IMA calls for issuing "Good Standing Certificate" to doctors

IMA calls for issuing "Good Standing Certificate" to doctors Writes to MCI in light of a recent incident to carry out probe against a doctor New Delhi, 21 May 2017: In light of a recent incident, the IMA has written to the MCI expressing its viewpoint about NRI doctors barred abroad working in India. As per the US court, the doctor has been ordered “not to practice medicine in any form within the United States or any other country". As per a recent court directive, based on news reports that an Indian-origin doctor, who has been barred from practicing by a US court, is now treating patients in Delhi and Gurgaon, the Member Secretary of Delhi State Legal Services Authority, Sanjeev Jain, was asked to verify the doctor's name and address, carry out an immediate probe, and file a report within four days. It also issued notice to the MCI to file a report on the mechanism, statutory regime as well as rules and regulations in place to scrutinize and check such practices and made the Ministry of Health and Family Welfare a party. Speaking collectively on behalf of IMA, 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, "IMA is for a defined policy in such cases. We believe that the MCI needs to issue a 'Good Standing Certificate' to all graduates and post graduates who wish to register with registering authorities in other countries. This will serve as an indication of a good track record and also be a proof of the fact that the concerned person has committed no ethical breach and/or violation. A similar condition should also be imposed for Indian doctors practicing in other countries and wanting to come back and practice in India after getting registered in another country. This will ensure transparency and hence, lesser mishaps of the nature." At Delhi High Court, a bench of Acting Chief Justice Gita Mittal and Justice V K Rao, took a suo moto note to examine the issue on whether Indian-origin doctors, barred from practicing by a foreign country can practice in India. Adding further, Dr Aggarwal, said, "It is just a way to ensure quality of doctors is maintained. If we are asked for a certificate when we go to practice abroad then why can’t we ask for it from those who want to practice in India. We had spoken to MCI officials about this and they asked us to write to them."

Vedas and fertility

Vedas and fertility Infertility has been known from the Vedic era. Examples of fertility and assisted reproduction can be read in cases of King Dashrath, Ganesha, Kartikeya, Dhritarashtra, Vidur and Pandu etc. The three Shahi Snans mentioned in our Vedic literature are undertaken in the month of Magh, Vaishakh & Kartik (Vikram calendar) months. Shahi snan denotes exposure to sunlight to get Vitamin D. The rituals also involve eating the calcium-rich sesame seeds in a fasting state. Increase in both vitamin D and calcium are necessary to increase fertility. The main wedding season starts from Devuthan Ekadashi, Tulsi Vivah followed by Amala Navami. The seeds of Shyama Tulsi are known to increase the viscosity of semen and in women they help the release of eggs, a clomiphene-like action. Amla also increases sperm concentration. Pooja means dharam karam i.e. whatever we offer to God, we should also offer to ourselves (God is in me, the basis of Advaita philosophy). Indian doctors have been practicing Fallopian tube patency test or HSG (hysterosalpingography) for years. In this test, water or medicated oil dye is used to test and flush the fallopian tubes. It was noticed that post-HSG, the women showed improved fertility. Now, with the advent of CT, MRI and hysteroscopy, use of HSG has reduced, while the need for IVF has increased. Can we consider the use of vedic era methods and HSG to get better fertility results? Unfortunately, IUI, which was done by GPs, has gone in disrepute because of some unethical practices by so-called sadhus and saints and is now in the domain of IVF specialists only to the extent that it is now being covered under a separate Act. Dr KK Aggarwal National President IMA & HCFI

India is the diabetes capital of the world

India is the diabetes capital of the world As many as 50 million people in the country suffer from Type II diabetes with the number likely to reach 87 million by 2030 New Delhi, 20 May 2017: According to statistics, India is the diabetes capital of the world with as many as 50 million people suffering from type-2 diabetes. The country certainly has a challenge to face with the number likely to increase from 51 million in 2010 to 87 million in 2030. However, timely detection and right management can help patients lead a normal life, feel medical experts. The WHO fact sheet on diabetes indicates that an estimated 3.4 million deaths are caused due to high blood sugar. Diabetes mellitus is one of the world's major diseases. If not monitored on time, diabetes can lead to an increased risk of vascular complications like cardiovascular, renal, neural and visual disorders which are related to the duration of the disease. 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, "Diabetes mellitus is caused due to insufficient production and secretion of insulin from the pancreas in case of Type-I diabetes and defective response of insulin Type-2 diabetes. Insulin, a hormone produced by the pancreas, helps lower the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize it. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. A lot of times, resistance and feeling of disbelief that 'I can have diabetes too' makes most patients defer on detection and treatment which can lead to complications." Although this is a chronic medical condition, it can be curbed at the initial level with lifestyle changes and controlled after its incidence with medicines in early stages and external insulin in advanced stages. However, this disease cannot be cured completely and lasts a lifetime. Adding further, Dr Aggarwal, said, "Regular check-ups and timely detection have a vital role to play in controlling and managing this condition. It is imperative for patients to adhere to medication and changes in lifestyle as this can help them lead a normal life." The following lifestyle changes can help manage this condition better. • Eat healthy What you eat affects your blood sugar levels. Consume plenty of vegetables, fruits, and whole grains and limit foods high in sugar and fat. • Exercise For those who are not active, now is the time to start. Walking, cycling, and running are all good to get you going. An active lifestyle helps you control diabetes by bringing down your blood sugar. • Get regular checkups Diabetes raises the odds of getting a heart disease. It is important to keep track of your numbers by getting regular checkups done. • Manage stress Stress shoots up the blood sugar levels. Find ways to relieve stress through breathing exercises, yoga, or hobbies that help you relax.

