April 27, 2008

Apollo Hospitals to start medical college in West Bengal

The Apollo Gleneagles Hospitals is to set up a medical college with a 350-bed hospital on the outskirts of the West Bengal capital.

Apollo Hospitals managing director Preetha Reddy told reporters: "We discussed the plan for the medical college at a meeting with Chief Minister Buddhadeb Bhattacharya Friday evening. He has promised to extend all possible help, including arranging for a 25-acre plot if we fail to arrange for it ourselves."

The hospital authorities are eyeing the outskirts of Kolkata to set up the medical college. "This Rs.700-million project will be operational by 2011," Reddy added. There will be a 350-bed hospital on the campus of the medical college.

"We are also planning to set up 100-bed hospitals in West Bengal towns. We will start with Siliguri, Burdwan and Kharagpur towns," said Reddy.

April 19, 2008

Medicines cannot have deceptively similar names: HC

In a significant order, the Bombay High Court recently ruled that medicines having the same composition but produced by different manufacturers cannot have deceptively similar names. The order was passed in a trademark infringement suit filed by Wyeth Holdings Corporation, which owns the trademark Folvite, a medicine used for prevention of vitamin deficiencies and anaemia, since 1946.

Wyeth Holdings had dragged Burnet Pharmaceuticals Pvt Ltd to court over the latter's move to change the name of its medicine from Folacid to Fol-V.

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Labelling the mark Fol-V to be deceptively similar to theirs, Wyeth alleged infringement and passing off. Relying on a SC judgment, which held that deceptive similarity in the case of medicinal products must be dealt with a greater degree of strictness in order to protect public from the serious consequences that may ensue, justice D.Y. Chandrachud restrained Burnet from using the mark Fol-V.

Chandrachud ruled that a less than strict standard cannot be applied on the hypothesis that the ailment, which the drug is intended to treat is not life-threatening, nor can the application of a lower standard be justified merely on the ground that the composition of the two drugs is the same and the confusion caused by mistaking one for the other would not result in danger to health. "Public interest lies in protecting the consumer against an unwary purchase of a deceptively similar product. The consumer must be protected against a reasonable possibility of confusion arising out of a deceptively similar mark," the judge said.

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Noting that Wyeth had been associated with the mark Folvite since 1946 and had built up a reputation and goodwill over the years, Chandrachud stated, "A manufacturer builds up a reputation for quality and standards assiduously over a length of time and an established mark assures to the consumer that the medicine which he has purchased is of a requisite quality that is associated with the mark."

April 15, 2008

Wanted doctors, nurses for BPOs

A team of nurses and paramedics led by two doctors in Noida are busy studying profiles of elderly patients to prepare risk reports for insurance companies.

Nothing unusual about this scenario except that the patients and the insurance companies are 15,000 km away — in the US.

More and more outsourcing firms in India are now hiring medical professionals — doctors and nurses — as they look for new areas of business to supplement shrinking incomes from sectors that have traditionally opted for outsourcing, like finance and banking.

Noida-based BPO Xansa deals with the insurance and legal aspect of settling medical claims. “We have a team of doctors, equipped with a specialised skill set, who assess prognosis, underwrite and evaluate the mortality rate of customers and the risk involved,” said Arijit Chandra, senior transition manager. He added that most medical outsourcing business takes place in Bangalore.

Four other outsourcing firms – Wipro BPO, TCS, Cognizant and HCL – told Hindustan Times that they are hiring doctors, nurses and paramedics. About 15-18 people come on board every month, said officials, though at the moment, companies are reluctant to reveal the exact figures.

The pay obviously depends on experience and quality of work done, but it’s common for these BPOs to offer the doctors double of what they have been making. So, the average salary could start from Rs 45,000 and go up to Rs 3 lakh per month, said industry sources.

The perks are many for doctors who are used to putting in anywhere between 16 to 18 hours daily at public hospitals. "The timings are decent," said a 32-year-old doctor who joined Wipro's BPO recently after practising for three years at a Chennai clinic.

"A doctor's salary is measly, and there's no way I can start my own practice considering the high cost of setting up a clinic. This is a good option." He used to earn Rs 25,000 a month, now his salary is Rs 45,000.

It's a good alternative for BPOs too. As the US heads towards recession, business from financial services does not look promising. But the healthcare sector, particularly for senior citizens, has remained untouched. "The US is getting older, and insurance companies need to keep track of the health of their elderly clients," said Sanjiv Kapur, senior vice-president and head, Patni BPO, the business process outsourcing arm of Mumbai-based Patni Computer Systems.

