May 28, 2009

‘Better to stop practising medicine than be sued for Medical Negligence’

The Honourable Supreme Court recently decided to grant a compensation of Rs 1 crore to a victim of medical negligence. While the verdict is laudable from a consumer’s point of view, the magnitude of the compensation needs to be debated dispassionately. Can we afford the luxury of compensations in crores in a country like ours?

The high compensation gives de facto legitimacy to claims of multiple crores for all cases pertaining to medical negligence.

The exorbitant medical costs in the USA explain why the American health system is failing and medical tourism to India is picking up. The costs are bolstered by ambulances chasing attorneys who have ensured that doctors cover all risks for patients for any treatment undertaken.

The Professional Indemnity Insurance, which most hospitals and doctors take for Rs 10 lakh will now need to be increased to at least Rs 1 crore. Again, there is no guarantee that the next judgment will not permit a compensation of Rs 10 crore. What then should be the tentative amount for a surgeon to insure himself with?

While this is a good business for insurance companies and the legal fraternity, who will ultimately will pay for this? Surprisingly, in cases of death due to accident caused by an inebriated state roadways bus driver, the government and the judiciary consider a compensation of about Rs 2 lakh.

Will the government, henceforth, award Rs 1 crore compensations to all those who fall victims to negligence on part of a government employee?

While corporate hospitals may not be affected by the high compensations, the average doctor has, however, been rendered a death blow by the judiciary.

As a doctor with 25 years standing, it makes more financial sense for me to stop medical practice rather than expose myself to being sued in crores and risk my lifetime savings.

Applying a common yardstick of accountability to all can help bridge the discrimination between professions.

Link: Original Article

Now health insurance till 65 years

The Insurance Regulatory and Development Authority (IRDA) is ramping up norms for health insurance products. In its latest directive, the insurance regulator has directed that health insurance policies must allow insurance cover to all people at least till the age of 65 years.

From July 1, no company will be able to deny health cover to a senior citizen without furnishing a documented reasoning. “Any proposal for health insurance of senior citizens, which are denied on any grounds, should be made in writing with reasons furnished and recorded. Such reasons should stand the scrutiny of reasonableness and fairness,” the circular said.

Besides, companies will not be able to charge exorbitant premium rates for senior citizens as well. The IRDA has said that the premium rates should be fair, justified, transparent and duly disclosed upfront. The details of any loading charged must also be made available to the insured.

Link: Original Article

U.S. health system discourages innovation

Countless workers in the United States are trapped in jobs they would like to leave because they cannot get health insurance elsewhere, calcifying innovation and mobility in the world's largest economy.

Daunted by health-care costs, a would-be technology entrepreneur in Texas decides not to start her own business. A communications expert in Washington decides not to strike out on his own. And a freelance magazine editor in Brooklyn decides to take a less satisfying corporate job.

"I would rather be freelancing, no question," said Jessica Tolliver, a former editor who now works in public relations. "I got my work done in less time, because once I finished what I had to do, the time was my own."

Economists call this phenomenon "job lock," and studies suggest that it keeps between 20 percent and 50 percent of workers from leaving their current jobs.

Because health insurance is tied to employment in the United States, workers who leave their jobs can see health bills skyrocket if they strike out on their own or take a position with a company that offers fewer benefits. Workers who would like to retire early stay on, unable to qualify for the government's Medicare program until they turn 65.

And those who have existing health problems may not be able to get coverage at all.

Job lock is difficult to measure because many employees don't like to advertise their unhappiness. But economists and small-business advocates say it takes an enormous toll on productivity.

"We can definitely say that it's slowing down the rate of innovation," said Tim Kane, an economist with the Kauffman Foundation which promoted entrepreneurship.

For Mike, a Washington-based communications professional who did not want to use his last name, health costs may force him to pass up the chance to be his own boss at a time when he could easily pick up several major clients.

With two children at home, Mike said he was reluctant to abandon the generous benefits he gets at the trade group where he currently works. Self-employment would probably mean spending more for fewer benefits.

"I don't want a bad event to knock me and my family out of the box," he said. "It's a real hurdle."

As head of the National Federation of Independent Businesses, Todd Stottlemeyer frequently encountered would-be entrepreneurs who let their ideas go stale and their products languish on the workbench because they did not want to shoulder their own health care costs.

When he asked audiences if health insurance has affected their employment decisions, often half the hands in the room would go up.

"There are lots of factors that go into why somebody starts a business or doesn't start a business: Do I have a good idea, do I have capital, do I have risk tolerance?," said Stottlemeyer, now an executive at a hospital chain. "Being able to get health insurance ... should not be one of those determinant factors."

Making insurance more affordable for the self-employed could lead to a wave of new businesses, one study suggests.

New Jersey saw a 14 to 20 percent rise in entrepreneurial activity due to a 1993 law making it easier for the self-employed to afford health insurance, a study by Philip DeCicca of McMaster University in Hamilton, Ontario found.

Roughly 60 percent of the U.S. population now gets its health coverage through work, but the system is increasingly strained due to rising costs.

Congress is working to overhaul the troubled system. The Democratic majority hopes to pass a law which President Barack Obama can sign by the end of the year. However, employer-based care is likely to remain a bedrock of any new approach.

The link between healthcare and jobs evolved during World War II, when the government imposed wage controls but allowed companies to adopt health-insurance plans to lure employees.

Small-business groups have often complained this unfairly tilts the playing field toward large employers that have the clout to negotiate rates that are 18 percent lower on average, according to the Commonwealth Fund.

