November 30, 2008

90 psychiatrists for 8.4 lakh patients in Bangalore

Bangalore's healthcare couldn't be more dismal. There are just 90 psychiatrists to treat an estimated 1.4 lakh people suffering from severe mental disorders and 7 lakh from minor ones, according to the state mental health authority. The government is struggling to provide mental healthcare due to lack of infrastructure and institutional support.

Outside Bangalore, there are approximately 200-210 psychiatrists across the state to treat 2% of the population who suffer from severe mental disorders and 10% from minor ones. Of these, 150 are in five districts -- Mangalore, Hubli, Dharwad, Mysore and Belgaum. The remaining are spread unevenly in other districts. But districts like Haveri, Koppal and Madikeri have no psychiatrists; Uttara Kannada and Chikmagalur have one each. Thus, many mental patients are deprived of treatment, particularly in rural areas.

Bangalore is known as the suicide capital of India, mainly because of deaths due to mental disorders related to stress, work pressure, health and family problems. Every year, 3,500 suicides and 30,000 attempted suicides are reported in the state.

According to state mental health authority secretary, H Chandrashekar, cases of suicides, alcoholism, schizophrenia and depression are rising in the state, and 60% emergency cases reported in hospitals are related to alcohol and suicide.

"Unfortunately, many people with mental disorders have no access to mental health services. With proper treatment and access to health providers, the number of suicide cases can be reduced," says Chandrashekar.

There is also a dearth of paramedics who have an important role. In Karnataka, there are 100 clinical psychologists who provide non-medical treatment like counselling and psychotherapy. Also, there are only 60-70 psychiatric social workers who provide rehabilitation of patients.

A major reason is not many students do the post-graduation course in mental health. Also, in the MBBS curriculum, students are not exposed to psychiatry and it is not part of their examination. There is also a shortage as many doctors go abroad. Of the 15,000 psychiatrists in India, only about 4,000 practise in the country simply because there is huge demand for psychiatrists all over the world.

November 28, 2008

Mumbai attack: Hospitals witness horror stories

St George, GT and JJ hospitals in Mumbai are centres of desperate hope for many as they anxiously wait to know about their relatives and some crest-fallen at the death of dear ones.
The St George hospital in south Mumbai, which saw a steady stream of bodies since the attacks last night, has been functioning with a sense of utmost urgency.

Paramedical staff and attendants have done a commendable job arranging for bodies to be taken for panchnama, arrangement of blood among other things, doctors at the hospital said.

The hospital, which received the highest number of bodies following the attacks, witnessed chaos in the morning when security personnel refused television crews from filming dead bodies.

GT hospital, also in south Mumbai, bore an uneasy silence and a sense of fear prevailed. Relatives of injured and dead were reluctant to speak to the media.

Hemant Tulin, an employee at the Taj, is battling for life at GT hospital, which is bustling with activity being closer to the scene of terror attacks.

The 27-year-old, who suffered multiple injuries, called his mother at 2230 hours last night telling her he was safe. At 0530 hours this morning, Talin's mother received a call from the hospital stating that he had been seriously injured and was in the ICU.

Talin, who witnessed the death of his colleague due to bullet injuries told his mother, "I am calling you now, because I do not know when I will be able to call you later," she said.


MedPlus partners with Wockhardt Hospitals

MedPlus Healthcare Services, a community pharmacy chain, on Thursday announced a tie-up with Wockhardt Hospitals in order to improve the access for cardiac care services.

Through the partnership MedPlus Healthcare will offer affordable cardiac care to its customers, MedPlus Healthcare Services Founder and CEO, Dr Madhukar Gangadi told reporters here. "This is the first initiative wherein a community pharmacy has collabora ted with health care specialists to reach out to the common man," Gangadi said.

As per the agreement, Wockhardt's patients would get special privileges from MedPlus and similarly, MedPlus customers too will be offered Value added services at Wockhardt.

The service would be launched on December 1 from Hyderabad and will be initially available in Andhra Pradesh. The partnership with Wockhardt Hospitals would address cardiac care needs at two levels-preventive care and comprehensive non-invasive treatmen t services, Mr Gangadi said.

As a part of the initiative, MedPlus will establish special "Cardiac Zones" across MedPlus clinics, where cardiac specialists from Wockhardt Hospitals would be stationed to offer consultancy services for early diagnosis as well as for post-operative card iac care, he said.

At the preventive care level, MedPlus and Wockhardt Hospitals will reach Tier II and Tier III towns through 'Mobile Cardiac Care Screening Units', he said adding MedPlus would have 1,000 outlets by March 2009 from the present 600.

"It is the right time to join hands and do something for the community," Head Operations, Wockhardt Hospitals (Hyderabad), Sudhaker Jadhav said adding Wockhardt would have 30 super specialty hospitals across India by 2010.

Activists cry foul as picture warning on tobacco packs is deferred

Activists associated with the health ministry and experts have cried foul and termed as "politically motivated" the government decision to defer making pictorial warnings on tobacco product packets mandatory.

The central government has defered the implementation of the proposal from Nov 30 to May 1 next year.

“The decision to defer and unduly delay the mandatory placement of pictorial health warnings on tobacco products is a cynical abdication of governmental responsibility to protect people's health by providing them the much-required information on the deadly effects of tobacco consumption,” said K. Srinath Reddy, an independent advisor to the health ministry on curbing tobacco use in India.

