November 26, 2007

Medicos of TN to go on ‘fast unto death’

Medicos of Government Medical colleges in Tamil Nadu have decided to go on ‘fast unto death’ from Friday after four days of protests failed to elicit a favourable response.

Medicos have been protesting since Monday this week articulating their grievances against the Union Health Ministry’s move to make a year’s service in rural areas compulsory for an MBBS degree.

After the first day of demonstrations, they started a relay fast that entered its third day on Thursday.

Two second year MBBS students of the Government Vellore Medical College (GVMC)--Jayasudha and Velvizhi--were admitted to the GVMC Hospital after they fainted on the third day of the fast. G.S. Rajesh, president of the Students’ Council, GVMC, said they were not opposed to rural service but only to the move to appoint MBBS graduates in rural areas on a salary of Rs.8000. There was no guarantee either that the job would be made permanent. Given the fact that most students, who hailed from poor families, would have to repay their educational loans on completion of their study, the offer of Rs.8000 would not be sufficient for them to repay their loan and make a living.

A pamphlet issued by the Tamil Nadu Medical Students Federation pointed out that as per the statistics furnished by the Ministry of Health and Family Welfare, Government of India, there were 2043 community health centres, 22842 primary health centres (PHCs) and 1,37,311 health sub-centres in the country.

While 13.3 per cent posts were vacant in the PHCs, the posts of 48.6 per cent surgeons, 47.9 per cent obstetricians and gynaecologists’ posts, 46.1 per cent general doctors’ posts and 56.9 per cent child specialists’ posts were vacant in the community health centres.

Under these circumstances, the compulsory one-year rural service would lead to 29,500 doctors being deprived of employment opportunities immediately and 40,000 junior doctors losing the chance of government jobs in another 10 years, it said.

Soon, get online MBBS degrees

Next year, if you fail to make it to a prestigious medical college, don't lose hope of studying medicine. A leading hospital chain is all set to offer India's first MBBS programme through distance education.

According to sources in the Medical Council of India which regulates medical education in the country, Max Healthcare and US-based Ocenia University have been in regular touch with MCI over the distance MBBS programme and their proposal is in the final stage of approval. Ocenia University offers online and distance medical programmes in the US and will help Max structure the course.

So far, only a few distance paramedical programmes are on offer in India by open universities like IGNOU as MCI is yet to approve online and distance programme in medicine. Since MBBS courses need a lot of hands-on training, distance courses were thought to be unviable.

Pervez Ahmed, executive director of medical operations at Max Healthcare, told TOI that the course and curriculum that Max plans to offer would be as per MCI guidelines and the mode of delivery would be similar to the Ocenia University programmes. "The theory part would be conducted in distance mode with interactive Internet tools. The practicals would be conducted on campus at various functional and upcoming Max Healthcare hospitals," he said.

Max Healthcare would be upgrading its six hospitals in the National Capital Region to 4,000 beds within three years, sources said. Anil Kohli, president of Dental Council of India, welcomed the plan for distance MBBS courses.

"This would definitely be a major boost to medical education and will make it within the reach of more students.

Currently, private medical courses are very costly and not properly monitored." According to Ahmed, the fees of the distance MBBS course would be "competitive."

November 24, 2007

Hiding medical history won't get you insurance: Supreme Court

Anyone not truthfully recording his past medical ailments in the application form seeking a life insurance cover could end up disentitling his kin from getting the promised amo-unt in the policy in case of his untimely death, the Supreme Court has ruled.

And this actually happened. One Chackochan did not mention a major operation for Andenoma thyroid, which he had undergone, in the life insurance policy application and died within five months of taking the policy. When his kin asked for the promised amount, Life Insurance Corporation (LIC) examined the medical records and found this serious lapse and cancelled the policy on the ground of hiding medical history.

The action of LIC was upheld by the apex court, which rejected the argument of the kin's counsel that the life insurance policy, being a requirement of social security, could not have been cancelled by LIC merely on the ground of suppression of medical history, especially when the corporation's doctor had examined the policy holder.

A Bench comprising Justices S B Sinha and H S Bedi said: “The purpose of taking a policy of insurance is not very material. It may serve the purpose of social security, but then the same should not be obtained with a fraudulent act by the insurer.”

Looking at the form in which Chackochan had stated that he had not undergone any operation and that his state of health has been good, the Bench said, “The proposer must show that his intention was bona fide. It must appear from the face of the record.”

It said a deliberate wrong answer, which has a great bearing on the contract of insurance, if discovered, might lead to the policy being vitiated by law.

“We are not unmindful of the fact that LIC, being a State within the meaning of Article 12 of the Constitution, its action must be fair, just and equitable but the same would not mean that it shall be asked to make a charity of public money, although the contract of insurance is found to be vitiated by reason of an act of the insured,” said Justice Sinha, writing the judgment for the bench.

If a person makes a wrong statement with knowledge of consequences thereof, he would ordinarily be not allowed to plead that disclosure of the suppressed facts would not materially alter the position, the court said rejecting the appeal filed by Chackochan's kin seeking the policy amount from LIC.

November 22, 2007

TN govt. signs MoU with private hospitals for financial assistance for children undergoin heart surgeries

The Tamil Nadu Government on Wednesday signed an MoU with 17 private hospitals in the state to perform heart surgeries for children belonging to indigent families.

As per the MoU, the State Government would extend a financial assistance of Rs 10,000 for closed heart surgery, Rs 30,000 for ordinary open heart surgery and Rs 70,000 for complex open heart surgery to be performed at private hospitals.

An official press release here said the number of children affected by heart diseases had been increasing due to changing lifestyle and food habits.Many children had been placed on waiting list to undergo surgery at Government hospitals.

Considering this, Chief Minister M Karunanidhi had announced a scheme to fund immediate surgery for children, below 12 years, at private hospitals, the release added.

Accordingly, the MoU was signed with the private hospitals, including Sri Ramachandra Hospital and Apollo Hospital here, in the presence of Karunanidhi at the Secretariat here.

Health village for medicare, research coming up near Chennai

A health village is to be established in Elavur, near Chennai, to serve as the hub for medicare and medical research in South Asia. It is a joint venture between Frontier Lifeline Hospital and the Tamil Nadu Industrial Development Corporation (TIDCO).

A memorandum of understanding, formalising the Rs. 450-crore project, was signed by representatives of the organisations on Wednesday in the presence of Chief Minister M. Karunanidhi.

Frontier Lifeline was represented by its founding chairman K.M. Cherian, and TIDCO, by its Managing Director S. Ramasundaram.

