Thursday, 25 May 2017

Proposed Revision of WMA Resolution on Tuberculosis: Inputs required

Document no:
SMAC 206/Tuberculosis REV/Apr2017
Proposed Revision of WMA Resolution on Tuberculosis

Constituent Members
Action(s) required:
For consideration
As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that the WMA Resolution on Tuberculosis should undergo a major revision. The Indian Medical Association (IMA) volunteered to undertake that work.
At its 204th session in Taipei (October 2016), the Council decided to circulate the proposed revised document within WMA membership for comments. The 206th Council session in Livingstone (April 2017) considered the revised version and decided to circulate it again within WMA membership for further comments.


1.            According to the World Health Organization, tuberculosis is a significant global public health problem affecting over 8 million cases every year with 2.2 million infectious cases and over 1.5 million deaths. South East Asian and African countries are most affected.

2.            In developing countries, the incidence of tuberculosis has risen dramatically because of high prevalence of HIV/AIDS, increasing migration of populations, urbanisation and over-crowding.

3.            The emergence of strains of tuberculosis bacteria resistant to first-line drugs have become a major public health threat in the forms of multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR TB) due to indiscriminate or inappropriate use, lack of access, poor compliance or incomplete treatment.

4.            MDR tuberculosis is a significant threat to development and the safety of global health.

5.            Community awareness and public health education and promotion are essential elements of tuberculosis prevention.

6.            Screening of high risk groups including PLHIV (people living with HIV) and vulnerable population including migrants, prisoners and the homeless is important in tuberculosis prevention.

7.            Rapid diagnosis with molecular tests and supervised daily treatment started at the earliest should help arrest the spread of disease.

8.            BCG (Bacille Calmette-GuĂ©rin) vaccination as early as possible after birth should continue until a new more effective vaccine is available.


8.       The World Medical Association, in consultation with WHO and national and international health authorities and organizations, will continue its work to generate community awareness about symptoms of TB and increase capacity building of health care providers in early identification and diagnosis of TB suspects and ensuring complete treatment utilizing Directly Observed Treatment Short course.

9.       The WMA supports calls for adequate financial, material and human resources for tuberculosis and HIV/AIDS research and prevention, including adequately trained health care providers and adequate public health infrastructure, and will participate with health professionals in providing information on tuberculosis and its treatment.

Health care professionals should have access to all required medical and protective equipment to prevent against the risk of infection and spread of the disease.

10.    The WMA encourages continuing efforts to build up the capacity of health care professionals about increase in the use of rapid diagnostics methods, their availability in the public sector and in the management of all forms of TB including (MDR and XDR).

11.    The WMA calls on its Member National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and in the community for early reporting.

12.    The WMA calls on its National Member Associations to propagate methods of TB prevention including respiratory hygiene, cough etiquettes, and safe sputum disposal.

13.    National Member Associations should encourage all its members to timely notify to relevant authorities, all patients diagnosed or put on TB treatment for initiation of contact screening and adequate follow up till the completion of treatment.

14.    National Member Associations should co-ordinate with their TB National Programme and promulgate the adopted guidelines to all members.

The WMA supports WHO's efforts and call upon all governments, communities, civil society and the private sector to act together to end tuberculosis world-wide.

All should jointly promote collaboration using new innovative approaches to achieve TB free World and achieve the Sustainable Development Goals (SDGs).

