart from lifestyle issues, there are other factors that can contribute to the development of this disorder. In some people, the liver produces too much glucose. Some people may also have a genetic predisposition to Type-2 diabetes. Obesity is a major factorin increasing the risk of insulin resistance.” While the early symptoms of Type-2 diabetes include constant hunger, a lack of energy, fatigue, weight loss, excessive thirst, frequent urination, dry mouth, itchy skin, and blurry vision; an increase in the sugar levels eventually can lead to yeast infections, slow-healing cuts, dark patches on the skin, foot pain, and feeling of numbness in the extremities. Adding further, Dr Aggarwal, said, “A healthy diet containing leafy vegetables, fresh fruit, whole grains, lean meat, fish, and nuts can help reduce a person’s risk of Type 2 diabetes and avoid complications. However, a healthy diet is more expensive than an unhealthy one. The wide availability of cheap, energy-dense, low-nutrient food is contributing to the global epidemic of Type-2 diabetes. Foods that reduce the risk of this disease such as vegetables, fresh fruit, whole grains, and unsaturated fats need to be made more affordable and more widely available.” Diabetes will be one of the many key topics of discussion at the upcoming Perfect Health Mela being organized by HCFI, to be held from 4th to 8th October 2017 at the Talkatora Stadium in New Delhi. IMA is the knowledge partner for the event. It is a must visit for those interested in learning more about preventive health and well-being. It will also have free health camps for checking blood sugar levels and other health parameters. The following tips can help in managing Type-2 diabetes. • Include foods rich in fibre and healthy carbohydrates in your diet. Eating fruits, vegetables, and whole grains will help keep the blood glucose levels steady. • Eat at regular intervals and eat only until you are full. • Control your weight and keep your heart healthy. This means keeping refined carbohydrates, sweets, and animal fats to a minimum. • Get about half an hour of aerobic activity daily to help keep your heart healthy. Exercise helps in controlling blood glucose as well.

Draft Recommendations to decide professional incompetence: Report of the Study Group

Draft Recommendations to decide professional incompetence: Report of the Study Group For Comments The present Study Group came to be constituted by the President Medical Council of India in response to a communication from National President Indian Medical Association Dr. K. K. Aggarwal addressed to her bringing to notice that Rule 8.6 in the Code of Medical Ethics Regulation 2002, which brings out that Medical Council of India has to prescribe guidelines with respect to judgment by a peer group pertaining to ‘professional incompetence’ of a professional. Accordingly the Study Group critically debated and discussed the said issue and is pleased to observe as under: Rule 8.6 of the Code of Medical Ethics Regulations 2002 reads as under: “Professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India” As such, it is evident that professional incompetence of a professional duly registered with the State Medical Council upon fulfilling the precondition of the eligibility of having acquired recognized medical qualifications from a University and duly incorporated in the concerned schedule appended to the Indian Medical Council Act, 1956, is required to be judged by a peer group in accordance with the guidelines prescribed by the Medical Council of India. It is noted that as of now no such guidelines have been prescribed by the Medical Council of India as contemplated under Section 8.6 of the Code of Medical Ethics Regulation 2002 whereby the modality of the assessment of professional incompetence of a professional required to be dealt by the registering council through a peer group constituted for the said purpose is not in vogue for want of prescribed guidelines by the Medical Council of India. In this context the Study Group noted that ‘professional incompetence, professional misconduct and professional incapacitation’ by and large are used interchangeably in a colloquial as well as operational sense on practically more occasions than not primarily because all the three within their fold include failure on part of the professional to take reasonable steps to safeguard the life and health of the person under his care. It is for this reason it is imperative that the distinction between the three needs to be taken note of. Preamble: These guidelines shall be titled as ‘Guidelines governing assessment of professional incompetence by a peer group under Rule 8.6 of Code of Medical Ethics Regulation 2000 as amended from time to time. 1. These shall come into the force from date of its Notification by the Medical Council of India. 