Electricity Minister Arcot Veeraswamy and Health Minister M.R.K. Panneerselvam were present along with Chief Secretary L.K. Tripathy.

The entire project will be completed in three phases over the next five years. Frontier Mediville, as the village is called, will also have a state-of-the-art national medical science park, which will facilitate research in basic and applied sciences, a multi-speciality 1,000-bed hospital, units of Indian systems of medicine, a vendors’ park and a medical university.

First of its kind


K.M. Cherian, founding chairman, Frontier Lifeline Hospitals, said it would fall under the category “bio-hospital,” first of its kind in the country, an emerging concept that combined clinical practice with regenerative medicine and basic sciences enhanced with holistic therapy. Frontier Mediville would also have a ‘Sterile Biomedical Corridor’ to facilitate manufacture of consumables, disposables and pharmaceutical products required for in-house hospital and research facilities.

This followed the Brazilian model, where the hospital generated products it required to run the entire unit, Dr. Cherian said.

The park would also be able to handle outsourcing orders from the rest of the world for tests, procedures and trials. Research and application of nano-technology and bio-informatics would be the frontier areas of exploration, he said.

Medical university

The comprehensive medical university would include a regional centre for nursing and paramedical training and would be run in collaboration with the Edward Dunlop Health Foundation, Australia. A herbarium was also on the cards, to be developed in collaboration with the Korean Research Institute of Bioscience and Biotechnology and the Asia Pacific Bio-Resources Consortium. It would house medicinal plants and develop genetically engineered strains, from which molecules could be extracted for therapeutic treatment.

“Our aim is to establish Frontier Mediville as a single-stop destination for any medical requirement. It will also serve as a holistic healing centre for medical tourists,” Dr. Cherian said at a press conference held after the MoU signing ceremony. He hoped that Frontier Mediville would evolve as a model for other States. The village would also be served by a helipad, a railway station and bus terminus to enhance accessibility to Elavur, located off National Highway 5.

November 19, 2007

Health screening: A business run on fear

Osteoporosis. Cancer. Heart attack. Pondering all the random, horrible ways we can get sick is enough to scare anyone stiff.

Hence the proliferation of new health screens--many not covered by insurance--that try to detect disaster early so patients can put up a decent fight. Screens differ from diagnostic tests in that screens are aimed at patients who are not at unusually high risk and exhibit no particularly alarming symptoms.

The problem: Plenty of screens don't really work that well. Many yield lots of false-positive results, which lead to unnecessary (and risky) treatments. Other tests work, though not in time for patients to act, leaving them to a life of endless dread.

"People forget that there are two sides to screening," says Dr Barbara Yawn, director of research at Olmstead Medical Center and a member of the United States Preventive Services Task Force, a government-backed group of health care professionals that study and evaluate health screens. "[Screens] can be beneficial, but there are always other risks."

Here's one horror story, from Dr. Robert Centor, dean of the Hunstville campus at the University of Alabama School of Medicine. Several years ago, during a simple diagnostic chest X-ray, Centor discovered a growth on the lung of one of his patients, who appeared to be in good health. He performed a biopsy to remove the nodule, which turned out to be benign. The patient, however, caught an infection at the hospital and died a few days later.

Despite the risks, health screens are on the rise. While no hard data exist, Yawn says the Preventive Task Force has been asked to review significantly more screenings in the past four years. Dr. David E. Bruns, director of clinical chemistry at the University of Virginia and editor of Clinical Chemistry, says he has seen an increase in the number of tests cited in his medical journal.

Health screening is a business run on fear. "If you find an issue of huge concern to the public and you can market peace of mind, particularly [with regard to] cancer or heart disease, people are willing to buy it," says Dr George Isham, chief health officer of HealthPartners, a health maintenance organization in Bloomington, Minn. "So you see a lot of tests pop up before there's good hard evidence of whether they work or not."

Indeed, the findings by the Preventive Services Task Force are under whelming at best: Of the 60 health screens the group has evaluated, it advises that physicians use only 29--and 10 of those, it says, should be done only at the physician's discretion.

Recommended tests are those that the Task Force believes deliver sufficient preventive value--net of false readings and the risks association with doing further procedures based on them. Some commonly recommended tests include Pap smears (to screen for cervical cancer in sexually active women), high blood-pressure tests, colorectal cancer screens and something called the Factor V Leiden test, which checks a person's predisposition to blood clots.

If a certain disease runs in the family, testing may be a no-brainer. In many other cases, the decision is anything but clear.

"Every advocacy group out there has a slightly different set of recommendations on screenings, so people get confused," says Isham. "Doctors and patients are getting conflicting messages about which tests to use."

Even recommended tests yield a scary number of false readings. Take mammograms, an often promoted and routine exam. According to research compiled by the US Agency for Healthcare Research and Quality, the percentage of false-positive readings is between 7% and 8% for women aged 40 to 59 who took the test. The figure drops to around 4% for women 60 to 79, mainly because the chances of getting breast cancer rise the older women get. If every woman between 40 and 59 in the US had a mammogram, a few million would be fretting unnecessarily over a wrong result.

When it comes to health screens, says Yawn, "it's really important to be honest with patients--what a test is likely to cost in terms of pain, angst and visits to the doctor."

The other problem: Many screens don't discover diseases in time to treat them. "It sounds great to catch cancer early, but it doesn't help unless you can treat it,” says Centor. “You need to be able to change life expectancy and possibly quality of life because of the diagnosis."

Which screens should you think twice about before having?

Perhaps the most dubious are "total body scans." These screens, performed using electron beam computerized tomography, are advertised as a tool that ferrets out cancers, heart disease, aneurysms, you name it. Many radiologists have set up freestanding businesses to peddle these scans.

In reality, the scans are more likely to pick up "incidentalomas"--blips that don't necessarily mean anything but require a follow-up test, says Dr. Roseanne Leipzig, professor of clinical and geriatric medicine at Mount Sinai School of Medicine.

According to recent research by G. Scott Gazelle, director of Massachusetts General Hospital's Institute for Technology Assessment, 90.8% of patients who had a full-body scan got a least one positive finding that led to additional testing. However, only 2% of those actually had a disease. Worse, these tests cost between several hundred and several thousand bucks--and most insurance companies won't pick up the tab.

Prostate-cancer screens create their own dilemmas too. These involve a blood test that looks for unusually high levels of prostate-specific antigens (PSAs). The American Cancer Society suggests men in their 50s take this test yearly (along with a digital rectal exam), but there are two potential flaws.