Consequently, workers at small firms are much less likely to have health insurance. While 99 percent of companies that employ more than 200 employees offer health coverage, only 49 percent of companies that employ between 3 and 9 workers do so, according to the Henry J. Kaiser Family Foundation.

Part-time workers are also less likely to get benefits than full-time employees, according to Kaiser.

Self-employed workers face a further disadvantage because they cannot deduct health-insurance payments from their income taxes, unlike companies that maintain a payroll.

As a freelancer, Tolliver could work from wherever she and take playground breaks with her daughters. But a $1,200 monthly healthcare bill ultimately led her to take a job where insurance only costs her $200 per month.

"It would be obnoxious to say were struggling to put food on the table. But that said, it was a lot of money."

Link: Original Article

May 23, 2009

Supreme Court stays surrender of PG medical seats

Chances of meritorious students getting a fresh crack at reputed government medical colleges brightened on Thursday with the Supreme Court staying the surrender of all-India quota PG medical seats to the states.

Petitioners pointed out that several states, who contribute to the All-India Quota PG seats' pool, filled through an open entrance examination, deliberately delayed intimating the number of vacancies in government medical colleges to the Directorate General of Health Service (DGHS) and for years have been cornering them for those who had cleared the state entrance test.

A vacation Bench comprising Justices Markandey Katju and Deepak Verma stayed the surrender of the all-India quota PG seats to the state governments till May 26. The surrender was to take place on Friday, as per the schedule, since DGHS has already conducted the second counselling. It is now likely that DGHS would have to conduct an extended second counselling to fill as many all-India quota PG seats.

There were over 3,000 PG seats under the 50% all-India quota open to competition sans reservation till the 2006-07 academic session. However, the apex court had last year introduced SC/ST quota in it. With this, the number of seats for general category, including OBCs, will stand reduced to around 2,300 and nearly 700 seats will go to SCs and STs.

On a 1985 order of the court, 25% post-graduation seats in medical colleges were culled out for the open all-India competition from the academic year 1987-88 solely on the basis of merit and sans any reservation for socially weaker sections. PG seats under the all-India quota was increased from 25% to 50% by the apex court in 2003.

Link: Original Article

Tata hospital Rs.100 Crore medicine scam

The medicines scam at a pharmacy attached to cancer speciality Tata Memorial Hospital-a Rs 100-crore misappropriation, according to the CBI-might not have come to light if not for a letter written by the father of a cancer patient.
M N Rao, a CISF head constable from Jhansi, had shot off a complaint letter to hospital authorities last May after his daughter was billed Rs 2,000 for an injection she was never given.

TOI had earlier reported about the CBI's claim that anti-cancer medicines worth crores had been smuggled out of the dispensary for five years, and sold to private chemists for a commission. The CBI has registered a case of cheating, conspiracy and forgery against six employees.

Rao is unaware that the issue has snowballed into a scam, but his complaint might have prevented many other cancer patients from being cheated. "It was his complaint that set the ball rolling. Some of the items on the bill looked like they had been inserted, which is why we set up an internal inquiry,'' said a senior doctor.

Rao's daughter Shruti (17) was admitted to the hospital for five months, undergoing treatment for blood cancer. "While paying, I realised that there were differences in the two bills (yellow and red) which we were given,'' said Rao, adding that he submitted an application to the medical superintendent before Shruti was discharged. "Her treatment is covered by my firm, so I was concerned about any additional costs,'' he said.

While Rao never got a reply, hospital authorities said they promptly launched an in-house inquiry. "We set up three inquiries and are cooperating with the CBI. We have computerised our billing processes to ensure that they are fool-proof,'' said hospital director Rajendra Badwe. The hospital had suspended the six staffers for 90 days so that they didn't interfere with the inquiry. They were subsequently reinstated in other departments, independent from the pharmacy.

"Patients and relatives should scrutinise their bills and shouldn't be afraid to raise questions, as it is their right to know every aspect of treatment,'' said Asha Idnani of the Council for Fair Business Practices.

Link: Original Article

May 21, 2009

PIL seeks more PG seats in Maharashtra medical colleges

The NGO People’s Health Organisation (PHO) has filed a PIL before the Bombay High Court seeking an increase in seats for the post-graduate (PG) medical course in the state before May 31.

The High Court will hear the application on May 21.

According to Dr Ishwar Gilada, secretary, PHO, until 2001 the ratio of PG teachers to PG students was 1:2, but thereafter, the ratio came down to 1:1 due to apathy of the state government as well as the Medical Council of India (MCI).

He said that in February this year, the then union health minister Anbumani Ramadoss had conceded in the Parliament that more specialists were needed in the medical field, and PG seats could be increased. However, by then the election code of conduct was in place and no decision was taken in this regard, PIL states.

Last year, PHO filed a PIL, alleging that because of state government’s indifference, number of PG seats came down to 600 from 1,900 in 2001.

Link: Original Article

Airtel Offers Health Services on Mobile

Airtel users in Karnataka will now have access to two new health care services via their mobile phones - Virtual Blood Bank Service and VacciDate service.

These services are being offered to subscribers free of cost. Here's a lowdown on what they can offer:

Virtual Blood Bank Service:

Airtel claims that in an emergency, its subscribers can rely on its service to call for this service when in need of blood. This service aims to bridge the gap between blood banks, donors & recipients of blood.

Subscribers will need to dial the toll free number 51514 from their Airtel mobiles to access this service. This IVR based emergency helpline number will assist & guide the Airtel customer till the time his / her requirement of blood is addressed.

