December 31, 2009

2009 Health Highlights: Swine flu, cancer, AIDS

The big health story of 2009 was swine flu. The H1N1 virus claimed thousands of lives. Also making headlines was a much-hyped AIDS vaccine that failed. Meanwhile, the cracking of the cancer code was perhaps the only silver lining on 2009. Take a look at the health highlights of the year gone by. according to CNN-IBN

April 2009: This was the month the new H1N1 virus was detected in Mexico. It rapidly spread across the world and the World Health Organisation declared a pandemic within months. By the end of the year, more than 16,000 people had died and 1.5 million people had caught the flu. A vaccine has proved effective and over 65 million doses of vaccine have been administered in more than 20 countries, though India will only see a vaccine by spring 2010.

September 2009: 2009 offered false hope. In September, it seemed like a vaccine against HIV/AIDS was a real possibility. Researchers from the US military and the Thai government said a new combination of vaccines could cut the risk of infection by almost a third. But the second and third analysis of the trial showed disappointing results. The vaccine appears only 26 per cent effective, below the threshold of statistical significance, given a modestly successful trial in Thailand.

December 2009: The best health news came in December. Scientists in the UK have cracked the cancer code - the entire genetic code of two of the most common cancers, skin and lung cancer. For the first time scientists can see every single mutation, which could could soon herald blood tests that detect tumours far earlier. Work is now beginning to map at least 50 more cancer genomes and India is one of 10 countries involved in studying cancer of the mouth.

Link: Original Article

December 28, 2009

Grace marks for doctors for rural clinics

Union Minister for Health and Family Welfare Ghulam Nabi Azad has said that his ministry has come out with certain changes in the MCI regulations, with an aim to provide better healthcare services to the rural population.

He was speaking at the inauguration of the modernised MS Ramaiah Medical Teaching Hospital on Friday.

As per the new guidelines, any MBBS doctor serving in rural area either on ad hoc or contractual basis for one year, would get 10 per cent marks in national entrance examination.
Similarly, if he or she spends two years, he or she will get 20 per cent marks. For spending three years, 30 per cent marks would be allocated in the national entrance examination.

The National Rural Health Mission (NRHM) was suffering because of doctors did not want to work in primary healthcare centres (PHCs) or hospitals in rural areas due to the inadequate working facilities, Azad said. The Minister maintained that it was difficult to push the doctors to work at the PHCs.

South on top “There are 300 medical education institutes in the country, of which 50 per cent are in the private sector and 80 per cent of the institutes are situated in the southern part of the country.

Consequently, the southern states are far better compared to other areas in providing healthcare services,” he said.

The Minister also announced concessions offered to start more private medical institutes.
“For the northern and hilly states, the establishment of a institute is now allowed on 20 acres of land, instead of the stipulated 25 acres,” the Minister said.
He said quality education and proper human resource management would boost medical tourism in the country.

Responding to a query on new appointment to the post of director at NIMHANS as the term of the current director was coming to an end on January 31 next year, the Health Minister said that a search committee would be set up for the appointment of the right candidate, as the number of candidates applying for the post was large. Bangalore, December 25 UNION Minister for Health and Family Welfare Ghulam Nabi Azad has said that his ministry has come out with certain changes in the MCI regulations, with an aim to provide better healthcare services to the rural population.
He was speaking at the inauguration of the modernised MS Ramaiah Medical Teaching Hospital on Friday.

As per the new guidelines, any MBBS doctor serving in rural area either on ad hoc or contractual basis for one year, would get 10 per cent marks in national entrance examination.
Similarly, if he or she spends two years, he or she will get 20 per cent marks. For spending three years, 30 per cent marks would be allocated in the national entrance examination.
The National Rural Health Mission (NRHM) was suffering because of doctors did not want to work in primary healthcare centres (PHCs) or hospitals in rural areas due to the inadequate working facilities, Azad said. The Minister maintained that it was difficult to push the doctors to work at the PHCs.

The Minister also announced concessions offered to start more private medical institutes.
“For the northern and hilly states, the establishment of a institute is now allowed on 20 acres of land, instead of the stipulated 25 acres,” the Minister said.
He said quality education and proper human resource management would boost medical tourism in the country.

H1N1 vaccine by March-end
The Health Minister said that the clinical trials for H1N1 vaccines were still going on. The clinical trials on animal and human beings would be over by January and the vaccines will be launched by either end of March or beginning of April next year. The Health Minister said that the clinical trials for H1N1 vaccines were still going on. The clinical trials on animal and human beings would be over by January and the vaccines will be launched by either end of March or beginning of April next year.

Link: Original Article

Medical sector reforms on the cards - Health Minister

The Union Health Ministry has come up with a wave of changes for the Medical sector to encourage the participation of private players in the field.

The ministry, in order to cope up with the shortage of doctors in the rural areas has decided to create another cadre of medicos who will be assigned duties exclusively in the villages and rural areas.

Besides announcing the incentives, the ministry has also amended an Act of the Medical Council of India (MCI) to facilitate opening of medical colleges and institutes in the rural areas of the country.

The Union Health Minister Ghulam Nabi Azad, while addressing a function after laying the foundation stone of a hospital here recently announced that his ministry has decided to introduce a four-year course for doctors to create another cadre of medicos.

"The proposed new cadre would although be below the MBBS degree but it will be recognized by the Medical Council of India (MCI). It is a three-year academic course and a year's house job. The syllabus has already been drafted by the MCI and has been dispatched to different states for approval," he added.

The final decision now resides with the state governments who have to recognize the course.

Expecting a revolutionary change in the health sector, Azad said that, "It is mandatory for all doctors, trained in the four-year course, to serve only in the rural areas. Urban areas are not their field of work once they are a part of this programme."

He further added that apart from this new cadre, MBBS doctors would also be deployed in the rural areas.

To rope in private players in the health sector, Azad said that the pressure on the government institutes would ease due to the opening of private hospitals.

The Health Ministry had amended the existing Act of the MCI to simplify the procedure of opening medical colleges in the underdeveloped and backward areas

"Zones are allocated by the Health and Medical Education Ministry divided into three parts and special attention will be given to those areas which lack basic health facilities. Various concessions have been already announced by the ministry," he said.

With new concessions every year, 4000 specialist doctors and a similar number of super-specialist doctors would pass out from different medical colleges.

Azad further informed that his ministry had given sanction to open 19 medical institutes on a par with the All India Institute of Medical Sciences (AIIMS) and 250 nursing colleges all over the country to cope up with the doctors and paramedical staff crunch.

"On an average, 20,000 candidates would pass out as qualified nurses every year from these colleges", he hoped.

Link: Original Article

IRDA allows products combining life and health insurance

The Insurance Regulatory & Development Authority (IRDA) allowed a new product class Health plus Life Combi Products for promoting the combined products of pure term life insurance offered by life insurance companies along with standalone health insurance products offered by non-life insurance companies under the single product umbrella.

IRDA said the proposed product class enhances the penetration of personal lines of insurance business with a wider product choice to policyholders. While the IRDA adopts a business facilitative approach, it is expected that all insurance companies will put in place prudent market conduct practices and operational procedures for protecting the interests of policyholders.

The ‘Combi Products’ may be promoted by all life Insurance and non-life insurance companies, Irda said. However, these guidelines do not apply to micro insurance products which are governed by IRDA (Micro Insurance) Regulations, 2005. Also the combi products are not allowed through ‘bank referral’ arrangements.

The insurers are expected to offer the best covers as an attractive proposition for the policyholders. The underwriting aspects, premium collection issues and also other policy service related issues of the ‘Combi Products’ under reference require suitable IT support at the offices of both the insurers. Hence, an advanced technology support is an essential pre-requisite to support the service of the ‘Combi Product class’.

The premium components of both risks are to be separately identifiable and disclosed to the policyholders at both pre-sale stage and post-sale stage.

The proposed productis expected to help policy holders choose an integrated product under a single roof without shopping around the market for two different insurance coverages from two different insurers.

Link: Original Article

December 23, 2009

Union Health Minister says steps are being taken to improve standard of medical education

Lok Sabha

To improve the quality of medical education, focus has been given to upgrading the skills of medical teachers, increase in post graduate courses/seats, revision of curriculum, introduction of new medical courses and revision of the norms of infrastructure etc. While these amendments have taken effect, the actual implementation is expected to commence from the next academic session. Some of the important amendments made in the MCI Regulations are as under:-

i) The ratio of post graduate medical teacher to the student has been relaxed from 1:1 to 1:2.

ii) Research publications in indexed/National Journals have been made compulsory for promotion to the post of Professor/Associate Professor.

iii) Permitted colleges which are not yet fully recognized are allowed to offer postgraduate courses in the subjects of preclinical and paraclincial Departments of Anatomy, Physiology, Biochemistry, Pharmacology, Microbiology, forensic Medicine & Community Medicine without waiting for full recognition.

iv) The teaching experience required for the post of Professor/Associate Professor has been reduced by one year in the respective feeder cadres.

v) Emergency Medicine has been incorporated in the medical curriculum so that the medical students are trained to tackle medical emergencies.

vi) Basic management skills in the area of human resources, materials and resource management related to health care delivery, General and hospital management, principal inventory skills and counseling have been included in the curriculum.

vii) A village attachment of atleast one week to understand issues of community health alongwith exposure to village health centres, ASHA, Sub Centres have also been included in the curriculum.

viii) The requirement of infrastructure like institution block, library, auditorium, examination hall, lecture theatres, etc. has been rationalized for optimal use, and

ix) Laboratories in different departments have been pooled to have common laboratories which can be used by all the departments for better utilization of the equipment and space and to reduce capital expenditure,

2. In addition, to facilitate expansion of medical education to the unserved and underserved areas of the country, amendments have been made in the Medical Council of India (MCI) Regulations, some of which are as follows:-

(a) For opening of new medical colleges, land requirements have been rationalized across the country and they have been further liberalized in the case of notified tribal areas, underserved/unserved areas and hill areas. In respect of these areas, land need not be unitary piece but can be in two pieces of land,

(b) In respect of North-East and Hill States, the requirement of bed strength in the teaching hospital has been liberalized, and

(c) Staff and infrastructural requirements have also been rationalized etc.