First, PSA levels generally increase with age and can be inflated because of more benign problems in the prostate, leading to false-positive results. Many men end up having unnecessary biopsies. Second, prostate cancer tends to grow very slowly, which means it might not kill you--or if it does, it will happen much later in life.

The calculation for patients: Skip the test and take your chances, or cut out the cancer early and risk post-surgery downsides like incontinence, impotence and a lot of discomfort.

Then there's the battery of computerized tomography scans. Since 2004, the National Cancer Institute has been conducting trials to see if CT scans (and standard chest X-rays) can reduce mortality in smokers by detecting lung cancer early. Sadly, there's little evidence thus far that supports this technique. In most cases, even with a CT scan, the cancer is found too late.

A full evaluation of the efficacy of CT scans will take at least several more years before any results are found. "These trials require such a large number of people because of the rareness of lung cancer in the overall population," says Isham. "It'll be some years before we have a conclusive answer on that. Good science takes a long time."

November 15, 2007

Corporates eye rural health centres

After setting up high-tech hospitals in cities corporates are now looking to the village. Healthcare giants such as the Hinduja group, Nicholas Piramal and Bombay Dyeing have approached the state government with proposals to manage some of its Primary Healthcare Centres (PHCs), say Mantralaya officials. PHCs are the equivalent of the neighbourhood clinic, where the government provides basic medical care, oversees surveillance and runs preventive camps.

While the state is "seriously considering" the public-private partnership (PPP) offers, healthcare activists have pointed out that primary health is the government's fundamental job and it cannot be leased.

"Corporates such as Hinduja, Bombay Dyeing and Nicholas Piramal have shown an interest in running PHCs. We are still fine-tuning how a PPP model would work," said Director General of Health Services Dr Prakash Doke. There are indications that the state may even consider a PPP model for its rural hospitals. On Monday, state health minister Vimal Mundada spoke at a health summit in Delhi about the need for all sectors—public, private and non-profit—to work together to "achieve ideal health parameters".

The trust-run Hinduja Hospital in Mahim has offered to run five PHCs in Raigad. Officials say the Nicholas Piramal group is looking at PHCs in the malnutrition-prone belt of Nandurbar while the Bombay Dyeing group is surveying PHCs around Pune.

Health activists, however, have voiced their reservations. "The provision of primary healthcare, especially to the poor, is the basic duty of the government. PPP can be used to provide something extra, for instance, to hire specialists such as anaesthetists or obstetricians in rural hospitals," says Dr Anant Phadke of the Jan Swasthya Abhiyan.

If a PHC begins to charge for its services (apart from the mandatory cost for preparing a case paper), the poor would stop using public health utilities, he adds.

But the PPP idea has caught on across India. If NGOs have adopted PHCs in Andhra Pradesh, the Gujarat government has joined hands with private groups under the Chiranjeevi Scheme to reduce maternal and infant deaths. In Haryana, a PPP titled the Vikalp Project caters to four far-flung districts. More recently, the Bihar government handed over several PHCs to the private sector. Dean of research and development at the Tata Institute of Social Sciences C A K Yesudian believes that the corporate interest in PHCs isn't a sustainable model as it depends on the business house's charity quotient rather than on a sustainable module. A PPP can only be useful if private players complement the government's functions. "The state should maintain its control while corporates could finance equipment or provide laboratory services," suggests Yesudian.

However, Dr Doke sees PPPs as a win-win situation. "We run 1,818 PHCs, of which private players will manage only a few to ensure better management and accountability," he says. He cites the example of Sastur in Osmanabad as a successful PPP initiative in Maharashtra.

State official believe that the shortage of specialists can be bridged with private participation. "We will explore options such as specialists visiting the PHC or initiating a referral system where poor villagers could seek cheaper treatment in hospitals run by these corporates," say officials.

Meanwhile, corporates say that their PHC foray is driven by charity not commerce. Hinduja Hospital, for instance, sees it as a CSR (Corporate Social Responsibility) initiative. CEO Pramod Lele told TOI that "we are likely to sign an MOU with the state in a week's time". Swati Piramal of the Nicholas Piramal group said they already have a pilot project in Rajasthan but she wasn't aware about the details in Maharashtra.

Corporates eye rural health centres

After setting up high-tech hospitals in cities corporates are now looking to the village. Healthcare giants such as the Hinduja group, Nicholas Piramal and Bombay Dyeing have approached the state government with proposals to manage some of its Primary Healthcare Centres (PHCs), say Mantralaya officials. PHCs are the equivalent of the neighbourhood clinic, where the government provides basic medical care, oversees surveillance and runs preventive camps.

While the state is "seriously considering" the public-private partnership (PPP) offers, healthcare activists have pointed out that primary health is the government's fundamental job and it cannot be leased.

"Corporates such as Hinduja, Bombay Dyeing and Nicholas Piramal have shown an interest in running PHCs. We are still fine-tuning how a PPP model would work," said Director General of Health Services Dr Prakash Doke. There are indications that the state may even consider a PPP model for its rural hospitals. On Monday, state health minister Vimal Mundada spoke at a health summit in Delhi about the need for all sectors—public, private and non-profit—to work together to "achieve ideal health parameters".

The trust-run Hinduja Hospital in Mahim has offered to run five PHCs in Raigad. Officials say the Nicholas Piramal group is looking at PHCs in the malnutrition-prone belt of Nandurbar while the Bombay Dyeing group is surveying PHCs around Pune.

Health activists, however, have voiced their reservations. "The provision of primary healthcare, especially to the poor, is the basic duty of the government. PPP can be used to provide something extra, for instance, to hire specialists such as anaesthetists or obstetricians in rural hospitals," says Dr Anant Phadke of the Jan Swasthya Abhiyan.

If a PHC begins to charge for its services (apart from the mandatory cost for preparing a case paper), the poor would stop using public health utilities, he adds.

But the PPP idea has caught on across India. If NGOs have adopted PHCs in Andhra Pradesh, the Gujarat government has joined hands with private groups under the Chiranjeevi Scheme to reduce maternal and infant deaths. In Haryana, a PPP titled the Vikalp Project caters to four far-flung districts. More recently, the Bihar government handed over several PHCs to the private sector. Dean of research and development at the Tata Institute of Social Sciences C A K Yesudian believes that the corporate interest in PHCs isn't a sustainable model as it depends on the business house's charity quotient rather than on a sustainable module. A PPP can only be useful if private players complement the government's functions. "The state should maintain its control while corporates could finance equipment or provide laboratory services," suggests Yesudian.

