December 30, 2008

Manipal varsity to start courses in alternative medicines

Pro-Chancellor of Manipal University H.S. Ballal said on Monday that the university was thinking of introducing courses in alternative medicines such as Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy.

He was speaking after inaugurating the two-day national workshop “Ayurvision – 2008” focussing on “Recent advances in Amavata” (rheumatologic diseases), organised by the Kasturba Medical College and Hospital here.

Prof. Ballal said that Manipal University was yet to get approval from the regulatory body to start courses in alternative medicines.

Ayurveda had bright prospects. The biggest factor that favours Ayurvedic medicines was that they did not have toxic effects. “But, a lot of work needs to be done to bring in standardisation of Ayurvedic medicines,” he said.

Some herbs were being used in Allopathic medicines also. Ayurveda was popular in the western countries and a lot of research on it was being done there. The Manipal Life Science Centre, a constituent of Manipal University, had entered into an agreement with the Himalaya Drug Company. “The varsity wants to develop Ayurvedic medicines on scientific basis,” he said.

Associate dean of Kasturba Medical College Shakuntala Pai welcomed the gathering. Dean of KMC-International Centre Poornima Baliga, Head of the Department of Ayurveda M.S. Kamath, and organising secretary of the conference Basavaraj were present.

December 29, 2008

Hospitals, the soft targets of terror

First Ahmedabad and now Mumbai, hospitals have been the new targets of terror. And post-26/11 authorities in Mumbai are cranking up security at these soft targets.

One of Mumbai's busiest hospitals King Edward Memorial has become the first civic hospital to do so.

It has installed cameras everywhere. At least 160 security guards will work in three shifts monitoring the premises with the help of 50 close circuit cameras.

The hospital has also installed four door frame metal detectors. However, the security guards have also been given hand held detectors.

The administration says these measures will now be a permanent fixture.

"We will have alarms for all six buildings for emergency situations. Those can walk will be asked to leave through pre-identified channels. And those are bed-ridden will be taken care of by the hospital staff," said Sanjay Oak, Dean, KEM Hospital.

Though patients and their relatives at this 1,735 bed hospital will have to put up with security checks, they aren't complaining.

"If it only stays for some time and goes away then it will do us no good," said one of the patients.

At any given time, there are over 3,000 people in the hospital. Post-26/11 the threat to this hospital is very real. So, introduction of security checks is a positive step but the challenge will be to ensure it is sustained.

December 25, 2008

Don’t worry, the doctor is just a call away now

Need to consult a doctor? Just call. Thanks to a new medical consultation service— entitled Doctor Talk — you can now consult a
specialist doctor over the phone for a small fee. You can choose from a list of doctors and also use teleconferencing to tap specialists in India and abroad for a second opinion.

To avail the service, all you need to do is buy a pre-paid voucher and select the doctor of your choice. “Users can then call the company which connects the patient to the physician and the service is charged per minute,” says Pramod Saxena, CMD of the Gurgaon-based IT services company Oxigen which has just launched the service. Doctor Talk works on mobile and landline phones of all operators.

“About 50% of medical consultations and 75% of follow up visits do not require physical examination. People spend hours visiting and consulting a doctor for a check up that usually takes just a few minutes. When most of the diagnostic
details can also be shared online, the patient doesn’t need to physically go and see the doctor. We are looking to tap this segment, ” Mr Saxena told ET.

While the cost of consultation would vary depending on the level of specialisation, the call charges for the service would be significantly lower than what doctors usually charge per visit. And it would also save time.

One of the reasons why doctors avoid phone consultations is because it infringes on their privacy not to mention the loss of consultation fees. In most cases, hospitals also do not allow medical consultation over the phone. The new service will protect the privacy of doctors as their numbers will not be disclosed to patients and the call consultations will be limited to a specified time.

The company is exploring talks with hospitals to work out a revenue sharing model so that there is no conflict of interest for doctors who work in these hospitals but have also been empanelled for Doctor Talk.

Doctor Talk will use the conference call service provided by Oxigen’s US-based group company Chorus Call. Started in 2004, privately held Oxigen offers several mobile-based services.

Special chips in mobiles to keep tab on Bihar doctors

Remember the Bollywood flick in which a cop fits a chip in the body of a habitual law-breaker to keep a tab on his movement? Though
government doctors in Bihar are no law-breakers, the health department has adopted a similar method to track them on field duty.

