Medical tourism is showing a steady growth in India

Medical tourism is showing a steady growth in India

Lower cost of treatment, government policies to make conditions conducive for tourists, form some of the reasons for this growth

New Delhi, 07 November 2017: Medical tourism is seeing a steady growth in the country as per recent statistics. What currently stands at 3 billion dollars is expected to grow to about 7 to 8 billion dollars by the year 2020. India issued more than 1.78 lakh medical visas in the year 2016. As per the IMA, some of the major reasons for this increase in medical tourism in the country include the presence of world-class hospitals and skilled medical professionals. Apart from this, the cost of treatment for various major surgeries in India is only a fraction or even as low as 10% of that in many developed countries.

Medical tourism is the process of traveling outside the country of residence for receiving medical care. This originally referred to the travel of patients from less-developed countries to developed nations in pursuit of the treatments not available in their homeland. Another major reason for the rise in medical tourism in India is the availability of alternative treatment options such as Ayurveda and Naturopathy.

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, “Medical tourism has been a major growth sector globally. The exorbitant healthcare costs in the affluent Western countries have made healthcare out of reach for even their citizens. Consequently, they are now looking beyond their borders to seek medical treatment. India has emerged as a prime destination in the last few years for people across the globe in need of medical treatment. Affordability, high quality healthcare, availability of specialist treatment and advanced technologies are just a few reasons that have made India a much sought-after destination. Furthermore, the diversity of its flora and fauna, its natural beauty including a rich and vibrant cultural heritage has already put India on the tourist map. Many facilities in India have become a destination for learning and healing together. One can opt for a complete body detox using Yoga techniques and learn them too.”

India now has a simplified e-medical visa facility which allows three visits to the country. The government is also taking steps to address other areas such as standardization and accreditation of services.

Adding further, Dr Aggarwal, said, “Tourism also contributes a fair share to the economy of a country. Therefore, the government has important roles to play in the development and refinement of medical tourism in India, not only as a regulator but also as a facilitator. In view of this, the government of India has constituted a Medical and Wellness Tourism Board as a dedicated institution to guide the promotion and positioning of India as a competent and credible medical and wellness tourism destination.”

IMA is a member of National Medical and Wellness Tourism Board. The following recommendations are likely to be implemented.

• Government to facilitate e-Medical Visa.
• Normally e-Visa given for 60 days but e-Medical Visa will be for 6 months.
• e-Visa will have a permission for double entry, but e-Medical Visa will permit Triple entry.
• e-Visa will be extendable to e-Medical Visa.
• e-Medical Visa will be available at five major Indian Ports i.e. Mumbai, Cochin, Goa, Chennai and Mangalore.
• e-Medical Visa will be available for 161 countries.
• Presently, medical attendants are given Visa, but the Committee has recommended that medical attendants should also be given e-Medical Visa.
• The Committee also recommended that all hospitals should have a common Greet and Meet Counter and it should be at major Airports / Ports.
• Free SIM card at entry will be given to e-Medical Visa patient.
• Committee have recommended a Translation App at Airports/ Ports.
• All Medical Tourism Hospitals will have to be NABH or JCI Accredited. We are pushing for IMA accreditation also.
• The Committee also recommended that fee for e-Visa and e-Medical Visa should be the same.

Natural diet efficient in reducing cancer risk

 Natural diet efficient in reducing cancer risk

Adding just one serving of fruit or vegetables per 1000 calories consumed can result in a 6% reduction of risk of cancer

New Delhi, Friday February 17 2017

As per a recent study, the consumption of fresh vegetables and fruits help lower your chances of getting head, neck, breast, ovarian and pancreatic cancers. Even one additional serving of vegetables or fruits could help lower the risk of head and neck cancer. The more fruits and vegetables you can consume, the better.

In another study, broccoli and soy protein were found to protect against the more aggressive breast and ovarian cancers. When consumed together, digesting broccoli and soy forms a compound called di-indolylmethane (DIM). In lab experiments, the researchers found that DIM could affect the motility of breast and ovarian cancer cells, which could help keep cancers from spreading. Soy, acts like estrogen and is a nutritious, healthy food, and should be eaten in moderation.

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 that, “Those who eat six servings of fruits and vegetables per 1,000 calories have a 29% decreased risk relative to those who have 1.5 servings. In the study, after adjusting the data to account for smoking and alcohol use – known head and neck cancer risk factors – the researchers found that those who consumed the most fruits and vegetables had the lowest risk for head and neck cancers. Vegetables appeared to offer more cancer prevention than fruits alone did.”

“Diets high in animal fat and low in fibre are associated with metabolic syndrome -- a collection of conditions including abdominal obesity, elevated blood sugar and high blood pressure. A high fat diet contributes to nourish cancer cells, thus accelerating the disease’s progression. Vegetable based diet also contains several protective compounds like flavonols which are found in fruits and vegetables, such as onions, apples, berries, kale and broccoli. Evidence suggests that people who had the highest consumption of flavonols reduced their risk of pancreatic cancer by 23%. The benefit is even greater for people who smoke”, added Dr. K.K Aggarwal.

Following are some healthy diet tips:

1. Eat multiple servings of brightly colored and seasonal fruits and vegetables every day. Fill half your plate with fruit and vegetables.