However, Dr Doke sees PPPs as a win-win situation. "We run 1,818 PHCs, of which private players will manage only a few to ensure better management and accountability," he says. He cites the example of Sastur in Osmanabad as a successful PPP initiative in Maharashtra.

State official believe that the shortage of specialists can be bridged with private participation. "We will explore options such as specialists visiting the PHC or initiating a referral system where poor villagers could seek cheaper treatment in hospitals run by these corporates," say officials.

Meanwhile, corporates say that their PHC foray is driven by charity not commerce. Hinduja Hospital, for instance, sees it as a CSR (Corporate Social Responsibility) initiative. CEO Pramod Lele told TOI that "we are likely to sign an MOU with the state in a week's time". Swati Piramal of the Nicholas Piramal group said they already have a pilot project in Rajasthan but she wasn't aware about the details in Maharashtra.

Wockhardt plans 14 new hospitals

Mumbai-based healthcare firm Wockhardt Hospitals is planning to set up 14 super-speciality hospitals across the country over the next two years, which could entail an investment of up to Rs 600 crore.

"We will almost double our hospitals by 2009 and would add more than 1,000 beds to the current 1,100 beds," a senior company official said here on the sidelines of CII Health Summit.

Asked about the investments, he said the company invests about Rs 55 lakh to Rs 60 lakh on each bed. It is planning to fund the expansion through the proceeds of its proposed Initial Public Offering (IPO), the official added.

The company is focusing on tier II and tier III cities such as Goa, Bhopal, Nagpur among others for expansion besides metros like Delhi, he said.

Wockhardt Hospitals Ltd has already filed its Draft Red Herring Prospectus (DRHP) with SEBI for its IPO. The company is issuing 30,000,000 equity shares of Rs 10 each through a book building process, which will constitute 28.77 per cent of the post issue paid-up capital of the company.

MedIndia Hospitals to launch rural voluntary health service

MedIndia Hospitals is launching a rural voluntary health service to screen the rural population of Tamil Nadu for digestive diseases and gastrointestinal cancers and offer subsidised treatment.

As part of the scheme, it is proposed to conduct free medical camps in rural areas to pick up these silent diseases at an early stage.

Poor and needy patients who are diagnosed with disease during the screening will be provided further investigations and treatment, excluding consumables and medicines, at a 30 per cent concessional rate.

The hospital has launched a helpline 09840993131 to advise the public on health and vaccination issues and to disseminate the services available under the voluntary health scheme. T. S. Chandrasekar, hospital chairman, said an estimated 3.5 per cent of the Indian population suffered from Hepatitis B virus and 1.5 per cent from Hepatitis C, both of which were silent killers. These hepatic infections could lead to permanent and serious liver damage.

According to World Health Organisation statistics, the incidence of digestive cancers ranged across esophagal cancer (11 per lakh of population), stomach cancer (7.5 per lakh), colon and rectal cancer (6.5 lakh) in men while in women the corresponding incidence of these diseases were 9 per lakh, 5 per lakh and 5.5 per lakh of population.MedIndia Hospitals has also commissioned a Video GI Manometry equipment to accurately detect motility disorders of the foodpipe and digestive system and to differentiate chest pain caused by heart disease and the food pipe.

The voluntary health scheme and the new facility were launched at a workshop on Saturday . MedIndia awards were also presented to senior teachers K.V. Thiruvengadam, S. Krishnan, V.I. Mathan, N. Rangabashyam, B. Krishna Rau and posthumously to Madanagopalan.

Chettinad Health City to be inaugurated next week

A non-profit arm of cement and construction major Chettinad Group is investing Rs 500 crore to set up Chettinad Health City, an integrated health care facility that includes medical education, patient care, research and community health initiatives. It is to be inaugurated on November 15.

This will be the country’s first non-profit health city venture. Others global health city initiatives include Aditya Birla Medicity, Pune and Apollo Health City, Hyderabad and Dubai Healthcare City, Dubai.

Conceived three years ago, the integrated tertiary referral CHC in Chennai will house all super-specialities, under a single roof, in phase three. “Though we are still in the investment phase, we are on-time as far as the project is concerned. We expect to complete the phase III by 2009, when we propose to have all super specialities and 1,000 beds for healthcare delivery,” CHC chief administrator N Venkat Phanidar told ET here on Saturday.

Promoted by the Rajah Sir Muthiah Chettiar Charitable and Educational Trust, Rs 250 crore investment has already been made into CHC. “We are still in the investment phase. Rather than tapping the boom in sectors like real estate and IT, our objective is to invest on a social asset. We also intend extending our facility to cover research and development and manufacturing activities, after meeting statutory compliance,” he said.

The idea is to be self-reliant in health care, as health care products like stents, are still import-driven. “We want to invest on knowledge and skills and nurture talent in health specialities,” he added.

Spanning an area of 100 acres, already an area of 12 lakh sq ft of construction has been completed. “CHC is replete with all the modern facilities. It houses a 600-bed hospital, a medical college and residential accommodation facility apart from outpatient amenities,” Mr Phanidar said. On the equipment side, Rs 40 crore has been invested, inclusive of the Rs 25 crore plus investment on cardiology department.

“CHC has three centres of excellence, institute of cardio-vascular diseases, institute of IVF and nephrology. We would like to improvise in phase II, where we propose to bring in specialities like cosmetics, neuroscience, ortho and ophthalmology. At a later stage, we would also like to bring in cancer speciality too,” he said
Of the 256 full-time doctors on CHC rolls, women constitute 40%. NRI-returned Dr R Ravi Kumar will spearhead the institute of cardiovascular disease.

Asked about the medical costs, Mr Phanidar said “our pricing will be competitive. Typically, our overall surgery costs will be 25% cheaper than those charged by hospitals in our category.”

A dialysis in CHC will be available for Rs 900, while the prevailing charges are Rs 1,500 outside. A bypass in CHC would mean a saving of at least Rs 30,000, he added.

CHC has a pact with Malaysia-based MasterSkill College of Nursing and Health, to train 120 students every two months. It is also negotiating with institutions from European countries and Australia. Its medical college, which has an annual intake of 150 students, is in the second batch, making 300 medicos available to CHC.

Knowledge panel for all-India entrance exam for MBBS

In a move that will affect lakhs of students across India, the National Knowledge Commission has asked the Centre to scrap state-level common entrance tests and conduct all-India entrance test for admission to medical colleges.

An NKC working group, which has comprehensively appraised the medical education system, has called for overhauling of the present system. "Policies of admission and fee structure of private colleges have to be regulated, not only to stop them from becoming sources of political and financial power, but also to arrest failing standards," NKC chairman Sam Pitroda told Prime Minister Manmohan Singh last week.

