June 28, 2008

Gates announces $23 million grant to India

On the day he leaves Microsoft to work for his pet social sector projects, software pioneer Bill Gates on Friday announced a $23 million grant to India to control the scourge of HIV/AIDS in the country.

The announcement was made when Union Health Minister Anbumani Ramadoss called upon him at his office in Seattle, United States.

Gates appreciated the efforts made by the Minister for improving the Health sector in India and congratulated him for the effective implementation of the National Rural Health Mission in India.

Gates announced that the foundation would make a $23 million grant to India, which would be spent through National AIDS Control Organisation (NACO) in India over the next three years.

In response to a query from Gates regarding the polio situation in the states of Bihar and Uttar Pradesh, the Minister explained the action taken by the government for its eradication from the country.

At a separate meeting of the Bill and Melinda Gates Foundation for which Gates would work full time after Microsoft, Ramadoss discussed the polio situation in UP and Bihar, Tobacco control programme, India's Drugs Regulatory Authority, HIV/AIDS situation in India and several other issues.

The Health Minister also made an appeal for popularizing Yoga and healthy life style across the globe.

The Foundation has already announced a grant of $58 million for HIV/AIDS Avahan Programme for a period of five years.

June 25, 2008

AIIMS performs India's first robotic chest surgery

Ela Srivastava had been suffering from double vision, chewing problem and weakness in the nervous system, but no more - thanks to All India Institute of Medical Sciences (AIIMS) doctors and a four-arm robot.

"It's the first robotic chest surgery in India," claimed Arvind Kumar, professor of surgery at AIIMS.

"In the last four days (since Saturday) we have performed chest surgeries on seven patients using the robot and have achieved complete success. This is a milestone for Indian medical fraternity," Kumar said.

All these patients were suffering from Myasthenia Gravis, a disease characterized by nervous and muscular weakness, walking and chewing problems, and double vision. To cure the disease, the thymus gland needs to be removed.

"The thymus gland is deep inside the chest. Earlier, we used to tear apart the ribs or the sternum bone for the operation. But now with the robotic assistance, the same operation can be effectively performed by three 1-cm size incisions on the left side of the chest," explained Kumar, who performed all the seven surgeries.

"I am feeling a little better now and there was no chewing problem," said Ela Srivastava, 21, who underwent the surgery Sunday.

Srivastava, a science graduate student from Kanpur, Uttar Pradesh, had been feeling almost numb since February. "Just 48 hours after I was operated upon, I could walk on my own," she said.

Nisha, from Moradabad in Uttar Pradseh, was suffering from the disease for seven years but is feeling a lot better now after her surgery assisted by the robot.

Kumar said that patients can be completely cured in a few months after the surgery.

"The surgery takes almost three to four hours and AIIMS charges nothing for the treatment," Kumar said.

N P Gupta, head of the urology department, said the AIIMS has been conducting cancer prostate robotic surgeries for the last two years but the chest surgery using a robot was a new feat for the institution.

The Da-Vinci S robot has already helped doctors perform more than 255 urologic surgeries.

Gupta said the chest surgeries were performed with assistance from J C Rueckert, a Germany-based surgeon.

Kumar said doctors sitting inside a special cubicle manage the robot. Of its four arms, two perform surgery, one holds a camera and the fourth is available for any other assistance. A high-resolution camera gives a 3D image of the relevant body part.

Gupta explained that a chest surgery reduces the post-operative pain and overall recovery period by almost seven times.

Apollo Hospital’s turnover crosses Rs 1,000-cr mark

Apollo Hospitals Enterprise Ltd achieved a turnover of Rs 1,150 crore for 2007-08, crossing the Rs 1,000-crore mark for the first time in its history.

Turnover for the year was up 28 per cent, over the previous year’s Rs 899 crore. Net profit was flat at Rs 100 crore, but the net profit for the previous year included a Rs 32-crore profit on the sale of the company’s hospital in Sri Lanka.

At a press conference today, the company’s Director-Finance, Ms Sunita Reddy, said that Apollo intends to spend Rs 1,400 crore over the next 18 to 24 months on various hospital projects across the country. Many of the projects are on, and the company has so far spent Rs 120 crore of the budgeted capex spends.

These include a 500-bed hospital in Hyderabad, a 150-bed one in Chennai, and two hospitals of 220 beds each at Visakhapatnam and Bhubhaneshwar.

As regards funding, Ms Reddy said that the company had recently raised Rs 400 crore through the private equity route. The promoters, by converting warrants issued earlier, would bring in another Rs 160 crore. Another Rs 200 crore would come from internal accruals. Rest of the capex would be debt-funded, she said. She said that the company might also go in for external commercial borrowings to raise debt.

Shorter stay

Speaking about Apollo Hospitals’ performance last year, she said that the company had been able to bring down the average duration of hospital stay of patients from 6 days to 5 days.

This is significant because hospitals make money in the first four days of a patient’s stay in the hospitals — through scans, tests and surgeries. After four days, the patient is recuperating and the “revenue intensity” of the stay goes down — the patient is just paying room rent.

For a 500-bed hospital, if the average stay comes down by a fifth, it is the equivalent of adding another 100 beds, without having to invest additionally in infrastructure, Mr K. Padmanabhan, Group President, Apollo Hospitals, said.