The Group of Ministers (GoM) under the leadership of External Affairs Minister Pranab Mukherjee, who met Monday, decided to defer the implementation of the rule on pictorial health warnings on tobacco product packages.

According to health ministry sources, Health Minister Anbumani Ramadoss met Mukherjee last week before the GoM meeting earlier this week.

Activists and experts said that the decision is “very unfortunate” and has “appalled the public health community” across the country.

They said the government is failing in performing its important duty to provide essential information to make Indian consumers aware of the effects of tobacco, particularly to the vulnerable poor and the illiterate.

Bhavna B. Mukhopadhyay, director of the Voluntary Health Association of India, said: “Since the tobacco industry sells a product that kills one million people in India annually, its interests will always be in conflict with the nation's public health and economic aspirations."

The Framework Convention on Tobacco Control (FCTC) imposes a time-bound obligation on each of its signatory parties, including India, to implement pictorial health warnings on tobacco product packages within three years of its coming into force.

The deadline for India to implement pictorial health warning was Feb 27, 2008.

P.C. Gupta, another activist and expert of the Advocacy Forum for Tobacco Control, said the news of postponement of implementation of pictorial warnings was most unfortunate - especially because it came days after 160 countries including India adopted a resolution to fight against industry interference of tobacco control.

November 25, 2008

Doctors from IITs? Not possible, say faculty members, alumni

The faculty members and the alumni of the premier Indian Institutes of Technology (IITs) have expressed opposition to any plan to

start medical courses in the institutions, claiming it is "neither feasible nor desirable" and any attempt in this regard will prove "disastrous".

"We have already biotechnology courses at IITs. I believe churning out doctors from IITs is neither feasible nor desirable," M. Balakrishnan, dean postgraduate studies at IIT-Delhi, told reporters.

There were reports that the government appointed 11th five-year committee for higher education, headed by eminent scientist Yash Pal, was planning to introduce a varsity structure and possible courses on medicine in IITs.

"This will prove disastrous. Instead of bringing in a varsity culture in IITs, it's better to improve infrastructure, maintain a certain benchmark in students intake and provide world class education in the field of engineering," said P.V. Indiresan, a renowned educationist and former director of IIT-Chennai.

He said the student-teacher ratio has worsened and this was "impacting the students-faculties interaction in the classroom."

Yatinder Pal Suri, an entrepreneur and alumnus of IIT-Kharagpur said: "It is not desirable to diversify too much. Expansion into too many things with the present infrastructure is not a viable option."

"Expansion is good but that must happen with a proper planning," Suri added, a view echoed by Pradeep Gupta, chairman of Cyber Media group and an IIT Delhi graduate.

"IITs in India are much popular. There is no point in diluting the brand. We should focus on becoming a leading global brand like MIT in the US," said Vijay K. Saluja, a retired chief engineer of New Delhi Municipal Council (NDMC), who has also studied at an IIT.

Many believe that the laboratories at IITs need to be upgraded on a priority basis before thinking of anything else.

"Instead of shifting gear towards a varsity pattern, it's better to improve the IIT-industry interface. This will improve employability and confidence of students," said Pramod Chawla, another alumnus.

In the beginning of the present academic year, the government opened six new IITs under the supervision of the existing seven

November 24, 2008

Recognition of emergency medicine is the need of the hour

In India, most patients requiring emergency care die because emergency medicine is still not a recognised speciality with the Medical Council of India (MCI),” Dr Krishan Kumar, Director, Emergency Medical Services at Nassau University Medical Centre in New York, US, said on Saturday.
Dr Kumar, who is on a visit to Dayanand Medical College and Hospital (DMCH), is a member of the board of the American Academy for Emergency Medicine in India (AAEMI). AAEMI had held talks with MCI on the issue last year, but to no avail, he said.

According to Dr Kumar, approximately 50 per cent of the patients who require immediate medical attention and treatment in India, especially road accident victims, die as they are not given timely emergency care.

“In the US, we have a very high success rate as far as the number of such patients is concerned. I would say that up to 99 per cent of these patients are saved by the team of emergency medicine. But I do not understand why MCI has not recognised it till now,” he said.

He added: “Emergency Medicine is recognised as a speciality mostly by developed countries and India stands somewhere at the bottom of the list as far as Emergency Medicine is concerned. But hopefully it should be recognised in India soon.”

Talking about its importance, he further said: “It is the need of the hour as most of the patients die because they cannot get emergency treatment. As they say, if a patient survives the golden hour i.e. the first 60 minutes of an emergency or acute illness, his chances of dying are very less.”

Dr Kumar said that while hospitals in south India are aggressively focusing on emergency medicine, those in north India are still lagging behind. “In fact, some centres in the south have already started providing training in Emergency Medicine though it is not an officially recognised speciality in the country,” he said.

When asked how the existing emergency facilities could be improved, he said that India required a unified emergency call number in the first place as nothing can be done about the roads or traffic jams.

“We can possibly have a unified emergency call number, preferably in three digits, such as 911 in the USA. How many of us can remember those 10 digit numbers when we are panic-stricken?” he said.

Dr Kumar gave a lecture on Emergency Medicine and held a workshop on emergency care at DMCH on Saturday. Those present on the occasion included Dr Sunil Puri, head of medicine and medical superintendent, DMCH, Dr Daljit Singh, principal of DMCH and Dr Sanjeev Uppal, professor of plastic surgery, DMCH.