In 2006, the US had over 3.73 crore people over 65 years for whom the state spent close to $401.3 billion (Rs 16 lakh crore) as per US census data. The spend is growing by 18.5 per cent every year, says Patni.

April 10, 2008

Bogus Medicines Responsible for Half a Million Deaths a Year

Fake pharmaceutical drugs are fast becoming a major threat across the world. Mostly they are sold over the internet but they are also infiltrated into the neighbourhood pharmacies or local hospitals.

While the bogus medicines are responsible for half a million deaths a year, the death merchants themselves rake in billions of dollars, it has been estimated.

Bogus pharmaceuticals come in all combinations - some with no active ingredient, some with too little active ingredient, others with too much, some with toxic constituents. One seized consignment of phoney Ponstan, a non-steroidal anti-inflammatory, had no active ingredients at all; but it did contain boric acid, a pesticide that can cause renal failure. (The pills' colour came from leaded road paint.) Fake antibiotics have been intercepted that are made of talcum powder, as well as birth-control pills made of rice flour. Other ingredients have ranged from floor polish to rat poison.

The developing world records the majority of such deaths. In China, between 200,000 and 300,000 people are estimated to die each year because of counterfeit or substandard medicines. The WHO estimates that 200,000 of the one million malaria deaths a year would be prevented if all the drugs were genuine.

Fake vaccines killed 2,500 during a meningitis epidemic in Niger in 1995. Eighty-nine children died in Haiti the same year after swallowing paracetamol cough syrup that had been made with cheap, toxic diethylene glycol. In Nigeria in 2003, three children died during open-heart surgery because the adrenaline and suxamethonium, a muscle relaxant, used were fake. Prof Dora Akunyili, the director of the country's food and drug agency, said, 'The evil of fake drugs is worse than the combined scourge of malaria, HIV/Aids, armed robbery and illicit drugs.'

But it is no longer only the developing world that is being duped. In Canada, 58-year-old Marcia Bergeron died just after Christmas 2006 after buying fake Zolpidem, a prescription sleeping pill, on the internet. The pills had been laced with traces of a medley of dangerous metals including uranium, strontium, selenium, arsenic and aluminium.

In 2004 in Chicago, Craig Schmidt, a salesman, bought the anxiety drug Xanax and the painkiller Ultram. He took one of each, and woke up in hospital three weeks later. The 'Xanax', it was found, contained quadruple the usual amount of active ingredient. He suffered a heart attack, coma and brain damage.

It is a huge process keeping track of the death merchants. At its London headquarters, close to the MI6 headquarters on the Thames, Medicines and Healthcare products Regulatory Agency (MHRA) detectives use web-crawling software to continuously search the internet for drugs most likely to be counterfeited at any given time.

There are currently 14 drugs on the 'watch list', which is updated every six months. 'We look for sites with a UK base, selling in sterling - something that brings them into our jurisdiction,' Malik, a senior operator, explains. Test purchases are made from suspicious sellers. 'Sometimes the card is ripped off and nothing arrives,' Malik says. 'Or you can get something different from what you ordered, or a drug that's counterfeit or unlicensed.'

Internet security experts believe that nearly 25 per cent of all emails - 15 billion messages a day - are spam advertising drugs. According to the WHO, more than 50 per cent of medicines offered by websites that conceal their physical addresses are fakes.

'It's front room and back room with the internet. You'll go to the site and there will be an image of a bloke with a white coat and a stethoscope hanging round his neck; they'll be offering all sorts of medicines. When we go round, it's a garage, filthy dirty, mucky, horrible. There are no people in white coats with stethoscopes,' says Mick Deats, a former detective chief super¬intendent who now heads the MHRA's intelligence and enforcement unit.

'There is far less risk [than with cocaine and heroin] and when you look at the money you can make you are going to make more out of this,' he adds.

Steve Allen, a former officer with the National Crime Squad (now the Serious and Organised Crime Agency) and senior director of global security at Pfizer, the world's biggest pharmaceuticals company whose drugs Viagra and the cholesterol-reducing Lipitor top lists of counterfeited medicines, says, 'The chances of detection are pretty low and the penalties don't really fit the crime. If you are bringing in cocaine or heroin, you are going to go to prison for the rest of your life. At the moment if you are smuggling in Viagra you may get a slap on the wrist and a fine.'

The trade extends far beyond Viagra and other 'lifestyle' drugs. Virtually all medicines have been counterfeited - increasingly, criminal gangs have moved into lifesaving medicines including antibiotics, antiretroviral drugs for Aids, and expensive cancer and infertility drugs. At the height of the bird-flu scare, fake doses of the antiviral drug Tamiflu were unleashed on to the world market that contained just vitamin C and lactose.