The department has entered into an agreement with BSNL which entails distribution of about 8,000 mobile phones and Sim cards fitted with special kind of chips. The chips would allow the department's bosses, if they wish, to find out the location of a doctor by dialling his or her mobile number. The locational details, if requested, would be provided by the service provider

While the department has decided to provide a talk time of Rs 500 every month to doctors who would be given these mobile phones, it has also issued directives that the phones should not be switched off in any circumstances.

"We keep on receiving complaints that many doctors do not live at places of their postings causing problems to patients," health minister Nand Kishore Yadav said, adding, "The new system would help us get the real picture."

Yadav said that in the first phase all civil surgeons have been provided with the chip-fitted mobile phones and very soon other doctors and field officials too would be given the phones. "Our sole intention is to ensure presence of doctors in the field and those found missing from places of their posting without proper reason would have to face the music," he added.

The minister's assertion notwithstanding, the Bihar State Health Services Association (BSHSA), a body of government doctors, has termed the move a discriminatory one. "Why doctors only? Field officials of all other departments should also be brought under the new system," BSHSA spokesperson Dr Ranjit Kumar said.

He said singling out doctors would send a wrong message among the medical fraternity as they would be forced to believe that they are the favourite whipping boy of the government.

December 24, 2008

Rumours of ‘vaccine death’ make thousands rush to hospitals

Panic that was triggered following television reports which claimed that a child had died after being administered polio drops, has jolted the national Pulse Polio programme. The door-to-door campaign on Monday was affected to a large extent across the State and was totally held up in Bangalore owing to the rumours.

Hundreds of parents and relatives of children rushed to hospitals, including private hospitals and clinics nearby. It was on Sunday that the national programme began across the country.

Health Commissioner P.N. Srinivasachari told presspersons here that rumours had affected the progress of the programme. “There is no truth in the rumours which have caused untold misery, hardship and inconvenience to the people, officials and medical practitioners.”

In Bangalore, doctors and health staff at various government hospitals worked without a break from 11 p.m. on Sunday until the early hours on Monday.

After the rumours spread, most parents did not get their wards vaccinated on Monday. To prevent a setback to the programme, the Department of Health and Family Welfare, through various mobile service providers, sent SMSes to random numbers. The messages said: “Polio drops are absolutely safe and no adverse effects reported from anywhere in the State. Request you to not pay any attention to rumours spread on polio drops.”

Close to 5,000 anxious parents thronged each of the various government hospitals on Sunday night. The police had to be called in to control the mob at many places.

The reported death of a two-year-old girl in a village in Shahapur taluk of Gulbarga district, nearly 18 hours after being administered polio drops, resulted in more panic among the people . The District Health and Family Welfare Officer, Nalini Namoshi, clarified that the death of the child had nothing to do with the Pulse Polio campaign, and it was due to health complications.

In Mysore and adjoining areas, a large number of panic-stricken parents and relatives took their children to hospitals following rumours.

December 19, 2008

Insurers pull the plug on group health policies

Employees of several small and midsized corporates may find themselves without health cover, with insurance companies serving

cancellation notices to group mediclaim policyholders whose claims are much more than the premium they pay.

With margins being squeezed following a crash in property insurance rates, insurers are taking a tough stance on group health claims. What this means is that many employees could find themselves without health insurance cover if the corporate fails to renegotiate a fresh cover in time. Bigger companies may be better placed to carry out such renegotiations.

The notices have taken many corporates by surprise, since it’s perceived that policies being annual contracts, the cover would be valid for a year. Insurers, on the other hand, are taking advantage of the fine print. The cancellation notice allows both sides to rescind the contract, with premium being refunded at a month’s notice.

The tough stand on claims is a reversal of an age-old strategy where insurers accepted group health business despite heavy losses as an incentive for the corporate to offer their property insurance business. But the removal of all pricing restrictions has resulted in property insurance rates crashing by 80%, leaving insurers with little room to cross-subsidise.

“We are not cancelling policies mid-term, but are carrying out a review of covers where the claims are already extraordinarily high,” said Sandeep Bakhshi, managing director of ICICI Lombard General Insurance.

