March 31, 2009

World watching Indian Rural Health Mission: London School of Hygiene and Tropical Health

“The world is keenly watching developments in India following the implementation of the National Rural Health Mission [NRHM], billed as the single-most largest primary health care programmes being run in any country. What happens in India in the primary health care sector will be crucial,” Professor Sir Andrew Haines, Director, London School of Hygiene and Tropical Health, told The Hindu here.

“The programme is getting close attention — its strengths as well as its weaknesses. Of particular interest are its features like recruiting women as Accredited Social Health Activists [ASHAs] and involving the community that would lead to accountability and transparency,” Sir Andrew said. Besides, ASHA would be excellent as an intermediary between the people and the formal health system, he said.

Not willing to comment on the impact the Mission has had on the primary health care system as he was yet to study the outcomes, Sir Andrew, nevertheless, said the bigger challenge before India was to reduce inequalities that existed within the States.

Sir Andrew, who delivered the Second Public Health Foundation of India Day lecture here on Saturday, said the strengths of any primary health care system were its cost-effectiveness and an increased money absorption capacity.

He also stressed on the need to integrate population issues with the primary health care systems.

“It was in 1978 that representatives from 134 countries gathered in Alma Ata and declared that primary health care was the key to delivering Health for All by the year 2000. Subsequently, however, attention shifted to promoting vertical, disease-specific programmes. These may be efficient in tackling specific disease burden but are inadequate in addressing socio-economic determinants of health, resulting in a still high burden of preventable diseases, particularly in low and middle-income countries,” he said.

Renewed interest
According to Sir Andrew, recent years have seen a renewed interest in primary health care in these countries for various reasons, including inequities in health, inadequate progress towards the millennium development goals, major shortfalls in the human resource in health sectors and the fragmented and weakened state of health system in many countries.

On whether India can achieve the goals set in the NRHM, he said there were variations within the States as some States were making strong progress while others lagged behind.

“I am an optimist and believe a lot can be achieved by way of enhancing absorption capacity, pushing resources, improving the quality of services and establishing an interface between the formal health care at the primary level and workers,” he explained.

The immediate expected outcomes would be a reduction in the child mortality rate while improving maternal mortality rate and chronic disease management would continue to be a challenge for some more time, he said.

Environmental issues
Advocating the need for factoring in environmental issues into public health policies, Professor Haines said India needed to respond to climate change through public health policies.

“A simple thing like reducing the green house gases can reduce the disease burden immensely,” Sir Andrew added.

March 28, 2009

No medical PG degree for students from other states in Gujarat

Govt out to improve headcount of docs; new eligibility: Higher Secondary Certificate from Gujarat or domicile of state for at least 10 years; move challenged in HC
In its bid to increase the number of doctors in Gujarat, the state Government has come out with a new set of rules to cut short the number of seats of medical students from other states.

As per the new notification issued to all the universities in the state on January 21, only those students are eligible for the postgraduate course who have passed their HSC examination in Gujarat or whose parents have been a domicile of the state for at least 10 years.

The notification was issued after the Kanubhai Kalsaria Committee stated in a letter addressed to the registrars of the medical colleges that the guidelines to the admission in the PG course was not properly stipulated till date.

In the PG course, over 50 per cent of the seats are reserved for the students from Gujarat, while admission to the remaining seats is done through the All India Post Graduate Medical Entrance Examination (AIPGMEE). Earlier, the students from outside were eligible for the PG course after clearing the Pre-Medical Test (PMT) for MBBS like the local students.

The move, which has put the fate of intern medical students from other states in the doldrums, has meanwhile reached the Gujarat High Court.
Over 150 students filed a petition as soon as they got hint of the brewing trouble. The court has passed an interim order allowing the students to fill up the forms and appear for the entrance exam. But the counselling of outside students has been put on stay till the final decision.

Interestingly, the students claimed they were notified of the new amendments only when the colleges started distributing forms for the PG course. “The admission forms were given at the Baroda Medical College on March 12 with a notice barring the outsiders to fill the same,” said Kalpana Jain, who is doing an internship at the college.

“No notification was given to us. We got to know when the outside students at the Government Medical College, Surat were barred from filling up the entrance exam form,” said Amit Agarwal, intern, B J Medical College, Ahmedabad.

The authorities on their part said the decision was taken after realising that outside PG students leave the state immediately after the completion of their course, without adding to the state’s medical fraternity. While the 50 per cent seats through centralised admission cannot be tampered with, the new rule aims to bring in more local students.

India emerges second in medical tourism race

India spends 1.2% of its GDP on health, but takes care of foreign patients — the country ranks second in medical tourism. In 2007,

Indian hospitals treated 4.5 lakh patients from other countries against topper Thailand's 12 lakh.

A two-year study by healthcare researchers Deloitte revealed there's always been an inflow of patients from neighbouring countries and West Asia, but now there's a significant rise in patients from the US, UK and Europe.

