IMA reinforces quitting tobacco for longer life on World No Tobacco Day Urges doctors to follow healthy practices and set an example New Delhi, 30 May 2017: According to statistics, India is the second largest consumer of tobacco and related products. The country records over 8 to 9 lakh deaths every year due to tobacco-related diseases. a vast majority which falls prey to tobacco-related diseases and other chronic ailments. A survey by the Global Adult Tobacco Survey (GATS) India states that about 35% of teen adults over 15 years use tobacco and 33% of males and 18% of females in the adult category consume some form of smokeless tobacco. The 31st of May every year is observed as the World No Tobacco Day and the theme this year is 'Tobacco: a threat to development.' Tobacco consumption in any form, be it cigarettes, beedi, ghutkas, pan, khaini, sheesha, or even e-cigarettes can have detrimental effects on health. This is by far the most easily available and most commonly found legal hazardous material and also heavily promoted and marketed. 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 most common factors cited for a rapid increase in tobacco consumption among different age groups, particularly adolescents, are peer pressure or societal norms, increase in stress, bad influence, behavioural changes, and parental and sibling addiction and depression. Tobacco contains a wide range of carcinogens which interfere with the reproductive system of both men and women, cause cardiovascular problems, cancer, and infertility, and also increase the risk of Type II diabetes. Consuming tobacco in any form also leads to genetic mutations and increases the risk of miscarriages and still birth." Tobacco cravings or the urge to smoke can be powerful. However, it is important to remember that this urge will probably pass within few minutes whether or not a person smokes a cigarette or takes a dip of chewing tobacco. Each resistance is one step closer to quitting this deadly habit for good. Adding further, Dr Aggarwal, said, "As doctors and brand ambassadors of health, we have a huge responsibility to fulfil. Though doctors also have immense work stress, this should not be a driver towards addiction to any form of tobacco. IMA's Koi Dekh to Nahi Raha campaign focuses on how doctors can set examples for their patients. Being a doctor is considered a noble profession. We preach good habits to our patients on a daily basis. Therefore, the public perception at large is that doctors and other medical professionals practice what they preach, that is, they do not smoke or drink. As a doctor or a healthcare professional, you should always ask yourself,' Koi dekh to nahi raha?' to remind yourself and ascertain that you are not drinking or smoking in the presence of your patient in a social setting. This will ultimately be for the patient’s benefit in the long run." One can try and follow the tips given below to try and quit this deadly habit. • Try short-acting nicotine replacement therapies such as nicotine gum, lozenges, nasal sprays, or inhalers. These can help you overcome intense cravings. • Identify the trigger situation, which makes you smoke. Have a plan in place to avoid these or get through them alternatively. • Chew on sugarless gum or hard candy, or munch raw carrots, celery, nuts or sunflower seeds instead of tobacco. • Get physically active. Short bursts of physical activity such as running up and down the stairs a few times can make a tobacco craving go away.
Wednesday, 31 May 2017
Any smoking is harmful to health: Social smoking carries similar heart risks as current smoking Today is World No Tobacco Day. Any amount of smoking is injurious to health. Even people who smoke only occasionally - ‘social smokers’ - have a risk of heart disease that is similar to people who smoke daily, says a new study published in the American Journal of Health Promotion. The study evaluated self-reported smoking habits, cholesterol levels and blood pressure in around 40,000 adults across the United States. Ten percent of the participants were found to be social smokers who smoked regularly in certain situations but not daily, while 17% were current smokers. Individuals aged 40 or younger were more likely to be social smokers. • Compared with non-smokers, social smokers had significantly higher risks of having hypertension (odds ratio [OR]: 2.08) and high cholesterol levels (OR: 1.53). • Social smokers and current smokers had similar odds of having hypertension (OR = 0.94) and high cholesterol (OR = 0.95), risk factors for heart attacks and stroke. • Both current and social smokers had similar rates of hypertension, 76% vs 75% respectively and high cholesterol levels 55% vs 53%, respectively. Although this study did not quantify the magnitude of impact of social smoking on heart health compared to other patterns of tobacco use, it does bring to the forefront the fact that any smoking is harmful to health. Social smokers often do not comprehend the health risks associated with only occasional smoking. It is important to educate them that social smoking is also a major health risk and counsel them about the need to quit smoking completely for long-term health, both general and heart specific. The Indian Medical Association (IMA) supports the efforts of the government to reduce the use of tobacco in the country. IMA has also introduced several initiatives to discourage use of tobacco and related products. • The IMA campaign “Koi Dekh to Nahi Raha” discourages social smoking amongst its members. Being public figures and role models for the society, it is our responsibility to adopt in our own lifestyle, what we teach our patients about healthy lifestyle habits. • All IMA CMEs will be (e) tobacco free and will serve health-friendly food. • IMA (e) tobacco policy will mention in all meetings “Thanks for not consuming tobacco” • IMA is for total tobacco ban with arrangements for alternative crops and rehabilitation of tobacco workers and industry. • IMA supports 85% pictorial warning on tobacco packs and high tobacco taxes to control non-communicable diseases. (Source: Medscape) Dr KK Aggarwal National President IMA & HCFI
