Friday, 27 February 2015

Indian needs extra health budget fort Rare Diseases

Rare Diseases day was observed on 27th February to raise awareness about rare diseases and improve access to treatment and medical representation for individuals with rare diseases and their families.

Addressing a press meet Padma Shi Awardees, Dr A Marthanda Pillai and Dr K K Aggarwal; National President and Honorary Secretary General IMA, said that rare diseases does not mean they should be rarely read.

A Supreme Court Judgment (appeal 2867 of 2012) quoted  "Finally, we hope and believe that the institutions and individuals providing medical services to the public at large educate and update themselves about any new medical discipline and rare diseases so as to avoid tragedies such as the instant case where a valuable life could have been saved with a little more awareness and wisdom from the part of the doctors and the Hospital. "

IMA has advised the medical students not to ignore reading about rare disease and the practicing doctors to update their knowledge about rare diseases.

IMA wants separate budget for the same In two recent high court judgments, the court had said    "....on account of lack of Government planning, there is ‘pricing out’ of orphan drugs for rare and chronic diseases, like Gaucher. The enzyme replacement therapy is so expensive that there is a breach of constitutional obligation of the Government to provide medical aid on fair, reasonable, equitable and affordable basis. By their inaction, the Central and the State Governments have violated Articles 14 and 21 of the Constitution.

•     "... Just because someone is poor, the State cannot allow him to die. In fact, Government is bound to ensure that poor and vulnerable sections of society have access to treatment for rare and chronic diseases........"

•     ".............After all, health is not a luxury and should not be the sole possession of a privileged few."

The court also took serious note of the limited availability of affordable treatment for persons with neglected diseases like Haemophillia and ensured that the State Government provide treatment free of cost, as part of its obligation under Article 21 of the Constitution of India.

Some of the rare disease

 Amyotrophic Lateral Sclerosis; Cystic Fibrosis; Ebstein Anomaly; Factor XII Deficiency; Fanconi Anemia; Friedreich Ataxia; Gaucher Disease; Hirschsprung Disease; Huntington Disease; Multiple Endocrine Neoplasia Type 1; Tourette Syndrome; Wegener Granulomatosis; Weil Disease;  Zollinger-Ellison Syndrome; von Willebrand Diseases etc. 

Thursday, 26 February 2015

Do not add an NSAID to a patient on dual anti platelet therapy after a heart attack

 IMA Alert

Do not add an NSAID to a patient on dual anti platelet therapy after a heart attack

It might boost bleeding risk, even if taken briefly as a painkiller.

Adding another NSAID atop recommended dual anti-platelet therapy with aspirin and clopidogrel  in a study was associated with 2.41-fold higher risk of bleeding requiring hospitalization than the same regimen without an NSAID. The study led by Anne-Marie Schjerning Olsen, MD, PhD, of Copenhagen University Hospital is published in JAMA Feb issue.

The same was true for an NSAID added to a regimen of oral anticoagulants plus any other single anti-platelet drug.

The association with increased risk was observed for all antithrombotic treatment regimens, and the association was apparent regardless of whether selective COX-2 inhibitors (rofecoxib and celecoxib) or nonselective COX inhibitors (ibuprofen and diclofenac) were involved.

There was no safe therapeutic window for concomitant NSAID use, because even short-term (0-3 days) treatment was associated with increased risk of bleeding compared with no NSAID use.

Overall, receiving an NSAID versus no NSAID was associated with 40% higher risk of cardiovascular events and 2.02-fold higher risk of bleeding requiring hospitalization.

While NSAIDs can be helpful and at times necessary medications for satisfactory quality of life, use of these medications among patients with a history of a recent MI is likely to be associated with clinically meaningful bleeding and ischemic risks. [Source: MedPage]

Wednesday, 25 February 2015

UNICEF and Indian Medical Association partner against Child Sexual Abuse

UNICEF and Indian Medical Association partner against Child Sexual Abuse (CSA)
Launches 10-key action points about CSA, for medical practitioners

NEW DELHI, February 25, 2015:  UNICEF and the Indian Medical Association (IMA) have joined hands to strengthen the response of medical practitioners in identifying, reporting and treating cases of child sexual abuse.

CSA is a widespread phenomenon and can cause lifelong consequences on the physical and mental health of a child In India, 4.5% of girls aged 15-19 have been subjected to sexual abuse [1]. Boys are also exposed to sexual violence but usually to a less extent.

In 2012, India adopted the Protection of Children from Sexual Offences (POCSO) Act, a comprehensive law which defines a child as any person below the age of 18. The Act applies to all cases of sexual assault on a child. It defines sexual offences as penetrative sexual assault (Section 3), (non-penetrative) sexual assault (Section 7), sexual harassment (Section 11) and use of a child for pornography (Section 13).

Any sexual activity with a child is a crime.

Announcing the special partnership, UNICEF India and the IMA said that they will equip medical practitioners with a detailed understanding of diverse facets of child sexual abuse (CSA), along with relevant legal provisions. Medical practitioners are often the first point of contact in a child sexual abuse case, and are required to take prompt action to ensure immediate and effective treatment of the child.