Cheaper treatment is a huge attraction and, during recession, that's a big fact. But other factors, too, have contributed to the growth of medical tourism in India. "Indian clinical and paramedical talent is globally appreciated and with JCI accreditation of some hospitals, international standard is proven. Third-party intervention through health insurance has also given it a boost," said Vishal Bali, CEO, Wockhardt Group of Hospitals.

"Thailand, which revolutionized medical tourism, is more into cosmetic surgery; India focuses on cardiac, neurological or orthopaedic problems," Bali said.

Another significant factor is long patient waiting list, especially in the UK and Europe. The per-capita healthcare expenditure in Korea is $720 against India's $94. Treatment cost is lowest in India — 20% of the average cost incurred in US; in Singapore, Thailand and South Africa, it's 30% of the US cost.

Medical tourism showcases the potential of Indian healthcare sector to the world which dreaded India for the incidence of AIDS, tuberculosis, cancer, malaria and diabetes.

March 24, 2009

Medical expenses and tax deduction

Some conditions that enable you to claim a tax deduction.

You can take a medical insurance plan for yourself, your spouse, parents or dependent children. Under Section 80D, you can claim a deduction up to Rs 15,000 for the premium paid.

Mediclaim policies are offered by almost all insurance companies. Mediclaim policies provide insurance cover for the treatment of most ailments and hospitalisation. In addition to the basic cover, addons are available on payment of extra premium.

You should go through the coverage and exclusion clauses carefully. In some cases, pre-existing ailments are also covered on payment of an additional premium. The cover may be enhanced to ailments which are not normally covered also. Some insurance companies provide cover for day-care and annual medical checkups as well.

March 19, 2009

An unhealthy trend: fewer students opting for medicine

Fewer Indian students want to be doctors because it takes longer to graduate in medicine than in any other subject and entry-level salaries are relatively lower than that for an engineer.
To be sure, demand for admission to medical schools is still higher than supply, but the progressively declining number of students appearing for India’s largest examination for entrance to such schools should be cause for concern in a country that is short of around 600,000 doctors, according to an estimate by the country’s apex planning agency, the Planning Commission.

“It’s a market need-based shift. Students are increasingly opting for engineering. An engineering graduate can get a salary of Rs20,000-40,000, while a person with an MBBS degree gets Rs12,000,” said M.C. Sharma, controller of exams, Central Board of Secondary Education, which conducts this examination, the All India Pre-Medical Test, or AIPMT.
In 2006, 233,591 students appeared for the exam. This fell to 210,318 in 2007 and to 161,230 in 2008. This year, only 145,200 students have registered for the exam. India’s 289 medical schools can admit up to 31,298 students every year. Of this, 10,000 is through AIPMT. The rest of the students are admitted through state-level admission tests.
Mint couldn’t immediately ascertain the trend in state-level examinations, although it is likely that the trend in AIPMT has been repeated in these.
According to the Medical Council of India, the country has one doctor for every 1,722 people. Data from the World Health Organization shows that the doctor to patient ratio in India is 6:10,000 (or 1:1667), compared with 14:10,000 (or 1:714) in China, 26:10,000 (1:384) in the US and 23:10,000 (1:434) in the UK.
That number is unlikely to get any better because the number of students opting for biology in school—a pre-requisite for medical school admission—is falling by around 15% a year, according to the head of a large Bangalore school. In every batch, “75% of the students take non-medical, 15% opt for commerce and 10% select biology,” said S.R. Prabhakar, principal, DAV School.
This fall in interest in medicine can be attributed to several reasons: lower salaries for doctors, a much longer tenure for the course (5.6 years as compared to four years for engineering), limited postgraduate seats, and a mandatory one-year rural posting for postgraduate medical students.
“Being a doctor is an elite profession. The directive to go to villages and practice for 12 months has not been taken very kindly by these young people. For them it’s a loss of a year,” said Swati Popat Vats, director, Podar Education Network, which runs high schools and playschools across India.
Prabhakar said he has noticed that children of doctors, particularly those who have nursing homes of their own, are keen to join medical schools.
Meanwhile, coaching institutes across the country are feeling the pinch too. Patiala-based Lakshya, which has been coaching students for both medical and non-medical entrance exams since 2006, had about 35 medical students in the first year, which came down to 15 in the second year and “hardly has any queries for this year”, according Vamsi Krishna, co-founder and executive director.
Brilliant Tutorials Pvt. Ltd, one of the oldest firms in the business, has also seen a fall of around 20% in the number of students preparing for AIPMT, according to K. Ravi, a general manager with the company.
Still, the slowdown in the economy and the reduced hiring by software companies—in some cases, these firms are not hiring at all, and some are even laying off people—that used to hire engineers by the thousands could, if it lasts, see more people turn to recession-proof professions.
Boom or bust—people fall ill.

