No cross pathy but Ayush systems and modern medicine specialists can work together

All systems of medicine are different. You cannot become expert in one without reading the course and cannot practice one without being registered with respective council.

Ayurveda is touching the world and India is the heritage country of Ayurveda. The need is for both of them to work together and if we can achieve the following we can conquer the world

• Combining principles of Panchkarma in chronic diseases and reducing the quantity and duration of allopathic drugs.
• Combining Panchkarma and modern medicine in reversing ageing and life style diseases like heart, kidney diseases etc.
• If we can reduce the duration and dose of antibiotics in modern system of medicine.
• If we can tackle the problem of drug resistance in the country.
• If we can find an indigenous vaccines from Ayurveda or Homeopathy etc etc.

Ayurveda Update in the Recent Media

1. AMAI urges Union government to declare Ayurveda as the mainstream medicine of India:

Peethaambaran Kunnathoor, Chennai; Tuesday, January 13, 2015: The Ayurveda Medical Association of India (AMAI) has urged the Ayush Department to declare Ayurveda system of treatment as the mainstream medical system of the country.  The AMAI passed a unanimous resolution in this regard at its 15th state conference held at Kollam in Kerala on January 11.For Ayurveda, challenge is to keep off allopathic drugs, says PM Narendra Modi was the headline in one of the news item appeared in the Indian Express.

2. Prime Minister Narendra Modi at the valedictory function of the 6th World Ayurveda Congress in New Delhi on November 10th said the biggest challenge for Ayurveda is the inclination of its practitioners towards prescribing allopathic drugs.

"The biggest challenge for Ayurveda are the people who have dedicated themselves to it, but when a patient comes, often say let us start with allopathic medicine for the first three days and then move to Ayurveda. Ayurveda doctors need to be 100 per cent committed it Ayurveda,” Modi said in his address. Crosspathy is not allowed as a per a Supreme Court order, but that does not stop Ayurveda practitioners from prescribing allopathic medicines.

The PM emphasized the point that the two are not competing streams of science because one has to do with prevention and the other with cure, but there is a need for Ayurveda to be spoken about in a language that the world understands. “Medical journals should dedicate 10- 20 per cent of their space to Ayurveda,” he added.

He cited the example of the global popularity of Yoga to assert that it is possible for Ayurveda too to attain such heights, but the precondition is that people who work on it should first believe it themselves.

Obama visit, short term exposure to pollutant air not risky: IMA

Short term exposures to air pollutants does not result in fatal outcomes and the effects are usually mild and reversible, said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General Indian Medical Association in a joint statement.

The experts said that short term exposure is only hazardous to children, elderly and individuals with chronic disease of respiratory or circulatory system.

Air quality index (AQI) is a composite indicator of air quality developed by Environment Protection Agency, USA.

President Obama has earlier visited countries with high levels of air pollution such as Afghanistan, Poland, Senegal, China, Brazil, Egypt, Saudi Arabia and India. Afghanistan has similar pollution levels. During his last visit to India, he had visited Agra, which had substantial particulate matter in ambient air.

The latest air quality data by Environmental Protection Agency shows that air quality in various parts of the United States had exceeded the cutoff values for adverse health effects.  In California, air quality had reached as high as 473. The AQI in Delhi has been ranging between 250 and 300.

Yearly average of New Delhi and Beijing are almost similar and pollution has not grown to a scale of visible public problem in New Delhi unlike Beijing.  Pakistan has the highest polluted regions such as Peshawar and Rawalpindi compared to all other cities in the world, added Dr. Muhammed Shaffi, a public health expert.

"The pollution levels in Delhi are comparable to Beijing and many other countries. Even though the United States has very low pollutant levels, the air quality index has touched unhealthy levels in some periods. Therefore it is unscientific to assume a different effect in Indian cities as short term exposure will have only minor effects on a healthy individual.   It's unfair to link air pollution in Delhi with a possible health hazard for Obama," said Dr Aggarwal.

However those who are living in Delhi may have long-term exposure effects of pollution and they need to safeguard themselves.

Air Quality Index of 0-50 is good; 51-100 is moderate; 101-150 is unhealthy to sensitive groups and 151-200 is unhealthy to all.

An AQI of 250-300 is very unhealthy and can cause significant aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly. It can have significant increase in respiratory effects in general population. People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion.

An AQI of 300-500 is hazardous to health. It can cause serious aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly. It is also associated with serious risk of respiratory effects in general population.

Everyone should avoid all physical activity outdoors; people with heart or lung disease, older adults, and children in particular should remain indoors and keep activity levels low.

Obama Visit, short term exposure to pollutant air not risky: IMA

                    

Short term exposures to air pollutants does not result in fatal outcomes and the effects are usually mild and reversible, said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General Indian Medical Association in a joint statement.