The program aims to build a nation-wide cadre of doctor-trainers who can later disseminate the knowledge at different levels. Under the supervision of IMA state branches, these doctor-trainers will take the training forward to state and district levels.  To assist these trainers, UNICEF has provided technical support to IMA for the preparation of a Teaching Manual, and Key messages for doctors. The focus will be to inform and implement 10-key action points about CSA that every doctor should know while handling cases of sexually abused children.

Addressing a press conference David McLoughlin, UNICEF India Deputy Representative, said, “Violence against children is all too often unseen, unheard and underreported. This partnership with the medical fraternity of the country will play a key role in strengthening the care for child survivors and in bringing new ideas and expertise to support our mission in generating awareness among medical and allied professionals”.

“Medical professionals have a critical role to play in the prevention, detection and response to sexual offences against children. They are often the first point of contact who come across a child abuse case and are required to take prompt action to ensure immediate and effective treatment of the child,” said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr KK Aggarwal, Honorary Secretary General IMA in a joint statement.

“Every case of child sexual abuse has to be taken as medical emergency. Treatment has to be provided free of cost by the government as well as private medical facilities. In a case of sexual assault of a child, it is the legal duty of a doctor to give medical care, collect forensic evidence, report the offence to the police and give testimony in court if required. Under Section 166B of the Indian Penal Code (IPC), a doctor who refuses to perform a medical examination in a case of sexual assault can be punished with imprisonment up to one year and / or fine” are a few of the messages to be known by every doctor in the country added Dr. Aggarwal.

Releasing the set of 10 key action points about CSA, for medical practitioners, Dr. Aggarwal added, “These messages will be distributed to more than 2.5 lakh medical doctors through 30 state level branches and 1700 district branches of IMA.”

Supporting the initiative, eminent Indian classical dancer and choreographer Padma Vibhushan Awardee, Dr. Sonal Mansingh said, “All children have the right to live free from violence. We believe that they are closer to God and therefore any violence on them is a sin. Violence harms their physical and mental growth. Violence against children is entirely preventable, when people come together and say that it is not acceptable. When they make the invisible visible. I appeal to one and all to support the initiative whole-heartedly and respect their dignity and self esteem.”

In addition to developing the capacities of medical practitioners, the two organizations, together with media partners, will pool resources to strategize and provide a platform to create a discourse on child sexual abuse in India.

This association is another step forward in UNICEF’s work to address violence against children and hence it also becomes a very important part of UNICEF’s campaign to ‘End Violence against Children’.

Launched by UNICEF as a global initiative, the ‘End Violence against Children’ campaign builds on the growing consensus that violence against children can no longer be tolerated and that serious attention and collective action are required to reduce violence against children.
Several other  celebrities have voiced their concern and pledged to protect children against violence. A video capturing voices of UNICEF celebrity Ambassadors and advocates was screened at the launch today.

Veteran actor Amitabh Bachchan, has called everyone to fight against child abuse, “Join us. Speak up,” he says in an audiovisual message. Madhuri Dixit Nene says, “Children deserve a serene childhood, without humiliation, suffering and violence.” Farhan Akhtar, director and actor, says, “Every single one of us knows there is violence and that it is perpetuated on the most helpless, fragile citizens amongst us all—children.” Ace cricketer Virender Sehwag says violence is never the answer to anything. It breaks children’s trust in you. Actor Priyanka Chopra says, “Children trust easily and that trust must never be broken.” She pledged to break the silence of every child who suffers alone. Kareena Kapoor Khan said, “Violence against children is no way to show concern or discipline.” To see, other celebrity pledges, please visit
The UNICEF-IMA project will also aim to advocate for training on child sexual abuse in the curriculum for medical students and doctors through Medical Council of India and the Ministry of Health & Family Welfare of the Government of India.

Thursday, 19 February 2015

Prefer Half-Dose Influenza Vaccine in view of the shortage of the vaccine

From a public health standpoint, it would be better to vaccinate many people with lower doses than fewer people with full doses when vaccine supplies are scarce, said Padma Shri Awardee Dr A M Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.

A study published in 2009 in Archives of Internal Medicine has shown that half dose flu shots are effective in adults, especially in women and those younger than 50, and offer a viable way to stretch supplies during vaccine shortages.

Earlier in June 2000, a NIAID conducted trial, published in journal Vaccine concluded that the immune responses to the full dose were higher, on average, than immune responses to the half dose vaccine but should a public health emergency arise, half-dose influenza vaccines for healthy adults might be an acceptable strategy if the vaccine supply is substantially limited.

Wednesday, 18 February 2015

Triad of swine flu prevention: respiratory hygiene, cough etiquette, and hand hygiene

Median incubation period is 1.5 to 3 days.

Virus shedding begins the day prior to symptom onset and often persists for five to seven days or longer in immunocompetent individuals. Even longer periods of shedding may occur in children, elderly adults, patients with chronic illnesses, and immunocompromised hosts

Respiratory transmission occurs mainly by droplets disseminated by unprotected coughs and sneezes.