March 16, 2009

Sri Lankan doctors not happy with Indian medical team

Sri Lanka’s government doctors have threatened to take legal action and go on a strike to express their opposition to the presence of an Indian medical team in north-east Sri Lanka to treat the sick and the wounded from the war-zone.
President of the All Ceylon Medical Officers’ Association (ACMOA) Dr Nishantha Dassanayake, said in a statement published in the media on Saturday, that the members of the association were opposing the presence of Indian doctors for several valid reasons.
Firstly, the government had not gone through the proper procedure for allowing foreign doctors to work in Sri Lanka.

Secondly, it was not clear what procedures the Indian doctors would follow in treating the patients, and what remedies there would be, in case treatments went wrong.
Thirdly, when there were so many Sri Lankan doctors who could work in the area concerned, what was the need to bring in Indian doctors? Fourthly, why, inspite of Pulmoddai already having a hospital, has the Indian hospital been based in the same area, when instead the nearby Padaviya could have been expanded and improved? Lastly, the association claims that the presence of Indian army doctors have posed a challenge to the sovereignty of Sri Lanka.
“If the Minister of Health turns a deaf ear to our demand, we will get all other unions also to go on strike,” Dassanayake said.
Health Minister Nimal Sripala de Silva however told newspersons that “all clearances” had been obtained before the Indian team arrived. It was done in a record two weeks’ time, in view of the emergency situation in the north-east.
A 52-member Indian medical team comprising military and civil doctors and other auxiliary medical personnel, arrived here earlier in the week.

Biometric security, CCTVs, hydraulic gates at hospitals

The women in white at Parel's KEM Hospital scream to keep the steady stream of visitors in line. "Don't stand there. Keep moving,'' they constantly yell. Considering that KEM now has a new hydraulic gate, leaving only a small path for patients and their relatives, the women in white and their management skills are all important.

KEM Hospital is not the only one. Visitors to a hospital in Vile Parle got a rude shock last week when the management issued a new order: entry passes for visitors should be prepared by family members who are waiting it out with the patients inside. No more casual trooping into hospitals to catch up with an ailing friend or relative. At Jaslok Hospital on Peddar Road, an armed private guard in plainclothes buttresses the hospital's beefed-up security.

Evidently, terror has taken its toll. "Security is a serious issue. For me, it is as important a department as surgery or medicine,'' says Dr Sanjay Oak, dean of KEM Hospital and director of all civic teaching hospitals. No longer can visitors walk in freely without being frisked or their bags checked. Be it the upmarket Lilavati Hospital in Bandra or civic-run LTMG Hospital in Sion, security is a now an established medical protocol.

On a recent visit to Hinduja Hospital in Mahim, Lakshmi Wadekar (name changed) was surprised at the series of security checks she had to undergo. While she didn't mind the drill-walking through metal detectors, getting her bag checked and being scrutinised by CCTVs-she admits it was an unnerving experience while going to visit an ailing relative.

After Kasab walked into Cama Hospital and fired indiscriminately, the state government spent crores upgrading its premier JJ Hospital with CCTVs and boom barriers. While it is still easy to sneak in from one of the 22 gates, state administrators hope that the CCTVs can get a grab of most visitors.

Civic hospitals have also floated a tender for biometric security systems. "With this system, entry will be restricted to only close relatives,'' says a senior BMC official.

The Association of Hospitals (AOH), an umbrella organisation of over 35 charity-trust-run hospitals in the city, has also written to the DGP asking for link-up between a hospital and the nearest police station. "Within five minutes of the hospital sounding an alert, reinforcements should be rushed in,'' says AOH president Colonel Manesh Masand.

March 15, 2009

Doctors on mobikes for 24X7 medical emergency

Emergency healthcare is set to take on a new dimension in the capital soon - doctors zooming on mobikes, equipped with GPS, blue beacons and a first-aid kit.

This paid emergency medical service was launched Thursday by Rapid Rescue Services, a Gurgaon-based company, with an aim to provide door-step medical emergency services.

The rescue service is run by qualified doctors.

"We intend to provide the most effective and reliable emergency rescue to our members in need of help. In any medical emergency, there is a need to give pre-hospitalisation treatment and we aim at addressing that with the help of our initiative," said Bhavin Shukla, director of Rapid Rescue Services.

The company has floated two kinds of memberships - Gold and Silver. The Gold customers will be located using a GPS key ring while the silver customers are covered within their homes and need to call a helpline number.

The Gold membership will cost Rs.15,000 anually while Silver costs Rs.10,000.

"In the event of an emergency, all a customer has to do is press the predefined number on the mobile phone in order to be connected to the team to take care of him," said Rahul Pande, head of operations.

The rescue team comprising over 30 doctors and paramedical staff will reach the location within 30 minutes and will give necessary medical treatment.

The company is also in the process of tying up with some of popular hospitals across the city. The team of doctors will be stationed in eight hot-spots in the capital.

"The moment an emergency call is received, our team carrying emergency medical equipment and administrative drugs will reach the spot on a specially designed motorbike to avoid the traffic congestion," said Mr. Pande.