3. The President of India in her address to the Joint Session of Parliament on 4th June, 2009, announced the Government’s intention to set up a National Council of Human Resources in Health (NCHRH) as an overarching regulatory body for health sector to reform the current framework and enhance supply of skilled personnel. Consequently, a Task Force under the Chairmanship of Union Secretary (Health & Family Welfare) was constituted to deliberate upon the issue of setting up of the proposed National Council. The Task Force submitted its report on 31st July, 2009. The report alongwith the draft bill for creation of NCHRH has been sent to the State Governments seeking their views and posted on the Ministry’s website for inviting comments from the general public. It is envisaged that the proposed National Council, when constituted, will deal with various needs of medical education in the country.

This information was given by Shri Ghulam Nabi Azad Minister Union Minister for Health & Family Welfare in a written reply to a question in the Lok Sabha today.

Link: Original Article

December 19, 2009

West Bengal passes controversial 3 year Rural Diploma MBBS Health bill

The West Bengal government on Wednesday passed the controversial Rural Health Regulatory Authority Bill 2009 in the state assembly by majority vote.

In doing so, the state government created a precedence in the sense that it over-ruled thereby the collective decision that was taken by the Left Front to send the bill to the assembly select committee in view of the differences that existed over various tenets of the bill among the Opposition.

The government’s move resulted in an immediate walkout by the Trinamool Congress and Congress.

The Bill introduces a 3-year diploma course on medical science and the apparent objective is to deploy these diploma holders in various parts of rural Bengal to meet the acute shortage there in terms of qualified medical practitioners.

The government’s move, good or bad, will undoubtedly lead to tremendous opposition from the leading Opposition parties as well as Left Front allies at this juncture when the state is going through one election after another and practically losing them all.

In early 1980s, the then CPIM state secretary Promode Dasgupta had mooted the idea of creating "barefoot doctors" to deploy them in rural Bengal, but had to relent to the huge opposition from the medical fraternity, including the Indian Medical Association (IMA). At the same time, it is not unknown either that during the raj days, a category of medical practitioners was created who were known as Licentiate Medical Practitioners. Sometimes jokingly referred to as "half-doctors", these practitioners did not go through the rigours of the Bachelor of Medicine (MB) course, but could practice privately under certain conditions. The system was abolished in 1946.

"I don’t understand why Buddhadeb Bhattacharjee is trying to follow the Promode Dasgupta formula which was rejected by the medical fraternity as well," said Partha Chatterjee, the opposition leader in the state Assembly. Congress leader Manas Bhunia, who is himself an MBBS doctor resented the fact that two categories of medical practioners were being created, the fully-qualified for the cities and the half-qualified for rural Bengal.

"The sole intention of the government behind framing the bill is to tide over the manpower crisis in the rural health care system. MBBS doctors often refuse to go to the villages and stay there. We want to send these diploma-holder to villages to treat people there," state health minister Surjya Kanta Mishra argued. Mishra told newsmen he was unaware of the Front’s earlier decision, although he is a central committee member of the CPIM.

Left partners were aghast. Ashok Ghosh of the Forward Bloc, CPI’s Manju Majumdar and RSP’s Manoj Bhattacharjee all said they couldn’t figure out how this faux pas had happened. All of them were hugely surprised at the passing of the bill and said they would talk to the Left Front chairman Biman Bose. The CPIM’s state secretariat will take up the issue at a meeting on Thursday.

Link: Original Article

No plans to privatise AIIMS: Health Minister

Health Minister Ghulam Nabi Azad said on Friday that the government has no plans to privatise the All India Institute of Medical Sciences at New Delhi.

Replying to a question in the Lok Sabha, Azad said: "There is no question of privatisation of AIIMS as it is the only premier institute that caters to poor people."

Apprehensions of AIIMS' privatisation were raised after the S. Valiathan Committee recommended that recruitment to Class C and D level posts in the institute should be done through reputed professional agencies.

The committee was set up to look for better management and functioning processes for the top medical institute of the country.

Link: Original Article

December 13, 2009

CET for medical PG: Decide in a month Gujarat HC tells govt

The Gujarat High Court has given a month's time to the state government to take a decision in the matter concerning holding a common entrance test (CET) for state quota in all institutions offering postgraduate medical degree courses from the next academic year.

Acting on second public interest litigation (PIL) filed by Parents Association for Medical, Dental and Paramedical, a division bench comprising Justice MS Shah and Justice AS Dave has asked the state government to act fast. The bench asked the government to decide in one month if it would hold a CET for admission to all state colleges' PG medical courses.

In addition, this time the high court has, in specific words, warned the government that it would face contempt proceedings in the case if it fails to reach a conclusion this time.

"State government will take final decision in the matter within one month, failing which, it will expose itself to
all the consequences for disobedience of the order of this court," the division bench wrote, after mentioning its five-month-old order, in which the court had given three-month period to the government to take decision on the same issue.

Last year, the state government made a resolution that admission to PG courses would be regulated by a common entrance test and there would be a single window system. However, the government and the universities did not implement this system, and a parents' association filed a PIL demanding that such institutes should not hold separate entrance test. In reply to this PIL, the state government in June this year told the court that a report of a committee headed by Kanubhai Kalsaria in this regard was under consideration of the government.

The court had then asked the government to take decision on whether CET should be held within three months or not.

But when the government could not come to any conclusion, the parents association filed another PIL reiterating their earlier demands.

Link: Original Article

December 12, 2009

Are physiotherapists doctors? - TN Govt in a Fix

Are physiotherapists doctors? For several decades, healthcare professionals have debated on the subject. With concerned authorities Upping the ante is a recent Tamil Nadu government order, prohibiting physiotherapists from using the title Dr' before their names. Protesting physiotherapists have appealed to the state health department to hold the order in abeyance until the matter is settled by the Supreme Court. The apex court, meanwhile, is hearing a special leave petition against an order of the Patna high court holding that there is no specific legal prohibition against physiotherapists using the Dr' title.

"There was no clarity on the issue; neither was there any rule for or against anyone at the national or state level," says state health secretary V K Subburaj. Senior health department officials point to the World Health Organisation (WHO) report on Allied Health (Paramedical) Services and Education Report' which lists physiotherapists with other paramedical personnel.

"Health being a state subject, we brought in our own rules to introduce an element of clarity. While doctors are governed by the Medical Council of India (MCI), there is no governing council for physiotherapists. We decided to start one and the common feeling across the healthcare sector and among officials was that physiotherapists should not be called doctors," he explains, adding that after the representation made by the physiotherapists' association, the state government is now reconsidering its decision and holding discussions.

According to MCI, the statutory body that regulates medical colleges, affiliations, new colleges and doctors' registration, the powers of the council are restricted to those who have studied allopathic medicine. "We can only say that people who have not cleared MBBS cannot use the title. There are several practitioners of ayurveda, homeopathy, siddha or unani. There are even traditional medical practioners who do not go to any medical school. Though the members of the council may have their opinion, the council does have the right to say whether they (physiotherapists) can use the title or not," says MCI vice president Kesavan Kutty Nayar.

Argues the head of the Indian Association of Physiotherapists, Chennai branch, I A Jayaprakash, "Like any medical doctor we study anatomy and physiology. We go through a curriculum for four-and-a-half years, just like they do. When dentists, ayurvedics and homeopaths can be doctors, why not us?" he asks.

Link: Original Article

An open appeal to prevent lowering of standard of Medical Education in India

An Open appeal to the Prime Minister, Health Ministry, the Medical Council of India and the National Board of Medical Examinations (DNB Board)

We want to prevent degradation of medical education standards! There is no point in lowering the standards of medical or health education to achieve the concept of appropriate rural health provisioning for India. Measures are required in right earnest by the MCI, DNB board, Health ministry, to allow for modernisation of medical education in a competitive unrestricted environment, as per world standards. We hereby call for help for disadvantaged medical professionals and to create a better environment and working conditions for all postgraduate medical doctors in India- this will prevent physician migration abroad and encourage rural health provisioning for the billion plus emergent India.