In the past, companies with the worst claims experiences were able to buy cheap cover, as there was always another insurer willing to accept the business in order to build marketshare. But now, with margins in property insurance getting wiped out, losses are beginning to sting all companies. Brokers say, cancellation notices are being sent out by private as well as public sector companies.

“There are many instances where companies are cancelling group health insurance policies,” said Pavanjit Singh Dhingra, vice-president, Prudent Insurance Brokers. “We do warn clients of the risk of cover being discontinued when they get extremely low quotes. But we also have cases where companies have gone in for mid-term cancellation of policies, even with clients who have been with them for three years. We feel there is no justification for such cancellations,” he added.

Insurers may negotiate other loss-reduction measures

According to Shreeraj Deshpande, head of health insurance at Bajaj Allianz General Insurance, “The pricing of group health covers is on the basis of historical data supplied by companies. If the data is not correct and losses are off track, the insurer would be justified in cancelling the policy.” He added that at an industry level, a correction in the cost of group mediclaim was expected, because cross-subsidy from property insurance was no longer available. “The overall insurance bill for companies is unlikely to go up because the reduction in property insurance will make up for the increase in health insurance,” said Mr Deshpande.

According to Mr Bakhshi, the combined loss ratio (ratio of claims and servicing expenses to total premium) of group business is over 160%. Group premium, which is currently around Rs 3,000 crore, needs to go up by at least another Rs 1,500 crore, he added. Besides asking for higher premium, insurers are likely to negotiate other loss-reduction measures. These could typically include reduction in the minimum room charges or asking companies or their employees for some level of co-payment.

Insurance companies are expecting some rationalisation of benefits in the IT sector where employers have gone for the widest possible cover, including one for employees’ parents.

December 17, 2008

Families want doctors to share bad news

Although many doctors worry about breaking bad news about seriously ill patients to their kin, most family members want to know the truth, a study published suggests.

Research has shown that many doctors hesitate to be fully open with critically ill patients and their families -- opting, for example, to give a more optimistic estimate of life expectancy, or to not discuss prognosis at all unless the patient brings it up.

One reason for the reluctance, studies suggest, is that doctors worry about erasing hope for patients and their families.

However, in the new study published in the Annals of Internal Medicine, 93 percent of family members of critically ill hospital patients said that avoiding discussions about prognosis "was not an acceptable way to maintain hope."

Instead, families said that "timely discussion" about prognosis was essential for them to prepare, emotionally and practically, for the possibility that their loved one would die.

According to Latifat Apatira and colleagues at the University of California, San Francisco, the study supports the belief that doctors should help families "hope for the best and prepare for the worst."

The findings are based on interviews with 179 family members of seriously ill intensive-care patients; all had been placed on a ventilator because they could not breathe on their own.

When asked, the vast majority of family members said that withholding prognostic information was unacceptable. Only six study participants thought that doctors should do so if they thought the prognosis would be emotionally damaging to the family or further harm the patient's health.

The findings, Apatira's team writes, show that family members generally feel they are "resilient enough to hear news of a poor prognosis and also need this information to begin to come to terms with the possible death of a loved one."

They say that further studies should look at how doctors can "best balance" the task of being truthful about prognosis while giving families the emotional support they need.

SOURCE: Annals of Internal Medicine, December 16, 2008.

December 16, 2008

Govt plans new legislation on medical devices

The government is working on a legislation to regulate the quality of medical equipment being marketed in the country, Kapil Sibal, Minister for Science & Technology and Earth Sciences said. Speaking at the inaugural session of the fifth India Health Summit on the theme “Optimizing Healthcare Delivery in India: A Patient Centric Approach”, Sibal said the new regulation will help standardization of the quality of medical devices manufactured in India.

“Most of the medical equipments in India are imported and the medical devices industry in India has not grown much. The government of India is working on Medical Devices legislation, in order to standardize the quality of Indian manufactured medical devices,” he said.

Sibal identified four key areas—R&D in the field of technology and genomics focussed on target drugging, vaccinations & innovative solutions, manufacturing & managing medical devices domestically, delivery of quality human resource and affordability—as the major challenges before healthcare sector.