Prevention lies in implementing respiratory hygiene, cough etiquette, and hand hygiene

Respiratory hygiene and cough etiquette applies to all patients and accompanying family or friends who have signs of respiratory illness such as cough, congestion, nasal discharge or increased volumes of respiratory secretions.

Maintain distance of 3-6 feet from a person who is coughing or sneezing , cover coughs and sneezes with disposable tissues and wash hands if get spoiled with respiratory secretions.  Do not cough in the hands or cloth handkerchief. Use tissue paper or cough on the sides of your sleeves.

Frequent hand hygiene should be performed, including before and after every patient contact, contact with potentially infectious material, and before putting on and after taking off personal protective equipment, including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol-based hand rubs. If hands are visibly soiled, they should be washed with soap and water.

All doctors should take steps to minimize elective visits ( telephone consultations for patients with mild respiratory illnesses)

In clinics all doctors should provide face masks to patients with signs and/or symptoms of respiratory infection and provide them space and encourage patients with respiratory symptoms to sit as far away from others as possible

Ask patients to avoid visiting crowded enclosed spaces.

Monday, 16 February 2015

Who needs anti viral drugs in swine flu

1.    In Us 0.3% of all cases require admissions
2.    The mortality rate of flu pandemic is 0.12 deaths per 100,000 population
3.    Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years
4.     Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features
a)    Flu requiring hospitalization
b)    Progressive, severe, or complicated flu
c)    Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)
d)    Swine flu at high risk for complications:
·         Children <5 years particularly those <2 years
·         Elderly ≥65 years
·          Pregnant women
·         Women up to two weeks postpartu
·         Residents of nursing homes and other chronic care facilities
·         Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases  and morbid obesity.

5. Severity of flu
·         Asymptomatic swine flu:
            Many contact illnesses may pass off without symptoms. In all  19 percent had                         serologically confirmed infection and 28 percent of those who were infected may                      remain asymptomatic.

·         Mild or uncomplicated Swine Flu ( require no treatment, no hospitalization, no investigations)
            Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills,                               malaise, and sometimes diarrhea and vomiting
            No shortness of breath
            Little change in chronic health conditions.

·         Progressive illness. Requires hospitalization
            Above symptoms plus
            Chest pain
            Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)
            Low blood pressure
            Confusion, altered mental status
            Severe dehydration
            Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or                       other cardiovascular conditions

·         Severe or complicated illness requires hospitalization
            Signs of lower respiratory tract disease
            Low oxygen requiring supplemental oxygen
            Pneumonia on X ray
            Brain involvement
            BP lower than 80, organ failure
            Heart involvement
            Persistent high fever and other symptoms beyond three days

Saturday, 14 February 2015

Should I give fitness for air travel to an asthmatic or a patient with heart failure?

·         Aircrafts cabins have pressurization but flying at a high altitude can lower oxygen levels in patients with underlying lung disease.

·         Patients at risk need supplemental oxygen during the flight.

·         Screen such patients with pulse oximeter at rest and breathing room air.

·         If SpO2 is above 95%: give them clearance. They do not need further testing.  If person has serious illness but with SpO2 above 95, better to do six minutes walk test as described below.

·         If SpO2 <92% : the person will need supplemental oxygen in-flight

·         If SpO2 is between 92 and 95%. Look for risk factors. If absent give them clearance. If present make them undergo a six minutes walk test. During test de-saturation to a SpO2 <84 percent indicates the need for in-flight oxygen.

·         If the patient is on oxygen at room air, increase the oxygen flow 1 to 2 L/minute over baseline while in flight.

·         Supplemental oxygen may be derived from approved portable oxygen canisters or oxygen concentrators.

·         Airlines allow use of portable oxygen concentrators throughout the flight but a medical prescription is needed.

Friday, 13 February 2015


Indian Medical Association will be coming out with an Emblem for medical profession which will differentiate doctors from modern system of medicine from doctors of other systems of medicine.

Giving the details Padma Shri Awardee Dr (Prof) M Marthanda Pillai, National President and Padma Shri Awardee Dr K K Aggarwal, Hony Secretary General IMA said that there is an urgent need for a new medical Emblem which can be used by all doctors who practice modern medicine so that public is not confused about the pathy they are approaching for treatment.

Today, doctors from all system of medicine prefix their name with the word “Dr” which cannot differentiate the system of medicine they practice. Even unqualified persons and quacks have also started using the prefix “Dr”.

The Association has asked all its 30 branches to send their suggestions and a suggested Emblem. The Association will also award a prize of Rs. 25,000/- for best selected Emblem.

Once selected by IMA, the Emblem will be sent to the Ministry of Health and Family Welfare, Govt. of India and Medical Council of India for approval, added Dr Aggarwal.

Letters are also being issued to all medical colleges to involve their students in designing the same.


1.      Health budget should be 6% of GDP.

2.      Central funding should contribute to at least 60% of government spending in health
3.      Primary level health care should be made free for all citizens.

4.      Since many of the factors like protected water, sanitation, nutrition, shelter, drug manufacturing and quality assurance etc related to health indices are dealt with different ministries, budget allocation to related ministries should be increased under the above heads.