The group in its report, which is with TOI, has said, "There should be only one all-India common entrance test for all students who would like to get admissions to self-financing medical colleges. Since the CBSE-conducted examination for the 15% all-India quota in government medical colleges is taken by a large number of students, this appears to be an ideal examination, whose ambit can be expanded."

To make admissions transparent, the commission has said colleges must announce their fees in their prospectus, so that students can make their choice. Computers and IT should be used to increase transparency and efficiency in admission, examination, administration and teaching, it says.

More significantly, the group has sought an independent and standardised national exit examination at the end of four-and-half-year course to assess skills and knowledge acquired by students. This should be conducted immediately after the university examination and can also serve as a post-graduate entrance exam.

November 08, 2007

Medical education in digital form soon

Medical students in India could soon have the benefit of learning course content at their own pace through lectures that would be offered in a digital format.

Over 7,500 multimedia enhanced digital lectures subscribing to the curriculum prescribed by the Medical Council of India (MCI) for MBBS have been digitised.

For slow learners, the digital options offers the advantage of listening to the lectures repeatedly and learn. It can effectively supplement the faculty’s efforts at the medical colleges as well.

The Hyderabad-based e-learning company, Medical Education Research Centre (MEdRC), which has digitised the entire MBBS curriculum has entered into an agreement with Dr NTR University of Health Sciences, Vijayawada to provide digital curriculum.

The NTR University is introducing the digitised medical lectures on an experimental basis for the first three months. Based on the feedback from the students it would be extended, according to Dr Neeraj Raj, Managing Director of MEdRC. “What we have developed is an e-learning programme for undergraduate medical students. It consists of text, tables, flow charts, colour stills, 2D and 3D animation, audio, video of clinical methods, case discussions and video lectures by over 700 expert faculty from across the country”, he said.

The company has spent Rs 8 crore on the project so far. It is in talks with several Medical colleges to promote it.

Students to get health cards

All schoolchildren in India, above class V, will soon be screened for diseases once a year.

In a massive National School Health Programme being planned jointly by the ministries of health and HRD, children across the country will be given smart health cards containing information on their health. They will be screened by doctors, either from public or private hospitals, for blindness, deafness, dental and cardio vascular health, vitamin deficiencies and anaemia. If they are found suffering from any of them, they will be immediately referred for further treatment. The programme aims to promote health of schoolchildren, and prevent diseases by early diagnosis and treatment. Officials from both the ministries have already held talks with the next one scheduled for mid-December.

Health minister A Ramadoss said, "A deafness and speech programme will teach doctors, family members and teachers to identify children with hearing and sight problems early, before it becomes damaging. The school health programme will be a public-private partnership. The programme will be started initially in states which show interest in such a screening programme to protect the younger generation."

A similar programme is being run by state governments in Mizoram, Maharashtra, Tamil Nadu and Gujarat. "It needs to be a collective programme with states working in unison. Associations like the IMA and Dental Council of India have agreed to help us with the screening. Students would be given personal health cards, which would chart the disease history of the child concerned," Ramadoss added.

School-children will also be routinely screened for health complications like congenital heart disease and diabetes.

Risk factors like high blood pressure, hypertension and obesity among children, the primary causes behind cardio-vascular diseases (CVD), will also be identified for parents to better manage and avert impending diseases.

Nearly 10 years after the idea was first mooted, Planning Commission has approved in-principle India's first national programme for prevention and control of cardio-vascular diseases, stroke and diabetes. To be implemented and supervised by the health ministry, from mid-December, the initial phase will cost Rs 15 crore. "The success of the initial programme will help seal a total clearance from Planning Commission to the national programme. Under the programme, children will be regularly screened for diseases and risk factors. Anti-hypertensive drugs will cut down on high BP and lifestyle changes will cut down on obesity. WHO calls this programme a vital investment," a health ministry official told TOI.

The ministry has asked the plan panel to sanction Rs 1,680 crore to run the programme from 2008-2012.

Is the doctor-drug industry nexus harming patients?

Companies in the U.S. that produce drugs and medical devices with a turnover of more than $100 million may soon be forced to reveal the amount of money that they give to doctors to influence their prescribing patterns. A bill was recently introduced in the U.S. Senate to this effect. Already five States and the District of Columbia have such regulations in place.

What in the first place warrants a bill to make it mandatory for the drug industry to disclose such information?

It has been well known that the medicines that doctors often prescribe are the medicines that pharmaceutical companies want them to prescribe.

Off-label use


No matter that cheaper alternatives are available, that certain medicines prescribed are unnecessary, that the medicines are put to off-label use (for indications that the regulatory authorities have not approved them), doctors tend to do what the pharmaceutical companies have asked them to do.

So what has made many doctors lose their objectivity and become the front for the industry? “Free pens and pizza lunches. Sponsored conferences and compromised medical education… and unaffordable holidays,” an Editorial in the British Medical Journal (May 2003) points out.

Doctors may be getting free lunches, but in reality there is nothing called a free lunch. For all the gifts that the drug industry provides, the quid pro quo arrangement, though unstated, expects the doctors to prescribe more of the company’s medicines.

Funding education


In some countries, the industry starts influencing the doctors much earlier. According to an Editorial in the British Medical Journal (April 2005), “over half of all postgraduate medical education in the UK… is funded by the pharmaceutical industry.”

But rarely would doctors acknowledge or even agree that their prescribing decisions are indeed influenced by the industry. They would like us to believe that they are fiercely independent and that their prescribing trends are never influenced by the industry.

Patients would only love to believe that it is indeed so. After all, they pay a price for any biased prescription.

Rewarding doctors


But the facts point out otherwise. A paper published in the British Medical Journal in 2003 noted that the industry admitted to rewarding doctors for switching from one drug to another but maintained that it was a “standard industry practice.”

A paper published last year in the Journal of the American Medical Association (JAMA) states that the industry spends about $13,000 a year per doctor on marketing activities.

In all they spend more than $20 billion a year on marketing, about 90 per cent of which goes to doctors.

National survey


A paper published in the latest issue of the New England Journal of Medicine based on a national survey conducted in the U.S. notes that 35 per cent of the respondents have received reimbursement for “…costs associated with professional meetings or continuing medical education.” And 28 per cent received payments from the industry for “…consulting, giving lectures, or enrolling patients in trials.”

One may wonder that small gifts will not have any influence on their prescribing patterns But the JAMA report of 2006 states, “…the impulse to reciprocate for even small gifts is a powerful influence on people’s behaviour.”