Speaking on the occasion, Prathap C Reddy, Chairman, CII National Committee on healthcare & Chairman - Apollo Hospitals Group, said: "The task before us is how do we rapidly fill the huge deficit for quality healthcare, which is inaccessible to many. We should look at innovative healthcare models, work on standard definition and working environment for PPP. Skills availability in healthcare sector is not upto the mark; the government should now look at healthcare's requirement to quickly multiply the number of healthcare professionals in India."

Highlighting on the aspects of corporate social responsibility, Pervez Ahmed, Chairman, 5th Indian Health Summit & Executive Medical Director, Max Hospitals Group said solutions to healthcare should follow a proximity approach which is customized to the local community. Integrating research and technology aligning healthcare delivery should be given immense importance, he added.

December 15, 2008

Few tips on buying a health insurance

Health insurance is a contract between you and the insurers and is intended to protect you and your dependents against any financial constraints that may take place because of a medical emergency. You need to keep the following in mind while shopping for an insurance cover:
Does the product match your requirements?
Ask yourself what it is that you want to cover: Is it just critical illness or injuries, all hospitalization expenses or OPD expenses as well? To put it more simply, ask yourself if you get cover for both inpatient and outpatient costs. If it is just critical illness, find out what critical diseases are covered. This makes sense in case you
have a family history of heart disease as most insurance plans do not cover existing ailments. Buying such a policy, however, comes for a higher premium. Some companies do not provide any coverage for pre-existing diseases for the first few years. You need to find out the premiums for all these years and also the amount of partial coverage of any pre-existing disease.
How many family members do you want covered?
Splitting policies can be advantageous. From the cost point of view, you can get a separate policy for the oldest member of the family. Generally, all insurance companies offer policies covering yourself, your spouse and up to two children under one policy. Some also give coverage for dependent parents.
What is the total amount of coverage?
The total amount of coverage needs to be determined by the number of people that you want the policy to cover, your estimate of the health care costs and the existing coverage that you might have from other sources such as employer provided group insurance. Here, it is important to understand the value of a secondary cover and experts stress that as a long-term plan, it is prudent for you to have an individual health insurance policy as well as one for the family. Why? Because the cover extended by the employer is valid only while you are employed with them. Once you move to a new organization, the terms and conditions change as per its insurance policy. An individual policy gives you the leverage of a long-standing relation apart from supporting the waiting term requirements for various critical illnesses and pre-existing diseases.
What are the exclusions, both permanent and period-based?
Exclusions describe the ailments and the conditions under which the health insurance coverage will not be valid. For example, a common permanent exclusion is cosmetic surgery. Such surgery is generally not life-threatening and is carried out at the insistence of the patient. The list also includes existing ailments, regular medical expenses such as pregnancy or vaccination and health problems arising out of an injury from adventure sports or expenses related to AIDS.
What is the network coverage of the third party administrator (TPA) engaged by the insurance company?
Ensure that the hospitals near your residence which might be used in case of an emergency as well as the hospital where you seek regular or specialist treatment is part of the TPA hospital network.

December 12, 2008

Use of unconventional medicine rising among Americans

An increasing number of Americans, adults as well as children, are turning to alternative medicine to ease their chronic health problems, confirms the latest health report.

According to a survey by the National Institutes of Health
(NIH) and U.S. Centers for Disease Control and Prevention
(CDC), nearly four in 10 U.S. adults and one in nine kids are using complimentary and alternative medicine (CAM).

There has been a significant rise in the use of some form of complementary and alternative medicine by adults in the recent years as the figures registered an increase to 38 percent in 2007 from 36 percent in 2002.

The leading problem for which more and more Americans are seeking complimentary and alternative medicine is back pain, followed by neck pain, joint pain and arthritis. Some of the most common unconventional treatments include acupuncture, message therapy, meditation, herbal medicines, chiropractic techniques and other natural products which are being considered of great help to ease chronic pain, NIH researcher Richard Nahin stated.

Dr. Josephine Briggs, director of the U.S. National Center for Complementary and Alternative Medicine at the NIH, shared his views saying, “As I look at this data, what I'm most struck with is how much people are turning to CAM (complementary and alternative medicine) approaches as part of the management of chronic pain conditions, particularly chronic back pain, but also neck pain and musculoskeletal pain and headache.”

Briggs told the reporters, “And from my days as an internist seeing patients in my office, I know that these are conditions that are hard to manage and tough to treat.”