VacciDate Service:

VacciDate service is a vaccination alert system on mobiles for Airtel subscribers. The service is aimed at parents so they can keep a track of their child's vaccination dates. This free service also has a special alert feature for POLIO Sundays organized by the Government of India.

Lasly, users can also query the system to check their kids' next vaccination date. Airtel customers need to SMS VACC (Date of Birth in DD MM YYYY Format) to 52225.

The Airtel VacciDate service allows customers to set alerts for basic five vaccination dates and 2-4 alerts can be set for each vaccination date. These alerts would typically alert customers 5 days before the date of vaccination, then 1 day before the date of vaccination, and finally on the date of vaccination.

Link: Original Article

May 16, 2009

The case for a well-paid village doctor

Wouldn’t it stand to reason that the jobs that were the least satisfying ought to be paid the most? Of course, by that logic, a street sweeper ought to be paid more than a CEO. By that same logic, a rural medical posting ought to get more than the measly Rs10,000 that it commands. Double their wages, I say

My maid’s son gets epileptic fits. His name is Gerald and he is a young handsome boy of 16. Every now and then, sometimes three to four times a day, he gets these fits and simply falls down on the road, unable to move. People in the neighbourhood carry him home. Many days, my maid Teresa doesn’t send him to school because she is worried about the fits. Teresa is young, slim and cheerful, except when she talks about her son. Then, her pretty eyes get teary. Like most poor people, she is able to set aside her troubles and smile. She giggles as she works and has the capacity, if not the circumstances, for joy.

Doctors tell me that epilepsy is curable. With the right medication, it is possible to remain symptom-free, they say. My sister-in-law, a paediatrician practising in Florida, examined the boy and asked Teresa why she had kept Gerald in this condition for 10 years.

Teresa’s answer was plaintive: Where do we go for medical advice that we can trust? They had taken their child to every type of hospital within their reach. The Chinmaya Mission hospital, free government hospitals, the local Ayurvedic doctor, and even her village equivalent of a shaman. Now the boy was on homoeopathic medicines that they got from a doctor in Chennai.

My view of my maid’s condition boils down to a single word—and I am hardly saying anything original here—access. This access, or the “on-ramp” as my husband calls it, isn’t simple. If it were, my maid would have solved her son’s epilepsy problem. It isn’t simply a question of setting up 23,236 primary health centres (PHCs) across rural India, although that is necessary. My cousin works in one and the number of patients he treats every day would give a US healthcare company determined to squeeze the maximum out of its doctors pause. Like the residents of “Hotel California”, my cousin “can never leave”—not to visit his daughters, attend family weddings or even take care of his own health. His clinic is next door to his house and his “compounder” dispenses an array of green, red and white pills. The patients come from villages all around and wait for hours to see him for 5 minutes. The diseases he treats, however, are his old friends, brought on by poor sanitation and nutrition; lack of health education and safe drinking water. Simple things. Easily solvable. You’d think so, wouldn’t you? Not in the least, according to my cousin.

I come from a family of doctors and here is what I know about physicians. They take pleasure in healing. Their calling is to cure people, rid them of illnesses, dispense medication, treat complications. Managers, they are not. And Indian healthcare, in my humble opinion, needs managers more than it does doctors. Simply posting a doctor in Kalakkad village isn’t enough. Just as Lincoln Center has a manager and the conductor sharing the top slot, doctors and healthcare administrators ought to be deployed in tandem, maybe as husband and wife. The doctor dispenses pills; the administrator executes plans.

The healthcare administrator’s job, I would argue, is more important than the doctor’s. Except, in most villages, such a job doesn’t exist. The PHCs are manned by doctors and the panchayat leader squeezes in the sanitation and nutrition work amid her other duties. The ASHAs (accredited social health activists) do a decent job and are one of the most innovative schemes that the Indian government has come up with. But they are stretched. Just as the government recruited local women into becoming ASHAs, they can perhaps climb the ladder to becoming rural health supervisors. This supervisor’s job would be part PR, part brute-force execution and part infrastructure. She needs to convince the people who live on the banks of the Krishna that streaming their wastewater into the river will cause water-borne diseases downstream. She needs to cajole and coerce the village panchayat into installing toilets rather than having people defecate under the great blue yonder.

Part of the problem is that doctors, let alone administrators, don’t want rural postings. In late February, then Union health minister Anbumani Ramadoss announced that he was going to make rural postings compulsory even though, as many Indian medical blogs noted, they have “failed miserably” in the past. One medical education blog written by a Dr Anshu said that after being trained in medical colleges with sophisticated equipment and colleagues, doctors found the “learned helplessness” of rural postings frustrating.

This is one instance where I believe throwing money at the problem will help. Rural postings can only become attractive when they afford job satisfaction. Private charitable hospitals are doing a great job with this. Teresa is now taking her son to the Sathya Sai Baba hospital in Whitefield, Bangalore. We got her son an appointment via email and the neurologist is treating Gerald without taking a penny. The Mata Amritanandamayi Hospital has a waiting list of doctors wanting to serve, I am told. I am not a follower of “Amma”, or Sathya Sai Baba for that matter, but I would urge them to set up their institutions in remote rural spaces. The global manpower and funds they can draw will ensure a facility that will serve as a draw for not just patients but doctors and therefore, a thriving medical community that gives job satisfaction in rural postings.

Wouldn’t it stand to reason that the jobs that were the least satisfying ought to be paid the most? Of course, by that logic, a street sweeper ought to be paid more than a CEO. By that same logic, a rural medical posting ought to get more than the measly Rs10,000 that it commands. Double their wages, I say, to compensate for the intellectual isolation that doctors complain about. In this recessionary economy, that would make doctors flock to villages in droves.

