Lifestyle diseases on the rise among professionals

Lifestyle diseases on the rise among professionals Stressful work commitments and unhealthy eating are some leading causes New Delhi, 18 June 2017:* According to a recent survey, about 45% of young professionals suffer from some lifestyle disorder, the most common onesbeing chronic body pain, obesity, hypertension, respiratory disorders, frequent digestive disorders, and high blood sugar levels. Statistics also indicate that one out of four Indians is at a risk of dying from non-communicable diseases like diabetes, cardio-vascular ailments, or cancer before the age of 70. Erratic eating habits, lack of physical activity, and stressful job commitments are some factors that contribute to health disorders among young working professionals in India. Many of them are also aware of the need to modify their lifestyle to improve their health. 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," Apart from the work stress and untimely working conditions, which are the two main contributors of lifestyle disorders, there has also been an increase in the total calorie intake of the average young professional. The diet patterns have transitioned from simple homemade food to easy available processed food. Today, the work culture also encourages smoking and alcohol intake which further makes this generation a sufferer. Lack of sufficient physical activity further exacerbates this condition." Studies have also revealed that many of these young professionals are also dependent on employer provided health insurance schemes and do not have a personal medical insurance. With time being converted to money, and corporate interests and personal ambitions being accorded priority over health, Indian professionals are sitting on a hotbed of lifestyle disorders. Adding further, *Dr Aggarwal*, said, "The need of the hour is to encourage these professionals to adopt a healthy lifestyle. A balanced diet, adequate physical activity, and giving due respect to the biological clock are the only solution. Those with long working hours, taking care of occupational posture is very important. It is imperative for such people to take frequent breaks for stretching and some physical movement in between work. Apart from this, reduced intake of junk food and eating in moderation are some other tips they can implement to avoid the risk of acquiring lifestyle disorders." Here are some ways in which one can prevent lifestyle disorders. - Consume a wholesome diet for overall health and well-being - Strike a balance between food and physical activity - Consume enough water between work hours to keep yourself hydrated - Move your eyes away from the computer screen frequently and walk around for some time - Avoid any kind of addiction such as smoking and alcohol - Keep a watch on your weight - Get periodic health checkups done

Mental disorders manifesting as a silent killer among Indian population

Mental disorders manifesting as a silent killer among Indian population Need to act against the social stigma and prejudice associated with the disorder New Delhi, 17 June 2017: According to recent statistics, about 7.5% of Indians suffer from major or minor mental disorders requiring expert intervention. About 56 million in the country suffer from depression and another 38 million suffer from anxiety disorders. What further exacerbates this situation is the lack of resources, dearth of trained health-care providers, and social stigma associated with mental disorders. Depression is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. On the other hand, anxiety disorders include generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). 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, "Mental illnesses are as serious or probably more serious than any other illness. They too have a biological basis. The same way as cancers develop due to both external and internal factors, so do mental illnesses. Under prolonged stress, the brain desperately searches for ways to relieve the pressure. In the absence of an effective coping mechanism or a good support system, people tend to sink deeper into negative thoughts and behaviours which in turn can affect even daily functioning. The situation is grim in India today with people who are depressed not correctly diagnosed or misdiagnosed and prescribed anti-depressants to treat the problems without understanding the real factors." Research indicates that women are more prone to mental disorders due to factors such as gender discrimination, early marriage, domestic violence, and rapid social change. Some of the common modes of treatment for mental disorders include psychotherapy, medication, hospitalization, peer support, and access to a support group. Adding further, Dr Aggarwal, said, "There is an urgent need to act against the stigma and prejudice associated with mental disorders in India. Depression can be prevented and treated if recognized in time. IMA's campaign called 'Bar Bar Pucho' aims at removing this very stigma. The campaign urges doctors to ask the patient 'If he is ok' at each visit and not just focus on writing a prescription. Doctors should check on the mental wellbeing of the patient including mood, depression, alcohol use, smoking habits, drug abuse, and sexual needs and preferences during every visit. Listening without any preconceived notions or bias will foster trust and help the patient to open up about his/her problems, which itself can be therapeutic." Here are some simple steps to avoid the risk of acquiring mental disorders. • Consume a healthy diet • Get regular exercise • Avoid stress • Discuss your problems with others • Avoid taking alcohol and drugs • Get enough rest • Spread awareness among people to initiate early treatment

Do clinical practice guidelines have legal implications?