The mobikes have been specially designed by Bajaj Auto and are fitted with GPS and blue beacons.

"The GPS system will help the team to find out the exact location of the patient. The service will be available to all customers signed to a plan round the clock," said Mr. Pande.

Medical records go digital in India

Medical history, health information of patients are digitised and uploaded to a secure online account.

Maintaining digitised personal health records for customers, not a new domain overseas, is only now catching on among the desi diaspora.

The management of personal health records is a tedious task, which is why digitisation is being offered as a viable alternative. While service providers like Microsoft and Google have already entered this sector, a few India players are also eyeing it.

So, what is personal health information management? Under it, the medical history and health information of patients are first digitised and then uploaded to a secure online account by the service provider, after which the customer can e-mail, access and share the same with a doctor. These online repositories also have other health-related features.

In India, there are entities like Noida’s, the Bangalore-based Yos Technologies and the new-born Pune-based ArogyaDarpan, among others. enables its customers to store, manage and access their health records online while Yos Technologies offers an end-customer-focussed health system of secure personal records. ArogyaDarpan, only a couple of months old, hopes to provide a holistic service of collecting electronic/paper medical records, scanning and digitising the information, and saving it in an online repository/CD format.

“The exact market size estimation is difficult at this stage, as this is still a nascent concept in India, and the market is not very established right now. We too have not quantified the market size yet. But one thing is for sure, there is huge potential here,” points out Anurag Dubey, programme manager, health IT and healthcare delivery practices, South Asia and West Asia, Frost and Sullivan.

Players aim to provide an online repository for personal medical and health records for their customers. “ArogyaDarpan targets customers directly for their record management needs. Internet access and computer know-how is essential for this. Computer literacy is increasing slowly, and is a matter of time. When asked, people from a cross-section of society said if they got a good proposition they would like to have a structured digitised medical database ready to be accessed anytime,” observes Sandeep Tapaswi, CEO, ArogyaDarpan Health Repository Pvt Ltd, who invested close to Rs 45 lakh in his venture.

Though this initiative may be new to Pune, there are other players who strategise differently. “Initiatives like these will reap more if they do not concentrate on patients directly. Patients establish a primary interaction with local or bigger city hospitals. In short, such companies usually target the second tier, that is, healthcare professionals, mid-size and big hospitals, which makes more sense,” adds Anurag Dubey.

Even though the concept is innovative, customers think there should be more to this service. “When it comes to something like mediclaim receipts it is great if someone is preserving them for me, so that I don’t have to run through different files at the year end. Reminders are the next step. Medical tests usually have follow-up tests or prescribed food. If customers were reminded about such things it would be a value-add. And, since there is already a server in place, it should not be difficult,” feels Rimpi Arora, software professional and customer of a health portal.

While some are satisfied with the services provided, others want more. But one challenge that remains is the standardisation of data. While big hospitals benchmark themselves against international standards, smaller players may not invest in that kind of technology.

March 11, 2009

Smoking costs America $101 bn annually in health care

Though use of tobacco is declining in the US compared to developing countries, the habit still costs the country more than $101 billion in health care.

"Annual healthcare costs, both public and private, caused by smoking amount to $96 billion while $5 billion is spent on healthcare related to second-hand smoke. Premature deaths caused by smoking amount to $97 billion in productivity losses," according to the Tobacco Burden Facts on the US, released by the Campaign for Tobacco-Free Kids, at the ongoing 14th World Conference on Tobacco or Health in Mumbai Tuesday.

According to the data, the US remains the second largest consumer of cigarettes in the world despite a decline in smoking with the percentage of current US adult smokers (above 18 years) decreasing 17 percent now from 1970.

However, smoking is still the leading cause of death, disability and disease, killing approximately 400,000 people each year while 8.6 million people currently suffer from a serious illness attributed to smoking. About 50,000 American adults die from exposure to second-hand smoke each year.

More then 43 million adult Americans smoke, which is less than 20 percent (19.8 percent) of the population, with male smokers (22 percent) outnumbering female smokers (17 percent). Among high school students, 3.5 million (20 percent) are current (past month) smokers, including over 21 percent boys and 18.7 percent girls.

Every day, over 3,500 minors (below 18) try smoking for the first time, and over 1,000 become regular smokers, according to the data.

Tobacco is responsible for 30 percent of all cancer deaths and 80 percent of all deaths due to chronic obstructive pulmonary disease. On an average, smokers in the US live 13-14 years less than people who do not smoke, according to the data.

March 10, 2009

Medical student killed in ragging

A Delhi Public School student who had taken admission in a medical school in Himachal Pradesh last year met with a horrible death at Aman Kachroo had repeatedly complained to his parents about the brutal ragging. (TOI Photo)
the hands of seniors who are training to be doctors. ( Watch )

Aman Kachroo (19), who passed out of DPS International in Saket and enrolled at the Dr Rajendra Prasad Medical College, Tanda, in Kangra last August had repeatedly complained to his parents about the brutal ragging that took place on campus — often by completely drunk third-year students.