2. Choose healthy fats. Use fat–free or low fat milk and/or dairy products.

3. Severely limit red meat, including beef, pork, lamb, and goat, and processed meat consumption.

4. Opt for healthier sources of protein like fish, skinless poultry, beans, and eggs.

5. Avoid partially hydrogenated fats (trans fats), present in many fast foods and packaged foods.

6. Cut down dramatically on salt.

7. At least half of your grains should be whole grains.

8. Regular exercise pares down your risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer. 

Public servants cannot show gifts as income from legal sources, says SC

Public servants cannot show gifts as income from legal sources, says SC In its judgement pertaining to the disproportionate assets case against Smt Sasikala Natarajan, the Supreme Court of India has ruled that presents could not be counted as income from lawful sources for public servants, reported Dhananjay Mahapatra in the Times of India, February 16, 2017. The Apex Court stated “Gifts to A1 (Jayalalithaa), a public servant in the context of Sections 161 to 165A IPC now integrated into the Act are visibly illegal and forbidden by law. The endeavour to strike a distinction between “legal” and “unlawful” as sought to be made to portray gifts to constitute a lawful source of income is thus wholly misconstrued." The Bench further said, “With the advent of the 1988 Act, and inter alia consequent upon the expansion of the scope of definition of the “public servant” and the integration of Section 161 to 165A IPC in the said statute, the claim of the defence to treat the gifts offered to A1 (Jayalalithaa) on her birthday as lawful income, thus cannot receive judicial imprimatur.” The defense of the counsel for Selvi J Jayalalithaa was also rejected by the Apex Court, which held that "To reiterate, disclosure of such gifts in the I-T returns of Jayalalithaa and orders of the I-T authorities on the basis thereof do not validate the said receipts to elevate the same to lawful income to repel the charge under Section 13(1)(e) of the PC Act." Accepting gifts has always posed an ethical dilemma for the doctors. They are required to maintain professional boundaries in their relationship with the patients as well as the pharmaceutical industry. Receiving gifts is one aspect of this relationship, which is fiduciary in nature. This judgement is important for doctors as it is also applicable to them, the government doctors in particular. The Medical Council of India has defined guidelines regarding this in section 6.8 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 especially in their relationship with pharmaceutical and allied health sector industry. The MCI has also defined the quantum of punishment for violation of these regulations. a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives. • Gifts more than Rs. 1,000/- upto Rs. 5,000/- : Censure • Gifts more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Gifts more than Rs. 10,000/- to Rs. 50,000/- : Removal from Indian Medical Register or State Medical Register for 6 months. • Gifts more than Rs. 50,000/- to Rs. 1,00,000/- : Removal from Indian Medical Register or State Medical Register for 1 (one) year. • Gifts more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register. b) Travel facilities: A medical practitioner shall not accept any travel Facility inside the country or outside, including rail, road, air, ship, cruise tickets, paid vacation, etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME Programme, etc. as a delegate. • Expenses for travel facilities more than Rs. 1,000/- upto Rs. 5,000/-: Censure • Expenses for travel facilities more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Expenses for travel facilities more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State medical Register for 6 months. • Expenses for travel facilities more than more than Rs. 50,000/- to Rs. 1,00,000/-: Removal from Indian Medical Register or State Medical Register for 1 year. • Expenses for travel facilities more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register. c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext. • Expenses for Hospitality more than Rs. 1,000/- upto Rs. 5,000/-: Censure • Expenses for Hospitality more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Expenses for Hospitality more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State medical Register for 6 months. • Expenses for Hospitality more than more than Rs. 50,000/- to Rs. 1,00,000/: Removal from Indian Medical Register or State Medical Register for 1 year. • Expenses for Hospitality more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register d) Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed. • Cash or monetary grants more than Rs. 1,000/- upto Rs. 5,000/-: Censure • Cash or monetary grants more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Cash or monetary grants more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State Medical Register for 6 months. • Cash or monetary grants more than more than Rs. 50,000/- to Rs. 1,00,000/-: Removal from Indian Medical Register or State Medical Register for 1 year. • Cash or monetary grants more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register. e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii) will be an imperative for undertaking any research assignment / project funded by industry – for being proper and ethical. Thus, in accepting such a position a medical practitioner shall:- (i) Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities. (ii) Ensure that such a research project(s) has the clearance of national/ state / institutional ethics committees / bodies. (iii) Ensure that it fulfils all the legal requirements prescribed for medical research. (iv) Ensure that the source and amount of funding is publicly disclosed at the beginning itself. (v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project(s). (vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way. (vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document / agreement for any such assignment. First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violation of the clause. f) Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never be any compromise either with his / her own professional autonomy and / or with the autonomy and freedom of the medical institution. First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register. g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always: (i) Ensure that his professional integrity and freedom are maintained. (ii) Ensure that patients interest are not compromised in any way. (iii) Ensure that such affiliations are within the law. (iv) Ensure that such affiliations / employments are fully transparent and disclosed First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violaton of the clause h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way” First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register Dr KK Aggarwal National President IMA and HCFI

Sameer Malik Heart Care Foundation of India an initiative by the Heart Care Foundation of India, celebrates its third anniversary

Sameer Malik Heart Care Foundation of India an initiative by the Heart Care Foundation of India, celebrates its third anniversary 

Marking the Sameer Malik Memorial Day, over 1000 beneficiaries of the fund come together with their families. New Delhi, February 16, 2017: Sameer Malik Heart Care Foundation Fund – an initiative by the Heart Care Foundation of India, a leading national non-profit organization committed to making India a healthier and disease free nation today celebrated its third anniversary. The Sameer Malik Memorial day saw over 1000beneficiaries of the fund coming together with their families for a lecture by the NGO’s president Dr. K K Aggarwal along with check-ups, consultations and recreational activities. Sameer Malik Heart Care Foundation Fund was launched three years ago with the basic ideology that no person should die of a heart disease just because of their economical background. Any person suffering from heart disease, in need of surgical intervention and cannot otherwise afford treatment can apply for the benefits of the fund by calling the helpline number +919958771177. Once shortlisted, the surgeries are performed at leading hospitals including Medanta – the Medicity and National Heart Institute. The foundation has sponsored over 500 such pro-bono surgeries till date and over 1000 patients belonging to economically weaker sections of the society have already been helped and treated. Speaking on the occasion, Padma Shri Awardee, President Heart Care Foundation of India and National President Indian Medical Association (IMA), Dr K K Aggarwal and Dr RN Tandon – Honorary Secretary General IMA said in a joint,“Women are not diagnosed or treated for heart disease as aggressively as men. Despite the fact that more women die of heart disease each year than men, they receive only 33% of all angioplasties, stents and bypass surgeries; 28% of implantable defibrillators and 36% of open–heart surgeries. Congenital heart disorders in specifically in girl children are also often left untreated until much later increasing the risk of diability and mortality. With this background, our focus in the previous year has been in helping more and more women and young children.We believe that through mass awareness, timely intervention and financial support, majority of the heart diseases can be prevented and cured. We have successfully saved over 1000 lives through the Sameer Malik Heart Care Foundation of India and continue to do so in the future. We thank the Malik family for all their support.” Addressing the press Chief Guest for the occasion, Mr. Najeeb Jung, Former Lieutenant Governor of Delhi, said, “I heartily congratulate the Heart Care Foundation of India for their relentless work in the healthcare field. The right to life, afforded by our Constitution is only possible when one is healthy, in the truest sense. India is currently booming, however, major epidemics and health crises lie in waiting and can only be averted by collaborative efforts in helping those in utmost need and raising preventive healthcare awareness.” Adding to this, Guests of honor, Mr. B.S. Bassi, Member, Union Public Service Commission (UPSC), Former Commissioner of Police Delhi and Syed Asif Ibrahim, Former Director Intelligence Bureau in a joint statement said, “Any advancement in the field of medicine is obsolete if its benefits do not permeate to those who need it the most. In a developing country like India many patients, especially from the underprivileged section of the society suffer, as they lack sufficient access to quality healthcare facilities. Women and children are the sections that suffer the most in this context. We are happy to see the efforts being put in by HCFI to ensure quality and affordable healthcare for all.” Mr. Deep Malik from the Malik family in his statement said, “I congratulate Dr KK Aggarwal and HCFI on their efforts to helping keep my brother Sameer Malik’s legacy alive through every life saved. With the increasing incidence of lifestyle diseases specially amongst a younger population, it is important to raise mass level awareness about the evils of eating junk food, smoking and drinking. We pledge our support to the NGO and will continue to support this initiative.” The helpline number +919958771177 for the Sameer Malik Heart Care Foundation Fund is open from Monday to Saturday from 9 AM to 5 PM. Individuals who wish to apply online can download the application form from the website, http://heartcarefoundationfund.heartcarefoundation.org/. An expert committee comprising of notable individuals would assess all applications received by the fund. Once sanctioned, the funds would be directly deposited in the bank account of the medical establishments treating the patient.