Tuesday, 30 May 2017
Criminal prosecution of medical negligence unacceptable, says IMA A fair judgment will help in retaining the nobility of the medical profession New Delhi, 29 May 2017: Highlighting another pertinent issue faced by the medical fraternity, the IMA has expressed its disagreement over the criminal prosecution of medical negligence and clerical errors and called it unacceptable. This is one of the many issues leading up to the Dilli Chalo movement being organized by the IMA on 6th June 2017. To be joined in entirety by the medical fraternity, the march will be undertaken by over a lakh doctors in the country, both digitally and physically, and followed by deliberations on issues ailing the medical profession. According to a judgment passed by the Supreme Court in 2004, it had stated that the medical man cannot be proceeded against for punishment for every mishap or death during treatment. Without adequate medical opinion, criminal prosecutions of doctors would amount to great disservice to the community. 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, "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. However, this is not the case in 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." Earlier, doctors from the IMA had also opined that many medical negligence cases took place in government hospitals. However, their comparatively lower bills kept such establishments out of the purview of the authorities. Adding further, Dr Aggarwal, said, "While it would be reasonable to cancel the registration of a doctor or a clinical establishment, booking a doctor under criminal charges will no longer result in this being called a noble profession. Justice has been denied to the medical fraternity on a number of accounts and this movement is a clarion call against all these issues." 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.
Straight from the heart: Enough is Enough Dear Colleague, Past National Presidents, Past Honorary Secretary Generals, Teachers and Friends Greetings from the Indian Medical Association (IMA), the collective consciousness of all doctors in India At present, we are directly connected to 3 lakh doctors and indirectly to more than 12 lakh doctors through Federation of Medical Associations (FOMA). And, via the World Medical Association (WMA), we connect to 112 countries. IMA has declared the “Dilli Chalo” movement on 6th June to bring to the attention of the Nation the plight of the medical profession, which is being strangulated from all directions and facing its worst period. Doctors are being denied justice even within the frame work of the constitution of India. How come everybody, including the government, is silently watching the rising incidents of violence against doctors? We become doctors to serve and not to harm the community. We are not against accountability, but no one can be allowed to take law in their hands. Violence against healthcare professionals is becoming more and more frequent in India. Often, there is an attempt to soften the resultant outcry by blaming the medical profession itself as being the cause of provocation. On many occasions, fraud on doctors is perceived as fraud by doctors. To prevent this, every healthcare facility should identify areas prone to high-risk violence in their establishment, which should be manned by adequate number of experienced doctors, voice activated CCTV cameras and adequate security. A well-structured and effective Grievances Redressal mechanism should be established at each clinical establishment (both for patients or their relatives and for the healthcare providers). A timely and transparent root cause analysis of every case of violence should be done and entered in a centralized IMA registry. Every establishment must have a policy to handle any situation of violence. We also must not forget that the patient and or their relatives at that moment are victims of acute stress and are likely to misbehave. Aggression will only fuel more aggression. Not losing temper at any cost in any situation should be a part of the emergency protocol. In any such situation, the first on call health reporter and/or the investigating officer are the most important. One should not avoid them. No news can be published or reported without the version of both the parties and that is the law. Never disclose patient details to the media, while giving your side of the defence. This may be a professional misconduct in lieu of violation of patient privacy. All health care personnel, who have been victims of violence must be adequately compensated, financially and also with regard to medical treatment. It is our luck that the Hon’ble acting Chief Justice of Delhi Smt. Geeta Mittal, in a suo moto order on violence against public hospitals dated 3.05.2017, has made IMA as a party in the case. Directly or through