That has been the basis for many institutions in the U.S. for not allowing sales representatives inside their institutions or the companies from providing free lunches to doctors in their campuses. More institutions are joining the fray.

While an institution-level policing may have worked successfully, making the companies reveal information on doctor funding has been far from successful. For instance, Minnesota, which was the first State in 1993 to have such a disclosure law in place, and Vermont require the information to be publicly available.

Not accessible


But a study published in JAMA (March 2007) found that accessing information was not as easy as it was originally intended to be. It found that in Vermont about 60 per cent of the payments made by the companies were not released to the public.

And the reason? “…Pharmaceutical companies designated them as trade secrets,” the study revealed. And it was not that the information accessible revealed all. About 75 per cent of publicly disclosed payment information did not identify the recipient.

If some of the leading medical journals, and not legislations, compelled the pharmaceutical companies to register human clinical trials for consideration of results publication, probably patient groups would be able to do the same with the disclosure laws.

One more platform


Alas, most patient groups themselves depend on pharmaceutical companies for funding and they act as yet another platform for the companies to sell their products!

With only a few potential blockbuster drugs produced in the recent past and with fierce competition in the market, companies are forced to milk the most out of the existing drugs. How far the legislation will be able to cleanse the system will be closely watched by other countries.

Is the doctor-drug industry nexus harming patients?

Companies in the U.S. that produce drugs and medical devices with a turnover of more than $100 million may soon be forced to reveal the amount of money that they give to doctors to influence their prescribing patterns. A bill was recently introduced in the U.S. Senate to this effect. Already five States and the District of Columbia have such regulations in place.

What in the first place warrants a bill to make it mandatory for the drug industry to disclose such information?

It has been well known that the medicines that doctors often prescribe are the medicines that pharmaceutical companies want them to prescribe.

Off-label use


No matter that cheaper alternatives are available, that certain medicines prescribed are unnecessary, that the medicines are put to off-label use (for indications that the regulatory authorities have not approved them), doctors tend to do what the pharmaceutical companies have asked them to do.

So what has made many doctors lose their objectivity and become the front for the industry? “Free pens and pizza lunches. Sponsored conferences and compromised medical education… and unaffordable holidays,” an Editorial in the British Medical Journal (May 2003) points out.

Doctors may be getting free lunches, but in reality there is nothing called a free lunch. For all the gifts that the drug industry provides, the quid pro quo arrangement, though unstated, expects the doctors to prescribe more of the company’s medicines.

Funding education


In some countries, the industry starts influencing the doctors much earlier. According to an Editorial in the British Medical Journal (April 2005), “over half of all postgraduate medical education in the UK… is funded by the pharmaceutical industry.”

But rarely would doctors acknowledge or even agree that their prescribing decisions are indeed influenced by the industry. They would like us to believe that they are fiercely independent and that their prescribing trends are never influenced by the industry.

Patients would only love to believe that it is indeed so. After all, they pay a price for any biased prescription.

Rewarding doctors


But the facts point out otherwise. A paper published in the British Medical Journal in 2003 noted that the industry admitted to rewarding doctors for switching from one drug to another but maintained that it was a “standard industry practice.”

A paper published last year in the Journal of the American Medical Association (JAMA) states that the industry spends about $13,000 a year per doctor on marketing activities.

In all they spend more than $20 billion a year on marketing, about 90 per cent of which goes to doctors.

National survey


A paper published in the latest issue of the New England Journal of Medicine based on a national survey conducted in the U.S. notes that 35 per cent of the respondents have received reimbursement for “…costs associated with professional meetings or continuing medical education.” And 28 per cent received payments from the industry for “…consulting, giving lectures, or enrolling patients in trials.”

One may wonder that small gifts will not have any influence on their prescribing patterns But the JAMA report of 2006 states, “…the impulse to reciprocate for even small gifts is a powerful influence on people’s behaviour.”

That has been the basis for many institutions in the U.S. for not allowing sales representatives inside their institutions or the companies from providing free lunches to doctors in their campuses. More institutions are joining the fray.

While an institution-level policing may have worked successfully, making the companies reveal information on doctor funding has been far from successful. For instance, Minnesota, which was the first State in 1993 to have such a disclosure law in place, and Vermont require the information to be publicly available.

Not accessible


But a study published in JAMA (March 2007) found that accessing information was not as easy as it was originally intended to be. It found that in Vermont about 60 per cent of the payments made by the companies were not released to the public.

And the reason? “…Pharmaceutical companies designated them as trade secrets,” the study revealed. And it was not that the information accessible revealed all. About 75 per cent of publicly disclosed payment information did not identify the recipient.

If some of the leading medical journals, and not legislations, compelled the pharmaceutical companies to register human clinical trials for consideration of results publication, probably patient groups would be able to do the same with the disclosure laws.

One more platform


Alas, most patient groups themselves depend on pharmaceutical companies for funding and they act as yet another platform for the companies to sell their products!

With only a few potential blockbuster drugs produced in the recent past and with fierce competition in the market, companies are forced to milk the most out of the existing drugs. How far the legislation will be able to cleanse the system will be closely watched by other countries.

November 06, 2007

Overseas Doctors seeking to work in Australia falls by 90%: The Haneef Effect

The number of overseas doctors seeking to work in Australia has fallen by 90 per cent because of the government’s handling of the case against Mohammed Haneef, a medical association said.

“This spells disaster for an already over-stretched and under-resourced medical work force — particularly for rural and regional areas where many of these doctors are posted,” said Nagamma Prakash of the Overseas and Australian Medical Graduates Association.

Haneef, an Indian doctor, was detained for weeks in connection with failed UK bombings on allegedly flimsy evidence before being allowed to fly home.

Prakash spoke of “growing anger among Australians of Indian background” at the government’s handling of the case.

Health insurance takes root in Orissa village

At the time when over 200 people died of cholera in southern Orissa's Rayagada, Koraput and Kalahandi districts recently, the deadly virus did not enter villages in the neighbouring villages of Gajapati district.

The virus did not spread into the villages of at least five blocks of Gajapati district as the tribal villagers are well-informed in their health care, thanks to the People's Rural Health Promotion Scheme, an integrated health insurance launched by the People's Rural Education Movement (PREM) in association with Plan International.

The scheme was launched 4 years ago to provide medical services, as well as health insurance to tribals and fishermen of the operational areas of PREM with a minimum and one time premium.

Praising the scheme the International Labour Organisation says, “Preventive health care programme of PREM-Plan and peripheral care offered through Village Medicine Depots help to reduce referral morbidity and thereby reduce the expenditure load on PRHPS.”