5.      Rs 50,000 Crores should be earmarked for “Cure in India Project”. This project to be earmarked for creating awareness and promoting indigenous manufacturing of kits, reagents and biomedical equipment/devices.

6.      Provision to be made for “Indian Health Act 2015” where a single window registration system should be done for medical establishments. At present 72 such registrations are required.

7.      Rs 50,000 Crores to be set apart for promoting digital health.

8.      Health care should be declared as a service sector.

9.      Health Care Establishments should be given infrastructure status.

10.  List of Life saving equipments should be expanded and completely exempted from all taxes and duties.

11.  Rs 50000 Crores should be earmarked for

a.       Promoting Medical, Drug and Public Health Research by setting up “Medical Research Parks” across the country in line with the Techno parks.

b.      CME programmes for health care providers for updating the medical knowledge and recent advances.

12.  Just like aided schools, “Aided Hospitals” should be promoted. In turn such hospitals should provide 15% free service to the poor.

a.       Subsidy in electricity, water, building tax.

b.      Interest free loans for starting new hospitals, nursing homes, dispensaries and clinics in rural areas

c.       Health care providers should be given subsidy for solar power and digital health.

d.      10 year moratorium for repayment of loans.

13.  Financial provision should be made for starting government medical colleges

a.       In rural areas where no health facility is available.

b.      In states / districts where government medical colleges are not available proportionate to the population.

14.  Special fund should be allocated to solve the problem of non availability of doctors in PHC’s /CHC’s. These PHC’s /CHC’s should be considered as special / difficult PHC’s /CHC’s. Special privileges should be provided like

a.       The salary for medical personal should be three times in these difficult PHC’s / CHC’s

b.      Just like railway colonies nearby railway stations, colonies for medical personals including schools, shops and other common facilities should be provided.

c.       Services of nearby practicing doctors in the private sector should be utilized on a retainership basis.

d.      Reservation for PG admission should be given for those doctors working in difficult PHC’s and CHC’s.

15.  Every doctor/clinical establishment providing charity services should have tax exemption for the amount spend on charity.

Thursday, 12 February 2015

Prohibition of use of Polyethylene Terephthalate in liquid oral formulations for primary packaging of drug formulations

(Department of Health and Family Welfare)
New Delhi, the 29th September, 2014

G.S.R. 701(E).—The following draft rules which the Central Government proposes to make, in exercise of the powers conferred by clause (i) of sub-section (2) of section 33 read with section 26A of the Drugs and Cosmetics Act, 1940 (23 of 1940), on the recommendation of the Drugs Technical Advisory Board, is hereby published for the information of all persons likely to be affected thereby; and notice is hereby given that the said draft rules shall be taken into consideration on or after the expiry of a period of forty-five days from the date on which the copies of the Gazette of India containing this notification is made available to the public;

The objections and suggestions, if any, received from any person with respect to the said draft notification within the period so specified shall be taken into consideration by the Central Government;

The objections and suggestions, if any, may be addressed to the Under Secretary (Drugs), Room No. 523-A, Ministry of Health and Family Welfare, Government of India, Nirman Bhawan, New Delhi – 110011.

Draft Rules

1. Short title and commencement.—(1) These rules may be called the Prohibition of Use of Polyethylene Terephthalate or Plastic containers for primary packaging of drug formulations for using in certain cases Rules, 2014.

(2) They shall come into force after a period of one hundred and eighty days from the date of its final
publication in the Official Gazette.

2. Prohibition of use of Polyethylene Terephthalate in liquid oral formulations for primary packaging of drug formulations.—No manufacturer shall use the Polyethylene Terephthalate or Plastic containers in liquid oral formulations for primary packaging of drug formulations for paediatric use, geriatric use and for use in case of pregnant women and women of reproductive age group.

3. Penalty for contravention.—Any manufacturer who contravenes the provisions contained in rule 2 shall be liable to penalty under the provisions of the Drugs and Cosmetics Act, 1940.

[F. No. X.11014/10/2013-DFQC]
K. L. SHARMA, Jt. Secy.

Printed by the Manager, Government of India Press, Ring Road, Mayapuri, New Delhi-110064

and Published by the Controller of Publications, Delhi-110054

Wednesday, 11 February 2015

Health Budget should be 5% of the GDP : IMA

Increase the health budget; promote cure in India concept reserve money for digital health and medical research and provide subsidy to doctors and medical establishments who provide concessional services to the poor are a few of the suggestion sent to the finance ministry by the  Indian Medical association.

Giving the details Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA said that doctors to open a medical establishment needs clearances from over 72 acts and unless there is a single window registration concept the cost of medical treatment will not come down.

Here are the suggestions sent

1.      Health Budget should be 5% of the GDP.

2.   Rupees 500 Crores should be earmarked for “Cure in India” Project. This project to be earmarked for creating awareness and promoting indigenous manufacturing of kits, reagents and equipment devices.

3.  Provision to be made for Indian Health Act 2015 where single window registration should be done of medical establishments.  At present 72 such registrations are required.