the court, we want the Ministry of Health and Family Welfare, Government of India to urgently and promptly implement MCI suggested amendments to make soft skill communications a compulsory part of UG and PG curriculum. Also, based on the inter-ministerial committee recommendations, the Central Government should urgently enact ‘uniform central act against violence’ along the lines of that enacted in 19 states and make violence against doctors a non-bailable offense punishable with up to 14 years imprisonment on the lines of abatement of a murder because violence against doctor may cause death of other unattended patients. Should we compromise on this issue? We want a central law against violence. Why are we suddenly being tried as criminals? Recently, doctors are being tried under criminal law for medical negligence. To establish criminal liability, it is first important to ascertain the presence of mens rea or intent to harm. Or that the doctor had the ‘knowledge’ that the treatment could harm but did not take the necessary informed consent. IPC 304 cannot be applicable on us on these grounds. Under IPC section 88, no harm is an offence if done in good faith, then why are criminal complaints filed against us? Why are we still booked under section 304? In criminal negligence cases, intent to harm has been replaced by gross negligence and we are booked under 304A. Gross negligence itself is not defined in IPC. As per MCI Code of Ethics regulation 8.6, “professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India”, but these guidelines are non-existent till today. Also, as per the Supreme Court Judgment in Jacob Mathew vs State of Punjab, no FIR can be filed against the doctor till a preliminary enquiry reveals a prima facia case of professional negligence. Every doctor is innocent till he or she is convicted. Media should not be allowed to report any doctor’s name till he/she is convicted of negligence. But today the first thing media does is to disclose the name of the doctor, even before even an FIR has been lodged. Is disclosing the name of the doctor before conviction not defamation? Criminal law punishes only affirmative harm but in medical negligence, failure to act in a prudent manner is also a crime. It should not be forgotten that medicine, especially emergency medicine, is inherently risky. Adverse outcomes or mistakes do not necessarily mean that care was negligent or that health care providers are criminally at fault. In emergency, triage becomes difficult with the present work load. In the event of a disaster, we are required to devote minimum time to dead patients (black code); immediate attention to serious patients (red code), semi attention to less serious patients (yellow code, can wait for one hour) and least preference to minor injury cases (green code, can wait for three hours). However, doctors are often abused by VIPs with minor injuries. IPC Sections 304 A (death due to negligence), 336 (act endangering life or personal safety of others), 337 (causing hurt by act of endangering life) and 338 (causing grievous hurt by act of endangering life) are being frequently applied against medical practitioners. Don’t you agree that criminal prosecution against doctors should be an exception and not a routine? Criminal penal provisions are also provided under MTP Act, PCPNDT Act, POCSO Act, HIV-AIDS Act, West Bengal Clinical Establishment Regulatory Commission Act etc. In many of these, a doctor can be prosecuted for non-professional violations like not wearing an apron, not wearing a name plate etc. Are we criminals? Do we deserve this? Doctors often take calculated risks, when treating their patients. Death does not automatically mean negligence. That error of judgment, difference of opinion, mere deviation from standard line of treatment are not negligence, is the settled law. Than why implicate us, till the matter has been decided by the court? In many of its judgments, the Supreme Court has said that judges are not experts and to decide a medical negligence, expert opinions are required. Then why does the media decide a case of medical negligence against us simply on the basis of allegations by the patient or their relatives. Even this is a settled law that when two experts differ, the benefit of doubt goes to the doctor. A doctor should not be judged by the expert’s level of competence. A doctor is only required to possess an average degree of skill, knowledge and expertise and not the maximum degree. Should we allow our doctors to indulge in loose talk in media or speak against their own colleagues? To re-emphasize, the law makers, experts and the police must consider section 88 of IPC, which saves medical professionals from criminal liability when the act is done in good faith, to be read with section 304 A. The West Bengal Clinical Establishment Regulatory Commission Act has used the word ‘shall’ for imprisonment of up to three years for any violation of the act. Don’t you think it is criminal on the part of the government to provide this criminal provision? What do we want? We want de-criminalization of clinical practice. Should doctors be made to face the limitations of the government? It is the constitutional duty of the governmental to provide free drugs and investigations for primary care and emergent care. The very fact that 80% of the health care services are handled by private sector means that either the services of the government are not up to the mark or they do not have enough infrastructure. The