The eight-year cycle of Chanakya

The eight-year cycle of Chanakya Chanakya in his neeti wrote that the cycle of corruption does not last for more than eight years. He said that people who acquire money by unethical means will have to pay back to the society within eight years. Right or wrong, whether you believe in Chanakya Neeti or not it provides a good message for the youngsters in the society to follow the right path of truthfulness. Lord Krishna in Bhagavad Gita has written that everybody has to pay the price of their bad deeds or karmas sooner or later. It is the sum total of bad and good karmas, which decides the ultimate fate. Chanakya probably meant that all those who keep on earning money by unethical means and not doing simultaneously good deeds will have to suffer within eight years. The eight-year cycle is also seen in public bhedchal. Public cannot be befooled for more than eight years in a succession. The number eight is an arbitrary number and may mean six or ten years. If we look back over the years, we can see the change in public behavior every 6-10 years as far as their preference for a particular type of health wave is concerned. There was the time of Sherry Lewis weight management program which came like a storm, stayed in the market for 6-8 years and then vanished altogether. Everybody wanted to manage their weight the Sherry Lewis way. Then came the era of Personal Point, which saw a chain of weight management programs coming up and which lasting for a few more years. This was followed by weight management the Vandana Luthra way. The weight management era was followed by the era of “Reiki”. During this period all the newspapers were carried reiki advertisements and every second person in the family wanted to become a reiki master. Today no such advertisements appear in the newspapers and nobody wants to learn reiki. Then came the trend of drinking ghiya juice and doing anulom-vilom Pranayama. In spirituality, we also saw a wave of transcendental meditation by Maharishi Mahesh Yogi but the movement did not last long as he quickly realized that selling spirituality in India was not easy and it was not the right time. In terms of public behavior too, we have witnessed phases of craze for cycling, exercising, jogging, aerobic dancing, gym, western dancing, etc. From health point of view the required era is that of walking. An era where everybody from child to adult takes up walking. Medical science has shown that walking 10,000 steps a day, routine walking 60 minutes, or brisk walking 40 minutes a day (continuous or divided into four walks of 10 minutes each) are health-friendly and can reduce the burden of diseases like high blood pressure, diabetes, obesity and heart disease. Following the Vyapam scam, the Supreme Court cancelled degrees of 634 doctors for corruption in MBBS admissions in Madhya Pradesh between 2008 and 2012 and said admissions obtained through a mass fraud called "Vyapam scam" could not be condoned. The cycle of stents has also shown a reverse gear now with its coming under price control. Things, just as life, come a full circle, completing a full cycle. Dr KK Aggarwal National President IMA and HCFI

NPPA Stent Notification

NPPA Stent Notification

(Published in Part II, Section 3, Sub Section (ii) of the Gazette of India Extraordinary)

Government of India
Ministry of Chemicals and Fertilizers
Department of Pharmaceuticals
National Pharmaceuticals Pricing Authority

New Delhi. The 13. February 2017

S.O. 412(E) Whereas the Government of India in the Ministry of Health and Family Welfare included Coronary Stents in the National List of Essential Medicines. 2015 (NLEM, 2015) by notification
No. X-11035/344/2015-DFQC dated 19th July 2016.

2. And whereas the Government of India in the Ministry of Chemicals and Fertilizers, Department of Pharmaceuticals, by notification No. S.O. 4100 (E) dated 21st December 2016 has incorporated Coronary Stents at serial no. 31 of Schedule I of the Drug Prices Control Order, 2013 (DPCO, 2013) and therefore, Coronary Stems arc 'scheduled formulations under the provisions of the DPCO, 2013.

3. And whereas die National Pharmaceutical Pricing Authority (NPPA) was established by Resolution No. 33/7/97-PI.I dated 29. August 1997 of the Government of India in the Ministry of Chemicals and Fertilizers to fix/revise, monitor prices of drugs/formulations and oversee the implementation of the DPCO; and whereas the Government of India by S.O. 1349(E) dated 30th May 2013 in exercise of the powers conferred by Section 3 and 5 of the Essential Commodities Act, 1955 (10 of 1955) has delegated the powers in respect of paragraphs 4, 5, 6, 7, 8, 9,10, 11, 12, 13, 14, 15, 16, 18, 19, 20, 21, 23, 24, 25, 26, 27, 28, 29,30 and 32 of the DPCO, 2013 to the NPPA to exercise the functions of the Central Government.

4. And whereas the aim of the DPC. 2013 issued under section 3 of Essential Commodities Act, 1955, is to ensure that essential drugs are available to all at affordable prices. Whereas the Hon'ble Supreme Court of India by order dated 12th November 2002 in SLP no. 3668/2003 (Union of India vs. K.S. Gopinath & others) directed the Government to ensure that life saving drugs do not fall out of price control.

5. And whereas the Core Committee which examined the issues relating to the essentiality of Coronary Stems in its report to the Government in April 2016 observed that there is very high incidence of coronary artery disease (CAD) in India associated with high morbidity and mortality; and that CAD has become a major public health problem; and that Percutaneous Coronary Intervention (PCI) procedure requiring coronary stent implantation is an important treatment modality for the management of CAD, and hence coronary stents are 'essential' for public health.

6. And whereas NPPA carried out an exhaustive exercise of consultation with stakeholders for fixing the ceiling price of Coronary Stents on 4th January 2017, 5th January 2017 and 6th January 2017, as per office memorandum no. 19(837)/2016/Div.11/DP/NPPA dated 23^rd December 2016; and whereas NPPA considered all available information and data on prices of Coronary Stents in its 40^th Authority Meeting held on 23rd January 2017. During deliberations, it was found that huge unethical markups are charged at each stage in the supply chain of Coronary Stents resulting in irrational, restrictive and exorbitant prices in a failed market system driven by information asymmetry between the patient and doctors pushing patients to financial misery; and whereas under such extraordinary circumstances, there is an urgent necessity, in public interest, to fix ceiling price of Coronary Stents to bring respite to patients.