There is still confusion among doctors regarding the word “Generic”

There is still confusion among doctors regarding the word “Generic” Confusion still prevails among doctors as to what does the word “Generic” mean. I have tried to explain what is a generic drug as below. There are two types of drugs - patented or generic. The patented drugs are introduced in the market by the original company that researched the basic molecule. Let us take the example of Pfizer, which introduced two original molecules - Amlodipine and Sildenafil – and launched them in the international market as Amlogard (Amlodipine) and Viagra (Sildenafil). Being their research molecules, Pfizer had exclusive rights for 10 years based on their patent. These drugs are called patented drugs and the pharmaceutical company will have exclusive rights to them till the patent expires. After 10 years as the patent period expires, other companies can also market these molecules under their own brand name or as generic molecules. These are called non-patented generic version of the drugs. There is no difference by law in the quality of generic or patent versions of the drugs. For example, amlodipine in India is still available as Amlogard (Pfizer) @ Rs. 8/-; however, Dr. Reddy’s Lab also markets it as Stamlo, at less than Re.1/-. Similarly, Viagra (Sildenafil) was introduced @ Rs 600/- during the term of the patent, but the generic version is now available at less than Rs. 25/-. When we are asked to write generic name of the drug/s, this means that we should write the generic version of the drug/s and not the patented drug/s still marketed in India. Prescribing Amlogard or Viagra, when the generic Indian versions are available, cannot be justified. The generic version will be available at fraction of a cost than the patented versions. Let us take another example of the patented drug Clopidogrel, which is available as Plavix (original drug) and Deplatt, the Indian generic version. Plavix costs Rs.100/- and Deplatt Rs 5/-. Why write imported patented versions, when Indian generic versions are available. India is the largest exporter of generic versions of the drugs in the world as they can manufacture drugs at fraction of a cost compared to international brands. The word ‘Brand’ has nothing to do with the words ‘generic’ or ‘patented’ drugs. In India, generic versions of drugs can be sold in the name of molecule (generic-generic) or brand (generic-brand). The only thing that the Indian Medical Association (IMA) wants is that all generic versions of drugs in India should be permitted to be sold only at one price by one company. At present, the generic versions are being sold at three different prices (generic-generic, trade-generic and branded-generic) by the same company. Dr KK Aggarwal National President IMA & HCFI

Cryptosporidium in swimming pools can cause of diarrhea

Cryptosporidium in swimming pools can cause of diarrhea Maintaining pool hygiene and self management are key to warding off this dangerous parasite New Delhi, 19 May 2017: In what can be called as avoiding another risk factor in the summer months, experts have advised against consumption of swimming pool water. Any inadvertent ingestion of even chlorinated pool water can produce cryptosporidium which results in stomach upset. Statistics indicate that the prevalence of this disease in diarrhoea patients in India is 1.3% from Northern India, 4.5% from the eastern part of the country (West Bengal), 5.5% from South to West (Mumbai), and 13.1% from South India.
"Cryptosporidium" or "Crypto", the microscopic parasite can make otherwise healthy adults and children feel incredibly sick with stomach cramps, nausea, and bouts of diarrhea lasting up to three weeks. Once a pool or water playground is infected with crypto, it is easy to spread, but not easy to get rid of. The parasite can survive up to 10 days in properly chlorinated water, and it takes just a swig to get sick.
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 R N Tandon – Honorary Secretary General IMA in a joint statement, said, "The infection begins when a person ingests the one-celled cryptosporidium parasite. There are some strains of cryptosporidium which can cause more serious issues. This parasite can travel to the intestinal tract and settle into the walls of the intestines. Once this happens, more cells are produced and shed in massive quantities into the feces becoming highly contagious with time. It is difficult to eradicate this parasite because of its resistance to many chlorine-based disinfectants and filters." The only way to ensure the health of the water once it has been infected is to close the pool and treat it with extremely high levels of chlorine. At an individual level, it is important to take precautions when swimming in pools. Adding further, Dr Aggarwal, said, "Avoid swallowing any water and rinse it off in the shower once you get out of the pool. It is also better to avoid the pool while you are sick and wait for two weeks after symptoms subside from a suspected case of crypto before going swimming." Additionally, the following steps can be taken as part of self-management against contracting this disease. • Use the toilet before entering the pool • Shower and wash thoroughly all over with soap before entering the pool • Take kids on bathroom breaks. Check diapers, and change them in a bathroom or diaper-changing area–not poolside–to keep germs away from the pool.