Postnatal depression is a silent killer in India

Postnatal depression is a silent killer in India Timely intervention can help cure 80% of such cases New Delhi 24 May 2017: Postnatal depression is an illness that affects about 20% of mothers in developing countries like India, according to the World Health Organization. However, this kind of depression is still not recognized much. There are roughly 130 million births every year in India and provided this situation is addressed, the number or women with clinical depression is only likely to increase in the coming years. There are many factors that trigger depression in new mothers, some of them being unplanned pregnancy, an abusive relationship, alcoholic spouse, pressures to have a male child, and hormonal changes. The symptoms of postnatal depression tend to often go unnoticed. Some of them include anxiety, crying spells, mood swings, lack of sleep, difficulty in bonding with the baby, and negative thoughts and hallucinations. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "A majority of new mothers experience some amount of distress. This may sometimes require medical help and counseling. However, the symptoms often go unnoticed in the excitement of welcoming a baby. Postnatal depression is often accompanied by phobia and anxiety. Timely intervention can help cure 80% of such cases in a matter of 5 to 6 months. However, the remaining 20% can develop severe mental depression and other related ailments." Postnatal depression can have other related effects as well. Stress can affect milk production in new mothers thereby hindering lactation. As a result, the baby may become irritable and not achieve adequate physical and mental growth. Dr Aggarwal further added, "One of the major challenges in addressing postnatal depression is the lack of awareness, ignorance and social stigma surrounding this condition. A majority of women do not recognize or are unable to understand the symptom that follow childbirth. Even if they do, many are unwilling to seek medical help as psychiatric problems are not taken very well in the Indian society even today. The need of the hour is to create awareness among pregnant women, new mothers, and the family and counsel them on how they can support the women through this phase. " Here are few things one can do as a new mother to understand and cope with their anxiety. • Get enough rest. Tiredness can make anxiety worse and give you a constant gloomy feeling. Try catching small naps when the baby is asleep. • Eat at smaller intervals. Low energy levels can impact mental health. • Try not to feel guilty about not helping around the house. Understand that this is a temporary phase and it is not wrong to ask for help. • Indulge in activities that can help you in getting distracted from any negative thoughts, such as reading a book and listening to music. Take a short walk if it helps you feel better • Lastly, do not compare yourself with other mothers. Each pregnancy is different and understanding this will help you feel better.

Wednesday, 24 May 2017

PCOS a major cause of infertility among Indian women

PCOS a major cause of infertility among Indian women Study finds about 25% of Indian women to be suffering from this condition, excess weight being a major contributing factor New Delhi 23 May 2017: According to a study by the PCOS Society, 1 in every 10 women in India suffers from polycystic ovary syndrome (PCOS). Out of every 10 women diagnosed with this condition, 6 are teenage girls. PCOS is a common endocrinal system disorder among women of reproductive age. Additionally, about 20% to 25% of the women in India who are in the childbearing age suffer from PCOS, shows a study conducted by the department of endocrinology and metabolism, AIIMS. Those with PCOS have been found to have higher than normal insulin levels. Such an increase in the level of insulin can make the ovaries produce more androgens such as testosterone. Such women therefore struggle with weight issues, complicating the disorder further. If left unchecked or undiagnosed, PCOS can lead to infertility and a host of other long-term health concerns. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "PCOS can lead to the development of cysts as the ovaries are unable to release eggs on time. As a result of this, the follicles keep growing and form multiple cysts, which appear like 'a string of pearls'. Women are more likely to develop PCOS if their mother or sister also have this condition. The symptoms of PCOS include weight gain, fatigue, unwanted hair growth, thinning hair, infertility, acne, pelvic pain, headaches, sleep problems, and mood changes. Symptoms can begin shortly after puberty and reach into early adulthood. Young girls with PCOS tend to have irregular periods or amenorrhea, and heavy or scanty bleeding during menses. PCOS can also make women vulnerable to other health complications like hypertension, high cholesterol, anxiety and depression, sleep apnea, heart attack, diabetes and endometrial, ovarian and breast cancer." Though PCOS cannot be cured, it can be managed by bringing about certain lifestyle changes such as losing up to 5% to 10% of body weight. It is also important to maintain an active routine and eat healthy. Adding further, Dr Aggarwal, said, "PCOS, particularly among young girls, is an urgent public health problem requiring careful assessment, timely intervention, and appropriate treatment. The best possible way to manage this condition is exercise and a healthy diet which in turn will regulate the menstrual cycle and lower blood glucose levels." Additionally, the following tips can help manage PCOS better. • Consume foods that are high in fibre such as broccoli, cauliflower, and spinach; nuts like almonds and walnuts; and foods rich in omega-3 fatty acids. • Have five small meals instead of three big meals as this will help in metabolizing food and maintaining weight. • Indulge in physical activity for about 30 minutes a day, five days a week to reduce or maintain a reasonable weight.

