Thursday, 30 November 2017

Majority of Indians are unaware of adult vaccinations

Majority of Indians are unaware of adult vaccinations
The need for vaccination does not end when one becomes an adult

New Delhi, 29 November 2017: As if the fact that the health of India’s citizens is marred by various health conditions was not enough, a recent study has indicated that about 68% of the country’s adults are unaware of adult vaccinations. While a majority of those surveyed thought that vaccinations were only for children, others felt they were healthy and did not require any vaccination. As per the IMA, the need for immunization does not end when one becomes an adult. Protection from vaccines received as a child can wear off over time, and leave a person at risk for new and different diseases.

Adult vaccines are recommended based on many factors. They can help avert and reduce the health consequences of vaccine-preventable diseases among adults. Incomplete and inadequate immunization against many communicable diseases can lead to substantial and unnecessary costs in terms of hospitalization and treatment.

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, “Just like healthy eating, physical activity, and regular check-ups, vaccines also have a very important role in keeping a person healthy, through their adult years as well. Vaccines are one of the most convenient and safest preventive care measures available. Urban lifestyle today includes unhealthy eating, untimely sleeping patterns, erratic work hours, and frequent travels. This has reduced our immunity and made us more susceptible to any disease. We stay at a different place, work at another, and then enjoy visiting a distant location. Coming across different people from different regions, we become prone to any communicable disease. Medical science advanced and there are new, improved facilities and treatments available for many health conditions. During our childhood, there were many diseases without vaccines. Those vaccines are possible now.”

The Indian government has been taking steps towards adult immunization. In 1985, a universal immunization programme was launched across the country to combat Tuberculosis, Tetanus, Diphtheria, Pertussis, Polio, and measles.

Adding further, Dr Aggarwal, said, “All adults over 50 years need to maintain protection against conditions such as seasonal influenza (Flu); pneumococcal disease (pneumonia, sepsis, meningitis); Hepatitis B infection (for adults who have diabetes or are at risk for hepatitis B); tetanus, diphtheria and pertussis (for all adults who have not previously received this); and shingles (for adults 60 years and older).”

Following are some quick facts about adult immunization.

  • Immunization saves 3 million lives every year
  • Except drinking water, no other human undertaking can equal the impact immunization has had in reducing infectious diseases mortality -- not even antibiotics
  • Immunization reduces mortality, morbidity, reduces direct and indirect medical cost
  • Flu vaccine has led to a 70% decline in hospitalizations
  • Hepatitis B vaccines have caused a drop in the incidence of liver cancer

Straight from the heart: IMA Road Map

Straight from the heart: IMA Road Map

The main objective of IMA is to provide affordable, available, accessible and accountable quality and safe health care to the public through its members in a stress-free environment.

IMA works hand in hand with the central and state governments to achieve its objectives via profession- and community-friendly policies.

One of the objectives of IMA is to concentrate on primary, preventive and primordial care.  In this regard IMA has launched many campaigns like:  Sun to Lo, Dekh to lo, Koi Dekh to Nahi Raha, Koi Sun to Nahi Raha, Baar Baar Pucho, Puchna Mat Bhulo, Woh to Theek Hai par Mara Kyon, Woh to Theek Hai par Heart Attack Hua Kyon, Katwayega to Nahi, among others.

IMA is also incorporating social determinants of health in providing medical care.  IMA Project Jiska Koi Nahi Uska IMA provides avenues to patients from every segment of the society in getting cost-effective treatment within their reach and within the same environment where he/she is residing.

IMA has helped achieve millennium development goals and now is committed to achieve sustainable development goals.