The medical council of India and the government of India are currently of the concurrent opinion that 4 and half year MBBS is the appropriate step forward to ease the shortage of medical staff in rural health facilities of India. True to similar concerns the supreme court in full earnest has reacted that a 3 year MBBS is sufficient for a rural populace so that it gets more doctors instead of getting rural health serviced by quack.

The president of India has exhorted at least two times this year that the MBBS fresh graduates and aspiring postgraduates serve at least one year in rural health provisioning. Meanwhile a new bill may be brought up in parliament in this winter session to effect the NCHRH bill provisions.
In the light of these facts, we from AIMDDA (All India MD/MS/DNB Doctors Association) wants to humbly draw attention of the nation to the plight of diploma and DNB candidates and seek government attention to these sons and daughters of the lesser god .

Case of the medical diplomates: Many medical diploma doctors have served this country as specialist’s doctors and tutors in medical colleges, and have worked for paltriest salaries, even lesser than an MSc educated non doctor, even within medical institutions and have suffered as second grade citizens in such institutions since independence.

We request the powers controlling medical education to take a liberal view of the problems face by these brethren and allow diploma doctors to be treated as par with MD doctors subject to certain conditions, well agreed by respective medical speciality associations. We can think of a national level written exam to elevate these medical diploma doctors to MD/MS degrees –or 3 year service as medical diploma can be deemed sufficient to treat them as equal to an MD/MS or similar suggestion. This problem if solved soon, will deliver many medical postgraduates to serve our rural population directly or indirectly.

Allow private practice during non office hours: also, currently all forms of private practice is restricted in government owned medical colleges. This results in many doctors not being able to serve of rural health and impoverished persons, in spite of their ability to treat competently. The doctors will have to be allowed to practice freely subject to precondition that they will not practice during their government duty hours. Also many MD/MS from preclinical and para clinical sciences are not practicing and these doctors can be incentevised by the government to help care the rural and urban poor better than ever.

Also the salary paid by the government is for the 8-10 hour stipulated work period only and cannot stipulate that a doctor cannot render consultancy services for profit beyond his designated office ours as similar consultancy is allowed in other professions, in India and abroad. If such moonlighting is legal for other professionals it cannot be illegal for our government Doctors to practice, beyond office hours.

Plight of the DNB brethren: We wish to draw attention to the fact that many doctors are trying to do post-graduation in hospitals attached to the DNB board, and many of these are well recognized by our medical education patron the medical council of India. But many of our toiling DNB brethren are unhappy that they are not getting the similar pass percentage as the MD/MS brethren in medical colleges permitted by MCI.

We request the powers within the health ministry to note that this high failure rate does not yield more postgraduates to serve the health impoverished nation. Hence it is in national interest to release more DNB postgraduates imprisoned in such failures. We, from the All India MD/ MS/ DNB Doctors Association fervently appeal to increase the pass percentage of such doctors, who will also alleviate rural health problems of India, soon. This will also fulfil the wishes of the nation, our president and other thinkers on health of our nation.

Recognise & value our rural services: No others professionals get compelled to work in rural areas-Also we understand that the nation or the courts do not make similar observation regarding rural service by a lawyer, judge, chartered accountant, an engineer, a dentist, a physiotherapist or any other professional. We can understand the importance attached to doctors, and the compelling reason thereof as a result of that extreme respect.

Loans @ 2 percent interest for rural medical practitioners to establish hospitals: Rural doctors should get loans to build their hospitals at lowest interest rates so that their patients (consumers) get the ultimate benefit of reduced service costs. We request the government should provide us broadband internet facilities to connect to the best hospitals in the world while we envision our rural hospitals for public benefit. Such doctors can be given land by the government at concessional rates. In short, we should be given a better deal if doctors have to shift to the countryside.

Foreign educated doctors: our doctors graduated abroad face similar discrimination by the health ministry which has to be more prudent and liberal in allowing the entry of medical graduates and postgraduates educated abroad, we appeal to the medical leadership to end this disturbance to our medical brethren, by ensuring parity, without harassing these professionals-as they will be hundred times better than 3 year or 4 year MBBS cadre to be created or a quack.

Act on illegal doctors/cross practicing doctors of Indian systems of medicine: Stop quackery: The government can publicise that quacks will be legally penalized if they continue their quackery after being noted by the local health authorities. The policing of quackery should be taken up seriously and the legal system should be empowered to take action against these forms of illegal medical practice.

We, the doctors of the All India MD/MS/DNB Doctors Association with like minded associations like the Indian Medical Association and other professional associations want health of our rural fellow Indians to be as healthy as per world standards and are ready to serve their health purposes. We request community support against quackery, dilution of medical education standards, and dilution of health education standards in general. We request the courts of this country and vigilant non-governmental organizations supporting health for all and against health inequities to support our cause.

For a healthy nation
All India MD/MS/DNB Doctors Association.

Microsoft To Purchase Health Care Software Specialist Sentillion

Software maker Microsoft has recently been moving cautiously in an attempt to expand its software in to health-care industry, on Thursday announced that it has reached an agreement to acquire “Sentillion Inc.,” a privately held developer of software tools for the healthcare industry.

Perhaps most publicly with its HealthVault services aimed at hospitals, which empowers users to share and control access to their own medical records, healthcare organizations, and researchers, will evolve with products from Sentillion starting in 2010, the Redmond company announced.

Financial terms of the acquisition were not disclosed; But essentially, the software giant plans to leverage Sentillion's products with the Amalga UIS, in order to streamline access to multiple IT applications, as well as sources of patient data.

“Microsoft and Sentillion share a common vision of a connected health system in which the free and rapid flow of information, combined with streamlined access to a hospital's myriad healthcare applications, empowers doctors and nurses to perform their roles with greater insight, speed and effectiveness,” explained Peter Neupert, corporate vice president, Microsoft Health Solutions Group. “As a result, our products and strategies are a natural fit. Joining efforts with Sentillion will allow us to amplify and accelerate the impact we can make in health IT and health globally.”

The two companies are anticipating to finalize the deal in early 2010, and said that Sentillion would continue to provide existing customers with support, as well as sell new products, all from its current corporate headquarters in Andover.

Sentillion's products include Vergence, a clinical workstation platform that streamlines caregivers' access to applications and patient data, and Tap & Go and Tap2, which offers instant access to clinical applications with the “tap of a passive proximity badge,” and proVision automatic provisioning system, according to the company's Website.

Microsoft officials said the acquisition will strengthen the company's presence in the growing market for healthcare IT systems.

Microsoft said it intends to unite Sentillion's context and single sign-on technologies into its Amalga UIS real-time data integration solution. The objective is to give physicians real-time access to patient information and other key, clinical data.

“With its commitment to enhancing health and the global resources it brings to bear, Microsoft is the perfect partner to expand our efforts worldwide,” said Sentillion CEO Robert Seliger, in a statement.

Sentillion's application is designed to streamline information stored in a variety of copyrighted systems, including legacy applications, Windows systems, Unix-based servers, and even Web-based data sources.

The digitization of healthcare records and information is fast becoming a hot-button issue in both technological and political circles, since easy accessibility of medical information presents abundant opportunities of privacy abuses, misuse, and fraud. On the other hand, being able to access appropriate medical information quickly can literally be the difference between life and death in some cases, and many prevent common medical errors.

Microsoft's commitment is that clinicians will be able to benefit from a boost in speed as well as increased insight in relation to patient data. Sentillion already caters to more than 1,000 hospitals in its customer base, where Microsoft's relatively new Amalga system is running at a little over 100 hospitals.

Sentillion's customers include University of Pennsylvania Health System, the U.S. Department of Veteran's Affairs, Kettering Health Network, and Texas Children's Hospital. Sentillion will continue to offer its products and operate out of its Massachusetts location, while Microsoft will work on combining the companies' technologies.

Link: Original Article

December 10, 2009

100 new med colleges for rural India

The Medical Council of India (MCI) is concerned about the health care situation in the rural areas of the country. It plans to set up around 100 medical colleges in the rural areas of India, said Dr Ketan Desai, president-elect, World Medical Council. He was in the city to attend the function organised by the Indian Medical Association, Gujarat branch, to felicitate him for his achievements.

India is in the driving seat in the field of medicine because of the sheer number of medical institutions it has. At present, India has around 300 medical schools which account for around 14 per cent of the total medical schools in the world, said Desai.

He also said that the health care services have not reached the rural areas of the country. Many people have to go to the nearby city for treatment which is reason enough for opening more medical colleges in the rural areas.

MCI is also planning to curb the menace of freebees given to the physicians by the pharmaceutical companies, said Desai.

Hundreds of doctors from across Gujarat turned up to felicitate and congratulate Dr Ketan Desai for being elected as president of World Medical Council. People from tribal areas of Virampur near Ambaji also performed their traditional dance as a gesture of gratitude.Lalabhai Lakhabhai from Virampur said that the tribal people of Virampur are getting medical facilities only because of the philanthropic work of Dr Desai and his wife Dr Alka Desai.

Link: Original Article

Maharashtra Health Minister for short-term health courses

Maharashtra health minister Suresh Shetty is for changing the norms and pattern of the medical education system so that it could respond to present day requirements.