4.      Rupees 1,000 crores to be reserved for promoting digital health (Cure & Learning)

5.      Health to be given an infrastructure status

6.      Medical services should be declared as a service industry.

7.      Interest free loan be provided for opening a medical college in rural area.

8.      Life saving equipments should be exempted from all duties.

9.      Rupees 1,000 Crores should be earmarked for promoting research and CME Programmes for health care providers.

10.  Health care providers should be given subsidy for solar power and digital health.

11.  Honeymoon period of 10 years should be given for new medical establishment for loan.

12.  Small Medical establishment and single doctor clinic who are ready to provide 15% free service should be given the status of aided Hospitals like the aided school.

13.  New Medical Colleges should be opened in rural areas where already no medical college exists by the Government.

14.  Permission for opening medical colleges should be given in the rural areas on fixed criteria ie states which do not have medical college proportionate to the population and areas where health care facilities is not available.

15.  In all life saving conditions where private medical establishments are supposed to provide free service, compensation should be given by State on CGHS rates.

16.  For doctors who want to serve in rural areas, salary should be 3 times more and should have facilities for accommodation education like Railway Colony near railway stations.

17.  Every doctor and hospital who does charity, should be given the same exemption as are provided in Section 80G of Income Tax Act.

Tuesday, 10 February 2015

Reactive depression can last for a few months

Politicians, who have lost the election, can suffer from anxiety and reactive depression which may last from a few weeks to months said Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India.

They should take it easy and not isolate themself. The best way is to communicate and communicate with others to take the depression away.

Heart and diabetic patients should be especially careful and ask their doctors if they need extra dose of their regular medicine.

Sudden anxiety can precipitate asthma, heart attack and make the blood pressure rise to a very dangerous level.

Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute heart attack. Episodes of anger are capable of triggering the onset of acute heart attack and aspirin can reduce this risk.

DNB not equivalent to MD or MS

No.MCI-4(3)/2014-Med./ MEDICAL COUNCIL OF INDIA/ POSTGRADUATE MEDICAL EDUCATION COMMITTEE/ Minutes of the Postgraduate Medical Education Committee meeting held on 9th September, 2014 at 10.30 am at MCI office:

Those who pass DNB from a Non-teaching Hospital (other than Medical Colleges / Teaching Institutions recognized by MCI as Teaching Institutions) would be required to have further three years experience as Junior Resident in a Teaching Hospital, before they could be considered eligible for appointment to the post of Senior Resident. They would also be required to work for another one year as Senior Resident (after DNB) in a Teaching Hospital before they could be considered as eligible for appointment to the post of Assistant Professor.

Those who pass DNB from a Teaching Hospital (Medical College / Teaching Institution) would be eligible for appointment to the post of Senior Resident. However, they would be required to work for another one year (after DNB) as Senior Resident/Equivalent post in a Teaching Hospital before they could be considered eligible for appointment to the post of Assistant Professor.

Monday, 9 February 2015

IMA Mental Health Initiative

Mental health has been neglected for too long in our country. It should be given priority to foster the health of our people. According to WHO, among the 10 diseases causing maximum Global Burden of Disease, five are mental and substance use disorders.

IMA will encourage mental health activities through all its 1700 branches. Since there is a glaring treatment gap, mental health through Primary Care will be encouraged said Padma Sheri Awardee Dr A Marthanda Pullai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.
IMA will undertake Mental health awareness programmes at a national level and World Mental Health Day will be observed on Oct 10 and Week in association with Indian Psychiatric Society and World Psychiatric Association, added Prof Roy Abraham Kallivayalil, Chairman , IMA Mental Health Initiative.                                                       

IMA will take up the matter with MCI that adequate training in Psychiatry and examination during MBBS is a must.

IMA will help establish Psychiatry Units in all Taluk and District Hospitals of the country. Uniform De-addiction Protocols for general practitioners would be started.
Regarding the new Mental Health Care Bill being introduced the Lok Sabha, IMA feels that the proposed Bill is severely deficient in many respects. General Hospital Psychiatry Units should be outside the purview of this Bill. MHC Bill in its present form is unacceptable to IMA and the same should be withdrawn or thoroughly revised in consultation with IMA and Indian Psychiatric Society.

Proposed new Mental Health Care Bill: IMA Objections

It is a bill that is meant to promote and protect the rights of the mentally ill,  but falls short of the expectations and the mandate of the very bill itself.

The mentally ill being vulnerable sections of society need their rights protected in all circumstances and the mandate “protection of the rights of the mentally ill during delivery of treatment” is a very narrow view of the rights of the mentally ill.

As the bill seeks to bring in all types of mental health care facilities under its ambit where admission procedure, discharge policy, treatment decisions will be placed under the control of non experts/non professionals, it will delay and deprive timely treatment of many.

It will stigmatize mental illness and artificially delink the treatment of mental illness from that of physical illness thus compromising on the quality of care. 

In India, there are not enough psychiatric hospitals to take care of the mentally ill and the right of families to get them treated has been taken away in the bill. 

Moreover, several concepts such as that of a nominated representative, advance directive, and exclusion of families from treatment decisions and responsibilities are extremely negative provisions, totally alien to Indian society, which will be unenforceable and lead to the severely mentally ill being exploited, disrupting the social fabric of society by social exclusion, roaming on the streets as they will neither be in hospitals nor in homes. 