IMA Road Map

·         IMA believes in patient-centric medicine where the treatment plan is adjusted to the needs of the patient on case to case basis.
·         IMA is fighting with government for one price-one drug-one company policy so that cost of 80% of medicine can be reduced. Today 80% cost of health care is on medicines and investigations.
·         IMA policy is to prescribe NLEM drugs and when writing non NLEM drugs, to take consent from the patient.
·         IMA members are implementing all national health programs. But, for the same, government should hire every general practitioner on retainership basis.
·         IMA wants 100% PG seats so that every doctor who does MBBS is ensured a PG Seat and those seats where Indian doctors opt out can be allotted to foreigners. Most of the new PG seats should be in Family Medicine.
·         IMA is for providing all emergent services to people, which is the mandate of state government who is not able to provide it. Hence, this should be reimbursed by state governments. 
·         IMA is not against accountability but is against the people taking law in their hands.  IMA wants single window accountability for the same.
·         IMA also want Single Window Registration for any health care facility.
·         IMA also wants Single Registration for doctors so that they can practice in any state in the country.
·         Medical profession is not a business and all doctors provide reasonable subsidy to their patients for which they are entitled to non-commercial rates for water, electric, property and and other amenities.
·         IMA respects Ayush doctors and the government should let them excel in their own field and not diversify into the modern system of medicine.
·         IMA believes in the concept of equity, equality and justice. To this end, IMA wants uniform age of retirement, uniform pay scale, uniform infrastructure, uniform hours of duty, etc.
·         IMA is for bringing preventable deaths to zero. Preventable deaths should be unacceptable. To achieve this, IMA recommends auditing every preventable death to find what went wrong so that another such death can be prevented by timely action.
·         IMA wants professional autonomy and for the doctors to be able to decide their drug, investigation and line of management based on patient-centric medicine. 
·         IMA is for competence-based training and not theoretical-based training.
·         IMA is against repeated multiple theoretical exams for doctors to test their updated knowledge status.
·         IMA wants all doctors to use petrol cars, car pool, grow grass in muddy areas, plant trees and promote walking as their contributions in efforts to reduce air pollution.
·         All IMA CMEs should be noise-free with noise levels between 45-50 dB.
·         The average life span of doctors is 10-13 years shorter than non-doctors. IMA recommends all doctors to have their annual check-up done and get 100% vaccinated.
·         The cost of intensive care is beyond reach of a common man. It’s the state government mandate to provide free emergency care. If they cannot, ICU establishment costs should be subsidized by the government.
·         All IMA CMEs should have a slide each on pharmacovigilance, bioethics and AMR.
·         IMA policy is to spend time on informing patient about the cost of treatment. The cost variation should not be more than 10%.
·         IMA policy is to promote GTN in TB (GeneXpert test, trace every contact and notify TB).
·         Even the dead have a right to dignity. All dead bodies, whether in the dissection hall or in the hospital settings, must be respected

·         To build credibility, all doctors should explain the reason if they are referring a patient to a specific lab, imaging center, pharmacy or a hospital.

Wednesday, 29 November 2017

Deficiency of Vitamin D can cause dementia over time

Deficiency of Vitamin D can cause dementia over time
Many Indians are unaware that they are Vitamin D deficient

New Delhi, 28 November 2017: While the benefits of Vitamin D in reducing the risk of heart disease, multiple sclerosis, and even rheumatoid arthritis have been documented in various studies, a new study has found that deficiency of this Vitamin D can increase the risk of developing dementia. As per the study, people severely deficient in vitamin D were 122% more likely to develop dementia. Despite being a country that receives ample sunlight, about 65% to 70% Indians are deficient in this most essential vitamin.

Vitamin D is not a simple vitamin and impacts virtually every cell in the body. It is synthesized in the skin on exposure to sunshine and is needed to absorb calcium and for bone health. Low vitamin D levels are widely known to harm bones, leading them to become thin, brittle, soft or misshapen. However, it is equally important for the heart, brain, and immune function.

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, "Vitamin D deficiency is linked with metabolic syndrome, heart diseases, and also with fertility. Research now has indicated a possible link to dementia as well. In India, the sun is worshipped as part of various festivals. The month of Magha, Vaishakha, and Kartik are considered as months for Shahi Snans where one is supposed to worship sun early in the morning and eat calcium rich food whether it is Urad Ki Daal or sesame seeds. The Chhat pooja which takes place immediately after Diwali is also linked to sun worship. The Marghshirsha month immediately after the month of Kartik also involves worshipping sun. Karkitpurnima and Vaishakhpurnima are especially known for sun worshiping. The current vitamin D mantra is that 40 days in a year for at least 40 minutes, one should expose 40% of the body to the sunlight either after sunrise or just before sunset.”

Vitamin D2 ergocalciferol is found in food items and our body makes Vitamin D3 cholecalciferol in the presence of sunlight. While both are extremely important, if D2 can be obtained from food, even little exposure to sun can help the body produce D3.

Adding further, Dr Aggarwal, said, “There are several reasons for deficiency of vitamin D. Lack of food fortification policies and more commonly our sociocultural practices, ‘sun-fleeing’ behavior, are major factors contributing to deficiency of this ‘sunshine vitamin’ in India which has abundant sunshine. Many people are unaware that they are vitamin D deficient.”