In Britain between August 2004 and the end of last year there were nine recalls of counterfeit medicines where there was clear evidence that fakes reached pharmacies and patients (four of them last year). In 2004 there were recalls for Cialis, an erectile-dysfunction drug, and for Reductil, an anti-obesity drug.

The following year, 120,000 packs of Lipitor 20mg tablets were withdrawn when counterfeit stocks bearing a valid batch number were discovered in the legitimate supply chain. Half of all the retrieved stocks were proved to be fake.

Last year 10mg tablets of Zyprexa, an anti¬psychotic medication for the treatment of schizophrenia and acute bipolar mania, were withdrawn after a worker, repackaging the tablets (legitimately) for the UK market, became suspicious. The bogus tablets contained only 60 per cent active ingredient; some of these tablets reached patients.

Also last year there were two alerts concerning bogus 75mg tablets of Plavix, an anti-platelet drug given after heart attacks or stroke. In one instance, the fakes had been mixed in with genuine packs.

Worldwide, according to figures collected by the pharmaceutical giant Eli Lilly, customs seized more than three million counterfeit or suspected counterfeit tablets in more than 1,000 separate actions in the two years up to January, writes Eric Clark in an exhaustive article on the issue in the UK newspaper Telegraph.

Counterfeit medicines are easy to produce, low risk and vastly profitable. A drug costing a fraction of a penny can be sold for 50 times as much and more. In one case investigated by the MHRA, 100,000 fake tablets supplied by a Chinese manufacturer for about 25p each were being sold for up to £20 each in the UK, worth £1.6 million in total.

Britain is on the front line, both as Europe's prime target for counterfeiters (medicine prices are high compared with most other EU countries) and as a staging post between producers in the Far East and the medicine-hungry buyers of the United States.

Although the World Health Organisation (WHO) began collecting data on counterfeit drugs in the early 1980s, until about 10 years ago they were regarded as a problem only in countries such as China. The situation has changed quickly: by 2001 counterfeit versions of major prescription medicines were appearing all over Europe.

The WHO estimates the business to be worth £18 billion, a figure that some forecast will more than double in the next two years, to represent about 10 per cent of all pharmaceutical sales worldwide. The WHO also believes that up to 30 per cent of medicines in Russia and in some countries in Africa, Asia and Latin America are counterfeit.

The temptation for counterfeiters to attack the legitimate chain in preference to selling direct to the public is huge. 'Why sell a single packet to John Smith when I can sell 400,000 to John Smith and Company?' Graham Satchwell of the MHRA notes.

Production is not difficult. 'You really don't need a huge amount of skill,' one pharmaceutical company investigator says. Most counterfeiting takes place in south Asia and the Far East, with China the biggest source. The scale varies from small-time entrepreneurs turning out 100 tablets a day to vast factories. Both producers and distributors have become more expert. 'It's a cat-and-mouse game, permanently escalating,' Thomas Thorp, the manager of government affairs for Eli Lilly, says.

'Ten years ago it might take a counterfeiter six months to copy your product once it had come on the market, and the quality of that counterfeit would probably be very poor. We're now seeing counterfeit product in some markets where we haven't even launched the legitimate one. They are getting more and more sophisticated.' Manufacturers of the anti-malarial drug Atesunate added a hologram to the blister foil to differentiate it from fakes: the counterfeiters followed suit in less than a month.

Nearly a third of all counterfeit drugs confiscated in Europe in 2006 came via the United Arab Emirates where free trade zones can be used to muddy the trail. Dubai is especially favoured because of its position between Asia, Europe and Africa. In July last year more than 500,000 fake Plavix tablets were seized near Dubai airport. Some contained cement powder.

The MHRA and the Royal Pharmaceutical Society collaboratively conduct spot checks at pharmacies and distributors. The number has been stepped up and concentrates on the 'hot list' of much-faked drugs, but the total number of batches examined is still in the low thousands - tiny compared with the 750 million prescription items dispensed in each year.

Pharmacists get advice, such as: 'Look for signs of a removed or switched product label.' As counterfeiters use a solvent such as lighter fuel, there may be a tacky residue or fading or discolouring around the edges of the label.

London is a major transit point. London postmarks add reassurance for buyers, and packages carrying them are less likely to attract attention. In one recent case pharmaceutical company investigators found that counterfeits went from the Chinese mainland to Hong Kong, then to the United Arab Emirates and the Bahamas, where individual prescriptions for American internet buyers were filled and put into packets and addressed. These packages then came to the UK where they were stamped and mailed to the US, all to hide tracks and to add credibility.