Link: Original Article

H1N1 flu: WHO rubbishes lab test gone wrong theory

The World Health Organisation on Thursday debunked the theory that the deadly H1N1 swine flu virus was the result of a lab test gone awfully wrong.

The theory was recently floated by a renowned Australian virologist Adrian Gibbs who said that the new flu virus may have been created in a laboratory having accidentally evolved in eggs that scientists use to grow viruses in and drug makers use to make vaccines with.

WHO's assistant director-general Dr Keiji Fukuda said, "Based on our evaluation, the conclusion is that the hypothesis does not really stand up to scrutiny. The evidence actually suggests that this is a naturally occurring virus and not a laboratory derived virus."

Dr Fukuda said the WHO made the conclusion after a series of discussions with scientists in its five collaborating influenza centres, virologists across the world, experts from the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE).

According to WHO, all the scientists were asked to look at the evidence and then provide their opinion on whether it was a credible hypothesis or not. "We took the hypothesis very seriously, because of the nature of the hypothesis and because of the credible nature of the scientist. Because we are dealing with an influenza virus that is new, which originates from swine, we contacted the FAO and OIE," Dr Fukuda said.

Gibbs had said that genetic markers suggested that the combination of genes in the virus was not a natural event.

Dr Gibbs, who had studied the gene sequences of the swine flu virus posted on public data banks, argued that it must have been grown in eggs, the medium used in vaccine laboratories.

He reached that conclusion, he said, because the new virus was not closely related to known ones and because it had more of the amino acid lysine and more mutations than typical strains of swine flu.

Scientists at Imperial College, London, recently found that the H1N1 flu virus presently causing havoc won't be as catastrophic as the Spanish flu outbreak of 1918 that killed over 50 million people.

However, the virus does have a full fledged pandemic potential and appears to be as clinically severe as the H2N2 virus responsible for the 1957 Asian flu pandemic, in which four million people perished.

The 1957 pandemic started in China and came in two waves -- the first wave mostly hit children while the second mostly affected the elderly. In total, the pandemic caused about four million deaths globally.

Genetic analysis of the present virus has also revealed that the 2009 virus is more transmissible than seasonal flu.

The researchers estimate that the new strain is fatal in around four in every 1,000 cases.

Link: Original Article

May 15, 2009

Supreme Court awards techie Rs 1cr damages for medical negligence

In the highest compensation ordered by an Indian court in a medical negligence case, a techie who found himself paralyzed waist down after a surgeon damaged his spinal chord during an operation to remove a tumour in the chest, was awarded Rs 1 crore in damages by the Supreme Court on Thursday.

The victim, Prashant S Dhananka, 39, who spiritedly argued his case from a wheelchair he has been confined to since the operation 19 years ago, had sought a compensation of Rs 7 crore. The court, however, settled for an almost seven-fold increase in the Rs 15 lakh amount awarded by the Andhra Pradesh high court.

Though it is a pittance compared to the 5 million pounds (a little over Rs 37 crore) awarded to British TV actress Leslie Ash in a similar case last year, this Supreme Court ruling could be a trendsetter for judicial re-evaluation of compensation for victims of medical negligence.

Dhananka, a senior manager with Infosys earning Rs 1.5 lakh a month and residing in Bangalore, gave vivid details of the gross negligence he suffered at Nizam's Institute of Medical Sciences (NIMS), Hyderabad, and demonstrated the inadequacy of the compensation awarded by the high court. NIMS, a semi-government set up, is rated as one of the premier hospitals in the country.

While increasing the compensation to Rs 1 crore, the bench comprising Justices B N Agrawal, H S Bedi and G S Singhvi showed both its disgust at blatant attempts by NIMS to wriggle out of its responsibility for the victim's condition and acknowledged the need to provide for the huge medical expenses that Dhananka has had to incur every month since 1990.

"Fighting the case was a great struggle. We were totally disappointed with the compensation. The hospital made him totally dependent. He cannot even turn on his own," Prashant's mother Indira Sheshadri, 64, told TOI, from Bangalore.

Dhananka's nightmarish experience is similar to the case of national table tennis player V Chandrasekhar, who fought a legal battle against Apollo Hospital, Chennai, for over a decade before being awarded Rs 19 lakh by the Supreme Court in February 1995 -- the highest compensation in a medical negligence case in India before the Dhananka verdict. Chandrasekhar too had been left partially paralyzed due to medical negligence.

For Dhananka, it all began on September 19, 1990, when he got himself examined at NIMS for frequently recurring fever. Dhananka was studying mechanical engineering at the time. The hospital diagnosed a benign tumour in the chest. He underwent thoracotomy for removal of the tumour but due to negligence during the operation, his spinal chord was damaged. He developed paralysis in the lower part of his body and since then has been confined to a wheelchair. The apex court agreed with Dhananka's plea that his bright future was cut short due to the mistake of doctors.

While it took Dhananka 19 years to get justice, British actress Leslie Ash got her compensation in just four years. She had brought the claim after contracting an MSSA (methicillin-sensitive staphylococcus aureus) infection while being treated by the Chelsea and Westminster Hospital in London for two cracked ribs in April 2004. As a result of the infection, she suffered severe mobility problems and even after four years walked with the aid of a stick.