Speaking to press persons here on Friday, Shetty said instead of the present system that takes six years to complete medical education, the Medical Council of India (MCI) should introduce short-term courses.

There were huge backlog in posts in the department of health in Maharashtra and it has become quite difficult to get enough candidates for the posts of doctors and paramedical staff. The demand was more than the supply in the paramedical field. Short-term medical courses may help get suitable candidates for health services in rural areas, he said adding that MCI has agreed in principle to the proposal to introduce short-term medical courses.

Link: Original Article

MCI asks Centre to reconsider NCHRH bill

In a last ditch effort to stop the ministry of Health and Family Welfare from tabling the National Council for Human Resources in Health Bill (NCHRH), 2009 in ongoing winter session of Parliament, which will make way for major changes in the field of medical education and will see the Medical Council of India (MCI) being scrapped, the council has asked the Centre to reconsider the proposed bill on the grounds that it is inconsistent with trends pertaining to regulation of health sciences education in the developed world.
According to a report furnished by MCI functionaries, the bill will hand over the entire control and the functioning of the democratically constituted council to government appointees and a few medical professionals nominated by the government. “This is nothing but a brazen attempt to take over of the entire control and functioning of the autonomous council by complete centralisation, a move that is contrary to well-established democratic principles that continue to remain imperative. This violates Constitutional rights and will affect the day-to-day functioning of the council,” the report says.
The report also states that the draft bill is directly in conflict with the conclusions and recommendations of an ad hoc committee constituted by the Supreme Court.
Criticising the government’s move as undemocratic, the report points out that members of the task force that recommended the scrapping of the MCI have never held any elected position in any medical education body themselves or been associated with the functioning of the council.
“Their recommendations are the antithesis of the legislation that constituted the MCI and against observations of courts that the autonomy of bodies like the MCI should be maintained. The proposed bill entirely destroys the most significant tool for securing autonomy of the council,” the report states.
The MCI has observed that “professional councils being manned by people from outside the profession who do not have the requirements needed and do not go through the tested norms of democratic elections is unheard of worldwide”.

Link: Original Article

Doctors, opposition slam West Bengal's Bill on 3-yr medical diploma course

The West Bengal government’s move to table a Bill to allow for a three-year medical diploma course in Bengal in the winter session of the state Assembly has failed to find favour with doctors who say it must not be an alternative to a four-year-MBBS degree.

State Health Minister Surya Kanta Misra, while refusing to discuss the details of the Bill, said it will be a three-year diploma course.

Satyajit Chakrabarty, secretary, Association of Health Service Doctors, said, “We want it to be made clear this is not a short-term medical course. Since this diploma will not be recognised by the Medical Council of India, they cannot write ‘doctors’ before their names and will not be allowed to hand out death certificates. There is a lot of confusion about it. We want clarity.”

He, however, said they were not entirely against the course since it could aid health care at the gram panchayat level.

“Those applying for the course should at least have a high school degree, much like the nurses’ training course,” said Chakrabarty.

Md Masiha, the chief government whip, said the state government had already drafted the entire Bill, which the subject committee has examined and submitted a report to the Assembly.

The state health department is likely to place the Bill in the Assembly on December 14 or 15,” said Masiha.

Meanwhile, Congress Legislative Party (CLP) leader Manas Bhuniya said the proposed diploma course was “unscientific and detrimental”.

“They did something similar around 10 to 15 years ago but the course had to be discontinued. How can the state government send people without MBBS degrees to villages to treat locals? This course will be illegal as it will not even have the recognition by the Medical Council of India (MCI). How can a person treat a patient without even the recognition from the MCI. There are enough village quacks...why does the state government want to increase their ranks,” said Bhuniya.

He said the Central government is already planning to address the issue of inadequate doctors in the rural sector.

“The central government is planning to introduce a Bill in the coming session of Parliament which will make it mandatory for all the MBBS pass-outs to serve in villages before they take up post-graduation,” he said.

Link: Original Article

December 03, 2009

Centre's decision for quota in medical PG not binding on states, says SC

In a ruling having a major ramification for medical education, the Supreme Court on Wednesday held that the Centre's decision to provide quota for SCs and STs in post-graduate medical courses did not automatically bind the state governments to follow suit and implement it in their medical colleges.

It took note of the fact that the Centre has provided for reservation to SC and ST candidates in the All India Entrance Examination for MD/MS/PG Diploma and MDS courses and also in the All-India quota PG seats, but firmly handed down the ruling that "the same cannot automatically be applied in other sections where state governments have power to regulate."

Moreover, the Bench comprising Chief Justice K G Balakrishnan and Justices P Sathasivam and J M Panchal appeared disinclined to grant a direction to the states to follow the example set by the central government. It upheld the Haryana government's decision not to provide quota for SC/ST in PG medical courses.

"In our view, every state can take its own decision with regard to reservation depending on various factors," said Justice Sathasivam writing the judgment for the Bench.

It said: "Article 15(4) is an enabling provision and the state government is the best judge to grant reservation for SC/ST/Backward Class categories at PG level in admissions and the decision of the state of Haryana not to make any provision for reservation at the PG level suffers no infirmity."

It accepted the Bhupinder Hooda government's explanation that reservation in under-graduate medical courses is being provided strictly as per their policy but the PG level education in medical education was governed by the Medical Council of India (MCI).
It noted that "even the MCI has not followed strict adherence to the rule of reservation in admisions for SC/ST category at the post-graduate level."

"In such circumstances, the court cannot issue mandamus (to the state) against their decision and their prospectus also cannot be faulted for not providing reservation in PG courses," the Bench said dismissing appeals filed by one DR Gulshan Prakash faulting the Haryana government's decision not to provide reservation in PG-level medical courses in Maharshi Dayanand University.

Link: Original Article

Law to prevent govt doctors from taking company favours soon

The Centre today said it would soon frame a law to prevent government doctors from receiving gifts and cash from pharmaceutical companies.

“Doctors take favours from pharma companies either in the form of cash or in kind and in return give unnecessary favour to them...They prescribe costly medicines of that company...To stop this, the Centre has decided to formulate a law and implement it soon,” Union Health and Family Welfare Minister Gulam Nabi Azad said at a Nationalistic Doctor’s Forum programme.

Azad said the Centre would set up an AIIMS-like institute in West Bengal soon and the state government has already agreed to allot 100-acre land for the purpose.

The Union government has sanctioned Rs 890 crore for the 960-bed hospital with super-speciality facility, he said.

A central fund of Rs 140 crore has also been sanctioned for upgrading Calcutta Medical College and Hospital.

He said the Centre has also decided to go in for a private-public partnership to accelerate and improve the healthcare system of the country.

Link: Original Article

Malnutrition reaches epidemic proportions in Madhya Pradesh

Malnutrition has reached epidemic proportions in most parts of Madhya Pradesh, with children being the most vulnerable group.

This, along with a general deterioration in the health conditions of children and continuing government apathy towards tribal regions, has resulted in a large number of child and infant deaths being reported.

Over 25 children died in two villages of the Jhabua district in the past four weeks. Agasia and Madarani villages, falling in the Meghnagar block of the predominantly tribal district, registered 27 deaths since October 19.

Alarmingly enough, most of these children were in the 0-6 age group and most weren’t even registered at the local anganwadi centre. Agasia and Madarani are just a small part of the larger story that has emerged. Recent reports from Sidhi district mention the death of 22 children in 48 days since August 2009. Malnutrition, especially among the tribal populations of the State, according to the reports of the Supreme Court Commissioners and the United Nations International Children’s Emergency Fund, is much higher than in sub-Saharan Africa.

According to the National Family Health Survey (NFHS)-III, 60 per cent of the children in the 0-3 years category in Madhya Pradesh are malnourished, while 82.6 per cent in this category are anaemic. The Infant Mortality Rate (IMR) in the State stands at 70/1,000, while the same indicator for tribal areas is 95.6/1,000.

In October, The Hindu first reported severe malnutrition among the Kol tribal group in Jawa block of Rewa district. Recently, the Hong Kong-based Asian Human Rights Commission (AHRC) issued an international appeal to several organisations urging them to persuade the State government to address the issue. The AHRC report mentions that over 80 per cent malnourished children are in Rewa.

The deaths in Jhabua have reportedly been caused due to symptoms resembling those of dengue and malaria along with high incidence of anaemia. However, the alarming levels of malnutrition in the region could be the primary cause, leading to a fall in immunity levels.

“We have discovered 14 deaths till now and the primary causes are severe malnutrition, anaemia and falciparum malaria,” says Meghnagar Block Medical Officer (BMO) Vikram Verma.

“Anganwadis are located far from these regions and the ANMs [Auxiliary Nurse and Midwives] too hardly ever reach there. This, along with the remoteness of these tribal regions, compounds the problem. We are taking this seriously and efforts are on to address the situation.”

While the BMO’s statements acknowledge the seriousness of the situation, the ambiguous position of the Health Department comes to the fore with an entirely different version of the story from the joint director of Health. “There have been only four deaths and that too, in early October. I have ordered action against the supervisor and the ANM and served a show cause notice on the BMO over the delay in reporting this situation,” said K.K. Vijayvargiya. He refuted any role of malnutrition in the deaths. “Although the reasons are not clear, there definitely is no malnutrition, maybe just seasonal fever.”