Also, last year, the company went aggressively on adding standalone pharmacies.

It added 262, taking the total number of standalone pharmacies to 612.

This was “EBIT negative” by Rs 88 crore, because a standalone pharmacy typically becomes cash-positive after 12 months. On an average, a standalone pharmacy turns over Rs 36 lakh each year.

Indian-Americans figure among New York's best doctors

More than 20 Indian-Americans have figured in the list of Best Doctors published by the New York weekly magazine.

The list of 1434 physicians was itself picked from a broader list of a guidebook, titled 'Top Doctors: New York Metro Area', published by Castle Connolly Medical, a research and information company.

More news, analysis | More Science and Medicine news

The company each year publishes a list of physicians, whom it considers the top 10 per cent of doctors in the region, comprising the city and its neighbourhoods. The magazine publishes a shorter version of the same and the present list was published in its June 16 issue.

Dr Chittaranjan Ranawat, who once conducted a knee surgery on former Prime Minister of India, Atal Bihari Vajpayee, figured prominently in the list.

Among other things, the list emerged following a peer nominating process, which was based not only on the qualifications of doctors, but also reputation and skills in dealing with the patients.

More International news | More Political news | More Offbeat news

The other Indians finding a place in the list are Mallikarjuna Reddy (family medicine), Hemant Kesarwala (allergy and immunology), Vinod Bopaiah (colon and rectal surgery), Ravindra Amin (geriatric psychiatry), Mukund Patel (hand surgery), Madhu Gudavalli (neonatal-perinatal medicine), Ashok Anant (neurological surgery), Raj Murali (neurological surgery), Chandranath Sen (neurological surgery), Laxmi Baxi (obstetrics and gynaecology), Harvinder Sandhu (orthopaedic surgery), Subhash Jain (pain medicine), Somasundaram Jayabose (paediatric-haematology oncology), Anup Singh (paediatric nephrology), Sarla Inamdar (paediatrics), Rajinder Gandhi (paediatric surgery), Vijay Vad (physical medicine and rehabilitation), Tanmoy Mukherjee (reproductive endocrinology), Jatin P Shah (surgery), Valavanur Subramanian (Thoracic surgery), Samir Taneja (urology) and Ashutosh Tewari (urology).

June 18, 2008

BCBS Signs With Google’s Online Healthcare Portal

Massachusetts’ medical insurance provider, Blue Cross Blue Shield, is all geared-up with the thought of digitized medical records. This week it teamed up with Google Health, Google’s latest healthcare Web portal, to become its first health insurer member.

Roughly around 3 million members of the Massachusetts’ Blue Cross and Blue Shield will now be able to go online and look up their healthcare claims and medical records.

The insurer also hopes to provide a more organized approach to its members and ensures high level safety and efficacy of its health care services.

“The partnership is expected to make available an important tool that can be used by members to keep better track of their medical information,” BCBSMA Chairman and CEO Cleve Killingsworth said.

"We believe Google Health will be an important tool used by our members to improve the safety and effectiveness of their healthcare," Killingsworth added.

About Google Health:

Google Health, a personal health information centralization service offered by Google has been under development since mid-2006. On completion and before its launch on May 20, 2008, the service underwent a two-month pilot test with 1,600 patients of The Cleveland Clinic.

Google Health allows its users to volunteer their health records -- either manually or by logging into their accounts at partnered health services providers -- into the Google Health system.

The online health program is powered by the ability to organize, manage and store personal health information in one secure online location. It is equipped with facilities like fix up appointments, e-mail doctors, transfer medical data to and from healthcare providers,refill prescriptions and access test results online.

Private hospitals to cross-subsidise treatment cost

Union Finance Minister P Chidambaram today urged private hospitals to cross-subsidise treatment cost, saying government alone could not meet the requirement of poor patients.

"Private hospitals should cross-subsidise treatment cost notwithstanding the increase in the cost of equipments following rapid advancement in technology as government alone cannot meet the requirement of poor patients," Chidambaram said today.

With the advancement of technology, the cost of the treatment was bound to increase in tune with the Intellectual Property Rights, he said after launching the 'World's fastest and Asia's first 128 Slice Heart CT Scanner,' produced by Siemens, at private K G Hospital here.

Since the government alone could not provide treatment at low cost or free of charge, the private hospitals should come forward to cross-subsidise treatment, like banks lending money at different interest rates for different sectors, he said.

Meanwhile Chidambaram also lauded the presence of Siemens in the country, saying the company, which supplied the Rs.6.5 crore machine, was making a turnover of Rs.11,000 crore in India, which offered a vast market for engineering and service sectors.

June 16, 2008

AIIMS leads the way in medical teaching

It’s a little past lunch on a May afternoon. Several young doctors in the making at this famed medical school—the All India Institute of Medical Sciences, or AIIMS—are ambling towards the teaching block. On their way to write the afternoon paper, no bit of the characteristic examination paranoia is visible. A handful of second-year MBBS students strolling by suddenly crackle with laughter; these folks are writing exams, too.