November 22, 2008

Digital doctors

To state that the Internet has changed the practice of medicine is to make a gross understatement. Expectedly, the sites that doctors and patients will surf are likely to be different. Thus, when Lounge asked me for a list of websites that lay people could use to access reliable health and medicine information, I pointed out that I never looked up the Web as a layman! What I did do, however, was look up sites for information that I needed in my practice.
Top of the list, of course, has to be the bibliographic database, Medline or Pubmed. The British Medical Journal (BMJ) wrote some years ago that America’s greatest contributions to man were jazz and Medline. Medline contains article titles or pertinent information on relevant medical literature since the 1950s: There are 18 million such citations. These are from 5,200 medical journals that reach a certain standard, as judged by the US National Library of Medicine. Pubmed is the motherlode: Pubmedcentral and other sites are useful sub-sites (incidentally, Medline is free to the world, courtesy the Bill Clinton administration. The now defunct hardcopy version of Medline, Index medicus, has a somewhat older history—it first appeared in 1879!).
This is one of the most popularly used websites by doctors and consists of reliable review articles on most diseases rather than cutting-edge research and is, hence, of immense practical use. Experts write the chapters and I find it an excellent quick 5-minute consult when I need information promptly on a subject.
Yes, I know that this looks like… I am desperately trying to curry favour with the editor of Lounge…but the fact is, I am also a medical journal editor and freelancer and need to get unusual, important and sometimes quirky information. This website and, of course, the newspaper, which I read daily, have reported that pharma companies in India have not documented any side effects of drugs in the past three years, that lifestyle products are available for diabetes and that a vaccine against malaria is about to be tried in a clinical trial—all news that I have not read elsewhere.,
The truth can now be told! I, and many physicians, routinely use Google for baffling cases. If you have a patient with symptoms you cannot explain (or morphological features in a biopsy slide, in my case: I am a pathologist and peer at tissues under a microscope to make diagnoses), Google can sometimes save lives. Google also often throws up a Wikipedia link that provides further information.
First, a conflict of interest statement. This has been developed by a friend and I am a non-remunerated editorial adviser to it. Isabel is a diagnosis decision support system. It is of practical use only to physicians and its use is restricted by the fact that it is a paid service. A subscriber only has to enter the symptoms, signs and other data into its search engine to get a list of possible diagnoses. This helps reduce error and acts as a safety net for the doctor and the patient. The difference between Isabel and Google is that the latter also throws up noise while the former only picks up possible diagnoses—and is linked to e-textbooks which provide further knowledge. Incidentally, whether you are a layman or a guru, it’s worth reading how and why Isabel was created and named so!

Dr Sanjay A. Pai is consultant pathologist and head, pathology and laboratory medicine at Columbia Asia Referral Hospital in Malleswaram, Bangalore. He is an editor with the Indian Journal of Medical Ethics ( and The National Medical Journal of India (

November 21, 2008

Soon, IITs may be turning out doctors too

Graduation day at the Indian Institutes of Technology may soon see more than just engineering whizkids stepping out of their portals.

In the coming years, the IIT palette will have on offer a range of shades beyond the cut-and-dry coding courses. A bunch of doctors, historians, perhaps policy makers too, could boast of IIT degrees.

The IITs may be currently stretched to the limit, but the XIth five-year committee for higher education is working with these centres of excellence to expand their charts. The committee, headed by educationist Yash Pal, that is meeting IIT heads on Friday will discuss how the tech schools can change their character and, like American universities, enlarge their menu.

"Currently, the IITs are premier undergraduate engineering schools doing some postgraduation and research work. Now, we want to give them a bigger role," Yash Pal told TOI. The noted scientist said that he had discussed his suggestions with some IIT directors and that a clearer picture would emerge after this week's meeting.

While the IITs will be given more oxygen in terms of starting courses of their choice, it's difficult to predict whether the new subjects offered will compare in excellence with the engineering departments, or be relegated to the sidelines, like the IITs' management schools. However, Yash Pal said, "All great universities around the world offer a range of undergraduate courses. Our IITs can't be great unless they think in that direction."

The committee is looking at the Big Daddy of engineering colleges for inspiration. "If MIT (Massachusetts Institute of Technology) or Caltech (California Institute of Technology) can offer a wider range of programmes that are well-known, why not the IITs? Our IITs have produced wonderful engineers for the country. It's time they looked at offering more," he added.

Former Indian Institute of Science director Govardhan Mehta, who's also on the committee, said that the country was currently at a stage where an institute running one programme was also being termed a university. "However, a university, as defined in the ninth century, is an institution with a confluence of many disciplines where research and teaching are carried out. While expansion of courses in the IITs is what our committee is thinking of, Friday's meeting will give us a chance to know what's in the IIT heads' minds," he said.

For some IIT directors, this move has come at a time when there is more on their plate than they can handle. Yet, they are open to starting more programmes. IIT-Guwahati director Gautam Barua said, "There has been some suggestion that the IITs start programmes in areas other than science and technology. I do not have a problem with doing that if our focus is clearly defined."

On the other hand, IIT-Roorkee director S C Saxena said the 54% expansion to accommodate OBC students and mentoring new IITs meant that they already had more than what they could handle. "There is a lot of expectation from the IITs. But we must move in a planned and regulated manner," he added.