7. And whereas the Hon’ble Supreme Court of India in its judgment in Glaxo India Limited vs UOI reported in (2014)2 SCC 753, while dealing with the implementation of notified prices for the benefit of consumers, referred to the prefatory statement made by the Hon’ble Supreme Court in Cynamide India Limited (1987) 2 SCC 722 as worth noticing, wherein the Court observed:

“2. Profiteering by itself. is evil Profiteering in the scares resources of the community, much needed life-sustaining foodstuffs and life-saving drugs is diabolic It is a menace which has to be fettered and curbed. One of the principal objectives of the Essential Commodities Act. 1955 is precisely that. It must be remembered that Article 39(b), enjoins a duty on the State towards securing 'that the ownership and control of the material resources of the community are so distributed as best to subserve the common good”.

8. And whereas the Government is under constitutional obligation to provide fair, reasonable and affordable price for Coronary Stents and therefore its immediate intervention is imperative to check unethical profiteering and exploitive pricing; and whereas Paragraph 19 of the DPCO, 2013 inter- alia authorises the Government, extraordinary circumstances, if it considers necessary so to do in public interest, to fix the ceiling price or retail price of any drug for such period, as it deems fit.

9. And whereas price fixation notifications issued for certain formulations under paragraph 19 of the DPCO, 2013 by the NPPA on 10th July 2014 have been upheld by the Hon'ble High Court of Bombay in its judgment dated 26th September 2016 in W.P.(C) No. 2700 of 2014 (Indian Pharmaceutical Alliance vs. Union of India) wherein the Hon'ble High Court. inter-alia, observed:

“20…… when such failure is considered in the context of role the pharmaceuticals play in the area of public health, which is a social right, the Government intervention becomes necessary especially when exploitive pricing makes medicines tin-affordable and beyond the reach of most and also puts huge financial burden in terms of out of pocket expenditure on healthcare....”

and whereas SLP (C) 30089/2016 filed by Indian Pharmaceutical Alliance has been dismissed on 24th October 2016 by the Hon’ble Supreme Court of India.

10. And whereas W.P.(C) 1772/2015 (PIL) and W.P. (C)11085/2016 have been filed in nature of Public Interest Litigation (PIL) including Cont. Case (C.) 815/2015 before the Hon’ble High Court of Delhi seeking directions to the Respondents (Union of India) to include Coronary Stents in the National List of Essential Medicines (NLEM) and thereby control the sale price of Coronary Stents.

11. And whereas, the NPPA in its Authority Meeting held on 13th February 2017, after duly examining in detail and considering all available information/data and all relevant options for price fixation of Coronary Stents, under present extraordinary circumstances of a failed and exploitative market system has decided that it is immediately necessary to fix ceding prices of Coronary stents in order to protect public interest.

12. Now, therefore, in the exercise of the powers delegated by Government of India in the Ministry of Chemicals and Fertilizers under paragraph 19 of the Drugs (Prices Control) Order. 2013 by S.O. No. 1394(E) dated 30th May 2013, the Government having been satisfied in view of extraordinary circumstances as explained above, that it is necessary to do in public interest, hereby fixes and notifies the ceiling prices, exclusive of local tax applicable, if any, in respect of Coronary Stents, as specified below:

TABLE

Sl. No.	Coronary Stents (Sl. 31 in Schedule I of DPCO, 2013	Unit (In Number)	Ceiling Price (In Rs.)
(1)	(2)	(3)	(4)
1.	Bare Metal Stents	1	7260
2.	Drug Eluting Dents (DES) including metallic DES and Bioresorbable Vascular Scaffold (BSV), Biodegradable Stents	1	29600

Note:

(a) The ceiling prices specified in column (4) of the above table shall be applicable from the date of publication of notification in the Gazette of India Extraordinary and shall also be applicable to all the stocks of Coronary Stents available for sale in the trade channel.

(b) All manufacturers of Coronary stents, selling branded or non-branded or both versions of gents at prices higher than the ceiling price (plus local taxes as applicable) so fixed and notified by the Government, shall revise the price of all such stems downward not exceeding the ceiling price specified in column (4) in the above table, plus local taxes as applicable and paid, if any

(c) All manufacturers/marketers of Coronary Stents having MRP lower than the ceiling price specified in column (4) in the above table plus local taxes as applicable and paid, if any, shall continue to maintain the existing MRP in accordance with paragraph 13 (2) of the DPCO, 2013.

(d) The manufactures may add local taxes/VAT and no other charges in the calculation of MRP if they have actually paid such taxes or if it is payable to the Government on the ceiling price specified in column (4) of the above said table in paragraph (12) of this order.

(e) The ceiling price for a pack of coronary stent shall be arrived at by concerned manufacturer/importer in accordance with the ceiling price specified in column (4) of the above table as per the provisions under DPCO, 2013.

(f) The manufacturers under Paragraph 24 of DPCO, 2013 shall issue price list in Form—V as prescribed in Schedule II of the DPCO, 2013 to the NPPA online through Integrated Pharmaceutical Database Management System (IPDMS) and submit a copy to all State Drug Controllers and all distributors/dealers/retailers. They shall also furnish quarterly return to the NPPA, in respect of production / import and sale of Coronary Stents in Form - III as prescribed in Schedule-II of the DPCO, 2013 through IPDMS.

(g) As per paragraph 24(4) of DPCO 2013, every retailer and dealer shall display price list and the supplement, price list, if any, as furnished by the manufacturer/importer, on a conspicuous part of the premises where he carries on business in a manner so as to be easily accessible to any person wishing to consult the same.

(h) Wherever institutions such as hospitals/nursing homes/clinics performing cardiac procedures using Coronary Stents are billing directly to the patients, they shall be required to comply with the ceiling prices notified hereinabove and follow the applicable provisions of the DPCO, 2013 including(g) above.

(i) Institutions such as hospitals/nursing homes/clinics utilizing Coronary Stents shall specifically and separately mention the cost of coronary gent along with its brand name, name of the manufacturer/importer/batch no. and other details, if any, in their billing to the patients or their representatives.

4) The ‘manufacturer’ for the purpose of this order means person who manufactures or imports or markets Coronary Stents for distribution or sale in the country.

(k) Any manufacturer or institution or person not complying with the ceiling price and notes specified hereinabove shall be liable to deposit the overcharged amount along with interest thereon under the provisions of the Drugs (Prices Control) Order. 2013 read with Essential Commodities Act, 1955.