The apathy and indifference displayed by the health officials have led the villagers to seek medical help from quacks and private practitioners. “The children here appear extremely weak and show malaria and dengue like symptoms and die within an average span of four days,” says Ajit Singh, a local journalist.

While the Health apparatus is obviously not serious about handling the issue, other social welfare schemes do not seem to be helping either. The fathers of all the four children who died in Agasia village were not with their families as they had migrated to seek employment since their National Rural Employment Guarantee Scheme cards were being withheld by the village sarpanch.

The displacement of tribal groups from their traditional forest dwellings, where they had access to minor forest produce like berries and other fruits to feed their children, has made matters worse in a scenario where the Public Distribution System shops in tribal areas often open only once a month.

The last reports received from the region said one more child died in Madarani. The situation in Agasia, where four deaths have taken place, was deteriorating, with eight children in the 0-6 age group being critical. The district administration’s response, however, continues to be cold.

Link: Original Article

MCI for ban on gifts to docs by pharma cos

Medical Council of India has written to Union ministry of health and family welfare for an amendment in Indian Medical Council (professional conduct, etiquette and ethics) regulations, 2002, to prohibit doctors from accepting any gift from any pharmaceutical or allied health care industry.

The move is likely to face stiff resistance from the pharma lobby as well as a section of doctors who have been benefiting from largesses showed by the pharma industry. MCI chairman Dr Ketan Desai, an Ahmedabad-based urologist, said the council has forwarded to the Centre an MCI resolution adopted on November 18 titled “Building a healthy relationship based on self-regulation between doctors and pharmaceutical and allied health sector industries and preventing unscrupulous practices by doctors.”

The resolution was passed by the MCI’s executive committee based on the recommendations of a sub-committee.

There are new proposed guidelines for a medical practitioner to carry out, participate in, work in research projects funded by pharmaceutical and allied health care industries. The particular research proposal will need to have due permission from the competent authorities concerned.

Dr Desai said: “If these recommendations are made a part of the ethics regulations of the MCI by suitable amendment, it will go a long way in ushering in a credible, transparent, just and scientific relationship between doctors and pharmaceutical and allied health care industries.”

Link: Original Article

India has 'world-class health care', say Canadians

Canadians are increasingly looking to India for timely medical treatment as wait periods under the country's public health system get longer. Many are saying they would recommend India to anyone seeking "world-class health care" at a small cost.

At this week's conference on medical tourism to India in Toronto, Canadians who benefited from medical treatment - heart operation, spine surgery or knee transplant - in India sang praises of the Indian healthcare system.

Narrating their experiences at the three-day "India: Medical Tourism Destination 2009" conference, they lauded Indian hospitals, doctors and after-care as among "the very best in the world".

Said Doug Antoniak, who has just returned from India after a successful spine surgery: "I would recommend India to anyone in a heart-beat. Indian doctors have changed my life for the better."

He said: "I had two failed surgeries in Canada, but my pain didn't go. It was getting worse all the time."

Then he and his wife Cathy watched someone on television narrating his successful spine surgery in India in 2007.

"This guy was Jeff Clarke. His television appearance assured me about the quality of the Indian healthcare system," he said.

Soon, the Canadian couple landed at Apollo Hospital in Chennai.

"The Indian surgeons put rods and discs in my back. But because I had been having this problem since 1988, the first surgery didn't help much. This year, they again put more rods to stabiliae my condition. I am much, much better," said the middle-aged Canadian from Waterloo near Toronto.

The couple paid $40,000 for the surgery, airfare, five-star accommodation and 45-day after-care.

"Had we gone to the US, it would have cost us $250,000. We got world-class medical care for a lot less. I will go to India in a minute," said Antoniak's wife Cathy.

"We want to tell people in North America that medical treatment in India is not only timely but also very cost-effective," said Dr Narottam Puri, who represented Fortis group at the conference.

Added Pradeep Thukral, executive director of the Indian Medical Travel Association: "Canadians will overcome the mental block as more and more of them go to India for a quick procedure (ortho, spine or cardiac)."

All major Indian hospitals, including Max, Fortis and Apoll, came here to woo Canadian patients. They also held talks with Canadian health institutions for collaboration in medical research.

Link: Original Article

Health card prop for national ID project

The health ministry’s smart card project for the newborn can provide valuable data to the Unique Identification Authority of India, which under former Infosys chief Nandan Nilekani, is preparing a social security card for all Indians.

Nilekani’s unique identity card programme may dovetail into the proposed e-health card project, which junior health minister Dinesh Trivedi is spearheading.

“I had an exhaustive meeting with Nandan Nilekani and officials of the unique identification project and we both agreed that the e-health card project could well form the basis of new data for the UID project, besides dovetailing into it,” Trivedi told The Telegraph today.

Besides birth details, the e-health card will have information on immunisation and major illnesses. It is being put together by Sam Pitroda, the brain behind India’s early telecom revolution and currently the chairman of the Knowledge Commission.

Nilekani was appointed the head of the unique identity project with the rank of a cabinet minister by Prime Minister Manmohan Singh earlier this year. His project, which comes after the Mumbai terror attacks, plans to give all Indians a social security card and a number, similar to the system in the US.

The smart card will not only help welfare departments to target beneficiaries more efficiently but also allow police to keep tabs on individuals who have illegally entered the country.

“We have already started a pilot project to collect data for the e-health card in Barrackpore in Bengal (which the minister represents),” said Trivedi. The project would be extended to cover the rest of the country on the basis of the Barrackpore experience.

Nilekani’s work has been hampered by a lack of comprehensive data on Indian citizens, especially the very poor, despite the voter ID and ration cards. Besides, his department is yet to work out a system of getting data on the newborns.

Link: Original Article

November 27, 2009

Govt plans to bring back diploma docs for villages

Desperate to address manpower crunch in the rural healthcare system, the state government has apparently decided to resurrect the ‘barefoot doctors’ of the early ’80s in a new avatar through the West Bengal Rural Health Regulatory Authority Bill 2009.

Once the regulatory authority is set up, it will pave the way for insitutes that will train and issue diplomas to rural health practitioners.

During the ’80s experiment, the diploma-holding ‘doctors’ had faced stiff opposition from the medical community. The latest bill, which will be introduced in the Assembly this Winter Session, is also likely to kick up a ruckus. Congress and Trinamool are ready to oppose it. As in the ’80s, the medical community is again prepared to take on the government.

Eligible to practice in rural areas, rural health practitioners will treat patients and prescribe medicines according to a standard treatment guideline to be handed to them. They will also carry out minor surgeries and issue illness and death certificates.

Doctors have raised their voices against the move. The Medical Council of India doesn’t recognise the diploma, neither does the West Bengal Medical Council. The state health department has cited the instance of Assam, where similar legislation was enacted in 2004.

“The government had tried this in the past and failed miserably. There is no doubt that Bengal has a shortage of doctors, but creating rural health practitioners is not the solution. More medical colleges — both government and private — should be set up,” said Subir Ganguly, ex-president Indian Medical Association (Bengal chapter).

Recently, some IMA members met Trinamool MLA Aroop Biswas, a member of the Assembly’s standing committee on health, and stated their objections. Objections have been raised on the usage of the term rural health practitioner and also granting them permission to issue death certificates.

“The government claims there is a shortage of doctors. How many times have they issued advertisements through the Public Service Commission for empanelling doctors? How many doctors have been recruited in the last five or 10 years?” asked a senior IMA (Bengal) member.

“Promode Dasgupta tried this and failed. I don’t know why Buddhadeb Bhattacharjee is trying to do the same thing. We will oppose it,” said Manas Bhunia, Congress legislature party leader.

Trinamool’s newly-elected MLA from Serampore Sudipto Roy, former president of IMA (Calcutta), said the Bill discriminates between urban and rural areas. “Why should there be two sets of doctors for urban and rural areas? Government should identify the number of vacancies and fill them up,” Roy said.

Doctors said the manpower crunch can be addressed by making all MBBS passouts serve a compulsory stint in villages. They also called for campus recruitment from medical colleges.

Link: Original Article

Lifeclinic plans Any Time Health check-up stations

Lifeclinic International Inc, a US-based manufacturer of blood-pressure monitors and health stations, is in talks with a wellness provider to establish ATHs (any time health check-up centres) across the country.

“Talks are on in an advanced stage. The company plans to pilot ATHs in Andhra Pradesh with 100 installations in four months, before scaling up them to other States,” Mr James R. Evans, Chief Financial Officer of Lifeclinic, said.

The company was also in talks with non-governmental organisations to install these machines in rural areas from where the results could be transmitted to the specialist doctors for advice.

Priced in the range of Rs 1.72 lakh to Rs 12 lakhs, the machines provide quick details of weight, blood-pressure, heart rate, body mass index and blood oxygen.

Addressing a press conference here on Monday, he said the company hopes to sell 1,100 monitors in 2010. “We have registered 100 installations so far. We are in talks with pharmacy chains, hospitals and doctors to sell the machines,” he said.