Dr P V Satyanarayana, who had performed the operation was then a professor of cardiac surgery at NIMS. He took voluntary retirement in 1996 and now works for a corporate hospital in Vizag. "The complication occurred in spite of taking all the precautions. It is not a case of medical negligence. Similar cases are mentioned in medical literature," he said.

Link: Original Article

WHO to publish guide for medical fraternity on H1N1 virus

With the number of H1N1 flu cases rising to 5,251 in 30 countries the World Health Organisation will soon publish initial guidance for clinical management to help the medical fraternity deal with the crisis.

"This guidance is to help doctors, nurses and persons who will be, and already are, caring for patients with this disease," Dr Nikki Shindo, Medical Officer in WHO's Global Influenza Programme, told reporters.

At the same time, she highlighted the fact that most patients will not require hospitalisation or antiviral therapy.

According to the latest figures, Mexico has reported 2,059 laboratory confirmed human cases of infection, including 56 deaths, while the United States has reported 2,600 cases, including three deaths.

Meanwhile, Canada has reported 330 cases, with one death, and Costa Rica has reported eight cases, including one death. Another 26 countries have reported laboratory confirmed cases with no deaths.

Shindo said her team has been looking closely into the clinical picture of the disease, including symptoms, severity and factors for hospitalisation and treatment, since the new flu outbreak began.

"The most important question from the beginning was why only Mexico was having very severe cases," she stated.

"The proportion of severe cases initially seemed to be very high in Mexico but not in the other countries. But as more information became available, the proportion of mild versus severe became very similar between these two countries – United States and Mexico."

Shindo said that there are mainly two groups that have been affected by very severe illness in these two countries. The first is persons with underlying chronic medical conditions, such as weak immune system, diabetes, cardiovascular disease and asthma. There have also been reports of very severe illness and death in pregnant women.

The second group is previously healthy, very fit young children and adults, and the reason why these cases become very severe is yet unknown, she said, adding that WHO is working with clinicians, especially from Mexico, to find the reason.

Link: Original Article

Wal-Mart is returning to business of medical clinics bit by bit

It has come to the knowledge that Wal-Mart is getting interested in the business of medical clinics yet again and hence, these days it is busy in rebuilding that business. However, at this time, the concentration is on building partnership with hospitals. Is this a new approach? In no way since the notion of medical business has been in the focus of Wal-Mart for years. It should be remembered that company spoke of having 400 walk-in clinics by 2010, near the beginning of last year. What did happen later on? The plan proved to be disastrous and of the 78 clinics that were in operation at the beginning of 2008, only 17 could operate.

Wal-Mart Stores, Inc. is a widely acclaimed American public corporation that runs a chain of large, discount department stores across the globe. What is more, it is the world’s largest public corporation by revenue, according to the 2008 Fortune Global 500. Besides the company is the largest private employer in the world and the largest grocery retailer in the United States, with an estimated 20% of the retail grocery and consumables business.

There are other aspects as well. It is H. Lee Scott Jr., the previous Chief Executive of Wal-Mart, who had allocated a big role for the clinic project to RediClinic, a privately held company backed by Steve Case, the AOL co-founder. But this was also black as RediClinic, on account of the moribund economic condition, shut down its 15 Wal-Mart centers all of a sudden.

Speaking on this Christi Gallagher, a Wal-Mart spokeswoman, confirmed that the company was “disappointed that RediClinic chose to close all of their locations.” She did mention that Wal-Mart had reopened two former RediClinics in Arkansas, Wal-Mart’s home state, in collaboration with the Northwest Health System. What is the current scenario of Wal-Mart medical clinics? There are only 33 clinics all over the country among them 26 are with a hospital affiliation.

Link: Original Article

Multi-disciplinary health care village planned in Kerla

A multi-disciplinary health care village has been proposed on 40 hectares of land in Kozhikode as part of providing integrated treatment facilities from all scientific streams of medicine.

Conceived by Infrastructures Kerala Limited (InKEL), the village, to be completed in four years, is estimated to cost Rs.417 crore. The project, being implemented in association with the State government, is expected to bring in another Rs.1,583 crore from the private sector in setting up other facilities.

The village is aimed at promoting medical tourism in the State, setting up wellness, preventive and alternative medicine centres, a medical college and a hospital with state-of-the-art health-care infrastructure, according to an InKEL official.

A 500-bed multi-specialty hospital is to be set up in the first phase. The village will ultimately have a 2,000-bed facility.

A medical college, a super-specialty hospital, a dental college, a nursing college and a paramedical institution will be part of the village. An exclusive Ayurvedic centre offering traditional treatment, along with a wellness centre, has been proposed, .

A medical education and training wing will come up on 10 hectares of land with the School of Medicine as the nucleus around which other institutions will function. The school will offer courses in multiple streams of traditional and modern medicine. Each stream will offer postgraduate and doctoral programmes in medicine.

The super-specialty hospital will come up in the medical services wing on another 10 hectares. The proposed recuperation centre is aimed at attracting NRI and medical tourists. Facilities such as helicopter evacuation, tele-diagnostics and telemedicine will be on offer for the needy.

Specialised centres for holistic treatment in Ayurveda, homoeopathy, naturopathy and Siddha will come up in the wellness, preventive and alternative medicine centre. An old-age home, along with a palliative care centre, is also included in the village.

Social amenities, such as residential quarters for the staff, recreation hubs, commercial hubs, educational institutions, solid- waste treatment plant, sewage treatment plant and biomedical waste treatment plant, have been proposed.

The village has been planned in such a way to project the State as a health-care and medical education hub for the world in the coming years, according to the InKEL official. InKEL will bring in co-developers or joint venture partners for the project.