The nationwide 2007 survey by the U.S. Centers for Disease Control and Prevention included responses from 23,000 adults and 9,500 children.

According to the survey, 12 percent of children under age 18 used unconventional medicine for various reasons including colds, anxiety, stress, and attention deficit/hyperactivity disorder apart from back pain.

Although the risks for children using alternative medicines are not yet clear, these natural therapies along with herbal medicines are emerging as the latest booming business considering the fact that more and more people believe these have fewer side-effects.

Growing number of people reportedly resorted to natural products including herbal remedies and some other types of dietary supplements other than vitamins and minerals and the trend showed a significant increase among those age 60 and above, Nahin maintained.

Known for its curative powers, fish oil was one such natural product which was an instant hit with adults for bringing high cholesterol and high blood pressure under control, while glucosamine was being used for relief in joints pain. Echinacea, a medicinal plant used for curing common colds, was used by an increasing number of children. Apart from that, fish oil was used by children for attention deficit/hyperactivity disorder.

Educated elite and women found deep breathing exercises, meditation and message therapy to be of significant help as compared to conventional treatment options available.

December 10, 2008

Disease's medical names worry people more than lay terms

Patients get more worried if a disease is referred to in the medical jargon rather than in lay terms, according to new research from McMaster University
The study, the second part of a larger study on how people understand and interpret disease, showed that labels used to identify a disease, whether it is common language or medical terminology, can influence how serious people think the condition is.

The researchers examined many recently medicalised disorders. For example, impotence is now widely known as erectile dysfunction; excessive sweatiness is also known as hyperhidrosis.

It was found that when study participants were presented with the medicalised term for these recently medicalised conditions, they were perceived to be more severe, more likely to be a disease and more likely to be rare, compared to the same disorder presented with its synonymous lay label.

"A simple switch in terminology can result in a real bias in perception. These findings have implications for many areas, including medical communication with the public, corporate advertising and public policy," said Meredith Young, one of the study’s lead authors and a graduate student in the Department of Psychology, Neuroscience & Behaviour at McMaster University.

In the study, participants were given a survey that included 16 disorders, eight of which were chosen due to the increased popular use of a medical label within the last 10 years (eg erectile dysfunction versus impotence). The remaining eight were established medical disorders with both lay and medical terminology in popular use for more than 10 years (eg hypertension versus high blood pressure).

"A lot of people have become critical of what is sometimes called ''disease-mongering'' - or defining more and more conditions as diseases when they were previously just in the range of normal health, and a change in language certainly seems to accompany this. We don''t mean to dismiss any of the recently medicalised conditions we tested as trivial. Rather, because public understanding of these conditions is still in flux, they are an excellent place to examine how different terminology impacts this understanding," said Karin Humphreys, one of the study’s authors and assistant professor in the Department of Psychology, Neuroscience & Behaviour.

The researchers found that the results pattern has implications for the patient-if a patient is informed that she has gastro esophageal reflux disease, for example, rather than chronic heartburn, she might think she is more ill.

One of the important implication is that patients'' understanding of the condition heavily influences how they go about taking care of their own health.

For established medical conditions, researchers found that it did not make a difference in perception if a lay term was used or if subjects were presented with the medicalised language.

"We can see that there are a number of conditions where the medicalese term has, over the past ten years or so, been really rising in how often it is used, compared to the lay term for the same thing. This is particularly important when you have lots of conditions that have recently become medicalised, some of them possibly through the influence of pharmaceutical companies, who want to make you think that you have a disease that will need to be treated with a drug," said Humphreys.

The study is published online in the journal Public Library of Science.

IRDA plans health data repository

The Insurance Regulatory and Development Authority (IRDA) is working on the formation of a data repository for health and motor transport insurance. It is also planning to developing insurance policies in vernaculars.
“It is a suggestion. Languages of the products and mechanics of the whole thing evolve through a process of interaction between the regulatory body, counsel and individual companies,” said J Hari Narayan, chairman, IRDA. Currently, insurance policy is issued in English only. The dry run for such a data mechanism health and motor is complete and it is likely to be made available to the insurers by the end of the current financial year.