“They can conduct 24 tests in five minutes, offering convenience to both patients and doctors,” Mr T. Venkateswhar Goud, President and Chief Executive Officer of Lifeclinc India, said.

He said these machines could add value to services at retail chains, banks and petrol pumps. “State Bank of Hyderabad branch at Zaheerabad (Medak district) has taken one machine on lease and found the response very encouraging,” he added.

Link: Original Article

Nova Medical to set up day care hospital chain

Nova Medical, a company floated jointly by US investment fund GTI Group and an Indian surgeon, plans to set up a chain of day care hospitals across the country with investments from teams of local doctors.

The firm plans to give a small stake in each hospital to local doctors who will also practice at the centre. GTI holds a 72% stake in Nova, while Bangalore-based ortho surgeon Dr Mahesh Reddy owns the remaining 28%.

The company plans to set up 25 such hospitals across the country in the next 18-24 months, Nova’s CEO explained. The investment will be around Rs 250 crore. The parent company will bring in 70%, or Rs 7 crore, of the investment in each hospital and the remaining Rs 3 crore is expected to be brought in by the doctors.

“We will invite only reputed specialised doctors across speciality areas who are willing to practice at the centre and can invest a minimum of Rs 5 lakh and up to Rs 10 lakh. In the next 2-3 years, we may go for an initial public offering or a strategic sale for the holding company, which will create value and exit opportunity for all investors,” said Girish Rao, managing director and CEO of Nova Medical.

The company now operates one hospital in Bangalore under the proposed business model. About 30 doctors are co-investors here. Nova plans to set up two more hospitals each in New Delhi and Mumbai.

The new centres will specialise in surgeries and would aim to bring down cost of treatment for patients. “Our business model aims to bring down cost of treatment for patients by 15-20% compared to what is charged in multi-speciality hospitals,” Mr Rao added.

According to MG Bhat, a gastroenterology surgeon who is an advisor to Nova Medical, about 70% of the surgeries in the US are done through day-care centres some of which are run under a co-ownership business model.

Link: Original Article

US Senate unveils $849 bn health care reform bill

A sweeping health care reform bill backed by President Barack Obama that promises to expand insurance coverage to 31 million more Americans at a whopping cost of $849 billion over a decade was unveiled today and is now set for a key test vote in the US Senate.

"We have travelled a long way to where we are, and (now) begins the last leg of this journey," Democratic Senate Majority Leader Harry Reid said while unveiling the 2,074-page Senate bill.

"The finish line is really in sight," Reid said as the Senate is expected to vote on the bill as early as Saturday.

Obama, who has made health care overhaul his top domestic priority, hailed the new legislation as "a critical milestone" that brought the United States "closer than ever" to a better health care system.

"From day one, our goal has been to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don't, and that lowers costs for families, businesses and governments across the country," Obama said in a statement, adding that the Senate proposal "meets those principles."

The non-partisan Congressional Budget Office has determined that the Senate bill would cut federal deficits by $130 billion over the next decade.

The proposal drafted from two separate bills approved by Senate committees now goes to the full Senate, where Republicans have vowed to try to block it.

Democrats on paper have the 60 votes needed to win on a procedural vote to formally launch the debate in the 100-member Senate. However, they must keep two independents and a handful of waverers in their own party to do so.

The House of Representatives approved its own trillion dollar version of the legislation on November 7 by a 220-215 margin after imposing tough restrictions on federal funds subsidising abortions.

The US is the world's richest but the only industrialised country that does not ensure that all of its 350 million citizens have health care coverage. It is estimated that some 36 million Americans do not have health insurance.

Officials say the legislation would require most Americans to carry health insurance and would mandate large firms to provide coverage to their workers. It also bans insurance company practices such as denying coverage on the basis of pre-existing medical conditions.

The Senate bill includes a range of tax increases and new fees. The Medicare payroll tax on individuals earning $200,000 a year and couples earning $250,000 a year would increase by half a percentage point, from the current 1.45 per cent to 1.95 per cent, CNN reported.

The bill would require individuals to purchase health insurance, with a fine for non-compliance of $95 in the first year that would escalate to $750 by 2016. Parents would be responsible for providing coverage for their children up to 18 years old, CNN said.

If the Senate manages to pass a bill, a congressional conference committee would need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to Obama's desk to be signed into law.

Link: Original Article

November 25, 2009

Supreme court suggests 3-year MBBS to meet rural health needs

Taking serious note of the fact that basic health facilities were not reaching the poor in rural areas, the Delhi High Court Wednesday in a notice asked the health ministry to consider whether the present course can be reduced from five years to three years.

A division bench comprising of Chief Justice Ajit Prakash Shah and Justice S.Muralidhar asked the health ministry and the Medical Council of India (MCI) to consider changing the MBBS curriculum so that basic health facilities can be reached to the rural population.

"This is a very important issue. Almost 80 percent of the rural population is devoid of the basic public health and this fact should be considered seriously," the court said while asking the ministry to file its response by Dec 9, the next date of hearing.

Asking the government to amend the present educational standards the court said: "You have to change the over-five years' MBBS course so that doctors who get trained don't fly to other countries or stick to the metro cities in the wake of good earning. Educational system should be changed to three years so that every doctor can cater to rural population."

The court was hearing a public interest petition filed by Dr. Meenakshi Gautham, a public health specialist, who contended that a person who completes his MBBS can practice modern medicine as soon as the course is completed.

These graduates, the petition said, either rush to big cities or go abroad, and therefore a large majority of people are not able to get proper medical treatment, and are forced to depend either on untrained and uncertified rural medical practitioners, or on quacks.

"The irony is that 80 percent of the common medical problems and ailments can be treated at the level of primary health care and do not require attention of a professional trained in highly academic, sophisticated, five-and a half-year long course like MBBS," advocate Prashant Bhushan said, and suggested the ministry should follow the educational model adopted by China.

Link: Original Article

Wipro announces launch of medical gateway solution

Wipro Technologies, the global IT services business of Wipro Limited, today announced the launch of a medical gateway solution.

The solution, powered by Intel Atom processor, would enable improved care co-ordination between patients and their care providers and help overcome some of the challenges faced in traditional care delivery processes, the Bangalore-headquartered company said in a statement.

The medical gateway is an intelligent embedded platform, which enables users such as patients, doctors and other healthcare professionals to monitor, track and manage healthcare information from a remote location, it said.

"The solution enables real-time clinical review by automatically capturing vital data from multiple medical devices such as blood pressure monitors, glucose meters, pedometers and weighing scales etc. available with the patients",New York Stock Exchange-listed Wipro said.

Medical devices can connect to the gateway solution through wired and wireless technologies using both standard based and proprietary protocols, to provide real time medical data, video and image transfer from a patient to doctor and in turn from a doctor to doctor, it was stated.

This technology provides doctors the ability to evaluate patient care against quality measures for a variety of health conditions, the statement added.

Link: Original Article

International health alliance pushes vaccine costs down

The price of a vaccine that helps babies fight off killer diseases has been forced down, thanks to a co-ordinated buying policy to meet the growing demand from developing countries, a U.N.-backed health alliance said on Wednesday.

Data from the United Nations children's fund (UNICEF) and Global Alliance for Vaccines and Immunisation (GAVI) showed average prices for the shots, which protect against five infant diseases, will have fallen by 22 percent over eight years by 2012.

"This price drop is no accident, but the result of a strategy to leverage the purchasing power of hundreds of millions of people," UNICEF Deputy Executive Director Saad Houry said in statement.

"Clearly, industry understands and responds to a market, regardless of whether that market is in poor or rich countries."

The five-in-one, or pentavalent, vaccine is given routinely to children in developed nations but price has kept them out of the reach of some poorer nations. GAVI, which buys and distributes vaccines for developing countries, said higher demand has pushed purchasing costs down.

A recent tender for the pentavalent shot showed prices for 2010 falling below $3.0 -- a drop of almost $0.50 cents per dose on the 2009 price.

"This will create approximately $55 million in savings in 2010 and enable GAVI to finance the immunisation of 6.3 million more children," it said in a statement.

By 2012 the dose will have fallen in price to $2.85. The vaccine offer protection against Hib (Haemophilus influenzae type b), diphtheria, whooping cough, tetanus and hepatitis B.

GAVI's programmes involve World Health Organisation-approved shots made by GlaxoSmithKline, Crucell, and the Indian drugmakers Shantha, owned by Sanofi-Aventis, and Panacea.

In 2006, UNICEF bought less than 50 million doses of pentavalent vaccine, it said, but this year it is projected to buy around 120 million doses -- a demand seen rising by about another 10 million doses each year until 2012.

GAVI's chief executive Julian Lob-Levyt said the price drop had come later than he had hoped but added: "This is the GAVI effect at work: encouraging and pooling growing demand from countries, attracting new manufacturers and increasing competition to drive down prices."

GAVI, which is supported by the WHO, the World Bank, UNICEF, vaccine makers and research centres and the Bill and Melinda Gates foundation, said 256 million children had now received vaccines through its programmes.