Under the scheme, if a patient suffers from any disease, he is first treated at the Village Medicine Depot set up by the organisation. A trained lady from the respective village is appointed to provide medicine to the patient for minor ailments. After three days, if there is no improvement, the patient is referred to the nearest Public Health Centre and to the medical college at Berhampur.

At the VMD, the treatment is given for at least 15 minor diseases including fever, malaria, diarrhoea, dehydration, minor injuries, cough, scabies, safe delivery and immunisation. The quality and low-cost medicines are stocked in the VMD. Trained women of the respective villages serve the medicine with elaborate health advice on sanitation and hygiene.

In order to insure his health, a person has to be enrol his or her name under the scheme paying Rs 30. The fund collected from the members becomes a corpus and managed by the villages themselves. “Our role is very limited as the scheme is operated by the villagers themselves,” said PREM president, Jacob Thundiyil.

The scheme is presently operating in 333 villages under 4 blocks — Mohana, Nuagada, Gumma and Rayagada in Gajapati district, 144 villages in 3 blocks — Krushnaprasad, Bramhagiri and Kakatpur in Puri district and covers over 80,000 people.

“We are planning to extend the scheme to Gunupur block in Rayagada district, Sanakhemundi and Dharakote blocks in Ganjam district and Vizianagaram district in Andhra Pradesh and to cover another 40,000 people,”he said.

The organisation has been provided some infrastructural facilities in all the referral government hospitals including the MKCG Medical College and Hospital, Berhampur for better treatment to their insured patients.

In MKCG Medical College and Hospital, PREM was donated at least 15 beds in the Orthopedic department.

“We never refer to any patients to the private nursing homes" he said. In this way we teach the people about the access to the government hospitals,” he added.

All the referral ad treatment expenditure will be borne by the organisation if the patient is enrolled under the scheme.

“The distance from our village to PHC is about 10 km while the district hospital and medical college are about 40 km and 160 km away respectively. Serious cases are taken to Paralakhemundi district hospital by bus or tractor. From the insurance we are being reimbursed the cost of the medicines,” said Digu Digal of Sadanga in Gumma block of Gajapati district.

“In our village one person had gone through a stomach operation, another person had a paralytic stroke. The scheme helped both the cases,” said Janab Majhi of Paleri village of the same district.

Jacob, the founder of the scheme said the People’s Rural Health Promotion Scheme was aimed at breaking the link between ill-health and poverty by ensuring the health care of the tribal and fishermen who are the focal groups of PREM-Plan’s development activities.

The scheme is embedded in the other health and development activities of PREM-Plan. He was influenced by other community health insurance schemes of RAHA in Chattisgarh and ACCORD in Tamil Nadu to launch the scheme with improvisations for the project areas of the organisation.

UK docs oppose curbs on Indians

Britain's medical community has resoundingly voted to oppose the government's proposal to restrict the employment opportunities for Indian and other non-European Union doctors in the National Health Service (NHS).

In a survey conducted by the British Medical Association (BMA) this week, members voted to oppose tighter restrictions on the employment opportunities of overseas doctors and medical students.

Britain's Health Minister Ben Bradshaw has recently drawn up proposals to slash the number of junior doctors from overseas coming to Britain to train. The idea is to preserve jobs for the rising number of British medical graduates.

The proposal is that doctors from countries outside the EU should not be considered for a job unless there are no qualified applicants from Britain or from elsewhere in Europe. This is an unlikely scenario given the popularity of medical training in Britain and the EU.

During the recent rounds of recruitment to the NHS, several hundred British doctors who could not find employment left the country as the issue snowballed into a major public controversy through demonstrations and petitions.

There is also a proposal that fresh British medical graduates would automatically get a first-year hospital training place on graduation, which would give them a head start over even other European candidates.

But BMA's survey released at a conference this week revealed that almost two-thirds (64 percent) of the 737 doctors and medical students surveyed believe that overseas students graduating from UK medical schools should not be prevented from competing for training jobs.

Over half (57.4 percent) think that doctors who qualified overseas should be entitled to compete for training posts with UK graduates, although most of these thought that this should apply only to those already working in the NHS.

Hamish Meldrum, chairman of council at the BMA, said: "The government has made a mess of medical training. It appears they are now trying to penalise the thousands of overseas doctors and medical students who want to work in the NHS."

Other key findings of the survey include: Half of respondents oppose the idea of a national computerised examination on entry to core specialist training; Eight in 10 respondents agree with recommendations that medical career structures should be the same across the UK

In a separate submission to the Department of Health's consultation on proposals to restrict employment opportunities to overseas doctors, the BMA said the proposals were 'unfair'.

The BMA said in its submission that "medical immigration" should be better controlled in future, but was concerned for the welfare of thousands of doctors and medical students from overseas who are already in the UK.

Terry John, chair of the BMA's International Committee, said: "Long-term, the UK should be able to produce its own medical workforce and managing medical immigration in the future will be necessary.

"However, the thousands of overseas junior doctors currently providing essential services in UK hospitals must not be scapegoated for the government's poor workforce planning. They came to the UK in good faith, and the honest expectation of training opportunities in the NHS."

The BMA is particularly concerned about overseas students currently spending large amounts of money - an average of 23,000 pounds a year during their clinical years - to study at UK medical schools.

John added: "International medical students are often making huge personal and financial sacrifices in order to study in the UK. If they are not allowed to apply for postgraduate training posts, and are forced to return home, they could face a huge struggle in repaying outstanding debts."

The BMA said it was aware that this would also adversely affect UK medical schools, which rely heavily on income from overseas students.

Teen doctors take charge in villages

For most children, playing 'doctor doctor' is just that, child's play. But for some kids in Andhra's Nizamabad district, it's much more than that because they are handling real health emergencies and giving first aid.

They are the chinnari doctors or 'small' doctors, in the age group 8-14, who have been trained to handle small health emergencies in their villages.

Most villages in Nizamabad district lack proper health facilities. Some like Bodhan and Yedapalle don't even have a single hospital or clinic and the villagers have to either wait for the midwives from the government's health facilities to visit them or travel 9-10 km to the nearby towns. To do that, they have to wait for local buses that come to their villages once or twice a day.

''Villagers come to me first these days (for any emergency). If it's just a minor injury, I treat them. Else, I refer them to a hospital in the neighbouring town,'' says chinnari doctor Vinod, who studies in a zila parishad school in Karegaon, 6 km away from his village. He walks all the way to school, gains basic knowledge from health workers and carries his newfound expertise home to help his people.