But why is everybody so relaxed when the stereotype one has grown up with is medical schools, worldwide, are famous for their stressful curriculum and scorching pace? “We are having fun; very few exams and a lot of practicals,” said Sankalp, one of the five examinees, who, expectedly, represent a good geographic mix—including a place as far as Bhutan. “We are enjoying life,” they say, almost in a chorus, agreeing that they are better off than their peers in other medical schools as there is more hands-on learning than theoretical teaching at AIIMS.

The students seem to be vindicated. Year after year, AIIMS has been ranked the top medical school in the country whatever the parameters surveyors use—factual data or perception, infrastructure or intellectual capital, training or research. Such is the reputation that even former AIIMS professionals cannot but help demonstrate a lingering nostalgia and pride in their association with the institution. “When it comes to academics, AIIMS is indeed the best,” says Arun Mohanty, a consultant cardiologist who joined Sir Ganga Ram Hospital in New Delhi in 2004.

A native of Orissa, Mohanty came to AIIMS for DM, a three-and-a-half-year doctorate programme, also the highest degree that the institution awards. As a student, he recalls, he felt confident that he was getting the right guidance under the “vastly experienced” teachers, who even today have the “dedication to begin their day at 8a.m., without ever thinking about the money they earn”.

“I’ve seen all disease types in the echo lab of AIIMS, which is a rarity elsewhere”, he notes, emphasizing that the teeming patient pool at AIIMS, which, though famously drowns the doctors under workload, is a boon for students. “No medical school can match the dedication of teachers at this institute, which is inbred in their genes,” says Dr V.S. Mehta, director of neurosciences at Paras Hospitals in Gurgaon, Haryana.

The starting point of excellence for the country’s premier medical school is of course the quality of students that get in. According to the sub-dean (examination) Amit K. Dinda, anywhere between 60,000 and 80,000 applications reach AIIMS every year, out of which only 50 get admission in the MBBS course.

Following the Supreme Court’s directive on other backward classes, or OBC, reservation, 27 more seats are being added in 2008 entrance test to be held in June, but the institute is open to the idea to increasing the total undergraduate seats to 100. “The strength of our teaching,” says Y.K. Gupta, head of the department of pharmacology and official spokesperson of AIIMS, “is the dynamism we introduce every six months after our academic committee meetings.”

Changes in the curriculum happen almost on a half-yearly time scale based on the changing knowledge, feedback, and arising needs, Gupta says. For instance, emerging and re-emerging infection was added recently when viral diseases such as chikungunya and dengue surfaced in different parts of the country a few years ago.

In fact, there’s a separate division called Centre for Medical Education and Technology, or C-MET, which ensures new educational technologies are made available to the faculty and the students on time. It develops instructional courses for certification as well as new learning resource materials and innovates on how research can be used in medical education, which the institute produces in large amount—almost 1,400 papers are published in reputed journals every year. C-MET also makes sure that students get problem-based learning. “We give them real life situation,” says Subrata Sinha, head, department of biochemistry.

Exposure to the vast patient population—more than 1.5 million outpatients in 2006-2007—is the hallmark of learning here.

“It’s a huge system with over 2,500 beds but our exposure to the cases is highly regulated and they are indeed discussed during the course,” says Rakesh Verma, an army doctor currently under a hospital training programme at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS.

Weekly workshops, integrated seminars, journal clubs (where a student is expected to choose a recent journal paper and give a presentation), continued medical education or CME, case-oriented discussions, et al., contribute to the institutes’ curricula. Even the cutting-edge medical technologies, which usually find a place first in private hospitals rather than in government medical schools, are available to students.

The entire teaching system seems to be geared towards producing well-rounded medical professionals for the country. Of the 15 medical fellowships in Kishore Vaigyanik Protsahana Yojana, a prestigious annual fellowship by the Department of Science and Technology, seven were won by AIIMS students in 2007, says Dr. Sinha, who thinks the ‘non-private-practice’ culture at the institute has enabled the faculty to try out innovative teaching methods. “The research atmosphere ensures that your thinking does not stagnate.”

But the 52-year-old institution is at a critical turning point in its history. “Our students don’t want to join government hospitals, in fact they don’t even want to stay back at AIIMS,” says N.P. Gupta, head of the department of urology and a robotic surgery expert.

Private hospitals, though good for clinical care, will not benefit medical teaching in the country and that’s where most fresh medical professionals are flocking, is his worry. He’s not alone in agonizing. Most of the faculty seriously debates the future of medical teaching in the country, especially at a time when the government has announced setting up six more AIIMS-like institutions.

It’s time for some introspection, believes Shakti Kumar Gupta, head, hospital administration and medical superintendent at the RP Centre. The excessive workload is diluting the mandate of the institute, which is primarily to be a medical teaching and research centre of high standard. “The government has to decide soon whether it wants AIIMS to be a high-end medical centre or a primary health care giver,” says B.K. Rao, chairman of the Board of Management at Sir Ganga Ram Hospital.

June 15, 2008

Almost a year after smoking ban in UK, less heart attack cases

In a pointer towards a connection between a cardiac arrest and smoking restrictions, studies revealed today that the number of heart attack cases have fallen sharply in the country since smoking was banned in public places in the United Kingdom.