Straight from the heart: The plight of the medical profession today

Straight from the heart: The plight of the medical profession today IMA is the voice and represents the collective consciousness of the medical profession in the country. It practically covers all the doctors in India directly through its membership of 3 lakhs, spread over 30 States and 17 Local Branches, and indirectly through federation of medical associations to the rest of the medical professionals in the country. IMA also is connected to every medical professional in the world through the Confederation of Medical Associations in Asia and Oceania (CMAAO) & the World Medical Association (WMA). The medical profession is going through its toughest time with the nobility and dignity of medical profession at stake. Some black sheep amongst us are taking away the entire nobility and dignity of the medical profession. They must be exposed at the earliest. Medical profession was, is and will always remain noble. First and foremost, it is important for us to understand that we are medical professionals and not a business house. To run a business, a businessman does not require a registered degree or follow a professional code of conduct. But we, professional doctors, are being controlled by corporate houses whose ethics differ from that of ours. They can market, distribute commissions and advertise their services, which is unethical for professional doctors and is a professional misconduct as defined by the MCI Code of Ethics Regulations. Bureaucrats and legislators must look into this matter and allow only professionals to own, manage and/or run medical establishments. Have we ever heard of law firms and legal arbitrators owned by business houses? To prosecute a doctor for criminal medical negligence, any medical action taken by him/her, should have been done with an intention to harm or with the knowledge that it can cause harm and the patient is not informed about the same. But, this is not the case in a medical practice, we never treat with an intention to harm or treat without an informed consent. Then why are doctors again and again subject to criminal prosecution? Criminal prosecution of doctor should be an exception and not a routine. The situation today is that doctors now are being prosecuted in various special acts for non-professional activities like not wearing apron, not displaying a defined board or not keeping a copy of PC PNDT Act. Doctors are also being prosecuted for minor violations of privacy, confidentiality of patient information and data and violations of minor clauses in surrogacy, IVF and HIV-AIDS Acts. This is not acceptable to the medical profession. Doctors provide subsidy to the patients. Doctors, whose consultation fees may be more than Rs. 2,000/-, constitute only a small percentage. Most GPs in metro cities charge less than Rs. 200/- as their consultation fee; often this also includes dispensing medicines along with professional consultation. To err is human. Doctors are bound to make mistakes and are covered for the same under indemnity insurance. But the compensation awarded for negligence cannot be in crores. There are more than six cases on record, where the compensation awarded against the doctors have ranged between 1 and 12 crores. Also, the method used for calculation of compensation is based on the income of the patient and not the seriousness of the illness. For the same amount of fee charged by a doctor and for the same illness depending upon the income of patient, the compensation awarded may be in lakhs or crores. The formula 70 - age x annual income + 30% - one third should not be acceptable to medical profession as it discriminates a poor from the rich. The formula of compensation calculation for drug trials as defined by the Drugs and Cosmetic Act may be the best alternative. This formula depends on age and the seriousness of the patient. Doctors are professionals and professional autonomy is their right. It is the duty of the doctor to provide rational treatment, which includes rational use of drugs and investigations. No one can take away this autonomy from a doctor. The job of a doctor is also to provide affordable, quality and safe health care. Today, most doctors are not informed about any new drug launched in the country, drug/s banned in the country, drugs found to be substandard quality or fake/spurious drugs. Similarly, any drug labelling changes, whether deletions or additions, are not communicated to the doctors. So, all doctors today depend on the industry to update their knowledge. The government allows the same salt to be sold by the same company at three difference prices as generic-generic, generic-trade or generic-branch. Why does the government not adopt ‘one drug - one company - one price’ policy? How can the government grant a license to companies to sell drugs at different rates, but then forces doctors to choose only the cheaper drugs? It’s like giving licenses to open five star hotels, but simultaneously issuing an advisory to the public to not to go these hotels. Medical profession is not against accountability, but violence at any cost is not acceptable. Disturbing a doctor while he/she is on duty in the critical area, either verbally, mentally or physically, is not acceptable. Any act of violence against doctors should be made a punishable, non-bailable offence with imprisonment of up to 14 years. The doctors posted in critical areas are on a sensitive duty, where they look after critically ill patients and violence can endanger multiple lives. A stringent central law is the only answer. Every critical area in the hospital must have voice activated CCTV camera and adequate doctor-to-patient ratio. The government policy of allowing four minutes per patient needs to be changed. Doctors also want single window accountability for registration for license to practice and registration of their medical establishment. Let doctors concentrate on their professional work and not divert their energies in permissions and administration matters. MBBS doctors are the need of the hour. They need to be cultivated and empowered. They should be involved under retainership in all national health programs. More than 25,000 postgraduate seats need to be introduced in family medicine. There must be a simpler way for them to get PG after completing their MBBS. It does not make sense for them to appear in another exam (NEXT) to get license to practice. As per the government, there is a shortage of doctors in rural areas. A rural posting is challenging and a difficult posting. Therefore, doctors posted in rural areas must be given income tax-free double income compared to a person practicing in an urban area. The professional autonomy must also be respected for specialists and for regulatory bodies. Consultants cannot be given targets to achieve and the government cannot take away the autonomy of the regulatory body ‘Medical Council of India (MCI)’ and bring a nominated national medical commission in its place. A knife in the hands of a monkey and modern medicine in the hands of quacks, chemists and doctors of other systems of medicine can kill a person. The general public has right to get the best of the treatment. Every citizen has a right to receive affordable or free preventive and emergency health care. If the government cannot provide this, then it shall ensure its availability through private sector for which the government should reimburse the same. But all this is not possible without increasing the health budget to 5% of GDP. At present, the government is looking after only 20% of population in the government sector for which 1% of budget may seem reasonable to them. All our doctors in service, residents and medical faculty must get uniform conditions of service, may it be with regard to retiring age, salary, or other service conditions etc. No way doctors can be kept on contracts and not made permanent for decades. Doctors are often blamed of being in a nexus with chemists, industry, hospitals and laboratories. One must not forget that for any unethical act, the ethical act needs to be defined first. If a pharma company is updating my knowledge free of cost and if I choose a drug of that company out of over 50 brands available in the market, I cannot be blamed of being partial. Anyone can criticize me but not the MCI or the ministry as pharma companies are doing their job of updating my knowledge. Similarly, any referral with a service involved is not a cut or a commission. If I refer a patient to a specialist and make a detailed summary, then I am entitled for my services to be paid by the patient. Let the government not forget that they are supposed to look after 100% of the population and not differentiate the poor from the rich. Today the private sector is forced to cater to 80% of the health care and is overburdened. But at what cost? The private sector should in fact be provided with all possible subsidies for the same. All this is possible and not difficult to achieve. IMA is willing to spend two hours every day at Nirman Bhawan and work hand in hand alongside the government. To our fellow colleagues, I say, all doctors are good. Let us not criticise each other and defame the medical profession. I hope this “straight from the heart” reaches the “Mann ki Baat” of the Prime Minister