Do clinical practice guidelines have legal implications? Call guidelines as guidance or advisories Dr KK Aggarwal National President IMA Clinical practice guidelines are becoming an increasingly common feature of the health care. The government has developed Standard Treatment Guidelines under the Clinical Establishments Act (CEA), for example, for critical care, orthopaedics, cardiovascular diseases, general surgery etc. There are 21 such guidelines. “To ensure compliance with Standard Treatment Guidelines as may be determined and issued by the Central Government or State Government, as the case may be, from time to time” is one of the conditions to be fulfilled for registration and renewal of a clinical establishment under CEA (Clinical Establishments Act FAQs). The government has three functions to perform • Administrative through bureaucracy • Regulatory through Medical Council of India and state councils • Legislative through law ministry Developing guidelines and updating them therefore is not the job of the Govt; instead it should be the job of professional bodies such as medical associations, which represent the collective consciousness of the medical fraternity. Unlike the Medical Associations, the Expert Panel enlisted by the Govt. to develop the guidelines does not represent the collective consciousness medical fraternity. In UK, the guidelines are regularly developed by the National Institute of Clinical Excellence (NICE), Royal medical colleges and the universities. Clinical practice guidelines are recommendations and suggestions that are evidence-based and show potential benefit or harm. They standardize treatment and improve quality of care. But they are not without their limitations. They cannot be generalized i.e. applied on each and every individual. Each patient is different and hence treatment has to be individualized. Also, western data cannot be extrapolated to our Indian settings. There is a need for a balanced perspective. Lawyers should really have no part to play in the development of clinical guidelines, as they are not clinicians. The basic legal premise to work from in designing clinical guidelines is the “Bolam principle”, which would be applied in any dispute about the correctness or otherwise of a clinical guideline. Basically, a clinical guideline would be viewed as proper if it satisfied the Bolam test. Lord Browne-Wilkinson stated in Bolitho v City and Hackney HA [1998] Lloyd's Rep Med 26 the test: "The locus classicus of the test for the standard of care required of a doctor or any other person professing some skill or competence is the direction to the jury given by McNair J, in Bolam v Friern Hospital Management Committee [1957] 1WLR 583,587. “I myself would prefer to put it this way, that he is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of men skilled in that particular art ... Putting it the other way round, a man is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view.” There are many ways to treat patients and any court would look to experts in the medical or nursing professions to help them assess whether the clinical guideline used in the case was proper or not. The views of experts are however not definitive; they may show that a reasonable body of medical opinion may have designed and used a clinical guideline in a certain way, but the judge in the case will have the final say. Issues to be considered when developing clinical guidelines: • The objectives for the clinical guidelines need to be clear, and clearly stated. This will affect their subsequent legal standing. • The intended use and applicability of clinical guidelines should be spelt out clearly, in the introduction. • The guidelines must make clear for whom they are intended. • Clinical guidelines that no longer reflect best practice might conceivably become actionable, and developers need to incorporate specific statements about their validity and review procedure. • They should be constructed in such a way that allows deviation and does not suffocate initiative that might bring about further improvements. • The development of clinical guidelines must involve all the relevant professionals and managers. In Jacob Mathew vs State of Punjab & Anr on 5 August, 2005, the Hon’ble Supreme Court of India has acknowledged that neither the investigating officer or the complainant or judges are experts as they do not have knowledge of medicine. It also held that “one man clearly is not negligent merely because his conclusion differs from that of other professional men … Differences of opinion and practice exist, and will always exist, in the medical as in other professions. There is seldom any one answer exclusive of all others to problems of professional judgment. A court may prefer one body of opinion to the other, but that is no basis for a conclusion of negligence." “Non-adherence to established guidelines does not necessarily bode an adverse outcome for the defendant. Adherence to guidelines may not exonerate the defendant” (J R Soc Med. 2003 Mar;96(3):133-8). So, differ with a reason. You should be able to justify your action or inaction and explain to the Court as to why you took the decision that you did. To remove the confusion and possible legal implications, do not call guidelines as guidelines but as ‘Advisory’ or ‘Guidance’. Dr KK Aggarwal National President IMA & HCFI