Coming 11 months after the smoking ban in public places was introduced in UK, the figures reveal that nearly six in ten National Health Service trusts reported a decrease in the number of heart patients being admitted in emergency wards. Some hospitals have seen the number of cases decline by as much as 41 per cent since last July, when the ban came into force.

The Government has not yet published figures documenting the effects of the ban in England, but the National Health Service records show that there were 1,384 fewer heart attacks in the nine months after the legislation was introduced than in the same period a year earlier. Similar studies in Scotland and Ireland, where a public-smoking ban was introduced in 2006, also registered hospital admissions for heart attacks falling by 17 and 14 per cent respectively.

Comparable evidence has also come from France and Italy, pointing towards a link between drop in heart attacks and smoking ban.

The British Heart Foundation said the figures showed that the smoking ban was the "most significant public health initiative (in) this century".

The drop in the rate of heart attacks have been attributed to a large number of people stopping smoking, and far fewer people being exposed to airborne toxins through passive smoking.

The Department of Health also welcomed the figures as "goods news" but added that it was too early to attribute the fall in heart attack rates to the new legislation.

June 14, 2008

Bio_Medical waste Norms : Criminal cases against 24 hospitals in Mumbai

In a crackdown on medical institutions violating bio-medical waste norms, the Maharashtra Pollution Control Board (MPCB) has filed criminal cases against 24 hospitals in the state.

Those operating the hospitals face imprisonment for a maximum period of five years or fine of up to Rs five lakh or both, for contravening provisions of BMW rules (Section 15 of the Environmental Protection Act), Board sources said.

The hospitals include five each in Pune, Nashik, Nagpur and Aurangabad regions, three in Amravati and one in Kolhapur region. The cases have been registered for their failure to implement the BMW rules, the official said.

When contacted, MPCB Member Secretary Sanjay Khandare confirmed that criminal cases have been filed against some hospitals but declined to divulge any details.

However, another Board official said that cases have been filed against the 24 hospitals and prosecution proceedings have been initiated under provisions of Environment (Protection) Act 1986 read with Bio-Medical Wastes (management and Handling) rules 1998.

The norms make it mandatory to set up bio-medical waste generators for waste treatment or ensuring treatment at a common treatment facility, among other things.

In April, the Board had issued BMW compliance notices to over 1800 hospitals in the state. Of these, about 880 were small hospitals, the official said.

In February, the Board issued notices to 16 Mumbai hospitals, warning two of them of immediate closure if they failed to initiate corrective steps. It asked the M A Poddar Ayurvedic Hospital at Worli and Bai Sakarbai Dinshaw Petit Hospital for Animals at Parel, to take corrective measures or face closure.

Besides the setting up of waste generators, rules also stipulate that bio-medical waste should be segregated into containers or bags at point of generation prior to storage, transportation, treatment and disposal and those containers must be labelled properly in different coloured bags.

List of 24 Hospitals

Electronic Medical Records Will Help Doctors Earn Incentives

Doctors from the University of Wisconsin at Madison may be soon reaping huge financial incentives through federal health care programs for implementing electronic health record system.

The initiative is a pilot program by the department of U.S. Department of Health and Human Services. The program was announced on Friday by Michael Leavitt, secretary of U.S. Department of Health and Human Services in Madison and Wisconsin is one of the 12 places where the pilot program will run.

The program aims at small and medium-sized health care centers to adopt electronic medical record systems as it is thought of as a much accurate method to provide better medical care for people.

Most of the doctors rely on paper records and retrieve clinical information about their patients from them. This can be a reason for medical errors in many cases. Electronic Medical Records (EMR) will prove to be efficient for providers and safer for patients.

It may require sizeable investments in the beginning but pays in long term practice establishment.

David Brailer, National Coordinator for Health Information Technology described typical components of EMRs in his report. It includes lists of problems, medications, allergies, tests and other patient information and a comprehensive automated system will include medical history, patient demographics, nurses’ notes, electronic prescriptions and diagnostic tests.

According to the Centers for Studying Health System Change, EMRs implementation in doctor’s offices will serve many purposes. Ability to access patient notes and generate treatment reminders is an important function of EMR. It can be used to exchange clinical data and information with other doctors to obtain detailed treatment guidelines and write prescriptions.

June 12, 2008

Narco-analysis satisfies UN definition of torture

Amar Jesani, a founder and an editorial board member of the Indian Journal of Medical Ethics, and a well-known human rights and medical ethics activist, tells The Times of India why he considers narco-analysis legally, professionally and ethically wrong:

Q: Why are you against narco-analysis?

Where is the independent scientific evidence to show that narco-analysis reveals only the truth and not also something else? Psychiatrists who use hypnosis, make certain suggestions which the patient accepts with less
inhibition than she normally would. Why isn't this possible in narco-analysis, where the same drug, sodium pentothal, is used to achieve a trance-like stage?

Doctors doing this have an obligation to provide evidence that their 'suggestions' are also accurate. Otherwise there will always be a suspicion that the 'truth' found in narco-analysis could be 'manufactured truth', planted by the interrogators.

Secondly, I am not sure about the 'painless' part. Sure, it is carried out in a sterile operation theatre by doctors. But can't there be pain and degradation of a person even in the absence of filth, broken bones and blood?