Tuesday, 23 May 2017

IMA to organize Dilli Chalo movement

IMA to organize Dilli Chalo movement Over a lakh doctors to join the movement digitally and physically to bring to light atrocities faced by the medical fraternity New Delhi, 22 May 2017: The National IMA is organizing the Dilli Chalo Movement on 6th June 2017 to bring forth the atrocities faced by the medical fraternity and has urged all its members to join the movement in entirety. The Protest March will start at 8:00 AM from Rajghat and reach the Indira Gandhi Indoor Stadium by 11:00 AM. The march, which will be joined by over a lakh doctors in the country, both digitally and physically, will be followed by deliberations on issues ailing the medical profession. The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of FOMA were also conducted. The IMA is undertaking targeted intensive lobbying in the month of May. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "The medical profession is facing the most difficult time of the era. Both doctors and patients have to understand that the 'Doctor–Patient' relationship is a sacred one and that the dignity of the profession should be maintained. It won't be wrong to say that justice has been denied to doctors even within the framework of the constitution of India. People are indulging in violence against doctors which is further being condoned by governments and other institutions. Prescription rights of doctors are being trampled upon which can have disastrous consequences for patients. There is absolutely no end to the injustice being heaped upon the medical fraternity and this noble profession. It is after having decided that enough is enough that the IMA has given this clarion call, Dilli Chalo." IMA is also initiating a signature campaign on the issues at hand on social media and has urged all doctors to join and collect hundreds of thousands of signatures to demand justice from the government. Adding further, Dr Aggarwal, said, "NEXT was stopped on track by the all-India strike by medical students on 1 February. IMA is now launching No to NEXT 2.0 on 6th June 2017. As part of this, all medical students and colleges in the country will go on strike and conduct protest meetings. The Pen Down Satyagraha will see all doctors across India, in all sectors, not giving any prescriptions for one hour between 10 am and 11 am in solidarity with the Dilli Chalo movement to save professional autonomy." The Dilli Chalo movement aims to address the following demands by the medical fraternity: • Implementation of the Inter-ministerial committee meeting report within six weeks • Stringent Central Act against violence on medical professionals • Single-window accountability with no criminal charges on doctors without intent to harm a patient • Single-window registration of doctors and medical establishments • Preserving professional autonomy by amending Indian Medical Council Act instead of bringing national medical commission • Uniform final MBBS exam instead of 'NEXT' • Pan-India uniform service conditions for medical doctors and other health care providers • Amendments in PC PNDT, Central CEA, and West Bengal CEA Acts • IMA member in every government health committee • No commercial rates on medical doctors providing subsidy • Anti-quackery laws (no one other than qualified MBBS or BDS can prescribe scheduled modern medicine drugs) • Protection of professional autonomy (no interference in freedom to choose quality affordable drugs, investigations, and treatment) • No variation in market prize for generic-generic, trade-generic, and brand-generic drugs • Reimbursement of all emergent services in private sector for people who cannot afford treatment • Health budget of 2.5% in the coming year • Promotion of family medicine in India with 25,000 PG seats in family medicine