13. The ceiling price fixed hereinabove shall be maintained for a period of one year from date of this notification, unless revised by another gazette notification.

14. Any manufacturer intending to discontinue production or import of Coronary Stents shall furnish information to the NPPA, in respect of discontinuation of production and /or import in Forrn-1V of Schedule-II of the DPCO, 2013 at least six months prior to the intended date of discontinuation as prescribed under paragraph 21(2) of the DPCO, 2013 and follow the ceiling price till clearance from the Government.

PN/I73/41/2017

F.No.8 (4I)/2017/DP/NPPA/Div II

(Dr. Sharmila Mary Joseph K)

Member Secretary,

National Pharmaceutical Pricing Authority 

New guideline for preventive care in inflammatory bowel disease

New guideline for preventive care in inflammatory bowel disease New Delhi, Feb 14, 2017: IBD is characterised by the chronic inflammation of gut and other parts of the digestive tract. A new clinical guideline from the American College of Gastroenterology has said that the primary care physician (PCP) should also be involved in the management of a patient with inflammatory bowel disease (IBD), especially with regard to preventive health maintenance such as vaccinations. The guideline published in the February 2017 issue of the American Journal of Gastroenterology says, “To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents.” The guideline includes 14 recommendations to address the preventive care needs of these patients. 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 stated that, “PCPs when integrated with routine practice for treating patients with IBD can help bridge an essential care gap. Coherence between evidence-based guidelines and clinical practice exist at several stages in this regard; low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors are to name a few. Most PCPs still approach irritable bowel disease as a diagnosis of exclusion, this creates further problems.” “PCPs have a crucial and fundamental role in management of patients with IBD. Collaboration with PCPs can prompt knowledge on when to suspect and refer patients with IBD, how to screen and treat for bone loss, update all vaccinations, screen and treat for depression and anxiety, when to consider screening for self-image, and how to monitor and treat nutritional deficiencies. PCPs are critical to optimizing patient care and outcomes”, added Dr K K Aggarwal. With evolving strategies of therapy in the care of IBD patients, evidence now suggests that outcomes are dependent on the quality of management, particularly in early years of diagnosis. Early referral to a gastroenterologist for diagnosis and a structured management plan in collaboration with a primary care team therefore, is vital. The following tips should help manage the symptoms of IBD: 1. Try taking small but frequent meals, this will also help with low appetite issues. 2. Smoking can worsen the symptoms of IBD, now is the best time to quit. 3. Exercise regularly followed by a healthy diet and sleep, this will also help with fatigue and tiredness. 4. Avoid alcohol if you are taking antibiotics for managing your symptoms. 5. IBD differs from person to person; your diet and treatment schedule needs to be tailored to suit your personal needs. Talk to your healthcare provider. 6. IBD can put you at high risk of dehydration, especially in summer months. Make sure you stay optimally hydrated at all times. 7. Maintain a food diary to track which food products trigger your symptoms. 8. Ask your doctor about vitaminB12, calcium and folate supplements. 9. Those taking steroid based medications for managing IBD also need to be vigilant.

New ACP guidelines on noninvasive treatment of low back pain

New ACP guidelines on noninvasive treatment of low back pain The American College of Physicians (ACP) has published new clinical practice guideline on noninvasive treatments for acute, subacute and chronic low back pain in primary care. The guidelines recommend use of non drug therapies such as exercise, mindfulness, acupuncture or yoga before prescribing drugs, NSAIDs or muscle relaxants. The use of opioids has strongly been discouraged. Acute back pain has been defined as lasting less than 4 weeks, subacute back pain as lasting 4 to 12 weeks and chronic back pain lasting for more than 12 weeks. The three recommendations by ACP are as follows: • Recommendation 1: Nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence) should be selected by both physicians and patients. Nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants should be selected if pharmacologic treatment is desired (moderate-quality evidence). (Grade: strong recommendation) • Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation) • Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, NSAIDs should be considered as first-line therapy, or tramadol or duloxetine as second-line therapy. Opioids should only be an option in patients who have failed the above treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence) (Source: Annals of Internal Medicine, 14th February, 2017) Dr KK Aggarwal National President IMA & HCFI

Thank you for not smoking: Run a positive campaign

Thank you for not smoking: Run a positive campaign

The prevalence of tobacco use in India is very high in India as shown by the Global Adult Tobacco Survey India (GATS India) 2009-2010, more than one-third (35%) of adults in India use tobacco in some form or the other. Of these, 21% adults use only smokeless tobacco, 9% only smoke and 5% smoke as well as use smokeless tobacco. The survey also showed that 52% of adults were exposed to second-hand smoke (SHS) at home.

Tobacco use is associated with many adverse health effects and is a major preventable cause of morbidity and mortality. As per the CDC, smoking increases the risk of coronary heart disease by 2 to 4 times, for stroke by 2 to 4 times, lung cancer by about 25 times. In addition, it reduces quality of life, and increases health care utilization and cost. India has a ‘National Tobacco Control Programme’ in place to make the public aware about the harmful effects of tobacco use, control tobacco consumption and minimize the deaths.

 “Smoking kills” has been the message that has been conveyed in the campaigns on tobacco control with the expectation that highlighting the potentially life-threatening health consequences would deter people from smoking or using tobacco products. It’s time to alter the tone of such public health campaigns, from negative to positive.

Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, “If you do not quit, you may die”. A statement worded as this may inadvertently sound discouraging to the patient.  While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.

Avoid violent communication. Do not condemn, criticise and complaint, the 3 Cs of violent communication. Instead use a nonviolent communication approach to help and support your patient in his efforts to give up smoking. Tell your patient, who is trying to quit smoking or other tobacco products “Thank you for not smoking”. Appreciate the hard work put in by him and his perseverance. This way the patient knows that he has your support and will have trust and faith in you. The chances that the patient would adhere to the lifestyle modifications are higher if communicated in an empathetic and supportive manner.

IMA is committed to working closely with all National Health Programs alongside the government.  As individual doctors, we too can contribute to the success of National Tobacco Control Program. Counsel your patients who smoke about quitting smoking but with a difference… Turn a negative situation to a more positive action.