Link: Original Article

May 08, 2009

Mass production of H1N1 Influenza vaccine may get WHO nod

Mass production of a vaccine against the deadly H1N1 swine flu virus — between one and two billion doses — could be given the go-ahead by the World Health Organisation next week.

An expert committee is meeting in Geneva on May 14 to finalise whether it is time for drug makers to switch from seasonal vaccine production to pandemic flu production.

Following this, another meeting at the highest level, among WHO director-general Dr Margaret Chan, UN secretary general Ban Ki-moon and heads of all big influenza vaccine manufacturers, will take place on May 19 to ensure fair and equitable distribution of the pandemic vaccine — once it is available — to developing countries.

It is expected to take four to six months for the first lot of the H1N1 flu vaccines to become available between the time the strain of the virus is identified and the first doses are made available to the general public.

CDC Atlanta has already isolated a sample of the virus and grown what’s called a seed stock — a strain of the virus that’s the first step towards growing a vaccine.

Marie Paule Kieny, WHO’s director of the Initiative for Vaccine Research, said on May 6 that the seed would be available to the manufacturers by the second half of May.

Link: Original Article

H1N1 flu outbreak may hit 1/3rd of world's population

Upto two billion people - one-third of the world's population - would be infected by the deadly Influenza A H1N1 flu human virus if the present outbreak turns into a full blown pandemic.

This is the World Health Organisation's official estimate made public for the first time on May 7 in Geneva.

The virus, which was isolated in Mexico around April 13, has already spread to 23 countries and has till now infected around 2,100 people and killed 42 others.

According to WHO's assistant director-general Dr Keiji Fukuda, the two billion estimate isn't a prediction "but that past experience with flu pandemics indicated one-third of the world's population gets infected".

Dr Fukuda said on Thursday night that with a world population of 6 billion people, "it's reasonable to expect that kind of infection tally".

He, however, said it is too soon to predict how many people would get seriously ill or die.

WHO had last week said a swine flu pandemic was imminent and raised its pandemic phase alert to phase 5, just one step away from a full fledged pandemic.

The medical journal `The Lancet' cited an article it published in 2006 recently which used data from the 1918-20 Spanish influenza pandemic to predict that the next global influenza pandemic would kill 62 million people, with 96% of the deaths occurring in low-income and middle-income settings.

Meanwhile, India continued to be free of infection with full-fledged health screening of passengers continuing in all its 21 international airports.

On Thursday, around 35,403 passengers were screened of which 6,009 passengers were from affected countries. Around 178 doctors and 87 paramedics have been deployed to man 70 counters at the 21 airports.

Two persons who disembarked at Bangalore airport have been referred to a identified health facility.

So far, samples of 24 persons have been tested and found negative for Influenza H1N1. Samples of two people - one from Hyderabad and the other from Jalandhar - along with the fresh samples from Bangalore are under testing at NICD and NIV.

As of now, no case has been reported in India.

Link: Original Article

Bill Gates pours millions into unorthodox health research

Microsoft co-founder Bill Gates has poured millions of dollars into unorthodox and largely unproven health research that would normally struggle to find funding.

Scientific projects, such as developing an anti-viral tomato, a flu-resistant chicken and a magnet that can detect malaria, will share millions of dollars of grants to support unorthodox thinking — and the outside chance of a world-changing discovery.

The Bill & Melinda Gates Foundation, the largest philanthropic foundation in the world, has thrown a lifeline to scores of such projects, awarding eighty-one $100,000 (£65,000) grants designed to encourage scientists to pursue bold ideas that could lead to breakthroughs, the Times Online reported today.

In a radical departure from conventional funding systems, the foundation sought only a two-page application for the first stage award.

Tachi Yamada, president of the Gates Foundation’s Global Health programme, said that unconventional approaches were necessary to stir up the thinking on diseases where advances had been slow.

"Some things require a revolution, rather than an evolution, in thinking. The problem is we can be locked into an orthodoxy of thinking that shackles us and prevents us from thinking in novel ways," he was quoted as saying by the British news portal.

Applicants were selected from more than 3,000 proposals, with all levels of scientists represented - from veteran researchers to postgraduates - and a range of disciplines, such as neurobiology, immunology and polymer science.

Dr Yamada said that he and Gates, both members of the review board which comprises scientists and entrepreneurs, accepted that 90 per cent of the projects might fail, and it was possible of an odd charlatan trying to apply for a grant.

"The point is that where there are currently no solutions, we must work hard to find new solutions. We really believe that true innovation is needed. Some of the ideas might seem crazy, but there is a fine line between crazy and absolutely novel," Dr Yamada underlined.

Each grant recipient will also get the chance of follow-on grants of US $ 1 million if their projects show success. The Foundation gave out US $ 2.8 billion last year but the global downturn will impact the fundings, with payouts likely to grow by about 10 percent.

Among the recipients of the Grand Challenges initiative are three British scientific teams pursuing novel approaches to prevent and treat infectious diseases such as tuberculosis, malaria and pneumonia, as well as viruses such as HIV.

"These are projects that are examples of high-risk research, in the sense that the outcome is less certain," said Professor Dickson, a leader of a British project that would receive funds.

Link: Original Article

Obama unveils $63 billion global health initiative

U.S. President Barack Obama on Tuesday announced a $63 billion, six-year health initiative to help people in the world's poorest countries, most of it to bolster existing programs.

"We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach to global health," Obama said in a statement.