Free, easy, convenient access to treatment of mental illness in general hospitals has been curbed. No distinction is made between the services or care centres treating minor mental illnesses or such major illnesses that have good prognosis and potential for quick recovery, from those, where patients have severe illnesses with impaired reasoning and insight who either do not voluntarily seek treatment or do not have families to bring them into treatment or are in need of long term supervised care in hospitals.  

Sunday, 8 February 2015

IMA members to offer 10% discount to elderly citizens

In a  national office bearers and all state presidents and secretaries meeting chaired by Dr A Marthanda Pillai IMA National President it was decided that all IMA members in the country will be requested to give 10% discount to all citizens above the age of 65.

It was also agreed that similar discounts will be offer to all girl child born in the country.

Giving the details Dr K K Aggarwal honorary secretary general IMA said that IMA has a special program welcome the girl child. Similarly the elderly needs to be taken care off as they need special attention.

The two days meeting held in Delhi was attended by over 100 IMA leaders from cross the country. 

Monday, 2 February 2015

IMA FLU update on anti viral drug oseltamivir : Mild to moderate flu requires no anti viral drugs

People do not die of swine flu but of swine flu pneumonia and other complications. So no breathlessness no panic, said Padma Shri Awardees Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General IMA in a joint statement.
Flue means fever with muscle pains, cough and cold. In patients with mild to moderate disease in whom the symptoms aren't going to last long anti viral drugs and tests are not needed.

"But at this time of year, if someone has fever of 103°F with massive muscle aches and a cough its is swine flu unless proved otherwise. It is justifiable to start swine flu anti viral drug within 48 hours of onset of symptoms even without going for the test. But if one has low-grade fever and feels just a bit poorly, no drug or test may be prescribed " added Dr Aggarwal.

" Remember if you need to give then give antiviral agents as early as possible. If you start the drug within 48 hours of onset of symptoms, you will see an improvement of about 30 hours in time to getting better, but if you start the drug after 48 hours, there is no discernible benefit" said Dr Aggarwal.
IMA guidelines said that " however in hospitalized patients treating these patients more than 48 hours after onset of symptoms still provides some benefit".

As per CDC and IMAS guidelines, for someone who is sick enough to be in the hospital and perhaps in the ICU, using the 48-hour cut-off for treatment is not appropriate. However, it is still important to start treatment as early as possible, because 24 hours results are better than 48 hours and 48 hours results are better than 96 hours in terms of reduction in ICU admission or death.

About antibiotics IMA guidelines said that out of 99 influenza cases less than one will get bacterial super infection leading to pneumonia. It is true that flu predisposes to bacterial pneumonia but giving an antibiotic will not prevent it. And if you treat all 99 of them with antibiotics there will be more complications like rashes, diarrhea and drug resistance than benefits.

Sunday, 1 February 2015

The insurance claim should not insist on intra venous line for admission: IMA

In a letter written to the Shri. T. S. Vijayan, Chairman  Insurance Regulatory and Development Authority of India, Indian Medical Association has asked the IRDA to intervene in many aspects as the current policies are injurious to the health of community.

Writing to the regulatory body, Recipient of Padma Shri Dr A Marthanda Pillai, National President and Recipient of Padma Shri, Dr B C Roy National Award and National Science Communication Award, Dr K K Aggarwal, Honorary Secretary General, Indian Medical Association said that " insurance claims often insist on 24 hours admission.  " The duration should be decided by the team of doctors and not the policy. Shorter the duration less will be the chances of hospital acquired infection and readmission rates. Infect there should be bonus if the admission is short and re admission rates are lower."

The insurance claim should not insist on intra venous line for admission. Most of the time the cash facilities are denied if the doctors have not used IV lines.  Doctors are forced sometimes to give IV drugs which is against the WHO policy of safe syringe practices. On the other hands bonus should be given for not using UV lines and switching early from IV to oral therapy.

IRDA must prevent delay in post discharge processing which at times can be up to 6 hours. This unnecessary occupies the bed and more chances of hospital acquired infections.

IRDA should not appoint doctors fron non modern systems of medicine to process claims and raising technical questions. It ends up in injustice to the community

IRDA must make sure that no agencies mushroom for getting TPA empanelment. This has started happening. Make sure that there is no brokerage, commission and fees etc. by agents in the process of empanelment.

IRDA must approve all government approved Nursing Homes for cash less empanelment.

 Process of Preferred Network (PN) Hospital is also a sort of brokerage being charged by TPAs as people who are offering more discounts / cut backs are given empanelment.  This is also against medical council of India rules

IRDA must revise GIPSA rates. These were pushed by four insurance companies without going into the costing and needs revision. They have not been revised since 2010 despite escalation on account of increased salaries of staff / nurses and all other establishment charges. Also GIPSA mechanism is not bothered about the quality as they apply the principle of L-1 rates.  GIPSA makes the system non competitive and is highly subsidized in favour of TPA.  GIPSA is not a declared policy and driven by controller i.e. Insurance business. We must follow L-1 rates while matching apple to apple.