On Friday night and Saturday morning, the boy was beaten so badly that he died.

"Aman used to tell us about ragging but we never thought that it was so serious. The first-year students had complained to the college administration recently, but despite that, no steps were taken to stop ragging. We've lost our son, but many others can be saved if timely steps are taken," his aunt Indira Dhar said on Monday. She said the body was being brought to Gurgaon where the parents have been living since the family moved back to India from Tanzania. Aman's father is still a visiting faculty at the Dar-es-Salaam University.

Indira Dhar alleged that due to severe beatings at the hands of senior students, Aman sustained grievous injuries on his chest, ears and face. The hostel manager had asked the students to file a written complaint, but even then no action was taken.

That the faculty and college administration had looked away from the campus brutality was obvious. But even after the death was reported, administrators tried to pass off the death as a suicide. Only after the matter blew up and cops got involved, the principal, as a token gesture, rusticated four students suspected to be involved in the ragging.

"Preliminary investigations reveal that the victim was under extreme stress following the ragging by third-year students and had collapsed on Sunday. We were informed of the incident around 9.30 pm," Kangra SP Atul Fulelzele said. That implies that the college authorities did not call the cops for nearly an entire day after Aman died.

Virkin Dhar, the victim's cousin, said he had told her that senior students used to rag juniors after getting drunk and the same thing happened on Saturday night, when they physical assaulted freshers. "We have come to know that senior students had punched and slapped Aman, inflicting internal injuries that proved to be fatal," she said.

Himachal Pradesh government suspended the hostel warden and manager after the death became public. Terming it as an unfortunate incident, state health minister Rajiv Bindal said, "Strict action would be initiated against students who were involved in it. Police are looking into the matter and well ensure total transparency in the proceedings. An autopsy was done in-camera and in the presence of a lawyer.

According to Times Now, two senior medical college students have been arrested and the principal of the college has resigned.

March 09, 2009

Why women must have separate health insurance

In the crowded by lanes of Varanasi, a 22-year-old mother of two trudges to the local health centre. Her energetic and demanding toddler skips along tugging at her sari while she tries to shield the tiny infant in her arms from the beating sun.

It has been days since she felt energetic. The early pregnancies, responsibilities of motherhood, lack of sleep and domestic chores have taken their toll. Her husband cannot accompany her as a day off from the weaver’s loom would mean a loss of wages they cannot afford.

The young mother shows the government issued insurance card at the healthcare centre and her tests and treatment are done free of charge. A blood test reveals that her haemoglobin has dipped to nine points. She needs diet supplements and iron tablets immediately.

The story is so common across India, The woman of the household distributes the limited income in managing a household, the health of the earning member (as his need to continue to work is critical) and the growing needs of children. Her own nutrition and healthcare are way down in her list of priorities.

Interestingly, the story in an upper middle class home in Mumbai sees just a slight variation. A 42-year-old mother of two is grappling with meeting the ever increasing demands of a stressful mid-management job, the long and tiring daily commute to work and the needs of her school going children.

A desk job, the wrong food during frequent travel and irregular sleep pattern have resulted in rapid and significant weight gain, leaving her susceptible to a range of lifestyle induced diseases. She certainly has the financial wherewithal to see a doctor, a nutritionist and join a gym, only if she had the time.

Having interacted with a cross section of women across socio-economic strata it is interesting to find a common thread, women tend to ignore their health and are most likely to visit a doctor only when the ailment has aggravated to the point of becoming unbearable.

Women need to acknowledge that they need to remain healthy in order to shoulder the responsibilities of looking after the family. Most women view preventive healthcare as an unnecessary expense or a luxury. As the quality of healthcare in India has improved over the years, the cost of healthcare has gone up significantly. And here is the need for a health insurance cover.

Women in urban areas face a higher risk of diseases like breast cancer. This is primarily due to the trend of late marriage and pregnancy. Older women ideally need to look at preventive measures like testing for breast and cervical cancer, nutritional calcium supplements to guard against osteoporosis, hormonal balance testing and others. Women have more complex health needs than men.

Women are also at a much greater risk for diseases like rheumatoid arthritis which require ongoing treatment or surgery. Due to cost reasons,

women who are younger and low-income are particularly at risk for being uninsured.

The Indian government has taken the initiative in introducing schemes for women in rural areas like the Swayamshakti scheme, the Handloom Weavers’ scheme or the Rashtriya Swasthya Bima Yojana (RSBY) for people below the poverty line.

However, most urban women do not qualify for public programs. Health insurance covers for women are essential for these very reasons. Women are less likely to be eligible to participate in their employer’s health plan due to the fact that women are more likely to work part time, have lower incomes and rely more on spousal coverage.

Health insurance is a key element in health care accessibility for women, as women with coverage are more likely to avail of primary and specialty health care services. Today, there is a variety of health insurance products available in the market. Besides, these products are easily available at price points which are affordable..