Educationist and former director of IIT-Chennai P V Indiresan, who has spent a large part of his life in the IIT system, said the institutes had been synonymous with excellence and they must not start any programmes unless they got very good faculty for the same.

How the IITs will rise to the challenge remains to be seen. What's certain, however, is that the flow charts on their lush campuses are set to be redrawn.

US FDA Opens its Office in China

The U.S. Food and Drug Administration opened its first overseas office on Wednesday in China, with others planned around the globe to control quality of food imported in to the country. David Acheson, the FDA's associate commissioner for foods said, "We are currently importing about 15% of the food we eat in the United States, and it is increasing every year. It's much easier if we can build the collaboration at a local level rather than trying to do it from 8,000 miles away."

The office came after the food safety scare generated by Chinese food products which were stopped at the U.S. border and tested for melamine, a chemical added to baby formula earlier this year that sickened thousands of Chinese infants. According to a recent statement from the U.S. Department of Health and Human Services, the FDA's umbrella agency, the United States intends to help the Chinese government improve its regulatory systems for exports. The HHS statement said, "Establishing a permanent FDA presence in China will greatly enhance the speed and effectiveness of our regulatory cooperation and our efforts to protect consumers in both countries."

U.S. Health and Human Services Secretary Mike Leavitt said they planned to open offices later this week in the Chinese cities of Guangzhou and Shanghai with India, the Middle East, Latin America and Europe being subsequent locations. The Chinese offices would be manned by eight American employees, with expertise in food, medicine and medical devices. They will work with Chinese government agencies and producers to raise standards and guarantee quality before goods are bound for the United States.

The new enterprise is aimed at 200,000 food manufacturers from 150 countries that export to the USA. Last year, the United States imported about $856 million worth of drugs from China, and $4.4 billion worth of food. FDA Commissioner Andrew von Eschenbach said, "The American consumer wants to eat strawberries in February. We don't grow strawberries in the United States in February."

“Because the world has changed a great deal, what we eat, medicines we take and products we use in the United States come from other countries," Leavitt said at Wednesday's news conference in Beijing. "This year we will import nearly $2 trillion of goods. To give you a sense of proportion, that is roughly four times the entire economy of Brazil," he added.

Shao Mingli, commissioner of the Chinese State Food and Drug Administration said regulators in China and the U.S. face a "major challenge. Strengthening and developing cooperation is our only, common choice."

Jeffrey Schultz of the R&D-based Pharmaceutical Association Committee, an industry group said, "They are eight people and this is a huge industry." He added that China's food and drug administration "has the hardest job in China — they've got thousands of factories that they need to regulate."
Chinese Foreign Ministry spokesman Qin Gang is quoted by The China Daily newspaper to have said, "We feel deep regret that the U.S. insists on unilaterally taking these steps. Such unilateral action smacks of protectionism."

US seeks help of Indian American doctors in Afghanistan

The Bush administration has sought the help of the powerful Indian American doctors' community to help it improve and build the fragile healthcare facilities in Afghanistan.

"We are keen to work in Afghanistan," Prasad Srinivasan, secretary of the American Association of Physicians of Indian Origin (AAPI), said.

Representing some 46,000 physicians of Indian origin in the US, AAPI is one of the largest and most influential ethnic physicians body in the US.

Srinivasan said Assistant Secretary of Health, Admiral Joxel Garcia, had conveyed that the US Department of Health and Human Services would like to engage AAPI in providing health care to the people of Afghanistan.

Indian physicians with their wide-ranging experience and knowledge could provide invaluable service and collaborate in rebuilding the system in Afghanistan, Garcia said.

This is an exciting opportunity for AAPI to get involved with the federal government in a big way, Srinivasan said, adding: "Our services are required in areas like general health, child health, anaesthesia and maternity healthcare."

The US is keen on reducing the high maternal and infant mortality rate in Afghanistan.

Garcia requested AAPI to ask Indian American doctors to volunteer in Afghanistan to improve clinical training and care besides offering clinical mentorship to local health professionals.

Srinivasan said Garcia had assured that adequate security would be provided to the doctors who volunteer to go to Afghanistan.

Following the request, Srinivasan said this would be discussed within the AAPI leadership and a detailed action plan would be prepared soon.

November 20, 2008

India turning affordable, quality option for medical tourists

India was soon growing to be a popular medical destination following the availability of health care facilities that matched international standards but offered it at a fraction of the cost abroad.

The estimated international medical tourist arrivals to India was 4,50,000 as against Singapore's 4,20,000 and over a million in Thailand, said Vishal Bali, CEO, Wockhardt.

Nearly 13 hospitals in India had been JCI (Joint Commission International) accredited. JCI was the US-based quality assessor that awards accreditation to hospitals outside US.

The Deloitte Study on medical tourist estimates that 750,000 Americans travelled abroad for health care in 2007 and the number is estimated to increase to six million by 2010.

The study estimates that the Global market for Medical tourism tobe currently at 60 billion dollars.

The growing cost of healthcare in the US, the high premium to be paid is leaving a lot of American out of the insurance cordon. Nearly 70 million US citizens were underinsured or not insured. In comparison health care cost in India was nearly just a fraction of the cost incurred in the US.