The following foods are good sources of Vitamin D.

Cod liver oil This oil comes from the liver of the cod fish and is considered extremely healthy. It helps ease joint pains and can be taken in capsule form or oil form.

Mushrooms If you love mushrooms, you are covered. Dried shitake mushrooms are a brilliant source of Vitamin D3 as well as Vitamin B. It is low in calorie and can be consumed daily.

Salmon Salmon is another good source of D3, Omega 3 and protein.

Sunflowers seeds This seed not only have Vitamin D3 but also comes with monounsaturated fats and protein.

Straight from the heart: Affordable ICU Health care

Straight from the heart: Affordable ICU Health care

IMA is the collective consciousness of the medical professionals practicing modern system of medicine and is represented by over 10 lakh doctors directly through its members spread over 32 State Branches and 1750 Local Branches and through FOMA (Federation of Medical Associations of India).

Through WMA, IMA is linked to 112 International Medical Associations.

The main objective of IMA is to provide affordable, available, accessible and accountable quality and safe health care to the public through its members in a stress-free environment.

The recent Fortis issue has opened a debate on finding and fighting ways to reduce the cost of intensive care.

How can affordable health care be achieved?

·         IMA is fighting with government for one price one drug one company policy so that cost of 80% of medicine can be reduced. Medicines account for 80% of the total expenditure on healthcare. The government allows the same company to sell the same quality drug at three different costs.
·         On lines of Delhi Government policy, patients should be allowed to bring medicines from outside.
·         Only NLEM (National list of essential medicines) drugs should be prescribed and patient must be explained if any non-NLEM drug is prescribed
·         IMA is for providing all emergent services to people which are not within the reach of state government.  This can be subsidized by IMA members but should be reimbursed by state governments. 
·         Medical profession is not a business and all doctors provide reasonable subsidy to their patients. To continue this subsidy they are entitled for non-commercial rates for water, electric and property.
·         IMA is for bringing preventable deaths to zero and for that IMA recommends that every preventable death should be audited to find what went wrong so that another such incident does not happen again.
·         Cost of emergent medical care in ICU is 200% on first day of admission, 100% on subsequent days and 150% in critical ill terminal patients. Most patients cannot afford terminal care in tertiary care hospitals and this care therefore should be subsidized by the government.
·         Do not resuscitate (DNR) policy should be enacted by the government so that once a patient develops brain death and/or is in a condition of no recovery, ventilator care can be stopped.
·         Hospitals should not charge for providing two new bed sheets after the death of a person.
·         At admission, weightage should be given to outside tests if done in last 24 hours. These tests need not be repeated.
·         In all corporate hospitals, DNB and nursing school should be compulsory so that PG DNB residents and Nursing students are available to serve in ICUs.
·         MCI or DNB should permit one-year training fellowship courses in intensive care in these hospitals to reduce the cost of staff. 80% of the cost of intensive care is on fixed cost with 50% on the staff salaries.
·         Better standardization of care practice though protocols and care pathways.
·         Protocolized care for sedation, analgesia, glycemic control, ventilator management, and liberation from mechanical ventilation have been shown to reduce variation and improve the outcome of critical illness.
·         Staffing the ICU with a multidisciplinary care team under the supervision of a trained intensivist. Fewer routine care decisions are in the hands of a single individual, ultimately reducing unnecessary variability. For example, pharmacists and respiratory therapists can standardize length of antibiotic courses and use of low tidal volume ventilation for patients with acute lung injury
·         The frequency of laboratory and radiological tests, the use of generic versus name-brand drugs, and the specific indications for transfusion are all opportunities for physicians to reduce variation in the process, and cost, of care.
·         Cost control is not just the task of the health policy expert or the hospital administrator, it is also the task of the individual ICU clinician. 
·         Three areas for improvement.
o   Standing orders for laboratory studies, ECGs and chest x-ray films to be eliminated.
o   Protocols to be developed for the appropriate use of sedation, analgesics, and neuromuscular blocking agents.
o   Protocol for weaning from mechanical ventilation should be developed to allow respiratory therapists to proceed through the weaning process
·         A significant method of controlling ICU costs is closely monitoring which patients are admitted and when they are discharged. Lab tests represent a source of cost reduction, and physicians must learn to order specific tests and not simply a battery of tests which includes the actual test desired. Limits should be placed on the tests that are ordered in terms of number and frequency.