Dr KK Aggarwal
National President IMA & HCFI

Air pollution increases risk of childhood obesity and diabetes

Air pollution increases risk of childhood obesity and diabetes There is increasing evidence for the role of environment in pathogenesis in many diseases. Children below 5 years of age and adults older than 50 years are most at risk. A global assessment of the burden of disease from environmental risks by the WHO has shown that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors. The harmful effects of air pollution on respiratory health are well-known to us and well-established. Air pollution has been linked to many non communicable diseases such as cardiovascular diseases, obesity, cancers and type 2 diabetes. A new study has again underscored the dire need for a healthier environment. This study has suggested that exposure to ambient air pollution may contribute to development of type 2 diabetes through direct effects on insulin sensitivity and β-cell function. The study reported in the January 2017 issue of the journal Diabetes investigated whether exposure to elevated concentrations of nitrogen dioxide (NO2) and particulate matter (PM 2.5) had adverse effects on longitudinal measures of insulin sensitivity, β-cell function, and obesity in children at high risk for developing diabetes. Although this was not a cause and effect study, an association between air pollution and risk of obesity and type 2 diabetes in children was observed in the study. • Higher NO2 and PM2.5 were associated with a faster decline as well as a lower insulin sensitivity at age 18 independent of adiposity. • NO2 exposure negatively affected β-cell function evidenced by a faster decline in disposition index (DI) and a lower DI at age 18. • Higher NO2 and PM2.5 exposures over follow-up were also associated with a higher BMI at age 18. (Source: WHO, Diabetes 2017 Jan; db161416. https://doi.org/10.2337/db16-1416) Dr KK Aggarwal National President IMA & HCFI

Eating more fruits & vegetables improves well-being

Eating more fruits & vegetables improves well-being
The beneficial effects of fruits and vegetables on physical health are well-recognized. And, several studies have established the advantages of eating a fruit and vegetable-rich diet. A new study published online February 3, 2017 in PLos One (PLoS One. 2017 Feb 3;12(2):e0171206) has further added to the repertoire of health benefits of fruits and vegetables by demonstrating the psychological benefits of eating more fruits and vegetables. 
The study participants included 171 young adults aged 18-25 years. They were grouped into two: one group was assigned into a diet-as-usual control condition. They took their normal diets and were sent regular text-reminders to increase their intake of fruits and vegetables and were also given a voucher to purchase fruits and vegetables. In the second group, or a fruit and vegetable intervention condition, the study participants were given two additional daily servings of fresh fruits and vegetables along with their normal diet.
The researchers found that only those young adults who were provided with high-quality fruits and vegetables showed improvements to their psychological well-being with increases in vitality, flourishing and motivation across the study duration of two weeks. The strongest effects were found for motivation. However, no changes in symptoms of depression and anxiety were observed.
The researchers state that “our research suggests that simply educating people about fruits and vegetables and reminding them to eat their recommended daily intake may not be sufficient in ensuring the wider population reaps the psychological benefits of fruits and vegetables consumption. Perhaps greater emphasis needs to be placed on actually providing people with fresh fruits and vegetables (stocking more fruits and vegetables in dorms, cafeterias, workplaces, substituting fruit for dessert, and offering free fruit for people when they shop)”.
Follow these tips for a healthy meal • Eat less and enjoy your food by eating slowly • Fill half your plate with fruit and vegetables. • Avoid oversized portions which can cause weight gain. • At least half of your grains should be whole grains. • Limit consumption of food high in trans fats and sugar. • Choose healthy fats. Use fat–free or low fat milk and/or dairy products. • Drink plenty of water. Avoid sugary drinks. • Avoid foods that have high sodium levels such as snacks, processed foods. • Above all, balance your food choices with your activity level. Dr KK Aggarwal National President IMA & HCFI

Compulsory columns in a medical prescription

Compulsory columns in a medical prescription A prescription is an integral part of a consultation as it summarizes the instructions of the doctor to the patient. The Free Dictionary has defined a prescription as “a written directive, as for the compounding or dispensing and administration of drugs, or for other service to a particular patient” (http://medical-dictionary.thefreedictionary.com/prescription). Handing over of the prescription by the doctor to the patient marks the conclusion of every consultation, be it a new consultation or a follow up visit. A medical prescription traditionally enumerates the drugs that have been prescribed, along with directions for the patient to follow when taking the drug and the diagnosis. Some significant clinical findings may also be mentioned. There are four parts of a typical prescription • Superscription: Indicated by the sign Rx meaning recipe, take • Inscription: This is the main part of the prescription, contains the names, doses and dosage forms of drugs ordered. • Subscription: Directions for compounding of drugs • Signature: Instructs the patient about how to take the drugs prescribed and is preceded by the symbol S or Sig (signature - Latin) Noncommunicable diseases (NCDs) such as heart disease, stroke, cancer, diabetes and chronic lung disease are a major public health problem now incurring significant costs in their management. The Global Status Report on Noncommunicable Diseases 2010 by the WHO states that “NCDs are caused, to a large extent, by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization and 21st-century lifestyles: tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol”. Given the alarmingly high prevalence of lifestyle diseases worldwide, including India, it’s now time to move beyond the confines of the traditional way of writing a prescription. In addition to the demographic data and drugs, a prescription should have some ‘compulsory columns’. • Hygiene • Vaccines • Addictions • Noise pollution • Standard Lifestyle • Rehabilitation: Exercise, job, vacation • Counselling: Diet, mental health, exercise • Point of Care Investigations: ECG, blood sugar, pocket spirometry, urine spot test, hemoglobin, blood counts, coagulation etc. • Noise pollution check • Air pollution check: PM 2.5, PM 10 • Important phone numbers: Police, hospitals, ambulance, fire department, emergency number (Similar to 911 in US, the single national emergency number in India is 112) Adding these components to a prescription is an intervention towards ‘preventive healthcare’, primary prevention or secondary prevention and check the rising prevalence of chronic lifestyle diseases. This way doctors can motivate their patients and support them to make healthier lifestyle choices. Dr KK Aggarwal National President IMA & HCFI