A cardiac surgery, which would cost 9000 USD, in India would cost around 75,000 to 100,000 USD in the US. A spine surgery costing around 8000 to 9000 USD in India could cost around 65,000 USD while a joint replacement in India would have a patient paying up around 8500 USD while it would cost around 55,000 to 65,000 USD in the states, says Bali.

Even with the travel to India and stay cost involved, patients would still end up paying much less if they chose India as an option to undergo treatment, he said which was leading to more US patients looking to India.

November 17, 2008

India falls behind neighbours in health, social indicators: UN

If health and social indicators are anything to go by, then India lags behind its neighbours like Bangladesh, Bhutan, Nepal and Sri Lanka who are considered to be economically much weaker, says a latest UN report.

While India has an infant mortality rate of 54 per 1000 live births, neighbouring countries like Bangladesh, Bhutan, Nepal and Sri Lanka have the rate of just 51, 44, 53 and 11 per thousand respectively.

The only exception to this is Pakistan which has a higher infant mortality rate of 67. On the other hand, China enjoys the distinction of having an infant mortality rate of just 23, says the report.

The report 'State of World Population 2008' prepared by United Nations Population Fund (UNFPA) shows that India lags behind its neighbours in terms of life expectancy also.

While Indian males have a life expectancy of 63.3 years, Bangladeshis, Pakistanis and Sri Lankans have 63.4, 65.4 and 68.8 years respectively while China has 71.4 years.

But when it comes to life expectancy of women, Indians are ahead though still much behind Chinese and Sri Lankans.

Indian women have life expectancy of 66.6 years whereas Bangladesh has 65.3 and Pakistan has 65.9. While China has a high female life expectancy of 74.9, it is still behind Sri Lanka with 76.3 years.

Reproductive health indicators point out contraceptive prevalence in India (any method) at 56 per cent among the married or couples entering consensual sex, while it is 58 per cent in Bangladesh and 70 per cent in Sri Lanka. Iran, which falls in South Central Asia has a contraceptive prevalence rate of 74 per cent. When it comes to modern contraceptive methods, Iran with 56 per cent is far ahead than the rest seven countries in the region including India with 49 per cent.

India with 62 births per 1000 women in the age group 15-19 years leads Iran, Pakistan and Sri Lanka with 20, 36 and 25 respectively. China walks away with the cake with just eight births per 1,000 women in the same group.

While India has 47 per cent births under skilled supervision, Pakistan does much better with 54 and Sri Lanka with 97 per cent.

In terms of improved drinking water sources, India again lags behind some of its neighbours. Pakistan tops the list with 91 per cent of the population having access to clean drinking water followed by Nepal with 90 per cent, whereas in India the percentage is 86.

November 14, 2008

e-Sanjeevani is here to bring medical help home

The Centre for Development of Advanced Computing (C-DAC), Mohali, has developed an Internet-based software solution, e-Sanjeevani, to provide an interface between doctors and patients. Having successfully tested the pilot project, the centre has signed an MoU with six states to share the database of patients through the Common Services Centres (CSC).
“e-Sanjeevani is an upgraded version of our existing telemedicine application, Sanjeevani. It is a result of core resource and development effort in the area of medical informatics, healthcare, telemedicine and e-health. We signed an MoU in September and the software will be used by Bihar, UP, Tamil Nadu, Orissa, West Bengal and Assam at the CSCs, where the database will be stored for the use of doctors,” said Dr J S Bhatia, Director, C-DAC Mohali.

C-DAC will conduct a pre-workshop conference on Friday, on the sidelines of the National Conference of Telemedicine Society of India — Telemedicon08, to create national awareness and visibility about its various e-products.

e-Sanjeevani is a web-based software, where a doctor can log on to the site just like an email account — with a specific user ID and password — and access the patients’ database and transfer medical records electronically to other consultants. Doctors can chat among themselves to discuss a particular case. Patients, too, can have their specific ID and log on individually to have their medical update and online consultation with doctors.

“e-sanjeevani is user friendly as it has comprehensive electronic medical recorder with unique patient IDs. Online diagnostic test reports are available to the doctors, and expert tele-consultation among leading healthcare institutions and professionals in various specialties is possible,” explained the director.

PGI has been running the pilot project of e-sanjeevani in which a database of 500 asthma patients has been fed and can be accessed any time by doctors on the Internet. Under the project, however, the patients do not have an access to their medical record.

November 13, 2008

Intel launches home medical monitor

Venturing its way into the health care industry, Intel, the chip maker, has launched a home medical monitor, called the Health Guide, essentially for patients with chronic problems.

The Health Guide was approved by the Food and Drug Administration in July this year. The apparatus, a medical monitor with a web interface, includes a home health laptop, web application and a database.

Akin to an alarm clock, it can beep at a preset time to jog the patient’s memory. It can enable patients to seek answers to their questions from the database. Since the 'Guide' is equipped with equipments like glucose reader, blood pressure cuffs and other sensors, it is likely to benefit patients suffering from heart failure, hypertension and diabetes.

Highlighting the importance of Helath Guide, Mariah Scott, head of sales and marketing at Intel Digital Health Group said, "Health care is an area where getting and gathering the right information, and getting decisions made in a timely matter can make an enormous difference in patient care. We hope this technology helps with that."

Health guide is likely to save billions of dollars as it will reduce medical costs drastically since the treatment will be done at home. The senior citizens are likely to be the biggest beneficiary of this breakthrough.