·         High-dependency units (HDUs, synonymous with intermediate care units, intensive observation units, step down units) or recovery rooms (post-anesthesia care units, PACUs) can undertake many of the traditional roles of the intensive therapy unit (ITU) at a fraction of the cost, because costs per patient day are considerably lower in the HDU (PACU) than in the ITU.

Tuesday, 28 November 2017

Indians at higher risk of heart disease due to genetic variations

Indians at higher risk of heart disease due to genetic variations
·         Heart disease does not indicate only heart attack
·         There are different types of heart diseases one should be aware of

New Delhi, 27 November 2017: A recent study has indicated that about 35% to 40% Indians carry a set of genetic variations putting them at a higher risk of acquiring heart diseases. The carriers of a set of genetic variants in the chromogranin A (CHGA) gene called ‘CHGA promoter haplotype2’ may be at higher risk for cardiovascular and metabolic disorders. This haplotype is found more frequently in those of South Asian origin. Heart diseases are striking young and old Indians alike and this disease is slowly turning out to be a silent killer.

Apart from this genetic susceptibility, what exacerbates the situation is the kind of lifestyle people have today. Increasing dependence on processed food, lack of physical activity, and stress are all contributing factors. One often confuses heart disease with a heart attack. However, heart diseases are of many different types and it is important to be aware of them and the risk factors.

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, “Every individual must be aware of the different forms of heart diseases and the associated symptoms. Some of these include Coronary Artery Disease – hardening or narrowing of the coronary artery; Cardiomyopathy – disease of the cardiac muscle due to several reasons; Angina – chest pain caused due to less blood flow to a part of the heart muscle; Valvular Heart Disease – disease affecting one or more of the four valves of the heart; Congenital Heart Disease – heart structure malformation at birth; Cerebrovascular Disease – disease of the blood vessels that supply blood to the brain; Rheumatic Heart Disease – damage to the heart muscles and valves due to rheumatic fever; Heart attack –permanent damage to the part of the heart muscle to which blood supply was cut off; and Heart failure- reduction in the heart’s pumping power.”

Most of these heart conditions are leading causes of death in both men and women. What exacerbates the problem is a lack of awareness among people about the symptoms as well as their risk factors.

Adding further, Dr Aggarwal, said, “Among one of the myths surrounding heart diseases is that the risk can be lowered with vitamins and supplements. However, there is no scientific evidence that these supplements prevent or treat heart diseases. The key here is to eat a wide variety of nutritious food which includes all 6 tastes and 7 colors and get natural vitamins and supplements. This is to be supplemented with other lifestyle changes.”

Some tips to avert the risk of heart diseases are as follows.
  • Avoid smoking or quit the habit altogether.
  • Aim at getting 30 minutes to 1 hour of exercise at least 5 days a week.
  • Eat a heart-healthy diet rich in fibre. Avoid saturated fat in any form.
Manage stress through meditation and activities such as yoga. 

Straight from the Heart: International IMA Activities Report 2017

Straight from the Heart: International IMA Activities Report 2017

Dr KK Aggarwal
National President IMA

The Indian Medical Association (IMA) actively participates in World Medical Association (WMA), Confederation of Medical Associations in Asia and Oceania (CMAAO), Commonwealth Medical Association (CMA) and World Organization of Family Doctors (WONCA) meetings. Internationally, WMA deals with all policies related to health, education and regulations related to all the countries in a broad base. Policies with regard to the above issues in Asia and Oceania regions are broadly dealt by CMAAO and that in Commonwealth countries are dealt with by CMA.

Of late many have criticized why IMA should participate in such meetings.

Here is a brief note:

·         International interactions play a major role in deciding most National or International policies.

·         World Medical Association (WMA) with the help of 112 National Medical Associations periodically develops concurrence statements, concurrence declarations and resolutions on subjects of common interest. Such Statements, Declarations and Resolutions are revised based on the current-day requirements. There are two types of Revisions: Minor revision (which can be made any time) and major revision (which can be made after 10 years of a Declaration / Statement).

·         All member countries / NMAs can raise their national issues even including work conditions of their Resident Doctors like their duty hours etc. through the International bodies. When these International bodies raise an issue even if it relates to individual countries or segments, all member countries follow up such matters with the relevant related authorities in those country(ies) / Segment(s), creating a huge impact on the early resolution of the issue.