Obama will request the money in his budget for the 2010 fiscal year that begins on Oct. 1. The White House has already released the main elements of that budget, but plans to offer greater details on Thursday.

The money will go toward efforts to fight AIDS, tropical diseases and other illness and to help improve maternal health. The initiative will be aimed at addressing "some of the biggest global health challenges," said Deputy Secretary of State Jack Lew.

The program to combat AIDS and malaria which is known as the President's Emergency Plan for AIDS Relief, and was created in the Bush administration, would get $51 billion over the six years.

The other $12 billion would be channeled to new programs to fight tropical disease and other health problems.

Link: Original Article

WHO changes swine flu name to 'H1N1 Influenza'

The World Health Organisation (WHO) updated on Thursday the number of laboratory-confirmed cases of what it is now calling only the H1N1 influenza, to 257, including eight deaths, but reiterated that there was no need for panic.

The largest spike came from Mexico, where the number jumped from 26 cases to 97, including seven deaths. In the United States, across ten states, there were 109 cases including one death of a toddler in Texas.

Keiji Fukuda, the health security chief of the WHO, said it would cease use of the word "swine" and stick with the scientific title of a new variant of influenza A(H1N1).

"We know it is an H1N1 virus. This is scientifically accurate and doesn't place any stigmas," he said.

"This is to try to reduce some of the overreactions to swine flu as a name," Fukuda said, urging people not to overstep in their reactions.

The spread of the virus is believed to be in the form of human-to-human transmission and not from pigs or pork. In spite of moves by states to ban imports of pork from affected countries, the WHO has insisted eating properly prepared pig flesh was not a danger.

Late Wednesday the health agency had raised its pandemic influenza alert to Phase 5, just one below the highest, in light of evidence showing sustained human-to-human transmission in communities in the United States and Mexico.

The WHO has not ruled out that it will raise the level once more, but said while the disease was spreading, it had not yet pinned down the nature of the virus. It caused mild disease in most cases but had also shown itself to be fatal.

"No move to phase 6 is imminent right now," said Fukuda. There is "nothing that epidemiologically suggests to us today that we should be moving towards phase 6."

"We shouldn't be panicking. The right way to approach this is to be alert," he explained.

"The whole reason for doing this, going through phases, letting people know, is to prepare and provide as much time to prepare as possible," Fukuda went on.

"Influenza pandemics occurred in the past. We know they can be quite mild, they can be in between or quite severe," he said, adding that the WHO wanted to avoid taking the situation too lightly now only for it to rear up later as a dangerous pandemic.

"Prepare for the worst and if something much softer comes along, count your blessings," he summed up the philosophy at the WHO.

Canada had 19 cases in four provinces. Spain had 13 confirmed cases, including one case of community spread, with the rest in people who returned from Mexico, where the outbreak is believed to have started.

Other countries with confirmed cases included Britain, New Zealand, Germany, Israel and Austria.

Countries were reporting some higher numbers while others, not on the WHO list yet, including Switzerland, the host country of the WHO, said they had confirmed cases.

The increases in statistics were largely from final laboratory results that were made public.

Meanwhile, the International Federation of the Red Cross and Red Crescent Societies (IFRC) said it was appealing for $4.4 million to respond to the outbreak.

The federation, which unites all national societies, said it was ready to mobilize hundreds of thousands of volunteers across the globe should the need arise.

"The number of volunteers is increasing by the hour," said Tammam Aloudat, a health expert with the IFRC. In Mexico they were "active in communities by spreading messages, doing surveillance support and also handling the transport of patients."

He noted that those most at risk were people who were uninformed about personal health and those living in poor, crowded areas where sanitation networks were dirty and insufficient.

Like the WHO and private sector drug companies, the IFRC said the world was better prepared then ever for a possible pandemic due to steps taken following the avian flu outbreak earlier this decade, primarily the preparation of national action plans.

Link: Original Article

Charitable hospitals may face I-T scan over Clinical trials

Public hospitals and speciality healthcare and research institutions operated by charitable trusts can no longer avail tax exemptions on revenue they earn from performing clinical trials, a profitable and growing business opportunity.

An amendment to section 2(15) of the Income-tax Act—which defines what a charitable purpose is—that came into force in April stripped such institutions of the tax breaks they enjoyed despite conducting such research for commercial gains, often for overseas drug companies. Such institutions could now come under the income tax (I-T) department’s scanner.

Clinical trials have emerged as a business avenue for several leading hospitals across the country, a majority of them speciality institutions and research centres run by trusts registered under the charitable trusts Act of various states. They perform research in fields such as cancer, cardiology and women and child healthcare.

Trusts are regulated by charity commissioners under state governments.
Because most commissioners are unfamiliar with clinical research, they often can’t differentiate it from normal charitable activity, allowing some institutions to get away with tax exemptions they are not entitled to.

According to healthcare industry estimates, India has 500,000 hospitals and at least 20% of them, or 100,000, are run by charitable trusts. Some 2,000 of them are speciality hospitals that conduct clinical trials.

According to a January study, conducted jointly by Yes Bank Ltd and the Organisation of Pharmaceutical Producers of India, the contract research and development market in India is expected to expand to $3 billion (Rs15,060 crore) by 2015.

The size of the market was $430 million in fiscal 2008 and it has been growing at the rate of 75% annually. Contract research is mainly the research work outsourced to India by global drug makers and at least two-thirds of it relates to clinical research.

Over the past three years, clinical research has become a profit-making industry, and is purely commercial in nature, said Kishore P. Ghiya, a trustee of Rajkot Cancer Society, which runs the VR Desai Cancer Research Institute, a speciality hospital in Rajkot, Gujarat.