Our campaign is not against narco-analysis per se, it is against torture, howsoever painless it may be. I am not in the business of humanising torture. For me torture remains torture, physical or otherwise.

Remember that infliction of psycho-logical trauma is often much more effective than physical torture. Bodily wounds heal very fast, other wounds may not heal at all.

Q: How can you equate it with torture?

The UN definition of torture has four components: it produces physical/mental suffering and is degrading; it is intentionally inflicted; it is intended for purposes such as getting information, confessions, etc; and it is inflicted by an official. Narco-analysis satisfies all four. In India, video clips of the actual narco-analysis are telecast repeatedly, when the same is not even admissible as evidence in court!

Q: You have been trying to get doctors to refuse. Can they do so, without being charged?

The World Medical Association, of which the Indian Medical Association is a member, in its 1975 Tokyo Declaration not only prohibited doctors from participating in or assisting any kind of torture, but also made it mandatory to report it if they happened to examine a tortured person. Here, doctors are actually conducting the torture on behalf of the authorities in the premises of a hospital, which must not be used for purposes other than healing patients.

Doctors have a moral duty to fight against any order in violation of medical ethics. This tolerance of unethical conduct and collusion in human rights violations by doctors worries me more, as willing participation is a sign of medicine providing increasing space to authoritarian tendencies in society.

Lotus Eye Care Hospital IPO opens Thursday

The initial public offering of Lotus Eye Care Hospital will open for on Thursday. The Rs 42-crore IPO is being made in the price band of Rs 38-42 per share. The issue closes on June 17.

Lotus Eye Care Hospital is a leading super-speciality eye care company with eye care hospitals and clinics at locations in South India. It has a network of four hospitals, out of which two are based in Coimbatore, and one each in Salem and Tirupur, Keynote Capital Services said in its report.

Keynote has not given a rating on the IPO, as it is being lead managed by their associate Keynote Corporate Services.

Lotus Eye Care Hospital’s top line and bottom line grew at 177.6 per cent and 147.7 per cent respectively in 2006-07 on year on year basis. EBITDA margin was 39.7 per cent in 2006-07.

Indian health care sector is valued at $34 billion and is projected to be $40 billion by 2012. Healthcare accounts for around 6 per cent of the GDP and is focused on by both the government and the private sector.

Medical tourism can be a major trigger. Indian medical tourism was estimated at $350 million in 2005-06 and is projected to grow to $2 billion by 2012. The emergence of India as a destination for medical tourism leverages the country’s well educated, English-speaking medical staff, state-of-the-art private hospitals and relatively low cost to address healthcare needs of western world. India provides treatment, at less than 1/10th of cost in US.

This industry is highly financial and human capital intensive. Lotus Eye Care scores well on this front; it has hi-tech eye care equipment and ophthalmic experts backed by a well-trained paramedical and administrative team. It has readily available human resources for the proposed expansion. It also has a training centre for budding ophthalmologists.

Expansion plan involves capital expenditure of Rs 55 crore to be funded through mix of equity, debt and internal accruals for expansion at existing units and setting up new centres.

Concerns are timely implementation of expansion and staff retention. Timely implementation of expansion of eye care centre may pose a challenge, as it may be difficult to get the required number of qualified doctors and other support staff to work in these locations. Retention of key personnel may also be a challenge, says the brokerage.

At the cap price, the IPO is priced at a 16 per cent discount to the price (Rs 50) in respect of pre-IPO placement in January 2008 to BCCL. IPO is priced at 31.8x based on pre-issue weighted average EPS and at 20.7x based on annualised EPS for nine months to December 2007 on pre-issue basis.

Traditional medicines can now safely go global

The quality, safety and effectiveness of traditional medicine will now be monitored better with the Shriram Institute of Industrial Research giving technical inputs to the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in the Union ministry of health.

“A growing lack of trust in traditional medicines had led to people turn to allopathy. This was also preventing India from capitalising on the growing global demand for traditional medicine, a market dominated by China. The new programme for enforcement of good manufacturing practices will increase the acceptability of these drugs, being manufactured by over 5,500 manufacturers across the country,” said Anita Das, secretary of the Department of AYUSH.

Quality issues have long plagued popular traditional systems of medicine such as Ayurveda, Unani and Homeopathy. Two years ago, the United States and Canada took Ayurvedic and Unani medicines off stores and banned further import following dangerously high levels of heavy metals such as lead, mercury and arsenic being found in formulations manufactured in India.

These heavy metals can accumulate in the body and cause health problems ranging from dizziness and muscle cramps to mental retardation.

Again, on May 8, Canada had raised a red flag and reminded people that some Ayurvedic medicines had heavy metals.

“According to the principles of Ayurvedic medicine, heavy metals may be used in a detoxified state in these medicinal products because of their presumed therapeutic properties. However, improper manufacturing processes may result in dangerously high levels of heavy metals in the final product,” it said.

US launches Rs 580 mn health initiative in India

The US on Thursday launched a Rs 580 million initiative to improve maternal and child health in India, with a focus on Uttar Pradseh and Jharkhand.

The Maternal and Child Health Sustainable Technical Assistance and Research Initiative (MCH STAR) will work to accelerate the resource mobilization of India's major programmes like the Notational Rural Health Mission and Integrated Child Development Services.