Hank Osowski, senior vice president of corporate development for Scan Health Plan said, "The power of this system is we can use it to see many more people on a daily basis and let seniors engage in their own health care."

Intel has associated with two major non-profit organizations in the United States viz Mayo Clinic and the American Heart Association, with a view to provide the application's assessments, treatment guidelines and the educational content.

November 07, 2008

Generic drug cos await US healthcare policies

Generic drug-makers are keeping their eyes on the President-elect, Mr Barack Obama, and the shape that healthcare policies will take under him, as the US is the world’s biggest market for generic medicines.

A greater use of generic drugs (medicines that are chemically similar to innovative drugs, but much less expensive) on the Government’s healthcare programme, was always on agenda for the Democratic party.

But what the new man at the helm could bring in, are policies to drive a hard bargain on the price of generic drugs through direct negotiations between Government and drug companies, observes Mr Sujay Shetty, Associate Director with consultant firm PricewaterhouseCoopers.

So while generic drug companies can expect their volumes to grow, prices will be under pressure, he observed. The Republicans were not for direct negotiations with drug companies, he added.

Also, the new Government may look favourably at reimportation. That would mean that drugs registered in Canada, for instance, could gain access to the US market, Mr Shetty said. And the regulatory pathway for medicines made from biological sources could see some progress, he added. This has been in the offing for long, and several Indian drug companies, including Dr Reddy’s, Wockhardt, and Intas, are betting big on biologics.

Governments & generics
Healthcare has always been a major player on the US political stage. But Mr Obama had sought to take the message home to voters through his mother’s battle with ovarian cancer and her struggle with getting insurance to cover her medical bills.

The pharma component in healthcare costs is gradually increasing, and so the new Government will be pro-generics to keep prices under check, observes Mr D.S. Brar, Chairman, GVK Biosciences, and former Chief Executive of Ranbaxy, instrumental in internationalising the company several years ago.

Though the US market per se will be pro-choice, the Government will look for generic drug options for its federal healthcare bill to cover more people, he said.

And it is not just the US, but other developed markets in Europe, like Germany and the UK and in Asia, like Japan, are increasingly pushing for generics, says the Indian Pharmaceutical Alliance’s Mr D.G. Shah.

As the financial crisis grips more countries, Governments are looking at generic drugs as a way to control expenditure, he said. Indian drug companies, across the spectrum, have been active in the international markets, helping clock-up pharma exports of over Rs 30,000 crore.

Narayana Hrudayalaya plans health city in Mexico

Indian hospital major Narayana Hrudayalaya plans to set up a health city in Mexico that will also cater to patients from the US.

"Our next project will be a health city in Mexico. We may tie up with some American hospitals for this project," said Devi Shetty, eminent cardiologist and chairman of the Narayana Hrudayalaya group of hospitals.

Shetty was addressing a news conference here to announce the setting up of a health city - a multispecialty hospital with research facilities - in Hyderabad on the lines of the group's famous facility in Bangalore.

"The health city in Mexico will be a 3,000 to 5,000-bed facility and we are looking for joint ventures," he said adding that the government of Mexico had requested the group to set up a large health facility.

Sources said the health city would come up either in Mexico City, the capital of Mexico or at Guadalajara, the second largest city in Mexico.

Shetty said the proposed health city would also cater to the requirements of patients from America.

"We foresee healthcare delivery problems in the United States. They also have problems in undertaking a 20-hour journey to India for heart and other surgeries. As Mexico is closer to America, they will find it easy to undergo treatment there," he said.

The chain of hospitals, which has already built one of the world's biggest cardiac hospitals in Bangalore and is planning similar facilities in other cities, is reportedly in talks with the US-based Sutter Health for the Rs.10 billion health city project in Mexico.

The Rs.16 billion group, which currently has two hospitals in Bangalore and Kolkata, plans to invest Rs.50 billion over next five years in expanding its operations to six other Indian cities.

November 06, 2008

Global Economic Recession: A blessing in disguise for medical tourism

Much before the credit crisis rocked the American economy and the world, Michigan-based Jill Howard (name changed) made up her mind to visit India during the Christmas holidays this year for a joint replacement surgery. The 58-year-old engineer had planned her surgery in India, because she knew that the costs for the treatment would be much lower here compared to the US.

However, with the turn of September, things began to shape differently across the world. The global crisis was now much palpable with the collapse of investment banks and the ensuing credit crunch. And as the crisis gnawed at the margins of some of the world’s top corporates, one could see the telltale signs of a global depression.

What ensued in the following months was an economic mayhem with the rising number of pink slips, sky-rocketing fuel prices, sinking stock markets and dimming sentiments. Everything, from food prices to air fares hit the roof.

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However, all this had no affect on Howard’s plans for her surgery in India. In fact, now she had all the more reasons to get the surgery done in India as a joint replacement surgery in the US would have cost her a stupendous $50,000 against only $8,000 in India.

“So even if I were to add the airline expenses, travel and stay, it would be cheaper to fly to India for the same treatment,” she said.

Like Howard, several medical industry experts, too, believe that it couldn’t be a better time to fly to India for medical reasons. In fact, many say that the recession was a boon in disguise for the country’s medical tourism sector. (Medical tourism refers to travel undertaken for medical care.)

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According to experts, the immediate impact of any recession was cost cutting and cost rationalisation. So, with the US being the hardest hit by the current crisis, efforts to reign in costs would be the strongest in that country.