Be a Part of IMA-PvPI Pharmacovigilance Initiative

Be a Part of IMA-PvPI Pharmacovigilance Initiative Report Adverse Reactions on +91-9717776514 Pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem. WHO established its Programme for International Drug Monitoring in the year 1968 in response to the thalidomide disaster detected in 1961. The aims of pharmacovigilance are to enhance patient care and patient safety in relation to the use of medicines and to support public health programmes by providing reliable, balanced information for the effective assessment of the risk-benefit profile of medicines. IMA-PvPI Pharmacovigilance Initiative The Indian Pharmacopoeia Commission (IPC), National Coordination Centre (NCC) for Pharmacovigilance Programme of India (PvPI) and Indian Medical Association (IMA) have initiated the ways to promote reporting of Adverse Drug Reactions (ADRs) in the country. The Indian Pharmacopoeia Commission (IPC) is an autonomous institution of the Ministry of Health and Family Welfare, Govt. of India, which was created to set standards of medicines commonly used for treatment of diseases prevailing in our country. The IPC has been functioning as the National Coordination Centre for Pharmacovigilance Program of India (PvPI) since 15th April 2011 to monitor all adverse drug reactions taking place in the country. The mission of PvPI is to safeguard the health and welfare of the Indian population by monitoring drug safety and ensuring that the benefits of use of medicine outweigh the associated risks. IMA is the only representative, national voluntary organization of doctors of modern scientific system of medicine, which looks after the interest of doctors as well as the well–being of the community at large. IMA-PvPI initiative will work towards promoting patient safety in the country. We have agreed to cooperate and work together on the following: • PvPI–IMA patient safety monitoring cell to be started at the IMA Headquarters in New Delhi • Organizing Continuing Medical Educations (CMEs) • IMA to identify the nodal centers for education/advocacy and ADR monitoring and recommend to NCC–PvPI for recognition • Providing training to the nodal coordinators and medical officers • Development and upgradation of a mobile App for ADR monitoring • To propagate the concept of drug safety to patients via eMedinewS Under the IMA-PvPI initiative, Indian Medical Association (IMA) has become a nodal centre for reporting of ADRs under PvPI. IMA is compiling the data of ADRs related to drugs/vaccines/medical devices/blood products and herbal products. You can contact the IMA-PvPI ADR helpline and report any ADR/AE to Mr Hammad Ali on Mobile No. +91-9717776514 from Monday till Friday between 9am and 5:30pm. IMA Members should also report all ADRs - known or unknown, serious or non-serious - due to medicines, vaccines, blood products, herbal products and medical devices to PvPI Helpline No. 1800-180-3024 from Monday till Friday from 9am to 5:30pm. IMA Members should also report ADRs via PvPI ADR Android Mobile App (Download from Google Play Store). At IMA, we are committed to the safety of our patients. Be a Part of IMA-PvPI Pharmacovigilance Initiative. Report ADRs to safeguard your patient. Dr KK Aggarwal National President, IMA Dr RN Tandon Honorary Secretary General, IMA Hammad Ali Patient Safety Pharmacovigilance Associate IMA (HQ)-NCC PvPI Dr KK Aggarwal National President IMA & HCFI

CAD on the rise among young Indians

CAD on the rise among young Indians Heart disease in the young Indian population primarily due to lifestyle and wrong dietary habits New Delhi, 16th June 2017: According to research, about 7% of those between 25 and 40 years of age in the metros suffer from coronary heart diseases (CVD). The incidence of heart diseases is increasing in the younger generation with both men and women equally at risk. Data also reveals that about 50% of all heart attacks in Indians occur under 50 years of age and 25% in Indians under 40 years of age. Those living in the cities are three times more prone to heart attacks than people in the villages. Heart disease is emerging as the number one killer in the country and India is likely to see the highest number of cases in the world. Studies indicate that heart disease has affected the young Indian population 10 years ahead of their Western counterparts. All this can be attributed to a sedentary and unhealthy lifestyle and lack of physical activity. 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 term CVD includes coronary heart disease, heart failure, cardiomyopathy, congenital heart disease, peripheral vascular disease, and stroke. Of these, CAD is the most common form of heart disease affecting young Indians today. CAD or hardening of the arteries results from the build-up of plaque. In this condition, the usually smooth and elastic arteries become rigid and narrowed due to the plaque buildup. Due to this, blood flow to the heart is restricted thereby starving it of oxygen. Further, the plaque could then rupture, leading to a heart attack or sudden cardiac death. The symptoms of CAD include chest pain or angina, or shortness of breath. There could also be unusual symptoms at times such as epigastric discomfort, jaw pain, or left arm pain." Men are more prone to the risk of heart diseases than women. Such gender differences and the genetic impact come under what are known as non-modifiable risk factors. Those at risk must take care to protect themselves early on and undergo frequent health checkups to rule out any possible risks. Adding further, Dr Aggarwal, said, "Factors like sedentary lifestyle and tobacco use, alcohol addiction, foods containing too much salt, and low physical activity increase the risk of high blood pressure, high cholesterol, diabetes and weight gain, all of which lead to heart disease. Those with a family history of heart diseases, diabetes, and hypertension should get the first check up done at the age of 25 followed by subsequent ones. Early detection can help in timely treatment and thereby reversal of heart diseases and the associated risks." Follow the Formula of 80 to live up to the age of 80 without lifestyle diseases including CAD. • Refrain from consuming alcohol. For those who still wish to drink, they should restrict it to not more than 80 ml of alcohol in a day or 80 grams in a week. • It is important to keep one’s blood pressure lower than 80 mm Hg and heart rate lower than 80 per minute. • Do aerobic exercises for 80 minutes a week. • Do stretching exercises for 80 minutes in a week. • Consume at least 80 fruits and vegetables servings in a week. • Do not consume more than 80 ml/gram of ghee, oil and butter in a week. • People at high risk should consult their doctor and consume 80 mg of aspirin for prevention of cardiac disease • People at high risk should consult their doctor and consume 80 mg of statins for prevention of cardiac disease • Reach 80% of your target heart rate when doing heart-conditioning exercises. • Learn hands only CPR, since it can help revive 80% of sudden cardiac arrest patients within ten minutes of their death