·         IMA led two major revisions polices on behalf of WMA, both of which were passed in the last WMA General Assembly held in October 2017 at Chicago. 

o    WMA STATEMENT ON HIV/AIDS AND THE MEDICAL PROFESSION ( Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006 and amended by the 68th WMA General Assembly, Chicago, United States, October 2017)

o    WMA RESOLUTION ON TUBERCULOSIS: Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006 and revised by the68th WMA General Assembly, Chicago, United States, October 2017

·         IMA is leading the revisions to third WMA policy on assisted reproductive technologies, which is likely to get passed in 2018: WMA is in the process of revising the under mentioned policy in their ensuing meeting

·         The following Declaration of Geneva, now called ‘The Physicians Pledge’ has been amended by WMA. Dr KK Aggarwal and Dr A Marthanda Pillai were members of the Working Group on behalf of IMA. 

“As a member of the medical profession:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely and upon my honor”

Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948
and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968
and the 35th World Medical Assembly, Venice, Italy, October 1983
and the 46th WMA General Assembly, Stockholm, Sweden, September 1994
and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006
and amended by the 68th WMA General Assembly, Chicago, United States, October 2017

·         IMA also organized / attended  various international conferences as follows:

o    Annual Scientific Meeting of Chinese Medical Association, Nanjing (China), 14-15 January, 2016
o    International Summit on Air Pollution - Health Advisories, New Delhi, March 10, 2017
o    12th World Conference on Bioethics, Medical Ethics & Health Law, Cyprus, March 19-24, 2017
o    206th World Medical Association (WMA) Council Meeting, Zambia, April 15-22, 2017
o    International Congress of Indian College of Interventional Cardiology, Dubai, May 4-7, 2017
o    10th Geneva Conference on Person Centered Medicine, Geneva, May 7-10, 2017
o    Annual Meeting of Swedish Medical Association, Sweden, May 29-31, 2017
o    Annual Meeting of the American Medical Association, Chicago, June 10-14, 2017
o    BMA Annual Representative Meeting, Bournemouth, June 25- 29, 2017
o    32nd CMAAO General Assembly, Tokyo, September 13–15, 2017
o    WMA General Assembly, Chicago, October 11-14, 2017
o    European End of Life Issues, Vatican, November 2017

·         IMA now has direct one-to-one association and communication with other Medical Associations of the world. IMA has entered into a Memorandum of Understanding for Developing Strategic Cooperation Partnership with the Chinese Medical Association

·          International collaborations

o    BMA Chair always attends the NATCON of IMA
o    Presidents of all National Medical Associations are invited in NATCON.
o    IMA is affiliated to BMA
o    Nepal Medical Association is affiliated to IMA.
o    IMA donated drugs worth Rs. 45 Lakh to Nepal Medical Association during the flood disaster in 2015.
o    Dr A Marthanda Pillai, Past National President and Dr KK Aggarwal, National President, IMA addressed a press conference in Nepal during their visit to Nepal during flood disaster in 2015.
o    Dr Ketan Desai, Past National President, IMA served the highest post of WMA as its President during the year 2016-17.
o    Dr V C Pillai, Past National President, IMA served as President, CMAAO during the year 1992-93.
o    Dr Vinay Aggarwal, Past National President, IMA served as President, CMAAO during the year 2013.
o    Dr KK Aggarwal, Hony Secretary General, IMA served as Vice President, CMAAO during the year 2015-16
o    Dr KK Aggarwal, National President, IMA is serving as 1st Vice President, CMAAO during the year 2016-17
o    Dr KK Aggarwal, National President, IMA will take over as President Elect, CMAAO for the years 2018-19
o    Dr. S Arulrhaj, Past National President, served as President, CMA
o    Dr K Vijaya Kumar, Past National President served as Vice President CMA
o    Dr Ajay Kumar, Past National President, IMA is serving as Council Member, WMA
o    Many Past National Presidents of IMA: Dr Vinay Aggarwal, Dr Ajay Kumar, Dr A Marthanda Pillai, Dr KK Aggarwal, National President, IMA and Dr RN Tandon, Hony. Secretary General, IMA have served / have been serving on various Committees of WMA/CMAAO
o    An international conference on Person Centered Medicine will be held in November 2018 at New Delhi
o    IMA will be hosting 2019 CMAAO meeting in September 2019
o    WMA raised and supported the “Dilli Chalo” movement of IMA

IMA is an integral part of global medical associations and should continue to lead the world in the field of medicine.