private sector does the job of the government. We are told to provide free services to government clinics on the 9th of every month for antenatal care. We are told to abide by national health programs, but are we given our due? Why is there no parity in pay scales for service doctors? Why is the uniform 7th Pay Commission not applicable to them? Why are our doctors continuing with ad hoc jobs for years together? Why is there no equal work for equal pay policy? Why is there no uniform age for retirement? Why are doctors paid differently in different states? Why are doctors posted in villages/rural areas not paid higher and income tax free salaries than the urban postings? Is this not exploitation? There is already a shortage of doctors, establishment and beds. We need twice the number of doctors, three times the number of nurses and four times the number of paramedics in the society. Than why so many exams for medical students, so many registrations for opening a new medical establishment and so many windows for accountability? Why can’t we have single window registration and single window accountability? Why is an MBBS graduate, who has gone through 36 examinations in 3 dimensions to get his degree, is being asked to sit for another 3-hour MCQ paper to obtain his license to practice under NEXT? Why can’t the government conduct a common final MBBS exam? Why force another exam ‘NEXT’, after getting an MBBS degree? Do we want NEXT? We are professionals and not businessmen. We have qualified one of the most difficult exams. Over 10 lakh students appear to secure admission to one of 50,000 seats. Once we are responsible professionals, then we are entitled to our professional autonomy, the autonomy to choose patients, drugs, brands, investigations and the line of treatment. We know and understand that we need to be rational, but we cannot be dictated to. When the government has allowed one company to market a generic drug under three name (generic-generic, trade generic and branded-generic) and also at differential prices, then why punish and defame doctors? In India, most drugs are generic and to choose the company is our right. Government should come out with ‘One Generic name, One Price, One company’ policy. I don’t want to be blamed for choosing a specific lab, pharmacy, diagnostic centre or a hospital. Can’t I refer patients to them on merit? Am I not entitled to take decision for the benefit of the patient and to choose a low radiation vs high radiation CT scan; 1.5 vs 3 TESLA MRI scan, ELISA vs Spot test? Why can’t I choose a drug from a particular pharma company as long as I am rational in choosing my drug? Is the company not doing the job of the MCI or the DCGI? Are they not updating my knowledge both in theory and skills? Why take away the prescription rights of doctors and give it to unqualified chemists? Why is the government allowing pharmacies to be run by outsourced non-professional chemists? It’s not the doctor’s job to search for the cheapest brands. It’s like the government saying that we will allow drugs to be sold at variable prices, but you should not write the costlier ones. In other words, we will give licenses to five star restaurants, but you are not allowed to go to the five star restaurants. The right to choose the brand or the company name lies with the doctor as it is he/she who owns the legal responsibility of the case. If the brand is chosen by the chemist, who will be responsible if the patient dies during treatment. Say no to NMC Why do we need a government? Why not a Supreme Court Monitoring Committee or twenty nominated members to run the government? If not, then why attempt to have an autocratic, bureaucratic, undemocratic, non-representative, 20-member nominated body including 8 non-medical persons to oversee medical education, ethics and practice by abolishing a democratically elected federally-represented 168 members Medical Council of India. If the Govt thinks that the IMC Act needs amendments, then that should be the option taken by the government. We also need to have a uniform and fair NEET exam. How can we allow different sets of papers for the same exam? Even if the exams are in different languages, the questions should be the same. Why finish AYUSH¬¬¬¬¬¬¬? By allowing and promoting AYUSH to practice modern medicine, are we not finishing the very existence of AYUSH in the country? Now and then it is said that AYUSH should be allowed to prescribe OTC drugs Are we saying that AYUSH doctors cannot treat even minor ailments? Scheduled drugs should only be allowed to be written by MBBS or BDS doctors. Anti quackery The floodgates of modern medicine practice are being thrown open to quacks and no action is taken against them. No unqualified person should be allowed to prefix ‘Dr’ before their name. Medicine in the hand of quacks is like handing over a razor to a monkey. Capping of compensation When the medical profession is considered noble and doctors provide subsidy in the consultation to all patients, than why are compensations awarded in crores basing it on the patient’s income? The formula 70-age of injury x annual income + 30% - 1/3 is not the right formula. Compensation has to take into consideration age of the patient and disease severity along with workman compensation formula. Instead of amending CPA now, the West Bengal Clinical Establishment Regulatory commission has provided one more avenue for compensation to patients. Do we deserve this? Empowerment of MBBS doctors Today most MBBS doctors