"Our aim is to bring real improvements in the lives of women and children. Led by USAID, our Indian partner organisations will help the initiative to achieve success," USAID mission director George Deikun said.

"We are investing Rs.581 million and our Indian partners will also mobilise some funds. The funds will be utilised over a period of five years across India with a focus on Uttar Pradseh and Jharkhand," Deikun told media.

"Each activity will respond directly to the programme and policy needs of Jharkhand and Uttar Pradseh. It will demonstrate policy and programme successes that can help others to emulate evidence based practices."

The Indian government has some good programmes, and USAID will work with the ministry of health and family welfare to bring better success.

"We need an extended reservoir professional research, public health and technical assistance institutions working at global standards that can support government programmes," said Naresh Dayal, secretary in the health ministry.

"Our country is growing well in almost all fields but our health indicators are poor. It's a shame to talk at international podiums about Indian's health parameters. We are trying to better the situation," he said at the function.

Currently, of every 1,000 kids born in the country, nearly 60 die. Similarly, 301 mothers succumb to pregnancy related complications after or during childbirth.

June 10, 2008

Public-Private Partnership model of running PHC gets another 3 yr term

The Public Private Partnership (PPP) model of running the Primary Health Centres (PHCs) in Arunachal Pradesh, a first in the country, has been given a further term of three years.

The PPP model was introduced in December 2005 for a period of three years under an MOU signed by the Centre, the state government and the NGOs, for three years.

It was the first such model to be introduced in any state in the country, Health Department Commissioner Anshu Prakash said today.

Under the terms, the Centre provides 90 per cent fund for running the PHCs while the NGOs provide the rest.
The steering committee of PPP model under National Rural Health Mission after review of the performances of different NGOs which have been given complete freedom in running 16 PHCs, one each in every district headquarters recommended a further tenure of three years.

The NGOs would get money to purchase medicines and engage doctors and other staff to maintain the buildings, ambulances and laboratories.

According to Prakash four NGOs — Karuna Trust of Karnataka, Voluntary Health Association, Prayas and Future Generation did an "excellent" job in not only providing treatment to the people but also kept the buildings clean.

The doctors, nurses and other staff were available for emergency services with ambulance and laboratory facilities.

The Centre has recognised the efficacy of the PPP model in the health sector by awarding Arunachal Pradesh last year as the best state for providing quality health services involving NGOs of repute and it also found mention in the 11th plan document, Prakash said.

Can physiotherapists be put on a par with doctors?

Intensifying a turf war between physiotherapists and medical doctors, a parliamentary standing committee is exploring the possibility of upgrading physiotherapy from a paramedical discipline to an independent system of medicine.

If physiotherapists' claim to have the competence to provide diagnosis and prognosis for medical problems is accepted by Parliament, physiotherapy will attain the status of an independent system of medicine. Doctors fear that the disruption of the existing hierarchy of healthcare may compromise the interests of patients.

One of the common causes for low backache, for instance, is the spread of cancer to the spine. Says S L Yadav, associate professor at the AIIMS department of physical medicine and rehabilitation: "Since he is not equipped to detect cancer, the physiotherapist may routinely administer traction or a heat modality, which could aggravate the problem and cause paralysis."

Ali Irani, president of the Indian Association of Physiotherapists (IAP), refutes the suggestion that greater autonomy to physiotherapists would undermine the health care system.

"Given our own expertise, we are as capable as general physicians in noticing the pathology of a patient and referring him to an oncologist for cancer treatment," says Irani, who was the Indian cricket team's physiotherapist for 10 years from 1987.

"It is just that doctors are unable to come to terms with the fact that our science has developed to an extent where we too could refer patients to them and they can't demand cuts from us any longer."

Irani adds that since IAP is not asking for any power to prescribe medicines or to perform surgery, "nobody can accuse us of encroaching into their domain".

What has caused alarm in the health ministry is a note prepared by the director general of health services, R K Srivastava, on February 12 after representing the health ministry at a closed-door hearing of the standing committee dealing with the Paramedical and Physiotherapy Central Council Bill.

The note, a copy of which is with TOI, begins by expressing surprise at the fact that the questions put to Srivastava were "focused only" on the proposed central council for physiotherapy, although it is just one of the three councils envisaged in the bill, which had been introduced in Parliament in December 2007.

The "salient points" of the discussion before the standing committee headed by Samajwadi Party’s Amar Singh included, according to director general of health services, R K Srivastava's note, a review of the very "definition" of the profession in order to pave the way for "equivalence to the medical doctor" and "recognition of physiotherapy as a system of medicine".

In his note, written within a day of the standing committee's hearing, Srivastava told other "concerned officers" of the health ministry that before the minutes of the meeting were sent by the Parliament secretariat, they should keep their responses ready so that the issues could be "disposed of quickly".

Health ministry officials are exercised over the issues raised by the standing committee as they see the hand of the physiotherapist lobby, which has been at work since the early 1990s to counter the proposal of setting up an omnibus council to regulate over a dozen different allied health professionals including radiographers, medical lab technicians and operation theatre technicians.