TPA companies also need to be tightened up. They do not make payment even after sanctioning or reduce the payment.  They have not been able to put the grievance Redressal system so far. Also TPA does not take into account difference in provisional and final diagnosis.  Based on tests if the final diagnose is different with provisional diagnosis claims are denied altogether even if there is enough supportive documents are there.  This indirectly forces hospitals and doctors to manipulate records which is unethical and illegal.

Finally the claim payments need to be enhanced as the premiums have been revised by 40%

IMA White Paper: What every doctor must know about THE DRUGS AND MAGIC REMEDIES (OBJECTIONABLE ADVERTISEMENTS) ACT, 1954

•             The act controls the advertisement of drugs in certain cases, to prohibit the advertisement for certain purposes of remedies alleged to possess magic qualities

•             The act extends to the whole of India except the State of Jammu and Kashmir

•             “Advertisement” includes any notice, circular; label, wrapper, or other document, and any announcement made orally or by any means of producing or transmitting light, sound or smoke

•             “Drug” includes- A medicine for the internal or external use of human beings or animals; any substance intended to be used for or in the diagnosis, cure, mitigation, treatment or prevention of disease in human beings or animals; any article, other than food, intended to affect or influence in any way the structure or any organic function of the body of human beings or animals

•             “Magic remedy” includes a talisman mantra kavacha, and any other charm of any kind which is alleged to possess miraculous powers for or in the diagnosis, cure, mitigation treatment or prevention of any disease in human beings or animals or for affecting or influencing in any way the structure or any organic function of the body of human beings or animals

•             “Registered medical practitioner” means any person: Who holds a qualification granted by an authority specified in, or notified under Section 3 of the Indian Medical Degrees Act, 1916 (7 of 1916) specified in the Schedules to the Indian Medical Council Act 1956 (102 of 1956); or  who is entitled to be registered as a medical practitioner under any law for the time being in force; in any State to which this Act extends relating to the registration of medical practitioner

•             “Taking any part in the publication of any advertisement includes- The printing of the advertisement; The publication of any advertisement outside the territories to which this Act extends by or at the instance of person residing within the said territories

•             Prohibition of advertisement of certain drugs for treatment of certain diseases and disorders. 

No person shall take any part in the publication of any advertisement referring to any drug in terms, which suggest or are calculated to lead to the use of, that drug for-

 (a)       The procurement of miscarriage in women or prevention of conception in women; or

 (b)       The maintenance or improvements of the capacity of human beings for sexual pleasure; or

 (c)       The correction of menstrual disorder in women; or

 (d)       The diagnosis, cure, mitigation, treatment or prevention of any disease, disorder or condition specified in the Schedule, or any other disease, disorder or condition (by whatsoever name called) which may be specified in the rules made under this Act;

Provided that no such rule shall be made except-

 (i)        In respect of any disease, disorder or condition which requires timely treatment in consultation with a registered medical practitioner or for which there are normally no accepted remedies, and
 (ii)       After consultation with the Drugs Technical Advisory Board constituted under the Drugs and Cosmetics Act, 1940 (23 of 1940), and, if the Central Government considers necessary, with such other persons having special knowledge or practical experience in respect of Ayurvedic or Unani systems of medicines as that Government deems fit.

 4.        Prohibition of misleading advertisements relating to drugs

No person shall take any part in the publication of any advertisement relating to a drug if the advertisement contains any matter which directly or indirectly gives a false impression regarding the true character of the drug; or makes a false claim for the drug; or is otherwise false or misleading in any material particular.

 5.        Prohibition of advertisement of magic remedies for treatment of certain diseases and disorders as specified in Section 3.

 6.        Prohibit on of import into, and export from India of certain advertisement

No person shall import into, or export from, the territories to which this Act extends any document containing and advertisement of the nature referred to in Section 3, or Section 4, or Section 5, and any documents containing any such advertisement shall be deemed to be goods of which the import or export has been prohibited under Section 19 of the Sea Customs Act, 1878 (8 of 1978), and all the provisions of that Act shall have effect accordingly, except that Section 183, thereof shall have effect as if for the word “shall” therein the word “may” were substituted.

 7.        Penalty: Punishable in the case of a first conviction, with imprisonment which may extend to six months, or with fine, or with both and in the case of a subsequent conviction, with imprisonment which may extend to one year, or with fine, or with both.

 8.        Powers of entry, search: Any Sate Gazette Officer can enter and search at all reasonable times, with such assistants, if any, as he considers necessary, any place in which he has reason to believe that an offence under this Act has been or is being committed; seize any advertisement which he has reason to believe contravenes any of the provisions of this Act. The officer can examine any record, register, document or any other material object found in any place mentioned and seize them.
The provisions of the Code of Criminal Procedure, 1898 (5 of 1898), shall, so far as may be, apply to any search or seizure under this Act as they apply to any search or seizure made under the authority of a warrant issued under Section 98 of the said Code. After seizure anything under clause (b) or clause (c) of sub section (1) he shall, as soon as may be inform a Magistrate and take his orders as to the custody thereof

 9.        Offences by companies: If the person is a company ( corporate, firm, associations, AOPs) every person ( director, partner) who, at the time the offence was committed, was in charge of and was responsible to the company for the conduct of the business of the company as well as the company shall be deemed to be guilty of the contravention and shall be liable to be proceeded against and punished accordingly provided if he proves that the offence was committed without his knowledge or that he exercised all due diligence to prevent the commission of such offence.