The experts said that short term exposure is only hazardous to children, elderly and individuals with  chronic disease of respiratory or circulatory system.

Air quality index is a composite indicator of air quality developed by Environment Protection Agency, USA.

In the past Obama has visited Countries with high levels of air pollution such as  Afghanistan,  Poland, Senegal, India, China, Brazil, Egypt and Saudi Arabia. Afghanistan has similar pollution levels. Obama has also visited Agra during his last visit to India which had substantial particulate matter in ambient air.

The latest air quality data by Environmental Protection Agency shows that air quality in various parts USA had exceeded the cutoff values for adverse health effects.  In California air quality had reached as high as 473. In Delhi the AQI has been ranging between 250-300.

Yearly average of New Delhi and Beijing are almost similar and pollution has not grown to a scale of visible public problem in New Delhi unlike Beijing.  Pakistan has the highest polluted regions such as Peshawar and Rawalpindi compared to all other cities in the world, added Dr. Dr Muhammed Shaffi, a public health expert.

" The pollution levels in Delhi are low compared to Beijing and many other countries. Even though USA have very low pollutant levels the air quality index has touched unhealthy levels in some periods. Therefore it is unscientific to assume a different effect in Indian cities as short term exposure will have only minor effects on a healthy Individual.   It's unfair to link air pollution in Delhi with a possible health hazard for Obama" said Dr Aggarwal.

However those who are living in Delhi, may have long term exposure effects of pollution and they need to safeguard themselves.

Air Quality Index of 0-50 is good; 51-100 is moderate; 101-150 is unhealthy to sensitive groups and 151-200 is unhealthy to all.

An AQI of 250-300 is very unhealthy and can cause significant aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly. It can have significant increase in respiratory effects in general population. People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion.

An AQI of 300-500 is hazardous to health. It can cause serious aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly. It is linked with serious risk of respiratory effects in general population. Everyone should avoid all physical activity outdoors; people with heart or lung disease, older adults, and children should remain indoors and keep activity levels low.

IMA to develop a Model Health Village – Dr. A. Marthanda Pillai

January 8, 2015, New Delhi: Addressing his first Press Conference, Padma Shri Awardee, Dr. A. Marthanda Pillai, National President, IMA said that under Aao Gaon Chalen Project of IMA, IMA will come out with a Model IMA Health Village in the coming year, which can be replicated at a national level, both by the Govt as well as NGOs including IMA branches.

Explaining further, Dr. Pillai said that the Model Health Village will have all parameters met within a year as defined by Millennium Development Goals.

The Conference was co-addressed by Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA.

In a joint statement, Dr. Pillai and Dr. Aggarwal said that IMA has written to all its 1700 branches to follow Hon’ble Prime Minister, Shri Narendra Modi’s initiative of Swachh Bharat, Swasth Bharat movement.  The IMA officials feel that 20% of the disease burden can be reduced if all the doctors in our country are sensitized to have their medical establishments follow hygienic principles and they in turn motivate their patients to follow the principals of respiratory, food, water and hand hygiene.  The IMA officials said that they have requested each of its 1700 branches in the country to nominate
9 Medical Icons of their area to lead this campaign in the coming year.

IMA also showed concern about the inclusion of Cross pathy in the National Health Policy, which has been put by the MoHFW, Govt. of India on its website.  Under this National Health Policy, the Govt is envisaging training AYUSH doctors for a limited period of time and allowing them to become midcare health providers.

IMA holds the view that it is not against AYUSH as a branch taking the front position and wants AYUSH to progress in their respective fields. However, IMA is against AYUSH doctors practicing modern system of medicine, as it will cause more harm than benefit to the patients.

IMA has already taken opinion of Joint Commission International (JCI) & National Accreditation Board for Hospitals (NABH) and is of the view that Indian Hospitals will never be able to provide quality and safe service to patients if half-baked AYUSH doctors are allowed to practice modern system of medicine.

If the Govt. goes ahead in this venture, it is a possibility that the JCI and NABH may not give accreditation to most of the hospitals, which may affect medical tourism in the country.

IMA, on the other hand, welcomes the Govt. move of making healthcare as a Fundamental Right. However, IMA made a very strong statement that “Nobody in India should die of illness, which is preventable or just because he/she cannot afford it”.

IMA in the statement also said that Govt. should also ensure their commitment of 5% of GDP as budgeted expenditure for their health care budget.

IMA expressed concern about the Govt.’s recent reduction of health budget and its spectacle to increase the GDP from 2.5% to 5% may not actually happen.

IMA’s statement is very clear of providing affordable and quality drugs to each and every person. Therefore, a public distribution system has to be in place, which IMA will support.

Today we have 75,000 Resident Doctors who are waiting for their PG and there are only 6500 rural medical vacancies, which is less than 10% of the total vacancies.