But thanks to the pressure mounted by IAP, the bill that was eventually drafted had accommodated their demand for separating them from other paramedical personnel. The proposed omnibus regulator was accordingly renamed as the Paramedical and Physiotherapy Central Council Bill with a provision to constitute sub-councils for various disciplines.

In September 2004, the cabinet of the UPA government cleared the bill in that form. But the bill was diluted further when it was introduced in Parliament after a lapse of more than three years. Instead of an omnibus body, the 2007 bill provided for three separate councils, including one for physiotherapists and occupational therapists.

Equally significant, the 2007 bill also gave up the idea of allowing medical specialities to have a say in the regulation of their paramedical disciplines.

Despite the concessions extracted in 2004 and 2007, IAP discloses in its latest website update that it is trying to get more changes in the bill by being "in contact with all top politicians and parliamentarians".

Drawing support from a couple of state legislations, IAP's most ambitious demand is that the standing committee should recommend a radical change in the definition of physiotherapy. This is because the bill defines it as a "medically directed therapy", thereby implying that physiotherapists will continue to work under the supervision of doctors such as orthopaedicians, physiatrists and neurologists.

In a bid to gain more autonomy, IAP proposed that their subject should instead be defined as a "physiotherapeutic system of medicine" involving "treatment modalities which have a diagnostic, prognostic, preventive and rehabilitative dimension".

June 07, 2008

SBI loan scheme for medical students

The State Bank of India will offer a student loan scheme for students joining medical and dental courses through the common entrance test (CET) conducted by the Karnataka Examination Authority for the year 2008-09. An agreement to this effect has been signed between the Rajiv Gandhi University of Health Sciences (RGUHS) and SBI.

The scheme, `Vidyadhana', will be offered as a financial package.

Under the scheme, students and their guardians can visit any SBI branch in Karnataka, preferably a branch nearest to their place of domicile, and avail of a temporary clean overdraft equivalent to the amount to be remitted at the time of CET counselling.

Subsequently, a regular loan limit will be sanctioned by the SBI branch as per the student's eligibility, the bank said in a statement on Friday.

June 05, 2008

Sharing medical information on Google Health a risk to privacy

Sharing medical information on Web sites like Google Health may be problematic for people when it comes to their privacy, warn experts.

Such web sites enable people to import their medical records from their healthcare providers, if they have signed up to the service.

Similarly, the users will also be able to share their reports with other doctors.

However, Washington DC-based privacy consultant Bob Gellman cautions people who use Gmail and Google's search engine that if they entrust the company with their medical data, it may have "more information about you than any other source".

Even though Google Health and its rivals like HealthVault promise to protect personal data, yet they have failed to allay concerns because of the fact that US privacy regulations concerning health records do not cover them, reports New Scientist magazine.

June 04, 2008

IBM Unveils New Public Health Data Sharing Technology

IBM Corporation has come up with yet another innovative technology solution, with an aim to transform healthcare. The newly launched solution, Public Health Information Affinity Domain (PHIAD), a Web-based portal, is focused on providing a platform for quick electronic exchange and analysis of critical public health information. The company has developed the solution in association with Nuclear Threat Initiative’s (NTI) Global Health Security Initiative (GHSI) and Middle East Consortium on Infectious Disease Surveillance (MECIDS). MECIDS, an organization for promoting long-term health, stability and security in the Middle East, will be the first adopter of the new IBM PHIAD. The partners are looking to promote deployments at international level, in order to have a standard automated system for surveillance that would help contain and counter the effects of infectious disease outbreaks.

June 03, 2008

Business of good health at gymnasiums

A modern day gym is a facility where you work out, meditate doing some yoga, feel good with some aerobics exercise, and relax your senses with a day spa and then look good by grooming at the saloon. Personal trainers get more and more professional and gyms make sure your follow the diet prescribed by providing the meals at you doorstep!

Not many years ago a plump Sridevi or a flabby Rishi Kapoor were accepted as superstars by their fans. Things have changed now and today, the badshaahs of the industry require six-pack abs and the queens need lissome charms to woo their fans. A well-toned body is not merely a requirement but an obsession.

The craze among the Bollywood stars is only a reflection of the society that is getting serious about battling the bulge. Encashing this trend are the modern gymnasiums that are adopting a comprehensive approach to the health and well being of its members.

Gymnasiums have thrived for long in small apartments converted into exercise dens. However, with popular international health chains entering the country and domestic players getting organised, this new base of theirs is becoming a haven for the fitness freaks.

Largely referred as ‘fitness or health centres’, these are no less than 10,000 sq ft in area and include a work out area, yoga studios, aerobics studios, sauna and steam rooms, day spas, swimming pools, massage centres, food courts serving holistic food and even DVD libraries ensuring relaxation and entertainment!

As per recent estimates, the fitness and wellness segment in India can be valued at Rs 2,500 crore. The growing segment and increasing number of health conscious Indians is attracting global players. For instance, Fitness First, UK’s popular international chain of health clubs, recently made its debut in India. Vikram Aditya Bhatia, the managing director of Fitness First India Private Ltd, describes the facility as a large-format gym.