GAVI raises money by leveraging long-term aid commitments from countries through capital markets, with regular offerings of "vaccine bonds" organised by the International Finance Facility for Immunisation
Link: Original Article

A must-read for doctors

Like most of us, Jerome Groopman believes that practitioners of modern medicine are all too human and so are prone to make errors in judgment. But since the doctor’s errors can be fatal, every effort should be made to minimise them. That requires studying medical errors scientifically. This is precisely what the author does in this splendid volume

The book, he says, “is about what goes on in a doctor’s mind as he or she treats a patient.” Every physician — even the most brilliant — makes a misdiagnosis or chooses a wrong therapy. Groopman differentiates “medical mistake” from “misdiagnosis.” While the former involves prescribing a wrong dose of drug or looking at an X-ray upside down, the latter is about the way doctors think, analyse a situation, or arrive at a diagnosis taking into consideration all the factors available at that time.

A majority of medical errors, according to him, do not qualify as technical mistakes, but are attributable to flaws in the physician’s thinking. He quotes a study of one hundred cases of incorrect diagnosis where inadequate medical knowledge was identified as the reason in only four cases. The rest are all due to what he calls “cognitive-traps,” which are of three types. First is “availability,” where recent or dramatic cases come to mind and colour judgment about the case in hand. Then comes “anchoring,” or short-cut thinking, where the doctor does not consider multiple possibilities but quickly and firmly latches on to a single one. And the third is “attribution,” where stereotypes can prejudice the doctor’s thinking and lead to conclusions that do not flow from the data on hand.

“Distorted pattern recognition” can be the result of the “ecology” of the patient. (A Navajo woman with breathlessness is diagnosed as a case of pneumonia when she, in fact, was suffering from Aspirin toxicity.) “Confirmation bias” refers to selecting data which suit the already made diagnosis and ignoring the rest. “Affective error” resembles confirmation bias in selectively surveying data.

To avoid falling into these cognitive traps, Groopman has this simple but sound advice: “Even when you think you have an answer, generate a short list of alternatives.” He cites examples from each speciality to explain these cognitive errors and goes on to show that availability of time, unethical promotional activities of the pharmaceutical firms, and patterns of health coverage like insurance can ultimately influence the treatment. “Zebra-retreat” refers to doctors’ shying away from a rare diagnosis and settle for a common one. “Diagnosis momentum” refers to mental fixation of a doctor, despite incomplete evidence. (An unkempt coloured labourer who admits to taking alcohol may be conveniently branded as having alcoholic liver disease when, in fact, he may be suffering from something entirely different, for example Wilson’s disease.)

Uncertainty
And there is a whole chapter on “uncertainty.” Based on previous studies, Groopman describes three types of uncertainty: one that results from incomplete or imperfect mastery of available knowledge; another, from the limitations in current medical knowledge; and the third, from the difficulty in distinguishing between the individual’s ignorance and the limitations of the present state of medical knowledge. The challenge of modern medicine is to make decisions “in the absence of certitude” which, according to him, forms the “core reality of practice of medicine.”

To patients, Groopman offers a very practical advice: expect from your doctors and demand of them, 3-Cs — communication, critical reasoning, and compassion. Note that he does not include academic brilliance! A medical practitioner who is able to deliver on these three counts is unlikely to err in his judgment. This book is a must-read for doctors who would like to re-evaluate their medical decisions, critically and constantly.

Link: Original Article

Goodbye MCI? Bill on health education watchdog NCHRH ready

The draft Bill to set up the National Council for Human Resource in Health (NCHRH) -- the overarching regulatory body for the health sector, that would replace the existing Medical, Dental, Nursing and Pharma Councils of India -- is now ready.

Moving swiftly to establish the NCHRH as a way to cleanse the already tainted medical education system in the country, the health ministry has finalized the draft Bill and opened it for public scrutiny. States have also been sent the Bill for their comments following which it will be taken to the law ministry and the Cabinet.

A 12-member task force set up to form the NCHRH under the chairmanship of the Union health secretary in June, in its report to the ministry, said that while India was one of the fastest growing economies in the world, it was also one of the weakest performers in health. The estimated density of health workers is 20% lesser that the WHO norm of 2.5 workers (doctors, nurses and midwifes) per 1,000 population.

According to the task force, there are important distortions in the production of health workers in India. It said that while there has been an increase in the number of medical colleges in the last decade, it has been due to increase in private medical colleges in the southern states.

"Private medical colleges also place a heavy burden of fee on students and their admission procedures are not transparent. The curricula of the medical schools are not designed for producing social physicians. Rather the training they provide is better suited to the problems of urban India and for employment in corporate hospitals," the task force report said.

This is why the ministry is going all out to set up the NCHRH, the idea of which was first floated by President Pratibha Patil.

The Bill says that the chairman of NCHRH should have at least 10 years experience in medical and health education or leadership of non-medical academic institutions imparting education in disciplines such as law, management and public administration.

The committee to chose the chairman will include the cabinet secretary, principal secretary to PM, Union health secretary and two other technical experts.

The Council will meet at least once every three months and will, among other things, give permission to establish new institutions or new courses of study, recognition or approval of courses, recognition of qualifications, recognition and disqualification of foreign degrees, prescribe standards of professional conduct and etiquette.

The single regulatory body will oversee the regulation of seven departments related to medicine, nursing, dentistry, rehabilitation and physiotherapy, pharmacy, public health/hospital management and allied health sciences.

According to the draft Bill, the Council will consist of the chairperson and four full-time members appointed by the Central government. They will hold office for three years. Every state will have separate bodies constituted by the Council for each department.

The Council will maintain a national register of human resources in health which will contain names of all persons who are enrolled by the Board.

The Council will also conduct a national level exit exam for super-speciality postgraduate students. The Council will be be an autonomous body independent of government controls.

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Docs told not to accept gifts from drug cos

The global association of doctors World Medical Association (WMA) has asked physicians to refrain from taking gifts, including hard cash from drugmakers, as an incentive to promote their medicines to the patients. It is part of a resolution passed by WMA outlining the guidelines for doctors to follow while dealing with pharma companies.

The advisory issued during a recent WMA meeting in Delhi comes at a time when the domestic pharma companies and medical bodies are in the process of finalising a detailed marketing code of conduct to curb the practice of pharma companies paying doctors to prescribe their medicines. The Indian government had recently asked the drug industry to self regulate so that the interests of the patients are not compromised.

The Rs 36,000-crore Indian drug retail market is fiercely competitive, with the largest player having a meagre 5% market share. Globally, drugmakers are not allowed to advertise their prescription drugs, or medicines that can only be bought on a doctors prescription. As a result, the success of a medicine largely depends on the recommendation of doctors.

The WMA guidelines has asked doctors to refrain from taking expensive personal gifts designed to influence clinical practice, payments in cash or cash equivalents from companies, payment to cover travelling expenses or room for conference or compensation for their time, and declare financial support they get from companies.

The Indian Medical Association (IMA), representing doctors in the country, and the domestic drugmakers associations say they agree with the WMA resolution in-principle. IMA secretary general Dharam Prakash said: “Once you take a gift or travel at somebody’s expense, you would be obliged to return the favour, which means promoting a company’s brand. The resolution should curtail the practice of drugmakers to unethically promote their drugs.”

“In many areas, the WMA statement is similar to our code of conduct for marketing practices. This is a good step in the right direction,” said Tapan Ray, director general at the Organisation of Pharmaceutical Producers of India, a group that represents the interests of large drugmakers in the country.

Most doctors in the country accept gifts and incentives in various forms to promote a particular company’s products. Industry experts such as CM Gulati, a veteran with medical regulations, feels the resolution will be ineffective and it is an attempt by the medical fraternity and industry bodies to prevent the government from regulating the drugmakers marketing practice.

“Both the doctor and industry are interested parties who benefit from the current practice, the consumers interest is not represented. The industry bodies are toothless and can’t take any punitive action, so the question of self-regulation is a hogwash,” he says.

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Now, entrance test for courses in Indian medicine

An independent entrance test for degree courses in Ayurveda, Homeopathy and Unani; annual assessments and gradation of colleges and 14 new diploma courses on specialisation in Ayurveda, are some of the key changes that are in the offing on a country-wide basis for studies in traditional Indian medicine.

President of the Central Council of Indian Medicine (CCIM) Raghunandan Sharma told TOI in an exclusive interview here on Saturday: "The move to have a separate entrance test was finalised on Friday at a meeting of representatives from the council and the Union health ministry's department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)." The CCIM is the apex regulatory body for education in traditional Indian medicine.

According to Sharma, the need to ensure timely completion of the annual admission process for degree courses in Indian medicine has spurred to decision for entrance test. "Medical (MBBS) and dental (BDS) courses often consume a major portion of the admission period for health sciences," he said.

As a consequence, the colleges offering studies in Indian medicine end up running against the October 31 cut-off date set by the Supreme Court for completion of admissions, he added. "Also, they (colleges) have to be content with the leftover of the aspirants for health science seats," he said.

In Maharashtra, the MHT-CET, a combined entrance test for health sciences, engineering and pharmacy courses, forms the basis for admissions to all health sciences and allied courses like MBBS, BDS, Ayurveda, Homeopathy, Unani, Nursing, Physiotherapy, Occupational Therapy, etc.