Speaking to the reporters on the sidelines of a health insurance summit, which was jointly organised by CII and KPMG in Mumbai on Tuesday, J Hari Narayan, chairman, IRDA said that the tariff advisory committee (TAC), which is part of IRDA, was working on the development of such a database. While data warehouse has already been created, things like the regulatory requirement and software for the same were being put in place, said Narayan. In this connection, the experiments in various forms are being conducted and the people have been trained how to send the data to the insurers as per their requirement. The whole transmitter of information from where it is created to the warehouse has been stabilised, said Narayan.

December 08, 2008

How green is Ayurveda?

Ayurveda, the oldest health system in the world, is going in for a makeover, but is it all for the good? Till now, the biggest innovation had been coloured ayurvedic pills and capsules. But the government's recent amendment of the 63-year-old Drugs and Cosmetics Act appears to allow a more fundamental change — ayurvedic medicine can now contain anti-oxidants, flavouring agents, preservatives and sweeteners. So is ayurveda about to lose its unique organic wholesomeness?

Ayurveda practitioners and drug-makers don't think so. They say the additives, natural or synthetic, must be in permissible quantities in order that the medicine retains its natural properties. "The purpose of allowing the use of anti-oxidants or sweeteners is to increase the shelf life of the ayurvedic medicines," says Dr S K Sharma, advisor to the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). The reasoning is that once they last longer, it would be easier to market ayurvedic medicines nationally and internationally.

But Sharma cautions that the changed law is not "purely for commercial reasons. There is a strong need for scientific innovation. It's time that we tried to improve ayurvedic medicines." So, the anti-oxidants that are being allowed to use will prevent the medicine from decomposing. The additives, says Sharma, will only help in making ayurvedic medicines more stable than ever before.

Some ayurvedic practitioners admit that there are legitimate concerns about additives. Dr V V Doiphode, dean of Pune University's Department of Ayurveda, stresses the importance of testing any product before it is added to an ayurvedic drug. "The onus is on the drug-makers to ensure these (additives) aren't detrimental to health," he says. For that they will have to conduct extensive research and lab testing.

There are other ways of ensuring compliance, not least guidelines issued by the Indian Pharmacopoeia Commission (IPC), an autonomous institution under the Ministry of Health & Family Welfare. The IPC sets strict standards for drugs and other pharmaceutical products. Add to this, the wording of the amended Drugs and Cosmetics Act, which allows "only natural colouring agents as permitted under rule 26 of Prevention of Food Adulteration Rules 1955 for ayurveda, siddha and unani drugs."

But what if someone wanted to market a flavoured chyawanprash, say chocolate, to attract the international market? Would that be more synthetic than traditional chyawanprash? Not really, so long as it retains its original properties, says Ranjit Puranik, CEO of Shree Dootapapeshwar Ltd, ayurvedic drug-maker and exporter.

The loophole, however, is that a product like chyawanprash, which is made of 54 herbs — of which amla (gooseberry) is the main — can be marketed internationally as a dietary supplement rather than a medicine. If it has to be marketed as a medicine, then all the 54 herbs have to go through a standardisation process that will certify that none of the herbs are harmful to health.

The amended act allows synthetic additives in ayurvedic drugs but insists they "carry a statutory warning stating the name and quantity of the artificial sweetener." Puranik says it's up to the individual manufacturer to decide how natural he wants the ayurvedic drug to be. And if he uses a large quantity of synthetic additive "he clearly can't then sell the product as ayurveda".

That may affect ayurvedic core market, but the holistic health treatment has a long way to go in persuading India and the wider world of the goodness of its old-style organic approach to healing. Industry experts estimate that the global market for ayurveda is worth $120 billion. But India's ayurveda exports are a paltry Rs 450 crore or $91 million. China and Sri Lanka lead the world in ayurveda manufacture and export.

India is finally trying to close the gap by adding innovation to the ayurveda mix. "These medicines can be tweaked a bit to suit people's tastes, but the medicinal properties should be maintained. Say for instance, a popular ayurvedic medicine, kashayam, is now available in the form of capsules and tablets. This has been achieved by spray drying but the original properties are not tinkered with." says V G Udayakumar, president of the Kerala-based Ayurveda Medical Association of India. He believes the same can be applicable to other medicines too.

But there's some way to go before the humble hajmola becomes the world's prescribed cure for indigestion.