New guidelines for ‘deprescribing’ PPIs

New guidelines for ‘deprescribing’ PPIs Proton pump inhibitors (PPIs) are a very commonly prescribed class of drugs for patients with acid peptic disorders. They have been generally regarded as safe and well tolerated. And, their long-term use is common. However, recently, there have been concerns about the use of PPIs, especially long-term use. PPIs have been linked to increased risk of osteoporotic fractures, pneumonia, Clostridium difficile infection and rebound acid hypersecretion, especially in the older population. Long-term use may also affect patient compliance to the prescribed treatment. Evidence-based recommendations published in the May 2017 issue of Canadian Family Physician to help the physician decide when and how to safely stop the PPIs or reduce their dose, called ‘deprescribing’ PPIs. This can be done in three ways: • Reducing the dose by ‘intermittent’ use for a fixed duration; ‘on-demand’ use or using a lower ‘maintenance’ dose. • Stopping the drug can be done by abruptly discontinuing the drug or via a tapering regime. • Stepping down means abrupt discontinuation or PPI tapering followed by an histamine-2 receptor antagonist (H2RA) These guidelines recommends deprescribing PPIs in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease (GERD) or esophagitis, and whose symptoms are resolved. • Decrease the daily dose or stop and change to on-demand use. This has been given a strong recommendation. • Or, an H2RA can be considered as an alternative to PPIs. This alternative has been given a weak recommendation due to the higher risk of symptoms recurring. These recommendations are not applicable to patients who have severe esophagitis grade C or D, or a documented history of bleeding gastrointestinal ulcers or have Barrett esophagus. (Source: Can Fam Physician. 2017 May;63(5):354-364) Dr KK Aggarwal National President IMA & HCFI

All IMA members should trace every positive HIV person

All IMA members should trace every positive HIV person It is imperative to start ART irrespective of CD count or clinical stage once a person is tested HIV positive New Delhi, 18 May, 2017: According to statistics, out of the 21 lakh people with HIV in India, only 14 lakh are on the registry. About two-thirds of people with HIV/AIDS die due to lack of access to antiretroviral drugs (ART). With these statistics as the basis, the IMA has adopted government 90:90:90 strategy: to identify 90% of those infected, place 90% of them on treatment, and ensure 90% have the virus under control. This is a part of IMA's commitment on “ending AIDS by 2030” in line with the Sustainable Development Goals (SDGs). As per the new policy, ART will be provided to anyone tested and found positive for AIDS, irrespective of CD count or the clinical stage they are in. This policy is being propagated in a big way by IMA and is also being practiced by the private sector. Speaking about this pertinent issue, 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, "It is a fact that a majority of people diagnosed with HIV/AIDS in India lack access to the initial and most important phase of treatment. This policy being adopted is for all men, women, adolescents, and children who have been diagnosed with HIV/AIDS. It will improve the lifespan and quality of life of those infected, and save them from many opportunistic infections, especially TB. These benefits begin even when ART is started in early HIV infection, reducing the risk of HIV transmission as well. This collective step by IMA is a small step towards the larger goal of ensuring access to ART for all and achieving the target of ending AIDS by 2030." ART is an effective way of suppressing serum viral RNA levels and increasing CD4 cell counts in the vast majority of patients with acute and early HIV infection. Initiation of ART earlier after initial HIV infection can help in immune reconstitution to normal or near normal CD4 cell levels. Adding further, Dr Aggarwal, said, "In India, ART has been available since 2004. At ART clinics, HIV positive people have access to HTC, nutritional advice, and treatment for HIV and opportunistic infections. The need of the hour is for initiatives that can help provide a larger access to ART for those infected with HIV." People with AIDS still face much discrimination and stigma in the society. Although, India’s treatment programme is an example to the world of what can be achieved through committed collaboration, there is still a long way to go. Much has been learnt from the past experiences and it is important to continue building on the strong foundation created. Free ART, along with care and support services will ensure timely treatment and a positive outcome on this front.