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA This is not true: Indian Medical Association Dr KK Aggarwal National President IMA DNA has reported a Lancet study that India's poor ranking is primarily because of the rise in cases of tuberculosis (TB), diabetes, rheumatic heart disease and chronic kidney disease. India has failed to achieve in healthcare goals, badly lagging behind China, Sri Lanka and Bangladesh in terms of accessibility and quality. India was ranked 154th position in the ranking of healthcare quality amongst 195 countries, whereas some countries like South Korea, Peru and China have seen greatest improvements in healthcare access and quality since 1990. China, with a score of 74 on the index, has been ranked at 82 - far ahead of India, and Sri Lanka has scored 73 on the index. Similarly, Brazil and Bangladesh have score 65 and 52, respectively. India performed worse than expected in TB, diabetes, rheumatic heart disease and chronic kidney disease. The 32 diseases for which death rates were tracked included TB and other respiratory infections, illnesses that can be prevented with vaccines - such as diphtheria, whooping cough, tetanus and measles - several forms of treatable cancer and heart disease, and maternal or neonatal disorders. I do not agree. This is not the correct picture. Government statistics are based on data from government set ups, which cater to only 20% of the society. The remaining 80% are seen by the private sector. When we say 10 million cases of TB are missing from government data, this does not automatically mean they do not get treatment. In fact they might be getting better treatment than the government sector. Private sector results for all these 32 diseases may be better than in the government sector. We should not extrapolate any inference from such studies. Unfortunately, British media is always negative with regard to the Indian health scenario. Why, we do not know? Most of their stories against India are negative. Is medical tourism in India responsible for it?

Monday, 22 May 2017

IMA calls for issuing "Good Standing Certificate" to doctors

IMA calls for issuing "Good Standing Certificate" to doctors Writes to MCI in light of a recent incident to carry out probe against a doctor New Delhi, 21 May 2017: In light of a recent incident, the IMA has written to the MCI expressing its viewpoint about NRI doctors barred abroad working in India. As per the US court, the doctor has been ordered “not to practice medicine in any form within the United States or any other country". As per a recent court directive, based on news reports that an Indian-origin doctor, who has been barred from practicing by a US court, is now treating patients in Delhi and Gurgaon, the Member Secretary of Delhi State Legal Services Authority, Sanjeev Jain, was asked to verify the doctor's name and address, carry out an immediate probe, and file a report within four days. It also issued notice to the MCI to file a report on the mechanism, statutory regime as well as rules and regulations in place to scrutinize and check such practices and made the Ministry of Health and Family Welfare a party. Speaking collectively on behalf of IMA, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "IMA is for a defined policy in such cases. We believe that the MCI needs to issue a 'Good Standing Certificate' to all graduates and post graduates who wish to register with registering authorities in other countries. This will serve as an indication of a good track record and also be a proof of the fact that the concerned person has committed no ethical breach and/or violation. A similar condition should also be imposed for Indian doctors practicing in other countries and wanting to come back and practice in India after getting registered in another country. This will ensure transparency and hence, lesser mishaps of the nature." At Delhi High Court, a bench of Acting Chief Justice Gita Mittal and Justice V K Rao, took a suo moto note to examine the issue on whether Indian-origin doctors, barred from practicing by a foreign country can practice in India. Adding further, Dr Aggarwal, said, "It is just a way to ensure quality of doctors is maintained. If we are asked for a certificate when we go to practice abroad then why can’t we ask for it from those who want to practice in India. We had spoken to MCI officials about this and they asked us to write to them."