Taking charge: The concept of chinnari doctors was born of the lack of basic health facilities in these villages. Plan India, an NGO, selected five children from nearly three villages some months back and gave them training about dealing with medical emergencies. These children now meet each other regularly and also the trainers to update themselves about the latest medical issues.

V P Shanthi, project manager, Samskar-Plan, says, ''The compounders have been treating the villagers. But they are not qualified, learnt the trick of the trade on the job, and charge a lot of money too. That's why we decided to teach these children about first-aid and other emergencies so that they can be self-dependent and help others too.'' Says 'Dr' Bhanuchander, 13, ''Every year, we are made to undergo at least four training camps. Then we are taken to government hospitals where we get first-hand experience.''

These small doctors carry a first-aid kit and attend to victims of burns, snakebites or fevers and other emergencies like accidents and drowning cases. Their kit contains an antiseptic cream, ointment, nail cutter, hydrogen peroxide, cotton, bandage, scissors and some tablets. ''I know what to do when someone's been saved from drowning. We have to press their abdomen and if they don't recover, we have to give mouth-to-mouth resuscitation. In case of eye infections, we tell things like not to rub eyes and to wash with clean water only. We recommend them to wear dark glasses,'' says Virmani, another chinnari doctor of Karegaon. Adds 'Dr' Monica, a class VI student, ''Sunstroke is very common in Andhra Pradesh. So we teach people methods to prevent that.''

These children also try to debunk health-related myths. Vijaya, who is in class X, says, ''There are certain practices that have been followed for years but are absolutely wrong. For instance, people in our village have the habit of putting hot oil in ears. We tell them such things are wrong.'' She is among the three chinnari doctors in her village.

Spreading social awareness: They are also spreading awareness among girls and their parents on how the early marriage of a girl can affect her health. ''My friend got married when she was just 12. A few months later, she ran away from her in-laws' place after suffering a lot of mental and physical torture. Later, she died. Since then, I see to it that I tell as many people as possible about how harmful early child marriage can be,'' says another chinnari doctor.

Not only do the villagers listen to these kids, they also encourage them in every possible way. In fact, the villagers want them to grow up to be professional doctors and improve medical facilities to their villages. K Prabhakar Rao, headmaster of a small school in Karegaon, is all praise for them. ''They are all well trained. I feel dizzy when I see blood, but these kids are so brave,'' he says.

''The programme has inspired them to become doctors in future and to channelise their energy towards social service at a very early age,'' says Dr Srinivas, project doctor. Vinod adds, ''When I grow up, I will become a doctor and construct a hospital in my village.''That's no longer an impossible dream.

TN keen on launching telemedicine projects

The Tamil Nadu Government is keen on taking the benefits of telemedicine to the poor in rural and urban areas, and the Government was launching projects in this regard, Chief Minister M Karunanidhi said.

In his address at the Third National Conference of the Telemedicine Society of India (TSI) and 12th International Society for Telemedicine and eHealth (ISfTeH) Conference here on Saturday, he recollected that his Government had sanctioned Rs 87 lakh in 1999 to implement a pilot project in telemedicine in Government General Hospital here.

"A state-of-the-art telemedicine facility is now available at the hospital," he said.

Another project will be inaugurated shortly at the Government Royapettah Hospital, linking six Government headquarters hospitals at Kancheepuram, Thiruvallur, Thiruvannamalai, Krishnagiri,Udhgamandalam (Ooty) and Rameswaram.

Further, a Tele Health Project was currently under implementation at the Tindivanam Taluk Hospital and Mailam Block Primary Health Care Centre in Villupuram.

"The Government has signed a Memorandum of Understanding (MoU) with Intel Technology India Pvt. Ltd. for implementing the project at Tindivanam," he said.

He also pointed out that Tamil Nadu was the first state in India to create 98 Comprehensive Obstetrics and Newborn Care Centres, in order to address "shortage of specialists in the Health Department."

However, such telemedicine facilities will help address the "shortage of specialists," especially in rural areas, he said.

Karunanidhi also lauded the Indian Space Reasearch Organisation for offering free services on its bandwidth for telemedicine consultations in the country.

L S Satyamurthy, Programme Director, Telemedicine, ISRO, said India's Edusat was the only satellite in the world dedicated for health and education. He also said 250 hospitals and 42 speciality hospitals were covered under the ISRO telemedicine network.

Leading names from the field of medicine and others participated.

November 01, 2007

Doctors can't endorse pharma brands

That doctors cannot promote themselves through advertisements is a known fact. But can medical practitioners endorse pharmaceutical brands? According to Dr Chandra Gulati, Delhi-based editor of the Monthly Index of Medical Specialities (MIMS), a foreign insulin’s promotional booklet recently carried descriptive endorsements by local doctors. This particular brand was variously deemed as the “ideal insulin", "as strong as steel", "a blue ribbon insulin" and carried passport-size photographs of all the 63 doctors who endorsed it.

Gulati says such endorsements, which are not few and far between, violate the Medical Council of India (MCI)’s 2002 regulations regarding professional conduct, etiquette and ethics for registered medical practitioners. The regulations specify: "A physician shall not give to any person, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report or statement with respect to any drug, medicine, nostrum remedy, surgical, or therapeutic article, apparatus or appliance or any commercial product or article with respect to any property, quality or use thereof or any test, demonstration or trial thereof, for use in connection with his name, signature, or photograph in any form or manner of advertising through any mode nor shall he boast of cases, operations, cures or remedies or permit the publication of report thereof through any mode."

Says Dr Vasant Pawar, an MCI member, "If it (an endorsement) amounts to advertisement, it is not permitted."
A senior pharmaceutical industry official too agrees that such endorsements are not allowed. However, the official adds, "A doctor can talk about a molecule based on the research data and quote studies in medical literature."
In other words, doctors can make claims about a drug like, say, paracetamol but not a particular paracetamol brand. That would amount to unethical conduct.

In a statement, the Advertising Standards Council of India (ASCI) too says: "The code of ethics of the Medical Council does not allow doctors to advertise and most senior doctors in India look upon (such) advertising with suspicion."

MCI’s Pawar says the body’s ethical committee looks into consumer complaints of unethical conduct and takes action within three months. MCI’s ethical regulations add, "Upon receipt of any complaint of professional misconduct, the appropriate medical council would hold an enquiry... If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate medical council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period from the register, the name of the delinquent registered practitioner. Deletion from the register shall be widely publicised in local press as well as in the publications of different medical associations/ societies/ bodies."

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