Sharma said, "We are now writing to all the state governments to formulate independent entrance test scheme for courses in Indian medicine with a view to introduce the test from academic year 2010-11."

The CCIM has consistently hit the headlines in the last two years for adopting a carrot-and-stick policy towards making the colleges overcome a slew of deficiencies regarding basic infrastructure and academic standards. "We have been constantly emphasising on a no-comprise policy for quality education and have gone to the extent of shutting down 107 colleges last year (2008-09) across the country. Measures like this spurred an improvement as we now have only 78 colleges shut down this year (2009-10) and 35 of these are border-line cases," he said.

Sharma said, "Starting this year, we have decided to follow a time-bound schedule for assessment of colleges on different parameters concerning infrastructure and academic standards. The assessments will begin from December-January and will be completed by April with our recommendation to the government for admissions at the assessed colleges. This will lead to timely commencement of admissions in July."

He said, "The CCIM will implement the gradation scheme that envisages A' grade for colleges meeting more than 90 per cent of the overall performance parameters and B' and C' grades for colleges meeting upto 90 per cent and upto 80 per cent parameters, respectively."

Those colleges graded in C' category will be given three years time to upgrade themselves to B' category while those graded B' will be given two years time to upgrade to A' category, he said. "The fee structure at these colleges will also be linked with the grade they score," he added.

Sharma said, "The gradation scheme will come into force over the next six months considering the time that needs to be given to the state governments and the colleges to understand and appreciate the scheme in a proper perspective."

The Indian medicine education faces a high level of about 30 to 35 pc shortage of qualified teachers. Asked how the CCIM proposes to tackle this problem, Sharma said, "The thrust has been on sanctioning greater number of post-graduate (PG) colleges in Indian medicine. We sanctioned 20 PG colleges this year. At the same time, the retirement age for teachers, which varies from 55 to 60 years in different states, has set at a uniform age of 65. These measures will help bring down the teachers shortage by 15 per cent."

From 2010-11, the CCIM will also introduce 14 new diploma courses on specialisation in Ayuurveda like panchakarma, child care, diet, etc, he said. The council has further recommended to the government to incude private unaided colleges in the centrally-sponsored scheme for upgradation of colleges. "Till recently, the scheme was applicable to only government-run colleges and now the grant-in-aid colleges. We have proposed its extension to the private colleges too."

Link: Original Article

November 24, 2009

PM Gordon Brown to curb entry of professionals, doctors to UK

Prime Minister Gordon Brown today pledged to curb the entry of doctors and other professionals from outside Europe into the UK in a new crackdown on immigration, a move likely to adversely impact thousands of Indians.

Signalling a major shift in the Labour government's immigration policy, the Prime Minister vowed to "stem rising tide of migration". He said his government plans to restrict the points based system for determining which migrants can work in Britain.

"One of the reasons that immigration will fall is the tightening of the new points system and it will continue to tighten over the next few months," Brown told the Daily Mail in an interview ahead of a major speech on immigration today.

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India has the largest number of stunted children: UNICEF

Underlining the dismal state of health and nutrition in Indian children, a UNICEF report says that the country has a whopping 61 million stunted children, the largest in any country. In other words, 3 out of 10 stunted children are from India distantly followed by China that has 12 million children.


Stunted growth is a consequence of long-term poor nutrition in early childhood. Stunting is associated with developmental problems and is often impossible to correct. A child who is stunted is likely to experience a lifetime of poor health and underachievement, a growing concern in India that is demographically a young nation. Astoundingly more than 90% of the developing world's stunted children live in Africa and Asia.

The findings of the `Tracking progress on child and maternal nutrition' also point out that undernutrition contributes to more than a third of all deaths in children under five. Undernutrition is often invisible until it is severe, and children who appear healthy may be at grave risk of serious and even permanent damage to their health and development.

Linking malnutrition to gender equality, the UNICEF report also says that children's health suffers not just due to poor hygienic conditions and lack of nutritional food but also because the mother herself is suffering from anaemia and malnutrition during adolescence and child-bearing. "They become trapped in an intergenerational cycle of ill-health and poverty,'' says the report.

Of all the proven interventions, exclusive breastfeeding for the first six months together with nutritionally adequate foods from six months can have a significant impact on child survival and stunting, potentially reducing the under five child mortality by 19% in developing countries. The report includes data showing that 16 developing countries successfully increased their exclusive breastfeeding rates by 20%, in periods ranging from 7 to 12 years.

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School health clinics prove ineffective

Despite endeavours by health department towards good health of schoolchildren studying in government schools, it is sad that due to lack of cooperation from government schools, the school health programme has been rendered largely ineffective.

School health clinics were formed long back. Under related programmes, thorough check-up of students studying in government schools was planned. These check-ups comprise physical check-up that includes dental, eye, and skin examination. In case of primary school, it is mandatory for the school health clinic doctors to do the check-up done twice a year while for secondary schools, it is required once a year.

A health department official said there was lack of cooperation from schools as ground-work including issuance of cards to students with regard to their check-up was yet to be completed. Moreover, instructions given to teachers with respect to children’s health have not been conveyed to the latter.

A teacher from a government school said it was very difficult for teachers to complete the work pertaining to schoolchildren’s health as they were overburdened with duties relating to mid-day meals and other work. Teaching work was suffering, the teacher said.

Notably, during the pulse polio campaign, employees of the health department had made a complaint to the civil surgeon that school authorities had not allowed health employees to administer polio drops to children studying in their schools. Authorities in such schools are said to have feared that parents of students might object to the idea. Health department identified 15 such schools in posh areas.

Dr Manu Vij, incharge of the school health programme, said it was true that most of the schools did not cooperate with the health department staff that had visited schools to examine children. He added that if schools cooperated with them, a lot of improvement could be effected in the school health clinic programme results.

Link: Original Article

November 07, 2009

Postage stamp in name of Apollo Hospitals released

Union Communication and IT Minister A Raja today released a postage stamp in the name of Apollo Hospitals and said the group has made important contributions towards the healthcare services in the country.

"The Apollo Hospitals is contributing its best to health services especially to the people of Tamil Nadu," Raja said.

Speaking on the occasion, Tamil Nadu Deputy Chief Minister M K Stalin said "The uniqueness of Apollo Hospitals is that it has good doctors, better equipment and offered world class treatment.

Link: Original Article

Comics take medical science to kids

When Sanjana Ramesh (13) was diagnosed with Type 1 diabetes six months ago, she was only told the name of the condition and to take insulin regularly. "When I asked the doctor what was happening to me, she told me You are becoming too sweet.' I don't know if they thought I was too stupid to understand my medical condition or if they were worried about scaring me. I tried searching for information on the internet and in medical books, but those details were too heavy for me to grasp," Sanjana says.

Every day doctors diagnose children like Sanjana with medical conditions they don't understand. But the launch of Medikidz in the country could change a scenario where parents and paediatricians feel that children are too young to understand medical concepts or that they are better off not knowing. Medikidz presents medical conditions, their prevention and treatment through the adventures of five superheroes - Pump, Chi, Skinderella, Gastro, Axon and his pet robot Abacus. For example, the book on asthma shows the super heroes passing through the food pipe of a giant human model and experiencing spasms of the respiratory tract. Another one on diabetes shows a visit to an insulin factory called pancreas.

"Medikidz has done a great job by coming up with a product to empower ill children and their parents with the information they need, so they can get better medical care, in partnership with their doctor. Information therapy can be powerful medicine. Ideally, every clinic, hospital, pharmacy and diagnostic center should have a patient education resource center, where people can find information on their health problem," says Dr Aniruddha Malpani, medical director of the Health Education Library for People in Mumbai, which provides free materials for patient education.

Dr Kim Chilman Blair and Dr Kate Hersov from New Zealand created Medikidz to empower children with medical information that will help them take charge of their health. So far the team has created 42 titles of around 30 pages each. "We want to cover 300 topics, including the most common and the rarest conditions. The books won't answer all your questions, but they will start a dialogue on the subject and a thirst to learn more about it. We tasted success when a child with epilepsy told us that he could tell other children why he had to take anti-convulsion pills every day that he didn't have to hide his condition from his friends anymore," Dr Kim says. They are working on A(H1NI1) flu, attention deficit hyperactivity disorder and autism now.

Medikidz has also published brochures explaining how MRI and CT scans, ultrasounds, X-rays and bone scans work and what the equipment does, so children are not nervous when they enter the machines. More titles are on the way. Siddhartha Jegannathan, director India, Medikidz, says, "We want the brochures in all diagnostic labs and hospitals that conduct these tests, so that children can read them before they take the tests. This way they'll be less nervous and there will be no need for sedation." The current series is targeted at children aged 10 to 15 years. A new series for children of five to 10 years will be out in six months.

Medikidz is in discussion with Philips Healthcare for funding their book on sleep apnea. Vice-president and business head of Philips Healthcare India Anjan Bose says, "We find that when information on medical conditions are provided in booklets, they are just left on the table, but this novel way of reaching the message to the people will help people go for check ups on time because they will know the complications that could arise out of neglecting such a condition."

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