Apart from modern equipment and machines, members can avail free beverages and DVD library. “The idea is to create a place other than the place to love and work. The comfortable ambience would encourage people to spend quality time here,” says Bhatia. The first center has come up in Gurgaon and next will open soon in Connaught Place in New Delhi. It will be spread over 24,000 square feet.

The company plans to invest Rs 12-16 crore in each club and Rs 200 crore over the next three years in India. The center promises to provide five-star fitness at affordable prices. The membership is available at Rs 3000 per month exclusive of taxes. If one opts for a personal trainer, Fitness First offers a wide variety of packages ranging between Rs 600 to Rs1,500 per session.

Another popular international chain Gold Gym already has its presence in India. It offers the latest equipment and services including group exercise, personal training, cardiovascular equipment, spinning and yoga, while maintaining its core weight lifting tradition. Additional facilities include steam, luxury massages and a juice bar.

The idea of a complete fitness center has attracted many domestic entrepreneurs as well. Take for instance, the two IIM Ahmedabad graduates Nikhil Vaswani and Rohit Shankar. Their brainchild Wellocity is a ‘wellness center’ offering programs customised to your requirements.

The USP of this center is its focus on “helping you implement the programs” essential for your fitness. “Our extensive service lines ensure that the requirements of your wellness program are fulfilled and obstacles experienced in your path to wellness are minimized,” asserts Vaswani.

It is well known that a healthy diet plays a significant role in keeping your body fit. Yet maintaining that diet is the biggest obstacle, given the modern hectic lifestyles and temptations of fast food. Wellocity will soon take care of this by offering to deliver food in homes and offices. The meals would be the one suiting your fitness needs.

Aside from gymnasium that offers a customised workout package, Wellocity offers an aerobics studio, a yoga studio, a kickboxing center, a day spa and saloon. The center takes care of providing the right atmosphere to exercise. While live DJ creates lively ambience at the gymnasium, peppy music provides an ideal setting for aerobics workouts. It offers membership at Rs 24,000 per year.

A healthy mind is vital for attaining a healthy body. What better way to unwind your mind through yoga or may be a relaxing massage! PowerHouse gym in Delhi offers the benefits of yoga and pilates classes, a sauna and steam room, and massage facilities. A dietician, physiotherapist, nutritionist are also available.

The gym is a dance lover’s delight as it boasts live DJ and will soon add Salsa classes to its repertoire. While the gym membership is available for Rs 12,000 per annum, massage facilities command an extra charge of Rs 2,800 per year.

Fitness First Pilates, Yoga, Spinning, Body Combat, Aerobics,Body Balance etc. Will have DVD library within the center Power House Whole body vibration equipment, aerobics activities, yoga classes, pilates classes, sauna room and steam room Wellocity Aerobics studio, a yoga studio, a kickboxing center, a day spa and saloon.

Will add a food court offering holistic food and home delivery Gold Gym Latest equipment and services - personal training, cardiovascular equipment, spinning and yoga. Additional facilities include steam, luxury massages and a juice bar.

June 01, 2008

Young entrepreneurs challenge doctors’ hegemony in healthcare business

The aura of unapproachability around the healthcare business for all but medical professionals is beginning to slip as realisation grows that the stethoscope may not be the only tool to run a successful hospital trade. The business of healthcare, traditionally a bastion of medical professionals, is now being breached by spunky young entrepreneurs trained in technology or management challenging the notion that the doctor knows best.

One of the challengers, Anoop Radhakrishnan , is an unusual blend of a doctor and a post-graduate degree holder in management from IIM-Lucknow . Dr Radhakrishnan and four of his management-school batchmates started Indigoedge Consulting, whose main focus is on projects related to healthcare. They conduct feasibility studies for hospital projects, evaluate public health impact and also undertake management consulting. “Young professionals are getting increasingly interested in this field and the sector too has realised that it needs professional help,” says Dr Radhakrishnan, CEO, Indigoedge Consulting.

While Indigoedge was begun by those who had just completed their education, Satyajeet Prasad started Asclepius Consulting after his experience with GE Healthcare honed his skills for the sector. “I was to get transferred to Chicago, where I’d be working for people I do not relate to,” says Mr Prasad, alumnus of IIT and IIM. The prospect of moving to foreign shores motivated him to utilise his expertise for the domestic market.

And an understanding of how processes worked in developed nations made him see the huge market potential for basic healthcare in urban and rural India. “We especially want to focus on early healthcare in the rural areas,” he says. Asclepius provides management consulting for hospitals and clinics — from process design to the opening of a hospital.

Ranjit Kovilinkal Ramakrishnan, who studied at IIM-Ahmedabad , had carved out over nine years what seemed like a perfect career in consulting in the Middle East. When the entrepreneurial bug bit him, he knew it had to be in the healthcare sector. “We (his team) felt that professional vision was what was lacking in this field and there was a huge market to explored,” says Mr Ramakrishnan, MD, Hygeia e-Services. His firm specialises in international patient care, outsourced sales and marketing, and consulting and training services for healthcare organisations. He is now eyeing the opportunity in medical tourism, a promising business according to him if powered by corporate tie-ups.

However, it has not all been hunky-dory for the pioneers. One common concern is that physicians are typically not receptive to technology and set procedures. Also, some find it awkward to seek help from outside their profession.



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