IMA feels that it can help the Govt. of India and be a link between young doctors and the Govt. and help them in filling 6500 vacancies if the Govt provides the following to these doctors:-

• A salary which is twice the normal salary as a hardship allowance.
• A free decent accommodation at the PHCs.
• Security and safety of the persons posted in the PHCs.
• Free basic drugs and investigations, as promised by the Govt. under Universal Health coverage.
• 10%  extra marks in their PG entrance examinations if they complete one year of rural service

IMA will issue them a one-year certificate of training in Rural Medicine, Rural Surgery and in Public Health, which can help them to upgrade their biodata.

IMA is of the view that if no vehicle can run on the road without insurance, similarly, health insurance should be compulsory and the same should be provided by the Govt. for those who cannot afford it.

Regarding medical education, IMA is of the view that the curriculum should be revised in every
7 years and IMA should a part of the revision process. Soft skills should be included in the curriculum. IMA wants 10% of the medical curriculum to include Mental Health & Bio Ethics.

Regarding legal medicine, IMA is of the view that doctors should not come under CPA because this is a different profession. If doctors come under the purview of CPA, then they will have to be allowed to advertise, have marketing agents and do all activities, which will no more make this profession a noble one.

‘To err is human’ for this every doctor goes for indemnity insurance.  But doctors want this compensation to be capped and IMA is of the opinion that a Medical Tribunal on the lines of CAT should be established by the Govt., which will take care of the responsibilities presently undertaken by MCI and CPA.

IMA is also launching its Grievance Redressal & Mediation Cell, where patients will be able to approach IMA for their redressals.

IMA will also launch many projects like Care of Elderly, Trauma Care, Waste Disposal, National Initiative for Safe & Sound against noise pollution and Reduction in maternal and infant mortality and Initiative for mental health.

Rural Retention of Medical Doctors

On the invitation received from MoHFW, the undersigned along with Dr Ramesh Dutta, attended the meeting on Rural Retention of medical Doctors at New Delhi which was chaired by Health Secretary, GoI. MCI president was also present.

Agenda Note

1.      The Central Govt, in consultation with MCI, made the following amendments to its Post Graduate Medical Education Regulations to encourage doctors to serve in difficult/remote areas:

• 50% of the seats in PG Diploma Curse shall be reserved for medical officers in the Govt. service, who have served for atleast three years in remote and difficult areas.  After acquiring the PG Diploma, the medical officers shall serve for two more years in remote and/or difficult areas; and
• Incentive at the rate of 10% the marks obtained for each year in service in remote or difficult areas upto the maximum of 30% of the marks obtained in the entrance test for admission in  PG medical courses.

2.      Thereafter, a draft notification was approved by the Ministry in June, 2013 to provide that one year rural posting at PHC will be mandatory for medical graduates for admission in PG courses from academic session 2015-16.  However, due to agitation by doctors against the proposed amendment in the PG regulations, the MCI was requested to keep the amendment notification in abeyance for publication till further orders from the Ministry.

3.      In July 2014,  with the approval of the Hon’bl HFM, it was decided to make the mandatory rural posting an integral part of PG course curriculum.  MCI was requested to furnish :
• Revised PG Course curriculum
• Draft notification amending PGMER, 2000
• Roadmap for implementation of the scheme

MCI has now sought following clarifications:
• Whether the Central Govt. envisages a PG degree course of 3 years or 4 years including one year rural scheme after completion of MD/MS course or during the course.
• Whether the programme for PG course incorporating the rural posting applied to both govt. & private medical college?
• During the 1 year posting that is proposed to be incorporated into the PG course, which authority shall pay stipend to the doctors during rural posting?


DISCUSSION IMA and Others, and outcomes


• It was agreed that at the moment, Govt. will not go ahead making rural posting compulsory during PG entrance examination. IMA said, they will oppose if that happens.

• MCI suggested that government may think of making one year rural training posting of pre and para clinical postings without increasing the duration of PG.

• It was proposed that in pre selected PHCs, any post MBBS student who does one year rural training posting, he or she will get 10% extra marks to be added to his PG entrance  examination. Apart he/she will get a salary more than other places and in addition will also get an additional certificate of training in rural medicine and rural surgery

Some suggestions by IMA, not carried forward

1. Doctors who may like to work in Govt. area, may be given income tax exemption and high salary.

2. Local GPs may be given extra incentives to run a 2 hours OPD in these PHCs

3. Doctors posted in these PHCs may be given one year diploma in rural medicine and surgery.  The same was not accepted by the MCI.

4. A 2 years PG course may be started by DNB in rural medicine and surgery and out of these 2 years, one year may be in the  rural area and one year may be in the DNB recognized hospital.  As there was no representation from DNB, the same was not further discussed.