“This activity is purely commercial. Clinical research organizations, or CROs, are carrying out this activity on behalf of drug companies for (the) sole purpose of profit, and there can be no scope of medical relief in an activity which is carried out as a trial on patients for finding out (the) usefulness of a particular drug or components of drug under research,” he said in a letter to the chairman of the Central Board of Direct Taxes (CBDT).

Ghiya, who asked CBDT to look into a possible nexus between hospitals and CROs, is concerned that donors to the trust may hesitate to continue supporting it as doctors and management of its cancer speciality hospital have been undertaking trials for drug makers, and wants a clear line drawn between commercial and charitable activity. He added that “the organization cannot claim tax benefit of scientific research as per section 35(1) (ii) of Income-tax Act, where the organization has to do original basic research and (the) parameters of research are designed by hospitals.”

A person from the Mumbai-based Tata Memorial Hospital, which focuses on cancer treatment and research, said the institution was aware of the income-tax regulation and is “already in the process of compliance to maintain separate books for such activities, if any”. The person didn’t want to be named.

A spokesperson for CBDT said action will be taken against entities that violate the rule relating to tax exemptions, but declined to comment on any specific cases.

The amendment to the Income-tax Act specifies that the “advancement of any other object of general public utility” shall no longer be considered a charitable purpose if it involves “any activity in the nature of trade, commerce or business or any activity of rendering any service in relation to any trade, commerce or business”.

According to an income-tax circular issued in December, the amendment was made because “a number of entities who were engaged in commercial activities were also claiming exemption on the ground that such activities were for the advancement of objects of general public utility”.
However, medical charitable trusts can continue to claim tax exemption under section 35(1) (ii) and section 80G of the Income-tax Act for providing other charitable social services which do not have any commercial benefits.

Link: Original Article

May 01, 2009

Indian Medicos Blog is now 500!

Indian Medicos Blog is now 500 posts old!

In the past 28 months issues and news that concern the Indian Doctors, the Medical Community and Indians at large have been diligently brought together at one place on the internet.

Since Indian Medicos rarely generates content, I've relied primarily on Google News to search, collect and present the information essential to us. Thanks to all the news agencies for the content.

Since Jan 31, 2007 almost 40,000 people have visited and hopefully benefited from this blog. If you're a regular reader or a first timer, please provide your feedback on the content, the new format of presentation etc.

Thank you all! Please link to Indian Medicos from your blogs and websites.

Is the world staring at the worst health crisis in 90 years?

This could be the worst health crisis facing the world in 90 years. With the World Health Organisation (WHO) on Thursday raising its alert level to phase five for swine flu — just one step short of seeing a full-blown pandemic affecting at least two regions of the world — health experts were fearing a situation similar to the 1918 Spanish Flu which killed at least 50 million people. That's because H1N1 (the swine flu virus) is the closest so far to the Spanish Flu virus.

While that kind of mortality is ruled out now, given the advance of medical science and the quick spread of information and awareness in today's world, WHO was taking no chances as it now knows that the disease can spread easily between humans and hence raised the alert which is read as a signal that a pandemic is imminent. The Avian Flu (also known as bird flu) had an alert which was two notches lower, which means the danger this time is much higher.

Worldwide, at least 13 countries have confirmed cases of swine flu. Switzerland became the fifth European country to report a case of the disease in a 19-year-old student, and the Netherlands soon after became the sixth, reporting a case of the virus in a three-year-old who had recently returned from Mexico. Britain, Germany, France and Austria are the other European countries where authorities have begun a campaign urging people to sneeze into tissues and wash their hands after that. The campaign was called, ``Catch it, bin it, kill it.'' The disease has also spread to Costa Rica and Peru.

Raising the alert — the second in three days — WHO's director general Dr Margaret Chan asked all countries to activate pandemic flu plans and called on them to be on high alert for a H1N1 swine flu outbreak. Describing Influenza viruses as notorious for their rapid mutation and unpredictable behaviour, Dr Chan said, ``Influenza pandemics must be dealt with seriously and precisely because of their capacity to spread rapidly to every country in the world. New diseases are, by definition, poorly understood. WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.''

According to Dr Chan, at this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities. ``This change to a higher phase of alert is a signal to governments, to ministries of health and to the pharmaceutical industry that actions should now be undertaken with increased urgency and at an accelerated pace,'' Dr Chan added.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefiting from it, said experts. According to WHO, the biggest question, right now, is how severe will the pandemic be, especially now at the start? Dr Chan says it is possible that the full clinical spectrum of this disease goes from mild illness to severe disease.

``From past experience, we know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries. This is an opportunity for global solidarity. After all, it really is all of humanity that is under threat during a pandemic,'' Dr Chan said.

Justifying raising the pandemic alert to phase five, WHO's assistant director-general Keiji Fukuda said in a global teleconference on Thursday night, ``Phase 5 indicates the spread of the virus among communities, normal people who haven't visited Mexico or come in contact with travellers.''

WHO has been tracking the spread of the virus at the epidemiological, clinical and virological levels.

Dr Fukuda said, ``We found sustained human to human transmission in multiple generations. When we looked at the virus in Mexico and US, we found that it was beginning to behave like a human virus and was becoming part of our community and not just being spread by travellers. This therefore made us increase the pandemic threat.''

He added, ``Pandemic phases aren't intended to be a barometer of epidemiology of the virus but a clear warning and alert that the risk of the virus to reach your country is now significantly high.''

Link: Original Article



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