Israeli doctors assist in trauma counselling

The time is now ripe to start the healing process in the city. Dr Rony Berger, who made this announcement, should know. As a director at

the Nadal Institute in Tel Aviv, Israel, he has travelled to some of the most dangerous places in the world, cities that have been plagued by natural disasters, war, terrorism, bomb blasts and other forms of violence. He has counselled families who suffered in the 9/11 World Trade Centre attacks in New York City, people who were injured in the quakes that hit the Sichuan territory of China, to name a few.

"The first concern in all terror attacks is physical safety. Once people are safe, psychological concerns set in,'' said Berger, who has been brought in by the management of Jaslok Hospital, Pedder Road. "We have set up a trauma counselling cell to help victims and others affected by the terror attacks. It will be done free of cost,'' said Dr Maya Kriplani of Jaslok Hospital.

Over the next week, Berger and his colleague, Marc Gelkopf, will be talking to teachers and counsellors on ways to tackle the trauma. According to the Israelis, around 15% of the people who were directly or indirectly affected by the terror attacks will need help. "In this group too, most will bounce back with help from friends and family, but a few will need professional help,'' Berger said.

Indian counsellors have their methods to tackle trauma, clarified the psychologists. "But Israel has been tackling terror attacks, almost on a daily basis, since its formation in 1948,'' said Berger, underlining the reason for the Israeli mission. There also is a bit of organisational skill that goes into keeping many Israelis sane despite the daily bombardment. "At every municipality level, we distribute manuals on how to manage trauma.'' If counselling is not provided at the right time, the emotional baggage can lead to something serious, said the Nadal team.

But there is, in their opinion, a silver lining to the tragedy in Mumbai. "Most Asians manage trauma better than their Western counterparts because of the support system,'' says Berger.

From Tel Aviv

- Who are they? The doctors have come from the NADAL Institute in Tel behest of Jaslok Hospital

- Modus operandi: Besides advising patients to give vent to pent-up emotions, they recommend talking about the attacks and deep-breathing exercises to relax the muscles

Pharma industry seeks hike in medicine prices

Pharma companies have sought a hike in medicine prices and warned of stoppages in manufacturing of medicines under price controls, a top industry player said.

"There is an urgent need to achieve a balance between product availability, price and quality. Unremunerative and unworkable prices have seen production stoppages. The devaluation of the Indian Rupee has also increased input costs," Indian Drug Manufacturers' Association (IDMA) President, B N Singh, said in a statement here.

Pharma companies have warned of stoppage in manufacturing of medicines under price controls, claiming that repeated pleas for price increases have fallen on deaf ears. They have appealed to the Ministry of Chemicals and Fertilisers to allow them to increase drug prices, claiming that procurement prices of bulk drugs and packaging materials have gone up substantially.

Other factors which have contributed to this situation, IDMA said, are the high cost of freight and accommodation. "The industry has found it hard to absorb these increases," Singh said, adding that this has led to domestic users paying more for imported inputs.

According to IDMA, a substantial quantity of bulk drugs are being imported from China where prices have gone up substantially due to several factors.

December 03, 2008

Curbs urged on long shifts for young doctors

New limits are needed to ensure that the long hours logged by young doctors in training at hospitals do not leave them so exhausted that they make medical errors, a U.S. expert panel said on Tuesday.

A panel of the Institute of Medicine, in a report sought by Congress and the Department of Health and Human Services, did not call for further trimming of medical residents' work hours from the maximum average of 80 per week established by the Accreditation Council for Graduate Medical Education in 2003.

But the committee recommended limiting the number of hours that residents work in a row without being given time to sleep from the current 30 hours, as well as increasing their days off and ensuring greater supervision by experienced doctors.

The panel said these doctors in training should work a maximum shift of 16 straight hours or alternatively work a 30-hour shift that includes an uninterrupted five-hour nighttime break for sleep after working 16 hours.

There has been concern for years that long work hours leave residents fatigued and more prone to make mistakes.

The Accreditation Council for Graduate Medical Education, or ACGME, the nonprofit group that evaluates and accredits U.S. medical residency programs, in 2003 limited the number of hours per week a resident could be made to work.

"Our committee's charge was not to focus necessarily on longer scheduling or shorter scheduling, but smarter scheduling to try to really identify the areas where we could have an impact in preventing excessive fatigue, both acute and chronic, that might contribute to medical errors," Dr. Daniel Munoz of Johns Hopkins University School of Medicine in Baltimore, a member of the panel, said in a telephone interview.