With a forward looking regulatory body like IRDA, the industry is likely to see further innovation in product development leading to women specific products specifically addressing their healthcare needs. These factors will contribute to a rise in women opting for health insurance.

Now, browse and save on medical bills

Soon, a simple online search on Google or Yahoo will help you save on your medical bill. The government is planning to provide

comprehensive details of all commonly used medicines and their cheaper versions on the Internet to enable both doctors and consumers make an informed choice.

The idea is to promote awareness about low-priced unbranded generic drugs available in the market, while keeping a check on big pharmaceutical companies that push their branded medicine with huge promotional expenses, an official in the department of pharmaceutical said on condition of anonymity.

The department is in talks with popular search engines like Yahoo! and Google to ensure that details of all popular medicines along with a price comparison between branded medicines and their generic counterparts are easily available for netizens.

Generic drugs are medicines marketed without a brand name but are identical to their branded counterparts in terms of dose, strength, route of administration, safety, efficacy and intended use. In terms of price, they are substantially cheaper than the branded drugs.

March 07, 2009

Can Google Health lead to worst disaster?

If you don’t reside atop the Alps or at the bottom of the sea but in a metropolis, you must have heard of and used Google. Now there is a great news for you (whether it’s good or bad depends upon your prudence). The Google Health users from this time forth shall have the power to share their online medical records. This new development happens to be a part of Google’s colossal initiative consistent with its mission to organize the world’s information, make it universally accessible and thus to leave privacy advocates speechless.

What is the efficacy of new Google Health sharing feature? It has been learnt that through it users, who have stored health information with Google, will be able to make that information accessible through a Web link sent via e-mail. Who can do the same? Well, it can be anyone provided that he/she wants to make his/her health record available to friends, family, or doctors and other medical service providers.

Is this a new war on the part of Google against the proponents of privacy? If we lend our ears to Google’s officials, this has never been the intention of Google. Nevertheless, the company has always remained fixed to organize information and make it accessible.

Whatever it is, this bizarre initiative of Google has made many frown though they are not conventional detractors. It seems that Lillie Coney, associate director with the Electronic Privacy Information Center in Washington, D.C. has taken strong exception to this. This has made her conclude health information is not trivial but highly sensitive and that there could be unexpected consequences to sharing health information outside of the health provider environment.

She said categorically, “People need to be very clear that once the information is shared, there may be other consequences.” “Undoing the sharing may be more problematic than most people would think.” However this has been brushed aside by Google product management director Sameer Samat. He has stated that health information sharing links only work with the e-mail account to which they’re sent and not if the message with the link has been forwarded.

But there are chances of disasters and this single aspect is exasperating people.

March 05, 2009

Harvard medical students push for disclosure of drug industry ties

In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who had asked about side effects.

Zerden later discovered something by searching online that he began sharing with his classmates: The professor was not only a full-time member of the Harvard Medical faculty but also a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

‘‘I felt really violated,’’ Zerden, now a fourth-year student, recalled. ‘‘Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.’’ Zerden’s minor stir four years ago has grown into a full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty members, intent on exposing and curtailing the industry influence in their classrooms and laboratories, as well as in Harvard’s 17 affiliated teaching hospitals and institutes.

They say they are concerned that the same money that helped build the school’s world-class status may be hurting its reputation and affecting its teaching.

The students argue, for example, that Harvard should be embarrassed by the ‘‘F,’’ or failing, grade it recently received from the American Medical Student Association, which rates how well medical schools monitor and control drug industry money. Harvard’s peers received much higher grades, including the top ‘‘A’’ for the University of Pennsylvania; ‘‘Bs’’ for Stanford University, Columbia University and New York University; and the ‘‘C’’ for Yale University.
Harvard has fallen behind, some faculty members and administrators say, because its teaching hospitals are not owned by the university, complicating reform; because the dean is fairly new and his predecessor was such an industry booster that he served on a pharmaceutical company’s board of directors; and because a crackdown could cost it money or faculty.

The dean, Jeffrey Flier, who says he wants Harvard to catch up with the best practices at other leading medical schools, recently announced a 19-member committee to re-examine his school’s conflict-of-interest policies.

The Harvard students have already secured a requirement that all professors and lecturers disclose their industry ties in class—ablanket policy that has been adopted by no other leading medical school in the United States.

(One Harvard professor’s disclosure listed 47 company affiliations.) ‘‘Harvard needs to live up to its name,’’ said Kirsten Austad, 24, a firstyear medical student who is one of the movement’s leaders. ‘‘We are really being indoctrinated into a field of medicine that is becoming more and more commercialized.’’ David Tian, 24, a first-year Harvard Medical student, said: ‘‘Before coming here, I had no idea how much influence companies had on medical education.