According to financial advisory, audit and consulting firm Deloitte, in 2007, about 4,50,000 patients from abroad visited India for medical treatment.

Experts peg the growth of the country’s medical tourism at about 30-35% in the financial year 2008-2009.

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Vishal Bali, managing director of corporate hospital chain Wockhardt, said India has been getting about 3,000 patients from abroad every year. “And we see this rising by 35% this year.”

According to Ankur Bharti, consultant, Technopak Health, cost-cutting would be the main growth driver for the country’s medical tourism this year. “Cost-cutting would be the main reason why more international patients would come to India, especially from the US as medical costs are four to five times lesser here,” he said.

Anupam Sibal, group medical director, Apollo hospitals, said a bypass surgery in the US could cost about $75,000. The cost could be around $8,000-9000 in India.

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“A liver transplant in the US would cost around Rs 1.5 crore. In UK, the cost would be around Rs 80 lakh. However, in India, a liver transplant costs only about Rs 18-20 lakh for adults and Rs 12-15 lakh for children. Since the difference is so huge, I think patients will prefer flying down to India,” Sibal said.

Kumar Menon, specialist, medical informatics and telemedicine at Amrita Institute of Medical Sciences (AIMS) at Kochi in Kerala, said the medical tourism sector would remain constant and largely unaffected by the global economic turmoil.

“At AIMS, we specifically get a huge chunk of Malayalees settled abroad, especially in the Gulf region, coming home for medical treatment during the holidays. This trend would remain unaffected by the crisis.”

Industry professionals, however, warn that treatment involving cosmetic surgery, including areas like cosmetic dentistry, dermatological treatment and ayurvedic massages, will witness a decline.

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Menon said the number of patients coming to India for those medical conditions that were not so intense and a treatment for which could wait, will see a decline.

However, areas such as cardiology, neurology, ophthalmology and oncology will continue to get more patients from abroad.

November 05, 2008

USA desperately in need for more family doctors

The US desperately needs to increase its numbers of family doctors to improve patients' care and reduce their costs, particularly for those most vulnerable in society. Incentives must be given for medical students to specialise in general, primary care rather than the narrow specialties which earn them more money but do not meet the needs of the public. The call for action is made by four doctors from the American Academy of Family Physicians in a Comment published early Online and in an upcoming edition of The Lancet.

Drs Perry A Pugno, Rick Kellerman, Amy L McGaha, and Norman B Kahn Jr say: "The US health-care system needs reform. On that point, we have national consensus. Information from WHO and the Commonwealth Fund shows the poor state of health-care access and patients' outcomes in the USA compared with other nations. These findings are despite US citizens paying the world's highest costs for health-care services; costs that are currently borne by government, employers, and—most importantly—patients themselves. US citizens are more concerned about their health-care system than any other issue, apart from the state of the economy and the effect of the war in Iraq."

They add: "Of all developed nations, the USA is the only one without universal access to comprehensive, continuous, and preventive services in a primary-care-based system. Moreover, our system is riddled with unconscionable disparities—geographical, socioeconomic, ethnic, and racial—in health care and health status, which could all be mitigated by consistent access to a medical home. A medical home is a health-care setting that facilitates partnerships between individual patients and their physicians. So, what we really need in this country is universal access to primary care."

Factors that adversely affect the choice of primary care careers for medical students include a payment system that favours procedures over cognitive services, increasing students' debt, decreasing federal support for both medical school and residency education in primary care, and specialty-focused admissions policies and processes for students.

The authors say that definitive steps must now be taken to support and promote careers in primary care to meet the health-care needs of the USA. Those steps need action in three domains. First, increase the attractiveness of careers in primary-care medicine, including appropriate payment for primary-care services and more control over one's lifestyle. Second, prioritisation of medical students' interests in primary-care careers that practise the generalist approach to health care, by contrast with practising only a narrow scope of care. Third, support for training programmes for primary-care physicians. Furthermore, they advocate payment reform, looking at the fee-for-service system which favours treatment volume rather than its treatment quality; and extension of after-hours on-call services for patients which reduces the use of emergency departments and costs.

The four doctors conclude: "The changes we need cannot be brought about by a single discipline of medicine. They require the concerted efforts of physicians, community leaders, businesses, policy makers, state and federal governments, and others. To fix our dysfunctional health-care system is in the best interests of the USA. We know what needs to be done—we simply require the political will to do it. Primary care, epitomised by family medicine, is the linchpin of success in all these endeavours."

November 04, 2008

Toll-free number for complaints on negligent doctors in TN

The public health department has been asked to set up a toll-free number to receive complaints from public on negligence of doctors and para-medical staff in primary health centres across the state.

The state-level consultative meeting with consumer bodies presided over by K Rajaraman, commissioner of civil supplies and consumer protection, recently instructed the department to set up the facility to help the public. The public could make complaints if the public health centres did not open on time.

The meeting also discussed a plethora of complaints over charging Rs 25 extra per cylinder and causing delay of over 40 days for refilling, the meeting directed the oil majors to conduct quarterly meetings with revenue officials and consumer organisations to address the problem locally.

On another complaint over selling stamp papers for excess amount, the authorities have directed to display the names of licenses vendors at all sub-registrar offices. "Licences of those vendors who indulge in corrupt practices will be cancelled," Rajaraman warned.