IMA So far

IMA So far Greetings from IMA HQs! Since the Team Digital IMA took over, we have achieved the following in the past 40 days: • In the PCPNDT Act, IMA is pursuing the Ministry to exclude clerical errors under Penal Provisions. • IMA is pursuing Ministry of Health to exclude single doctor establishment out of Clinical Establishment Act (CEA). • IMA has been able to pursue the Govt. of India to write to all States to enact special Laws, where absent, in their respective states to tackle violence against medical profession and medical establishments and requested their strict implementation, where present. • On IMA’s persuasion the government will recommend to Consumer Ministry to cap medical compensation. • IMA 1 Voice Satyagraha, IMA 1 Voice Solidarity day and IMA 1 Voice Action Day was a great success • IMA is in process of starting certifying IMA Clinics involving all national health programs. • IMA has finalized IMA Prayer. • Kerala State government has included noise and health as a Chapter in 8th standard syllabus on IMA’s recommendations. • On IMA’s intervention, 304-B was converted into 304-A in Pune case. • On IMA’s intervention, the 3 attempts for UG MBBS admission were shifted from retrospective to prospective. The Ministry of Tourism, Govt of India has been persuaded by IMA for the following: • Duration of e-medical visa to be 6 months, with double entry. • Attendants traveling with patients to be made eligible for e-medical visa on automatic route with a simplified online application procedure. • Hospitals to be responsible for reporting of personal details of patients to FRRO (Foreign Regional Registration Office) in lieu of present system of personal reporting. • Requirement of referral letter from local doctor may be dropped. • Visa fee for e-medical visa to be rationalized. • Concerned agencies to expedite accreditation process and issue of accreditation letters with respect to treatment at Ayurveda and Wellness centers. • Clear indication of the broad cost of various treatments readily available for the patients; hospitals should have all inclusive packages advertised within a band. • Under the purpose of visit for e-TV category, a separate check box to be included for Medical Attendant and that this could then be linked with documentation of the original applicant for the e-Medical Visa so that it could be clearly established who is coming in as the attendant. • e-Medical Visa on the basis of invitation letters from NABH-accredited hospitals. • Separate immigration counters at major international airports for e-Medical Visas • A facilitation counter for such tourists outside the immigration area under the aegis of the Ministry of Health and Family Welfare (MoHFW) and the Hospital Association with interpreters for Russian and Arabic languages. • NABH may set up such counters. The counter could also be connected to the MoT Helpline number 1363 for multi-language assistance, which is 24X7 service for tourists. • The cost of e-Medical Visa should be on par with that of the Tourist Visa. • MHA may be requested to include at least one Medical Attendant who could accompany the patient on the e- Medical Visa and that the visa application for the attendant be linked with that of the patient (e-Medical Visa applicant) The aim of every State of IMA should be to act locally and think nationally. Let’s all join hands together with IMA HQs and solve all national issues in the coming months.

Jaroorat Bhi Hai Kya? Rationalization of clinical practice

Jaroorat Bhi Hai Kya? Rationalization of clinical practice The practice of medicine today relies a lot on diagnostic investigations as an aid to diagnosis and management. The fact that the medical profession was placed under the purview of the Consumer Protection Act, may certainly have contributed to this trend. But, practicing ‘defensive’ medicine by overinvestigating a patient may not help the patient as they could lead to false positive results. The number of tests may make the patients more anxious. They also add to the healthcare costs, which should be a matter of concern for a country like ours, where patients pay most of their medical expenses out of their own pockets. Prescribing too many and at times unnecessary tests overburdens the healthcare system translating into an inefficient healthcare system. The Choosing Wisely campaign launched in 2012 was a step forward to avoid medical tests, treatments and procedures. The campaign aims “to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary (www.choosingwisely.org)”. Non-maleficence (do no harm) and beneficence (do good) are the pillars of medical ethics. As clinicians, it is our duty to provide the safest, cheapest but quality drug to our patients and prescribe the right investigation to the right patient. “Jaroorat Bhi Hai Kya” is a campaign of the Indian Medical Association (IMA) to promote rational use of drugs and/or rational ordering of investigations and hospitalizations. This will help avoid litigations. Rational use of drugs assumes importance particularly in view of the widely prevalent problem of antibiotic resistance globally. Extensive and injudicious use of antibiotics has been a major factor driving this public health crisis. Be cautious about off-label use of drugs, procedures. This may be considered a trial and need approval of Ethics Committee. Before you prescribe any drug or order investigations, ask yourself the following questions: • Is it necessary? • Will it benefit my patient? • Is it safe? Remember, Think before you Ink …Use Wisely and not widely…

Updated ACIP Immunization Schedule for Adults

Updated ACIP Immunization Schedule for Adults The Advisory Committee on Immunization Practices (ACIP) has released updated immunization schedule for adults aged 19 years or older, United States, which have been published February 7, 2017 in the Annals of Internal Medicine. • ACIP recommends against live attenuated influenza vaccine (LAIV) during the 2016–2017 influenza season. • Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). • Healthy adolescents who start their human papillomavirus vaccine (HPV) series before age 15 years are recommended to receive 2 doses of HPV. But, for adults and adolescents who did not start their vaccination series before age 15 years, 3 doses are recommended. • Hepatitis B vaccine is recommended for adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal. • A 2-dose primary series of serogroups A, C, W, and Y meningococcal conjugate vaccine is recommended for adults with HIV infection. • Three doses of MenB-FHbp are recommended for adults at increased risk for meningococcal disease and for use during serogroup B meningococcal disease outbreaks, while 2 doses have been recommended for healthy adolescents and young adults who are not at increased risk for meningococcal disease. (Source: Ann Intern Med. 2017;166(3):209-219)

New guideline for preventive care in inflammatory bowel disease

New guideline for preventive care in inflammatory bowel disease A new clinical guideline from the American College of Gastroenterology has said that the primary care physician should also be involved in the management of a patient with inflammatory bowel disease (IBD), especially with regard to preventive health maintenance such as vaccinations. The guideline published in the February 2017 issue of the American Journal of Gastroenterology says, “To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents.” The guideline includes 14 recommendations to address the preventive care needs of these patients. • Guideline recommends appropriate vaccinations including influenza, pneumococcal, herpes zoster, varicella, Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis), hepatitis A and B and HPV, as per guidelines. • Consult an infectious disease specialist prior to travel to endemic areas for yellow fever. • Household members of immunosuppressed patients can receive live vaccines with certain precautions. • Women on immunosuppressive therapy should be evaluated for cervical cancer annually. • All patients should be screened for depression and anxiety. • Evaluate these patients for melanoma independent of the use of biologic therapy; patients on immunomodulators should be screened for non-melanoma squamous cell cancer. • Screen for osteoporosis at the time of diagnosis as well as at regular intervals in at-risk patients. • Crohn’s disease patients who smoke should be counselled to quit. (Source: Am J Gastroenterol. 2017;112:241-58)

Timing and meal planning affect heart health, says AHA

Timing and meal planning affect heart health, says AHA A new scientific statement from the American Heart Association (AHA) has highlighted the role of meal timing and frequency in prevention of cardiovascular diseases. According to it, planning when to eat meals and snacks and not skipping breakfast are patterns associated with healthier diets, which could reduce risk of cardiovascular disease. The statement reviews the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency and timing of eating occasions. It recommends that “intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management”. As clinicians, we stress upon eating a healthy diet, one that is rich in fruits, vegetables, whole grains, low-fat dairy products, poultry and fish and limiting red meat, salt and foods high in added sugars. Now, we should also educate our patients that “when and how often a person eats” are also important in promoting heart health - a more intentional approach to eating. Irregular patterns of eating have adverse impact on cardiometabolic health such as obesity, high blood pressure, cholesterol, blood glucose levels, insulin resistance. The statement titled “Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention” is published online January 30, 2017 in the journal Circulation. (Source: AHA News Release, Circulation) Dr KK Aggarwal National President IMA & HCFI