And it’s something that’s purposely meant to be under the table, providing information under the guise of education when that information is also presented for marketing purposes.’’ The students say they worry that pharmaceutical industry scandals in recent years — including some criminal convictions, billions of dollars in fines, proof of bias in research and publishing and false marketing claims — have cast a bad light on the medical profession. And they criticize Harvard as being less vigilant than other leading medical schools in monitoring potential financial conflicts by faculty members.

Flier, the dean, says the faculty of Harvard Medical may lead those of others in the United States in receiving money from industry, as well as from government and charities, and he does not want to tighten the spigot.

‘‘One entirely appropriate source, if done properly, is industrial funds,’’ Flier said in an interview.

The payments, however, are drawing scrutiny even in Washington. On Tuesday, Senator Charles Grassley asked the drug maker Pfizer to provide details of its payments to at least 149 Harvard faculty members in the last two years.

The request expands Grassley’s investigation of industry payments to three Harvard psychiatrists who had promoted antipsychotic medicines for children. According to records Grassley obtained from drug companies, the professors were accused of not properly reporting at least $4.2 million in payments from 2000 to 2007. One of them has been suspended from conducting clinical trials.
The senator, an Iowa Republican, also asked for any Pfizer e-mail, faxes, letters or photos regarding Harvard medical students who have protested drug company influence.

At an October demonstration, which involved about 50 Harvard Medical students and was sponsored by the American Medical Student Association, some protesters saw a man photographing them with a cellphone. He later identified himself as a Pfizer representative but did not give his name.
A Pfizer spokesman said Tuesday that the company ‘‘will fully cooperate with Senator Grassley’s request.’’ The spokesman, Ray Kerins, said Pfizer regrets it if the photograph taken by the sales representative ‘‘was offensive to anyone involved’’ but believes the company has acted legally and ethically and that collaboration with medical schools is ‘‘a valuable source of innovation and scientific advancement.’’ Kerins said recently that the man had told him the photos were for personal use. Kerins said the man, whom he declined to name, had done nothing improper.

Harvard policy prohibits drug representatives from interacting with students on the medical campus but does not bar them from the campus or from taking photographs.
David Cameron, spokesman for Harvard Medical School, said in an e-mail message, ‘‘We are unable to provide comment on this matter.’’ With Harvard’s endowment having lost 22 percent of its value since last July and the recession causing philanthropic contributors to retrench, school officials maintain that corporate support for their faculty is all the more crucial.

The school said it was unable to provide annual measures of the money flow to its faculty, beyond the $8.6 million that pharmaceutical companies contributed last year for basic-science research and the $3 million they provided for continuing education.

But no one disputes that many individual Harvard Medical faculty members receive tens or even hundreds of thousands of dollars a year through industry consulting and speaking fees.
Under the school’s disclosure rules, about 1,600 of 8,900 professors and lecturers have reported to the dean that they or family members had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizer and 130 with Merck.

The rules, though, do not require them to report specific amounts received for speaking or consulting, other than broad indications like ‘‘more than $30,000.’’ Some faculty who conduct research have limits of $30,000 in stock and $20,000 a year in fees. But there are no limits on companies’ making gifts to faculty—meals, trips or the like.

A smaller faction among Harvard’s 750 medical students has circulated a petition signed by about 100 people that calls for ‘‘continued interaction between medicine and industry at Harvard Medical School.’’ A leader of the group, Vijay Yanamadala, 22, said, ‘‘To say that because these industry sources are inherently biased, physicians should never listen to them, is wrong.

China’s anti-smoking campaign against smoker doctors

In its efforts to curb rising smoking rate in China, the Chinese government has urged the doctors to shun the habit in the first place for making the general public follow suit.

China Preventive Medicine Association (CPMA) launched a campaign Sunday to discourage the habit among the medicos.

Health Minister Chen Zhu said, “Medical workers and those who take the decisions regarding people's health should take the lead to quit smoking and completely ban indoor smoking to set a good example for their patients and others who look up to them.”

“International experience has it that when doctors give up smoking, it encourages a lot of others to kick the habit,” he added.

About 56.8 percent of male doctors are smokers in china, making it the highest rate in the world, China Preventive Medicine Association confirmed.

It is crucial to discourage the habit among doctors to contain the overall smoking rate in China, which is the largest cigarette producer in the world with a market of 320 million smokers.

Chinese are also quite heavy smokers as the cigarettes made in the country are among the cheapest in the world.

Zhu lamented that despite having conducted smoke-free Olympics last year, China still fails to encourage citizens to kick the habit. He blames it on the lack of strict legislations and awareness campaigns.

10 leading health associations and 10 universities have joined CPMA to eradicate the smoking habit among medical staff.

They aim to make medical schools, hospitals and associations "completely smoke-free" this year. The institute already has been offering bonus incentive to employees who do not smoke.

Wang Longde, head of the CPMA, who is also a deputy to the upcoming National People's Congress, said that he would propose to move the draft legislation for anti-tobacco movements.

Americans cut back on entertainment, medical care

Entertainment, vacations and eating out in restaurants have taken a hit as Americans look for ways to save money and cut costs.