He also appealed to the consumer organisations and activists to lodge their complaints and grievances on-line through the website and complaints can be sent to

Only genuine NRIs eligible for medical quota: SC

You have to be a genuine NRI to take admission under the NRI quota in medical colleges, said the Supreme Court on Monday frowning at

local Indians side-stepping the requirements to get admitted in MBBS and BDS courses.

As the fees for each NRI quota seat was high, medical colleges were seen blinking at the rule and allowing local Indians to get admitted to NRI quota seats as long as they got NRI sponsorship and paid in greenbacks. The objection of a Bench comprising Chief Justice K G Balakrishnan and Justice Aftab Alam was to local candidates, that is Indian residents, getting a sponsorship from a non-resident Indian and paying the high fees in dollars to get admitted to medical colleges under the NRI quota.

The case pertained to several candidates getting admitted to Uttarakhand Forest Hospital Medical College, Haldwani, under the NRI sponsored quota, which was objected to by the high court. Agreeing with HC’s objection, SC said: "You (the candidates) are not NRIs. You are just willing to pay in dollars. We will not encourage this practice. You have no connection with NRIs except for getting a sponsorship."

It refused to entertain the appeals of the candidates, who were earlier granted provisional admission to the 2008-09 MBBS course before the HC intervened. The HC had dealt with the issue elaborately in its judgment under the head "whether there could be NRI sponsored candidates". It said: "They are pure ordinary resident Indians who get their names sponsored by NRIs, and only on the strength of such sponsorship and by payment of huge sums of money, these simple ordinary resident Indians are being given admission as against other ordinary resident Indians, who do not get their names sponsored by NRIs and who are not in a position to pay huge sums."

As there was a question mark about the legality of NRI sponsored candidates and on the legality of special category of such candidates, the HC had directed initiation of fresh process for filling up of the NRI quota seats. The SC upheld the HC order.

November 01, 2008

Medical Insurance Information

Hospitalisation is something that most people hate, irrespective of the age they are. There is a sense of helplessness that overcomes you as you lie prostate on the bed, the subject (and victim) of the close study by doctors, nurses and the topic of discussion of those around.

The irritation only magnifies itself in the case of an elderly person who is more prone to such emergencies. The sense of helplessness is compounded by a fear that rising medical expenses will force you to look at close relatives (mostly children) for support.

Many elderly persons are unwilling to let go of their pride and request either financial or physical help from close relatives. To give elderly citizens the privilege of being independent and keeping their ever-increasing needs in mind, a few health insurance companies in the country have launched specific health insurance products for senior citizens. SundayET gives you an idea of what these policies entail.

A standard complaint of many elderly people approaching companies for health insurance used to be that companies were unwilling to issue fresh insurance policies after the age of sixty, when the need was most acute.

Senior citizens’ health policies fill this lacuna by offering fresh insurance policies to people between the ages of 60 and 70 years (the person should not have completed 70 years though). But if you are an existing policyholder who has crossed the age of 70, you don’t need to worry as your policy can be renewed even after this.

However, watch out as some companies have restrictions like 75 years even for policy renewals. Some companies have also lowered the bottom limit to include people who are less than sixty in their elderly insurance product. “We have launched a separate cover exclusively for people aged 46 years to 70 years with renewals up to 75 years of age,” says Shreeraj Deshpande, head-health insurance, Bajaj Allianz General Insurance.

If you are possession of health insurance policy, a sizeable chunk of your medical expenses is guaranteed to come down. “For every claim, an individual needs to pay only about 30% of the expenses, the other 70% will be taken care of by the insurance company,” says Ashok Tandon, Area Manager, Star Health and Allied Insurance.

Hospitalization resulting from sickness or injury is the major component that is covered under most health insurance policies . Some policies make it possible for you to avail of cashless treatment. So keep yourself updated on the hospitals that are in the network. Under senior citizens’ policies, insurance coverage is also available for pre-existing diseases; however, the coverage on the part of the insurance company will generally be limited to about 50% in this case.

In addition, there may be a clause regarding the time period after which pre-existing diseases come under the purview of the policy. You also need to watch out for company-based specifications regarding diseases you have acquired or conditions that you have been hospitalised for, in the 12 months before and after the policy.

The sum insured in such a health insurance policy could range anywhere between Rs 50,000 to a maximum of Rs 5 lakh.

However, the premium you pay could vary depending on your age. “Premiums are based on the anticipatory risk which an insurance company covers. But the premium increases with increase in age slab/SI,” says Deshpande. However , the process of getting the policy is not very difficult. A proposal form generally needs to be accompanied by an age-proof , details of any insurance cover in the past.

While most companies insist on pre-medical tests, there are a few who ask for a declaration form showing the absence of certain diseases.

“Major exclusions to our health insurance policy are cancer, kidney problems, brain stroke, Alzheimers disease and Parkinsons’ disease,” says Tandon.

Similarly, conditions arising from war, self-inflicted injuries that have undertaken intentionally, AIDS or sexually transmitted diseases, cosmetic treatment and so on come under the framework of excluded diseases. Generally, the list of exclusions does not vary during the renewal of a policy unless a person has applied for an increase in the sum insured.

However, if a person is found to have a certain ailment (which can be traced to a period before the policy is taken) and has not declared it in the form at the time of policy application, there could be certain steps taken by the company either in terms of further exclusions or at the time of renewing the policy.



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