are facing problems and they need to be empowered. We need to think of a three tier system of referral. More than 25000 additional PG seats in Family Medicine are needed. All GPs should be in retainership under government programs. IMA in policy making Why are professional decisions about the medical profession taken without taking the medical profession into confidence? Why can’t IMA be a part of every policy making committee of the government. Why can’t IMA be allotted a room at Nirman Bhawan? Inter-Ministerial Decisions An Inter-ministerial committee was formed more than two years back. It has still not delivered its results. The ministries involved are Health, Consumer, Law and Home. Other ministries are now raising objections on most of the demands. Why should clerical errors be a crime under PCPNDT Act? Why should CEA be not consumer-friendly? Why should there not be a central act against violence? Why should we be liable for crores for only hundreds of fee charged? Etc, etc. There is no end to the injustice heaped on the medical profession. Let us not compromise on our demands • Criminal prosecution of medical negligence and clerical errors is not acceptable. • Capping the compensation in CPA on doctors. • Professional autonomy in treatment and prescriptions. • Stringent central act against violence. • Amendments in PC PNDT, Central CEA, West Bengal CEA Acts. • No unscientific mixing of systems of medicine. • Empower MBBS graduates. • One drug - One company - One price. • Implement recommendations of the inter-ministerial committee in six weeks. • Single window accountability. • Single window registration of doctors and medical establishments. • No to NMC: Amend IMC Act to maintain professional autonomy. • Uniform final MBBS exam instead of 'NEXT'. • Uniform service conditions for doctors and faculty. • Same work - Same pay - Pay parity - No to adhocism. • Fair conduction of NEET exam. • IMA member in every government health committee. • Central anti-quackery law. • Reimbursement of emergency services for private sector. • 25000 family medicine PG seats. • Aided hospitals and retainership in general practice. • Health budget of 5% of GDP for universal health coverage. Dr KK Aggarwal National President IMA & HCFI
Monday, 29 May 2017
IMA encourages use of safe water and safe sanitary pads on World Menstrual Hygiene Day Says menstrual hygiene as important as food and water hygiene
IMA encourages use of safe water and safe sanitary pads on World Menstrual Hygiene Day Says menstrual hygiene as important as food and water hygiene New Delhi, 28 May 2017: According to statistics, between 43% and 88% of adolescent girls in urban India use reusable cloth for their periods, but do not clean them properly. A majority of rural women also employ rags during menstruation. These predispose them to reproductive tract infections as it is difficult for them to keep these used clothes and rags clean and free of harmful bacteria. In India, only 1 out of 2 girls have knowledge about menstruation before their first period. Statistics also indicate that only about 12% of Indian women are able to employ the commercially available sanitary napkins as an alternative. Every year, 28th May marks the World Menstrual Hygiene Day. The theme this year is "Education about menstruation changes everything". Menstrual hygiene is as important as food and water hygiene. 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," Safe water and safe sanitary pads both are important for maintaining menstrual hygiene. In India, there is still a lot of ambiguity about menstrual hygiene. Using unclean cloth during menstruation can increase the risk of infections by up to 200%. Repeated use of unclean clothes and improper drying of used cloth before its reuse in menstruation can harbour microorganisms and thereby cause RTI. There is a need to conduct awareness programmes, particularly in government schools, about the onset of periods and practicing hygiene during those days. Girls cannot predict the onset of menstruation and therefore, schools should have a ready supply of sanitary napkins." As part of the World Menstruation Day this year, the IMA is also campaigning to encourage education and awareness on this topic which is still considered taboo by many in the country. Adding further, Dr Aggarwal, said, "This day offers the opportunity to create awareness on the importance for women and girls to hygienically manage their menstruation, safely and with dignity. It is imperative to educate girls and women alike on safe and hygienic practices to be followed during their menstrual cycle to avoid any infections and ensure good health." Here are some basic menstrual hygiene tips you can follow. • Choose your method of sanitation Be it sanitary napkins, tampons, or menstrual cups, choose what you are comfortable in. • Change regularly It is important to change the sanitary pad every 3 to 4 hours at least in the first two days. An excessively damp pad can harbour microorganisms and cause infection. • Wash yourself regularly Clean yourself every time you use the washroom or change, as this will keep you away from infections and also remove any bad odour. • Avoid using soaps or vaginal hygiene products Soap can kill the good bacteria and make way for infections. It should only be used on the external parts. • Discard the used sanitary product properly Used products can spread infections and can smell foul. It is therefore important to wrap it properly and discard it in a proper way.