5. That all district hospitals may be made teaching hospitals and internship & DNB programme may be started, the matter is under discussion.

Some other suggestions and facts from the panel

1. Under the existing MCI Act, it is not legally possible to withhold the degree of a person for one year in the absence of completion of rural posting by him/her. So bond theory was not accepted.

2. To make PG entrance more difficult so that students are forced to go for rural posting for getting 10% extra marks.

3. Out of one lac only 6500 postings are without doctors. It is not that doctors do not want to go to rural areas. They do not want to go to these 6500 rural areas.

4. At any given time only 10% of the PHCs are without doctors

 5. In some states, they have incentivized by increasing the retirement age from 60 to 65 to post some specialists in rural areas.

6. In some states, hard area allowances are given and salaries are upto 1.5 lacs.

7. In  one state, 10 lac penalty bond has been kept in for not doing rural services after PG and  Rs 18 crore was the revenue. So this is not a solution.

8.  To have different fee structure, which means people who are ready to go for rural services will have a substantial subsidy in their PG educational fee by the Govt. But this was not again followed as the private medical colleges may not agree for the same.

IMA stand and offer

1. IMA will invite suggestions from its members through eIMA news

2. IMA will connect to its students through facebook.com/imsaindia and facebook.com/imayoungdoctorsforum

3. IMA will call representatives of IMSA India and have a discussion in Delhi along with MOH officials. MOH said that have no budget. IMA will call representatives. They will come of their own. IMA will support stay and food.

4. Every year  lac doctors appear in PG examination and only 25000 get admission. Remaining 75000 doctors at given a time start preparing for the PGs.

Final IMA Offer to students and government

Out of 75,000 doctors who are appearing for PG, if 10,000 are willing for a one year  positing in selected PHCs, IMA will get them five things

1. High pay scales

2. IMA certified (Non MCI) fellowship (one year) in Rural Medicine and Rural Surgery

3. 10% extra marks in their PG entrance examinations, by the government.

4. One year IMA certificate in "Community and Public Health ( this may help students who aspire further training abroad)

5. IMA will make ensure that government provides them free accommodation and security in these PHCs. IMA presumes that under the new MODI Jis promise basic free drugs and investigations will be available in every PHC.


Suggestions are invited. No final decision taken. 

Dr K K Aggarwal
Padma Shri, National Science Communication and
Dr B C Roy National Awardee
Hony Secretary General IMA

IMA wants state of the art forensic labs in every state

IMA New Delhi India: 56th January 2015: IMA is the collective consciousness of over 2.5 lac Indian doctors. The association is concerned about the forensic lab facilities available in the country and has written to the health minister and prime minister of the country to establish state of the art forensic labs in every district.

In the letter written to the ministry by Honorary Secretary General and Padma Shri Awardee, Dr K K Aggarwal said that in the recent Sunanda Murder case it took over a year for the police to decide that it was a murder case.

Also the AIIMS report said that they do not have all the facilities for forensic examination and the viscera needs to be sent abroad for further testing.

" It only means the country does not have even a single lab for full forensic exam and if it would not have been a high profile case, the mater could have ended as suicide case. Thousands  such cases of murder in today's date might be getting closed as suicidal cases." writes Dr Aggarwal.

When the crime rate in the country is so high, every state has a right to have a state of the art forensic report. Why the samples need to be sent to other states for examination.

The association National President Dr A M Pillai has asked the health ministry to treat this matter on priority and let them know what steps are being taken in this regard.

IMA showed concern on the survey that 44% surgeries were needlessly advised

IMA has written letter to Medical Council of India and Maharashtra Medical Council to call upon the Medi Angles –the 2nd Opinion Center based out at Navi Mumbai who has released their survey  to one of the National Daily which has shown that over 44% of the surgeries were advised needlessly.  The survey released a data of 12,500 patients.

IMA National President, Padma Shri Awardee, Dr. A. Marthanda Pillai and Honorary Secretary General, Padma Shri Awardee Dr K K Aggarwal in a joint statement said that if the findings of this survey are correct, it is a matter of national concern but if the findings of this survey are not correct, it will cause a great damage to “Doctor-Patient Relationship”.

IMA officials said that as per the report, it looked that the 2nd opinion was given via Email or web based Consultation.

As per the IMA guidelines, difference of opinion is not negligence and 2nd opinion of a single doctor would only amount to difference of opinion. By IMA definition, the 2nd opinion is always a peer review which must have an opinion of 2 or 3 more doctors in consultation.

Various Supreme Court Judgments have shown error judgments and difference of opinion is not a professional mis-conduct or negligence.

IMA officials also said that as per MCI Guidelines, any survey which has a national impact should have been published in a reputed medical journal and/or presented in a medical conference before going to the media.