IMA Alcohol policy for all

IMA Alcohol policy for all Dr KK Aggarwal National President IMA Doctors are “Brand Ambassadors of Health”, and as part of our professional responsibilities, we not only take care of the health needs of our patients, but also that of the community by advocacy of various public health issues. We prescribe a healthy lifestyle to our patients and emphasize upon them the need to adopt healthy habits and lifestyle. 'Practice What You Preach' is an age-old saying. Doctors have a responsibility to put into practice themselves what they teach their patients about healthy lifestyle. It is also important that we maintain our dignity before the patients, a dictum also laid down in the MCI Code of ethics regulations, which says that “A physician shall uphold the dignity and honour of his profession (1.1.1)”. A patient should be able to trust his doctor and have confidence in him. Any public display of “undignified” behavior erodes the trust in the doctor and gives a bad name to the profession. IMA has formulated an alcohol policy for all its members to follow. • Both 1st July and 5th September are dry days and no alcohol should be served in any function as a mark of respect. • No social alcohol in company of non doctors. • 6 grams (18 ml of whisky) is the social and safe dose of alcohol. • No alcohol should be served in IMA Meets. • If served, follow 6 g limit for relaxation, if can't then less than 10 gram per serving, no second serving in less than one hour and no more than two servings in one day, 50% for women. • IMA host should ensure that guests do not drive back, if they are served alcohol. • One standard peg = 10 g (1 ml alcohol = 0.8 g) = 30 ml of 80 proof whisky with 40% alcohol • 12 g = 360 mL beer, 150 mL wine, or 45 mL of 80 proof distilled spirits • Liver can metabolize 10 gm of alcohol in one hour (50% in women) Dr KK Aggarwal National President IMA & HCFI

IMA demands zero tolerance and stringent law against quackery

IMA demands zero tolerance and stringent law against quackery • Lack of awareness on the recognized and registrable systems of medicine • Quacks endangering many lives due to zero knowledge New Delhi, 15 June 2017: Amidst many cases of patients in print and electronic media every day, who have suffered major health setback or even died while receiving allopathic treatment from unqualified quacks, the IMA has demanded zero tolerance for quackery in the medical profession. The Association recently concluded the Dilli Chalo movement, where one of the major demands was the formulation of a stringent, central anti-quackery law. Further, the IMA has urged that anyone who is not qualified or not registered, if practices a system of medicine, should be punishable for a term, which should extend up to ten years and with stringent fine. The recognized and registerble systems of medicine are modern medicine or Allopathy, Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy. All other unrecognized systems of medicine are illegal and cannot be practiced without permission of the institutional ethics committee and a registry under a clinical trial as prescribed in the Drugs and Cosmetics Act. Speaking on this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "It is a settled law that quacks are untrained and cannot diagnose or treat routine and emergency situations. They will invariably miss the diagnosis of acute heart attack, paralysis, meningitis, early cancer, early rheumatoid arthritis, appendicitis, acute abdomen, acute pregnancy situations, dissection of aorta, pulmonary embolism, etc., leading to high mortality and morbidity. Their modus operandi is based on referral practice to corporate set ups with a desire of getting commissions. It takes over a decade for a modern medicine doctor to acquire sufficient knowledge to decide which antibiotic should be prescribed in a certain situation and which should be avoided. It’s not mathematics. One cannot learn medicine via Google or following the prescriptions of modern medicine doctors. Every case is different and therefore, treatment should be individualized according to a particular patient." Additionally, the Association feels that most preventable deaths can be traced to ignoring warning signals or self-prescriptions or relying on medicines by quacks or chemists. It further put forth that all registered practitioners should fearlessly indicate: 'I am proud to be a qualified and registered doctor' and 'I am not a quack who lives on cuts and commissions'. Adding further, Dr Aggarwal, said, "Lack of awareness among state governments, the legislature(s), judiciary, and doctors themselves regarding the danger posed by quacks and about non-entitlement of practitioners of Indian Medicine and various contradictory government and court orders have compounded the problem of quackery. All this has put the health of the people especially the poor, critically ill, women, and children, at stake. The need of the hour is to act against quacks wherever any of us come across them." IMA urges one and all to beware of quacks as they indulge in cuts and commissions, will never refer the patient in time, invariably give steroids in every case, and will over investigate the patient to appear genuine. On the other hand, one should have faith in registered and qualified doctors as they do not indulge in unethical practices, do not take or give commissions, work with the primary aim and dharma of healing and not financial gain, believe in Karma and not Kriya, and will always guide patients with the best of interest.