WHO confirms three Zika cases in India The first three cases of Zika virus infection were confirmed on Friday from Ahmedabad, Gujarat by the World Health Organization (WHO). In its report dated May 26, 2017, the WHO said, “On 15 May 2017, the Ministry of Health and Family Welfare-Government of India (MoHFW) reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area, Ahmedabad District, Gujarat, State, India. The routine laboratory surveillance detected a laboratory-confirmed case of Zika virus disease through RT-PCR test at B.J. Medical College, Ahmedabad, Gujarat. The etiology of this case has been further confirmed through a positive RT-PCR test and sequencing at the national reference laboratory, National Institute of Virology (NIV), Pune on 4 January 2017 (case 2, below). Two additional cases (case 1 and case 3), have then been identified through the Acute Febrile Illness (AFI) and the Antenatal clinic (ANC) surveillance." (Source: WHO, May 26, 2017) Zika virus disease was declared as a Public Health Emergency of International Concern (PHEIC) by the WHO in February last year. And, in November 2016, the WHO declared an end to its global health emergency over the spread of the Zika virus. Guidelines on the Zika virus disease were issued by the Ministry of Health and Family Welfare last year. NCDC, Delhi and National Institute of Virology (NIV), Pune were designated as the apex laboratories to support the outbreak investigation and for confirmation of laboratory diagnosis. According to the WHO report, an Inter-Ministerial Task Force has been set up under the Chairmanship of Secretary (Health and Family Welfare) together with Secretary (Bio-Technology), and Secretary (Department of Health Research). The Joint Monitoring Group, a technical group tasked to monitor emerging and re-emerging diseases is regularly reviewing the global situation on Zika virus disease. In addition to National Institute of Virology, Pune, and NCDC in Delhi, 25 laboratories have also been strengthened by Indian Council of Medical Research for laboratory diagnosis. In addition, 3 entomological laboratories are conducting Zika virus testing on mosquito samples. The Indian Council of Medical Research (ICMR) has tested 34 233 human samples and 12 647 mosquito samples for the presence of Zika virus. Among those, close to 500 mosquitoes samples were collected from Bapunagar area, Ahmedabad District, in Gujarat, and were found negative for Zika. However, this report has highlighted India’s vulnerability to vector-borne diseases due to its huge population, climate and people traveling into the country in large numbers. These cases provide evidence on the circulation of the virus in India suggesting low level transmission of Zika virus and chances of more cases occurring. Dengue and Chikungunya are already endemic in the country. All these three diseases – Dengue, Chikungunya and Zika – are viral infections and share a common vector, the Aedes mosquitoes. Dengue or Chikungunya-like symptoms with red eyes, fever with a rash or joint pain should not be ignored. Such cases could be Zika. Eliciting a travel history in such patients is very important. There is no specific treatment. Patients should be advised to take paracetamol to relieve fever and pain, plenty of rest and plenty of liquids. Aspirin, products containing aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should be avoided. In view of the detection of Zika in India, the need of the hour is enhanced surveillance: community-based and at international airports and ports to track cases of acute febrile illness. While awareness needs to be created about the disease, the public needs to be reassured that there is no cause for undue concern. There is no vaccine for Zika virus infection. Protection against mosquito bites is very important to prevent Zika infection. People traveling to high risk areas, especially pregnant women, should take protections from mosquito bites. • Stay inside when the Aedes are most active. They bite during the daytime, in the very early morning, and in the few hours before sunset. • Buildings with screens and air conditioning are safest. • Wear shoes, long-sleeved shirts, and long pants when you go outside. • Ensure that rooms are fitted with screens to prevent mosquitoes from entering. • Wear bug spray or cream that contains DEET or a chemical called picaridin. Dr KK Aggarwal National President IMA & HCFI
Sunday, 28 May 2017
IMA votes for a uniform MBBS exam NEXT 2.0 to be launched alongside the Dilli Chalo movement in protest against the exam New Delhi, 27 May 2017: In continuation of its intensive month-long campaign against various issues faced by the medical fraternity, the IMA has urged the government for a uniform MBBS examination instead of NEXT. The introduction of NEXT has already been mooted as the centre turning a blind eye to some harsh realities in medical education such as inadequate infrastructure in medical colleges, insufficient academic facilities, and faculty shortage. The test was introduced as a substitute to three tests, including NEET for postgraduate admissions, recruitment for central health services, and the foreign graduate medical examination. The introduction of NEXT is likely to create discrimination between Indian Medical Graduates (IMG) and Foreign Medical Graduates (FMG). IMA is of the opinion that the MCI is empowered enough to check the standards of final MBBS exam by each medical university/college. The need for another exam when the students have already cleared the final MBBS exam is unclear. 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, "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 programmes. 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." 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. Adding further, Dr Aggarwal, said, "There is no doubt that the medical profession is facing some of the toughest times so far. It is imperative for both doctors and patients to understand that this relationship is a sacred one and that the dignity of the profession should be maintained. Justice has been denied to us and this movement is a call against that." The Dilli Chalo movement being organized by IMA on 6th June 2017 is an attempt to bring forth the atrocities faced by the medical fraternity and the IMA members will join the movement in entirety. The march will be undertaken by over a lakh doctors in the country, both digitally and physically, and followed by deliberations on issues ailing the medical profession.