With unemployment figures rising and tumbling stocks about 70 percent of Americans questioned in a Zogby International interactive poll said they have cut back on their entertainment budgets.

Forty percent also said they are spending less on food and groceries, and 16 percent have gone without medical or prescription drugs in the past year.

"This is a very depressing poll," CEO John Zogby said in an interview. "I think we have a ways to go in terms of hitting the bottom," he added.

Discretionary spending and entertainment have suffered the most, according to the survey. Forty percent of people said they have also limited or canceled their normal vacation plans because of concerns about the costs.

Another 40 percent have decided the time is not right to buy major items such as automobiles, homes entertainment electronics, or a computer.

Nearly 80 percent of younger adults, aged 18-29, said they have scaled back on going out, compared to 55 percent of people 65 years and older.

Zogby said younger people are learning to economize. With less experience in the job market and lower salaries they may not have a choice.

Thirteen percent of people under 30 also said that money worries have affected their educational plans in the last year, and nearly 10 percent have decided not to continue their studies.

Even people with higher household incomes of more than $100,000 are cutting costs, according to the nationwide interactive survey 1,474 adults with and without jobs.

Almost 30 percent of people in higher incomes brackets are watching their food budgets, while 64 percent of people earning less than $25,000 have decreased their spending on groceries.

Zogby said one of the most concerning findings of the poll is the impact on healthcare.

Slightly more than a third of people earning less than $25,000 said they gone without medical care, compared to 10 percent of adults in the upper income brackets.

March 03, 2009

IMA welcomes SC judgement on medical negligence complaints

Welcoming the Supreme Court judgement on medical negligence complaints, the Indian Medical Association (IMA) on Sunday said it would help in improving doctor-patient relationship.

"This judgement will clarify many ambiguities and confusions regarding complaints of wrong treatments, which will definitely help in improving the doctor-patient relationship," IMA National President Ashok Adhao told reporters here.

The Supreme Court in its judgement on February 17 held that the police cannot arrest doctors over complaints of medical negligence and courts, including consumer fora, cannot issue notice to them for alleged medical negligence without prima facie evidence.

Adhao said the judgement was necessary to avoid harassment to doctors who may not be found to be negligent. "We further warn the police officials not to arrest or harass doctors unless the facts clearly come within the parameters laid down," he said.

Doctors buy bio-medical waste sold as scrap

There has been an uproar over spread of the deadly hepatitis-B virus across north and central Gujarat through recycled injectibles. Yet, about 35 scrap dealers in the city continue to trade in used injectibles and most shockingly, blood bottles, with impunity.

The campaigning by the state government's health department against fake doctors and medical practitioners who do not follow the Bio-medical Waste Management and Handling Rules 1998, has not deterred them. What is shocking is that the dealers, as admitted by them, are hand-in-glove with several local practitioners.

According to sources, these 35 scrap dealers buy used syringes, needles, multiple vials, I-V sets, empty medicine bottles, catheters and even blood bottles which have crossed the stipulated expiry dates. A source in the market said, "The bottles are purchased as scrap and sold at Rs 8 to Rs 20 per kg."

A medical practitioner, not wanting to be named, said, "These practices continue under the nose of health officials of Bhuj, Mandvi, Anjar, Rapar or Gandhidham and no one is bothered." He added, "In Bhuj, these scrap dealers store the goods just beside the police chowki of Madhapur main road. Local doctors send their aides to visit these dealers and buy the stuff."

Admitting this, a scrap dealer said, "Some doctors visit rural areas on their vehicles and their assistants buy the used I-V sets, needles, syringes and other things from the health care centres there."

Meanwhile, an official of Bhuj civic body confessed that only a third of Kutch's doctors have made provisions for disposal of bio-medical waste as suggested by law.

March 02, 2009

New bill to empower patients against hospitals

If a proposed legislation goes through, you may soon be able to raise your voice against a hospital for overbilling you, denying your medical records or referring you elsewhere without a reason.

Patients' rights as well as the rights of healthcare providers might get legal recognition with the Union health ministry recently drawing up a draft legislation called the National Health Bill 2009.

The draft is the outcome of a long-standing demand by the Jan Swasthya Abhiyan (people's health movement) which has been advocating a national health act to regulate both the public and private healthcare systems. The draft bill has recently been put up on the ministry's website to invite public comment.

"Public health is an important area and the draft was intended to bring in regulation. It is still under consultation and was recently circulated among individual state governments," said joint secretary, ministry of health and family welfare Amarjeet Sinha.

He explained that patient's rights, such as the right to emergency care for instance, were till now largely based on the interpretation of the law in various cases, and the bill once passed would be all-encompassing.

A comprehensive legislation, the bill will make it mandatory for hospitals to have independent complaint forums headed by a 24x7 official to redress patient grievances.

This will offer recorse to patients, in addition to existing courts and quasi-judicial bodies such as the medical council.



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