These junior doctors frequently are the front-line medical staff on duty around the clock in teaching hospitals. Residency training takes three to seven years.

"It ought to be rigorous. But it also ought to be humane and it ought to be safe for both patients and for residents," Munoz said.

As an illustration of the fatigue residents may experience, the panel noted that research has shown they have an increased risk of being involved in traffic accidents or falling asleep at the wheel after an extended-duty shift.


The panel urged the ACGME to adopt the recommendations within two years. The independent Institute of Medicine provides advice to U.S. policymakers.

"Cutting hours alone won't do it," added Dr. Ann Rogers of the University of Pennsylvania School of Nursing in Philadelphia, who also served on the committee.

"We need to pay attention to work load. We need to pay attention to supervision. The whole package will make a difference. Without it, you could end up with a more severely stressed resident trying to do more work with less hours."

Rebecca Sadun of the American Medical Student Association said the recommendations are "unambiguously a step in the right direction." She said the 2003 limits have proven to be insufficient because the current 30-hour shifts do not enable residents to remain at a high level of functioning throughout.

Sadun, a medical student at University of Southern California's Keck School of Medicine, added that her association hears many accounts from residents about how the current 80-hour work weeks in reality are 100-hour work weeks, with school administrators insisting that residents fill out time logs dishonestly.

Myanmar to take measures to enable traditional medicine acceptable

Myanmar top leader Senior-General Than Shwe Wednesday called for measures to enable the country's traditional medicine to be acceptable internationally.

"The government is giving effective encouragement to measures for enabling Myanmar traditional medicine to be well-known at the international level by means of improving it through medical research and manufacturing potent Myanmar traditional medicine without infringing their effectiveness and essence in accordance with fine traditions," Than Shwe, Chairman of the State Peace and Development Council (SPDC), said in his message to the 9th Myanmar Traditional Medicine Practitioners' Conference underway in Nay Pyi Taw.

"With this lofty aim in view, measures are being taken as a pivotal role in the national health policy for promotion and safeguarding of Myanmar traditional medicine and using it effectively and on a wider scale in public healthcare," he noted.

He urged Myanmar traditional medicine practitioners to make collaborative efforts through the conference, taking full advantage of the encouragement and assistance of the government in order to provide better healthcare to the people across the country including rural and border areas through the traditional medicine.

He called for working hard to make Myanmar traditional medicine a genuine national legacy or national prestige to earn a good reputation around the world.

According to the report, SPDC First Secretary Lieutenant- General Thiha Thura Tin Aung Myint Oo pointed out at the two-day annual Myanmar Traditional Medicine Practitioners Conference, which was inaugurated Tuesday, that a good headway has been made in combined therapies of Western medicine to cure some major diseases that are resistant to Western medicine, which are outlined as malaria, tuberculosis, hypertension, diabetes, dysentery and diarrhea.

He stressed the need to do research more effectively and on a wider scale to have the Myanmar traditional medicine standardized.

The Myanmar traditional medicine, composed of such ingredients as roots, tubers, bulbs, natural items and animal products, has in a historical perspective, represented the typical Myanmar culture and traditional value and norms.

December 01, 2008

Media Often Err in Reporting Health News: Study

Significant mistakes made by the media in reporting clinical trials could led public to make wrong decisions, according to a study.

Tania Bubela of the University of Alberta, Canada, says that it is often not possible for the layman to evaluate the credibility of the explained research since elements needed for complete comprehension can be missing.

Bubela and her colleagues compared the coverage received by pharmaceutical and herbal remedy trials, and studied 201 pharmaceutical and 352 herbal remedy newspaper articles.

Observing the 48 pharmaceutical and 57 herbal remedy clinical trials that the stories referred to, the researchers that the stories under-reported risk and lacked any disclosure of trial funding or scientists' conflicts of interest.

Bubela said: "There were significant errors of omission of basic information such as dose, sample size and methods for randomised clinical trials. In addition, there is an under-reporting of risks, especially in the context of herbal remedies".

The study further revealed that the media was extremely dependent on narratives from satisfied patients, researchers, clinicians and patient groups, and did not unveil these people's financial ties to industry and conflicts of interest.

The study has been reported in the open access journal BMC Medicine.



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