Maintaining good sleep hygiene is important for health and well-being Sleeping is a part of our day to day living, but not everybody is aware of what comprises a good sleep hygiene and its importance in terms of health. Maintaining healthy sleep hygiene is essential for over-all health and well-being. Evidence has shown the association of poor sleep quality with common diseases such as obesity, depression, hypertension, diabetes and heart disease. Sleep deprivation also contributes to stress in relationships, decreased performance at school and work, accidental injuries, memory and cognitive impairment and a poor quality of life. A new study reported in the Journal of the American Heart Association says that sleeping less than 6 hours was associated with 2.1 times higher risk of death due to heart disease or stroke in people with metabolic syndrome, especially in those who had high blood pressure or poor glucose metabolism. While, those who those with metabolic syndrome who had more than 6 hours of sleep time were about 1.49 times more likely to die of stroke. The risk factors clustered together as metabolic syndrome included body mass index (BMI) greater than 30 and raised total cholesterol, blood pressure, fasting blood sugar and triglycerides. Sleep duration of less than 6 hours was also associated with 1.99 times higher risk of death due to any cause in subjects with metabolic syndrome than those who did not have metabolic syndrome. In 2015, an Expert Panel from the National Sleep Foundation developed age-specific recommendations for appropriate sleep duration (Source: National Sleep Foundation) • Newborns (0-3 months): 14-17 hours • Infants (4-11 months): 12-15 hours • Toddlers (1-2 years): 11-14 hours • Preschoolers (3-5 years): 10-13 hours • School age children (6-13 years): 9-11 hours • Teenagers (14-17 years): 8-10 hours • Younger adults (18-25 years): 7-9 hours (new age category) • Adults (26-64 years): 7-9 hours • Older adults (65+ years): 7-8 hours (new age category) But, while it is important to get adequate hours of sleep daily, good sleep quality is also essential A scientific statement titled “Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health” from the American Heart Association (AHA) published in 2016 in the journal Circulation, has acknowledged the association of sleep duration (short duration more than long duration) and sleep disorders (insomnia) with adverse cardiometabolic risk, including obesity, hypertension, type 2 diabetes mellitus and cardiovascular disease. So, when we counsel our patients about lifestyle modification, the importance of sleep hygiene should also be included and emphasized upon. Dr KK Aggarwal National President IMA & HCFI
Saturday, 27 May 2017
IMA condemns violence against doctors Calls for a stringent central act against this practice and making it a non-bailable offence New Delhi, 26 May 2017: The IMA has called for a stringent central act against the increasing incidence of violence against doctors. This comes as part of the Association's intensive month-long campaign to raise awareness on and bring to light the issues faced by the medical profession today. IMA is a unified voice and the collective consciousness of the medical profession in the country. In this capacity, it has organized a protest march called the Dilli Chalo movement on 6th June 2017, which will be followed by deliberations on issues facing the medical fraternity. An estimate by the IMA shows that over 75% of doctors across the country have faced at least some form of violence. About 18 states across the country have laws in place to address this issue. However, doctors still continue to face the wrath of patients' kin due to lack of efficient implementation of these laws. 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, "Disturbing a doctor while he/she is on duty in the critical area, either verbally, mentally or physically, is definitely 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 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. There is also a need to change the government policy of allowing four minutes per patient." As per a nationwide study conducted by IMA earlier, doctors face maximum violence while providing emergency services, with as many as 48.8% of such incidents reported from intensive care units (ICUs) or after a patient undergoes surgery. The main reason reported behind such violence is unnecessary investigations or delay in attending to a patient. Adding further, Dr Aggarwal, said, "It is important to understand that doctors are also human beings and not healing angels. Once treatment is administered, the recuperation of a patient depends upon physical and organic factors. It is unacceptable and absurd to victimize the medical practitioner if the patient does not respond to treatment." It is after having decided that enough is enough that the IMA has given this clarion call, Dilli Chalo. The march will be undertaken by over a lakh doctors in the country, both digitally and physically. 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.