9A.      Offences to be cognizable: An offence punishable under this Act shall be cognizable.

 10.      Jurisdiction to try offences: No court interior to that of a presidency magistrate or a magistrate of the first class shall try any offence punishable under this Act.

 10A.    Forfeiture: Where a person has been convicted by any court for contravening any provision of this Act or any rule made there under, the court may direct that any document (including all copies thereof), article or thing, in respect of which the contravention is made, including the contents thereof where such contents are seized under clause (b) of sub section (1) of section 8, shall be forfeited to the Government.

 11.      Officers to be deemed to the public servants: Every person authorized under section 81 shall be deemed to be a public servant within the meaning of section 21 of the Indian Penal Code (45 of 1860).

 12.      Indemnity: No suit, prosecution or other legal proceeding shall lie against any person for anything which is in good faith done or intended to be done under this Act.

 13.      Other laws not affected: The provision of this Act is in addition to, and not in derogation of the provisions of any other law for the time being in force.

 14.      Savings. -Nothing in this Act shall apply to-

 (a)       Any sign board or notice displayed by a registered medical practitioner on his premises indicating that treatment for any disease, disorder or condition specified in section 3; the Schedule or the rules made under this Act, is undertaken in those premises; or

 (b)       Any treatise or book dealing with any of the matter specified in section 3 from a bonafide scientific or social standpoint; or

 (c)       Any advertisement relating to any drug sent confidentially in the manner prescribed under section 16 only to a registered medical practitioner; or

 (d)       Any advertisement relating to a drug printed or published by the Government; or

 (e)       Any advertisement relating to a drug printed or published by any person with the previous sanction of the Government granted prior to the commencement of the Drugs and magic Remedies (Objectionable Advertisement) Amendment Act, 1963 (42 of 1963).  Provided that the Government may, for reasons to be recorded in writing withdraw the sanction after giving the person an opportunity of showing cause against such withdrawal.

 15.      Power to exempt from application of Act are with the Central Government that to only in public interest and by notification in the Official Gazette.

 16.      Power to make rules: The Centre Government may, by notification in the Official Gazette, make rules to specify and disease, disorder or condition to which the provisions of section 3 shall apply and prescribe the manner in which advertisement of articles or things referred to in clause (c) of section 14 may be sent confidentially. Every rule must be passed by the parliament.    

 THE SCHEDULE:  [See Sections 3(d) and 14]: Name of the disease, disorder or condition
Appendicitis; Arteriosclerosis; Blindness; Blood poisoning; Bright's disease; Cancer; Cataract;      Deafness; Diabetes; Diseases and disorders of the brain; Diseases and disorders of the optical system;      Diseases and disorders of the uterus; Disorders or menstrual flow; Disorders of the nervous system;     Disorders of the prostatic gland; Dropsy; Epilepsy; Female diseases (in general); Fevers (in general);  Fits; Forms and structure of the female bust; Gall stones, kidney stones and bladder stones;  Gangrene; Galucoma; Goitre; Heart diseases; High or low blood pressure; Hydrocele; Hysteria; Infantile paralysis; Insanity; Leprosy; Lecuoderma; Lockjaw; Locomotor atoxia; Lupus; Nervous debility; Obesity;     Paralysis; Plague; Pleurisy; Pneumonia; Rheumatism; Ruptures; Sexual impotence; Small pox; Stature of persons; Sterility in women; Trachoma; Tuberculosis; Tumours; Typhoid fever and  Veneral diseases, including syphilis, gonorrhoea, soft chancre, veneral, granulima and lympho granuloma. (total 54 diseases)
Asthma , AIDS added in the rules ( total 56)

The Drugs and Magic Remedies (Objectionable Advertisements) Rules, 1955

Scrutiny of Misleading Advertisements Relating to Drugs

Any state government authorized person if satisfied, that an advertisement relating to a drug contravenes the provisions of section 4, by order, require the manufacturer, packer, distributor or seller of the drug to furnish, within such time as may be specified in the order or such further time as may be allowed in this behalf by the person so authorized information regarding the composition of the drug or the ingredients thereof or any other information in regard to that drug as he deems necessary for holding the scrutiny of the advertisement and where any such order is made, it shall be the duty of the manufacturer, packer, distributor or seller of the drug to which the advertisement relates to comply with the order. Any failure to comply with such order shall, for the purposes of section 7, be deemed to be a contravention of the provisions of section 4:

Manner in which Advertisements may be sent Confidentially

All documents containing advertisements relating to drugs referred to in clause (c) of sub-section (1) of section 14, shall be sent by post to a registered medical practitioner by name or to a wholesale or retail chemist, the address of such registered medical practitioner or wholesale or retail chemist being given. Such document shall bear at the top, printed in indelible ink in a conspicuous manner, the words. “For the use only of registered medical practitioners or a hospital or a laboratory”].