IMA Intervenes for the cause of medical students

IMA Intervenes for the cause of medical students IMA was flooded with students calls after the Central Board of Secondary Education (CBSE) said that AIPMT attempts will be included in the proposed NEET exam (UG) starting this year. IMA immediately took up the cause. I spoke to MCI and also to Dr Ketan Desai, President World Medical Association (WMA). Immediate action was taken and the result is the enclosed clarification circular (as below). The Health Ministry has now clarified that “since any new regulation takes effect prospectively, NEET-2017 shall be counted as the first attempt for this purpose irrespective of the previous attempts in AIPMT/NEET, subject to the upper age limit. CBSE has been advised to make necessary corrections in the information bulletin and on their website cbseneet.nic.in ¬so that any application is not rejected on this ground. Data pertaining to applications already rejected will be erased so that rejected applications can be filed afresh” (Press Information Bureau, 3.2.17). If this clarification had not been made in time, this could well have proved detrimental and may have led to an untoward incident. This is the power of IMA 1 Voice. The true strength of IMA lies in our unity and common commitment to the betterment of the medical profession. We are working for the cause of medical students and also for those who are likely to enter the medical profession. Dr KK Aggarwal National President IMA & HCFI

World Cancer Day: IMA Campaign for Cancer Awareness, Prevention & Early detection

World Cancer Day: IMA Campaign for Cancer Awareness, Prevention & Early detection The burden of cancer cases in India is rising. About one million new cases of cancer occur in India every year. According to a report compiled from cancer registries across India by Indian Council of Medical Research (ICMR) (May 19, 2016), India is likely to have over 17.3 lakh new cases of cancer and over 8.8 lakh deaths due to the disease by the year 2020. An estimated 8.8 lakh people are expected to succumb to the disease by 2020. The most common cancer among women is breast cancer, while mouth cancer is the commonest cancer among men. About one third of cancer deaths are related to 5 leading behavioral and dietary risks 1. Tobacco 2. High BMI 3. Low fruit and vegetable consumption 4. Lack of physical activity 5. Alcohol use Tobacco is the biggest and the most preventable cause of cancer. It causes nearly 20% of global cancer deaths and around 70% of lung cancer deaths worldwide. Creating awareness becomes especially important as only 12.5 per cent of patients come for treatment in early stages of the disease. IMA requests all its branches / members to plan an activity to increase awareness about cancer among their patients and the community. Press sensitization, poster in your clinics, lectures, CMEs, SMS or email to all members are some of the activities can be done. Dr KK Aggarwal National President IMA & HCFI

Indian Medical Association: “NO” to NEXT

Indian Medical Association: “NO” to NEXT Suggestions of the IMA are as under: • Common final MBBS examination. • A national schedule for final MBBS Examination including date of declaration of result applicable for all the examining universities in the country should be made. • PG entrance examination for the purpose of commonality of the date of the commencement i.e. PG NEET to be conducted within 45 days from the date of declaration of the common MBBS final result, which is included in the declared schedule. • The Rotating internship to begin on a common date, so that it also in the generic sense ends on the common date across the country. • Allowing foreigners to participate in NEET is discrimination unless there is country reciprocity. • Putting a cap of 25 years for NEET exam & maximum 3 attempts is taking away the rights of students. The rationale for the aforesaid suggestions is based on the material reality that the different examining universities, which almost number more than 100 as of now have their different schedules of examination resulting in different dates of commencement of the examination, declaration of the result and therefore commencement of the rotating internship and accordingly different dates for the completion of the same. As a result of this in spite of the eligibility of appearance at the postgraduate entrance test being completion of the rotating internship before 31st March of the concerned year, there is invariably a loss of six months. Further, the period of internship, which otherwise is expected to be a period of hands-on training under supervision in operational reality, stands reduced down to the intern mugging up MCQs on a whole time basis eating into the vitals of the period of internship and thereby defeating the set out purpose in a big way. This malady can be sorted out by the suggestion so made, whereby the schedule of final MBBS examination would be common including the dates of declaration of results thereto. This would entail commencement of the internship on a common date and resultant completion of the same. Further, if PG NEET is held within 45 days from the date of declaration of the common result of the MBBS examination, the internship can be meaningfully completed and the existing loss of more than 6 months, which takes place as of now would easily be avoided; hence, these solutions vide the suggestions aforesaid made. Why are we opposing the screening exam? The screening test came to be incorporated by the Government of India, vide an amendment to section 13 of the Indian Medical Council Act, 1956. The Indian Citizen holding foreign medical qualification seeking registration in to a State Medical Register is required to clear the said screening test which is conducted by the National Board of Examination. Upon clearing the same he / she is entitled for a provisional registration with the State Medical Council and then is mandated to complete the rotating internship satisfactorily in a recognized medical college. Upon the said completion he / she is entitled to seek permanent registration in the State medical register. The condition of satisfactory completion of internship is mandated in view of the fact that during the said period he / she is to undergo hands on training under supervision so that they are well-equipped for purposes of handling the health-related issues as registered medical practitioner. This entails that the said graduates possessing foreign medical qualification do not remain half-baked and are appropriately oriented to practice modern medicine as registered medical practitioner. It is also a matter of record that the inspection teams of the Medical Council of India (MCI) and also joint inspection teams of MCI along with representatives of the Government of India, had inspected medical schools in Soviet Russia as well as in China and have observed that the standards operating there are far from satisfactory and are not in consonance with those that govern the Indian system of medical education in medical colleges located in India under the ambit of the MCI as their regulatory body. In view of the logical rationale that has been quoted herein above, the proposed waiver of the said screening test would open floodgates for foreign medical education holders where the standards of education are far from satisfactory and are compromised for easy, handy and unchecked / unfiltered permission to them who realistically would be half baked doctors and would be licensed to deal with the lives of Indian population at the premium of a very high risk which would not be conducive to the public interest at large, hence the opposition. Reservation of PG Seats The proposed 50% of the reservation of PG seats would not augur well in as much as presently 50% of the PG Diploma Seats in terms of governing PG regulations are already earmarked for the public health personnel under State govt UT/ Government of India. In addition to the same, the proposed reservations when tagged with constitutional reservation would end up with miniscule number of seats being available for open category meritorious students and would also end up in a ratio of hardly any seats being available to a large number of eligible meritorious open category population. This tilting of balance is not conducive to the public interest and also the legitimate expectations of the meritorious students from open category seeking entry into the portals of postgraduate medical education in the country. Dr KK Aggarwal National President IMA Dr RN Tandon Hony Secretary General IMA