2. Extent and coverage: These shall be applicable for any medical trial jurisdiction at the institutional or at any council level. They shall not cover criminal aspect of professional negligence. 3. Definitions: Unless the context requires otherwise a) ‘Adverse event’ means an unintended injury to patient that results from healthcare management (rather than the underlying condition of the patient), which results in measurable disability, prolonged hospitalization or both b) ‘Bolam Test’ means the test evolved out of the judgment in the case of Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 used to assess standard of care when deciding medical negligence. c) ‘Clinical Establishment’ means an establishment as defined in the Clinical Establishment Act, notified by the Government of India. d) ‘Guidelines’ means recommendations or standards notified by the Medical Council of India in terms of Section 8.6 of Code of Medical Ethics Regulation 2002. e) ‘Institution’ means a medical college permitted / approved / recognized by the Medical Council of India/Non teaching Hospitals f) ‘Medical accident’ means an unforeseen or unexpected medical event causing loss or physical damage or injury, brought about unintentionally, as a result of treatment or failure to treat appropriately due to ignorance or lack of knowledge. g) ‘Medical Council of India’ means the council constituted in terms of section 3 of the Indian Medical Council Act, 1956. h) ‘Medical error’ means the failure of a planned action to be completed as intended or use of a wrong, inappropriate, or incorrect plan to achieve an aim. i) ‘Medical malpractice’ means negligent or improper or unreasonable lack of skill in the treatment of a patient, on the part of a health care professional or health care facility that causes harm, injury, or death to a patient or any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. Or improper, unskilled, or negligent treatment of a patient by a Health Care professional. Or medical malpractice is the failure of a medical professional to follow the accepted standards of practice of his or her profession, resulting in harm to the patient. j) ‘Medical mishap’ means an unfortunate accident k) ‘Peer’ means a person who is equal in ability, standing, or rank with another l) ‘Professional incapacity’ means inability to carry out professional activities and responsibilities/obligations due to a physical or mental condition/illness that may limit the capacity of a professional person to fulfill his/her professional responsibilities/obligations temporarily or permanently m) ‘Professional incompetence’ means failure to exercise due care and diligence in professional responsibilities due to lack of knowledge, skill. n) ‘Professional misconduct’ means unacceptable/dishonorable and unethical behavior by a professional person or noncompliance with the applicable laws and regulations o) ‘Professional negligence’ means an act or omission (failure to act when there is a duty to act) which a reasonable man in the circumstances would do or an act of commission (wrong doing) by a medical professional, which a reasonable man in the circumstances would not do. p) ‘State Medical Council’ means a council constituted and notified under the governing legislative enactment adopted by the concerned State legislature. q) ‘Untoward event’ means an unfavorable or adverse event 4. Mandate: To judge professional / medical incompetence of a registered medical practitioner by a duly constituted peer group 5. Composition of the peer group: a) Peer Group shall be constituted at Institutional / Clinical Establishment / State Medical Council / Medical Council of India level to judge the professional incompetency of a registered medical practitioner in a time-bound manner. b) The peer group shall be a three-member committee with a chairman, one IMA nominee and one professional subject expert. c) The peer group on receipt of any complaint shall examine the allegation in a time-bound manner, preferably within two weeks and forward its reasoned-out speaking order following the principle of natural justice and based on “Bolam’s Test” to the Institutional Head, Clinical Establishment Head / Chairman of the Ethics Committee of the State Medical Council / Chairman of the Ethics Committee of the Medical Council of India as the case may be. Report submitted to the President, Medical Council of India, New Delhi, for needful. Dr Vedprakash Mishra Chairman, Academic Committee, MCI & Convener Study Group Dr KK Aggarwal Dr RN Tandon National President, IMA Secretary General, IMA Member Member Dr Vinay Aggarwal Past National President, IMA Member Place: New Delhi Date: 23rd Sept. 2017