The situation is indeed alarming, and agencies across the West are gearing up before counterfeits swamp the developed countries.

April 07, 2008

Health Insuarance illegal: Islamic body

Comparing the benefits of health insurance policy to gambling, key Islamic organisations have termed the policies as "illegal" and directed Muslims to keep away from them.

At a seminar to deliberate whether insuring health was permissible under Islamic law Shariat, the Islamic Fiqh Academy (India) decided that availing such policies was illegal.

Representatives from around 300 Madrasas, including Darul Uloom Deoband, Jamiat Islami participated in the three-day meet, where they reached a conclusion that seeking insurance cover was only another form of gambling.

Health insurance schemes have turned a noble service in to a business activity, hence under Islam it is not permitted, they said.

The Academy, however said, if a person had insured himself under some legal constraints, then it was matter that could be thought over.

It also said that in such a situation, the patient should the spend the left-over amount of the claim he receives from the company on some form service to Allah.

The Ulema suggested that the community could itself organise services to help in the treatment of poor.

April 05, 2008

Malaysian doctors oppose sending heart patients to India

Flaying Malaysian government's plan to send heart patients to India as a last resort due to low cost of treatment there, a doctor's association has said the move would hamper the domestic healthcare industry.

The Malaysian Medical Association (MAA) termed the Health Ministry's plan as "retrogressive" and contradictory to the government's stated aim of promoting the country as a health tourism destination.

"Sending patients overseas might solve the immediate problem for a while but will be detrimental for the development of comprehensive cardiac care in this country," MAA President Khoo Kah Lin said in a statement here on Thursday.

"Malaysia has been working hard to position itself as a health tourism destination. This move of sending our citizens overseas is going to send the wrong signals and hurt the efforts grievously," he was quoted as saying by Bernama news agency.

Health Minister Datuk Liow Tiong Lai had yesterday said that children born with congenital heart disease would be sent to India for treatment as a last resort, if it was not possible to schedule their treatment in Malaysia.

The cost of treating cardiac patients in India was much lower than the cost here, it has been reported.

April 04, 2008

Fortis Healthcare promoter to start 10 medical colleges

Fortis Healthcare promoter Shivinder Singh on Thursday said he is forming a new company that would look into setting up medical colleges in the country.

"Academic medical centres are the new opportunities in the country especially when India is being promoted as a healthcare destination," Singh told reporters.

Singh said he is looking to start 10 medical colleges. But getting the permission of the regulator is considered tough because it has become "archaic".

The colleges would be run by societies as per the law, he added.

Apollo to invest Rs 380 crore for 10 new hospitals

Apollo Group Chairman Pratap Reddy said he plans to invest Rs 380 crore for 10 hospitals in the next 18 months.

With this expansion, Apollo's bed count would go up to 10,000 from 7,400, he said.

India needs to add 1 lakh beds every year to overcome the present deficit. "We need to invest $20 billion every year for the next 20 years," he said.

April 02, 2008

Resistant super bugs defeat doctors

Drug-resistant super bugs have foreclosed treatment options for critically ill patients and forced doctors to prescribe medicines banned 20 years ago because of severe side effects.

But some of these microbes have quickly developed resistance to even these older drugs, says a new study.

"Doctors in many countries have gone back to using old antibiotics abandoned 20 years ago because their toxic side effects were so frequent and so bad," said Matthew Falagas of Tufts University, Massachusetts.

One such super bug is Acinetobacter, which has challenged doctors worldwide by becoming resistant even to these older and more dangerous medicines.

Colistin, an antibiotic discovered 60 years ago, was recently salvaged to treat patients with Acinetobacter infections, said Falagas, who presented the study at the Society for General Microbiology's meeting in Edinburgh.

"It was successful for a while, but now it occasionally fails due to recent extensive use that has caused the bacteria to become resistant to all available antibiotics," he said.

Greek researchers have shown that Acinetobacter is a more serious threat than previously thought - it doesn't just cause severe infections, it kills many more patients than doctors had realised. Acinetobacter can cause pneumonia, skin and wound infections and in some cases meningitis.

The scientists have also identified a whole range of drug resistant strategies being used by the bacteria.

These include the production of compounds that can inactivate the drug treatments, cell pumps that can bail out the drug molecules from inside bacterial cells making them ineffective, and mutating the drug target sites.

"There have already been severe problems with critically ill patients due to Acinetobacter baumannii infections in various countries," Falagas informed.

"In some cases we have simply run out of treatments and we could be facing a pandemic with important public health implications."



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