AHA statement on management of poststroke fatigue Fatigue is a debilitating sequelae of stroke, both ischemic and hemorrhagic. About half of all patients who survive an episode of stroke often report fatigue, which may be mild and occurring occasionally to that which is severe and constant. Unlike the typical tiredness, post-stroke fatigue may or may not be related to a recent activity and does not improve with rest. It adversely affects daily activities of life and limits participation of the patients in rehabilitation programs, which in turn hampers recovery. This makes post stroke fatigue an issue that is of concern not only to the affected patient and the caregivers, but also to the clinician taking care of the patient. The American Heart Association (AHA) has published a scientific statement for healthcare professionals on the management of fatigue in patients who have had a stroke. Published May 25, 2017 in the journal Stroke, the statement recognizes the multidimensional nature of poststroke fatigue and lists factors such as old age; female gender; physical impairment and functional deficits; comorbidities such as hypertension, diabetes, kidney disease, heart diseases; medications such as sedatives, antidepressants, and hypnotics and pain as factors that contribute to the fatigue. Patients should be evaluated at the time of discharge from acute care followed by regular follow-up post-discharge at 3 months, 6 months, and 1 year and then yearly. The Fatigue Severity Scale is recommended. These patients should also be evaluated for depression. The statement elucidates the evidence related to the use of tirilazad mesylate, a neuroprotective agent and Modafinil, a drug originally used for patients with hypersomnia or narcolepsy to promote wakefulness, as agents that have shown some efficacy in relieving poststroke fatigue. Vitamin B12, vitamin B1, and idebenone, a synthetic coenzyme Q10 analog may also have a role. Nonpharmacological interventions include aerobic exercise and education of the patients and their caregivers about the condition and the need for exercising, establishing good sleep patterns and avoiding sedating drugs and excessive alcohol The statement also touches upon the impact of fatigue on the caregivers and states that “caregivers can be taught to help the stroke survivor space activities out throughout the day to conserve energy if this is found to be an effective intervention”. (Source: Stroke. 2017;48:e000-e000) Dr KK Aggarwal National President IMA & HCFI
Friday, 26 May 2017
IMA demands allocation of 5% of GDP to the health budget Says only a quantum increase in allocations can secure the future of quality healthcare in the country New Delhi, 25 May 2017: In what can be called as one of the demands leading up to IMA's Dilli Chalo movement to be organized on 6th June 2017, the IMA has urged the government to consider allocating 5% of the GDP to the health budget. The Dilli Chalo movement is being organized to bring forth the atrocities faced by the medical fraternity with the IMA members joining the movement in entirety. The march will be undertaken by over a lakh doctors in the country, both digitally and physically, and followed by deliberations on issues ailing the medical profession. IMA is undertaking intensive lobbying in the month of May to raise national awareness on issues plaguing the medical fraternity, one of them being the lack of adequate funds for healthcare. The healthcare sector in India still suffers from underfunding and bad governance. According to statistics, India ranks among those countries with lowest spending on public health. 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," At 1.3% of GDP, the health sector in India continues to be among the countries with lowest relative public expenditure on healthcare. Surprisingly, even the figures for Nepal are higher! Every Indian citizen has the right to receive affordable or free preventive and emergency health care. If the government cannot provide this, then it should at least ensure its availability through the private sector, and reimburse the same. However, 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. Provided there is a quantum increase in health allocations, India’s health systems will remain ailing with a large number of its citizens remaining diseased and undernourished without the means to afford expensive private healthcare." India still accounts for the largest number of infant deaths, maternal deaths, and tuberculosis cases in the world. The country's public systems are also in disarray: about 15,000 doctor positions at primary health centres lie vacant; and 4,000 out of 5,000 community health centres are without even a single obstetrician. This issue is, however, just one of the many concerns that the IMA aims to address through its intensive campaigns all through the month leading up to the movement on 6th June. Adding further, Dr Aggarwal, said, "The medical profession is going through its toughest time with the nobility and dignity of medical profession at stake. It is high time we speak as a collective voice against these issues and address the gaps with immediate effect. 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.
Indian Penal Code & Criminal prosecution of medical doctors According to the provisions of Indian Penal Code 1860 (IPC) any act of commission or omission is not a crime unless it is accompanied by a “guilty mind” or mens rea. If it can be established without reasonable doubt that death was the result of malicious intention/gross negligence or with the knowledge that the act could cause harm and patient was not informed about the same, only then can a doctor can be charged with criminal negligence. No doctor treats a patient with an intention to harm or without taking an informed consent. Doctors must be aware of the Indian Penal Codes, under which they can be charged for negligence. They should know whether the act undertaken by them amounts to rash or gross negligent action under the provisions of the law of the country. This is very relevant today, where doctors are increasingly being subject to criminal prosecution. Is the act done in good faith with proper consent? IPC 88: Act not intended to cause death, done by consent in good faith for person’s benefit Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm. Illustration A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z’s death and intending in good faith, Z’s benefit performs that operation on Z, with Z’s consent. A has committed no offence. Has the consent taken by frightening the patient or without scientific data? IPC 90: Consent known to be given under fear or misconception A consent is not such a consent as it intended by any section of this Code, if the consent is given by a person under fear of injury, or under a misconception of fact, and if the person doing the act knows, or has reason to believe, that the consent was given in consequence of such fear or misconception; or Consent of insane person.—if the consent is given by a person who, from unsoundness of mind, or intoxication, is unable to understand the nature and consequence of that to which he gives his consent; or Consent of child.—unless the contrary appears from the context, if the consent is given by a person who is under twelve years of age. Is there any violation of a special act? IPC 91: Exclusion of acts which are offences independently of harm caused: The exceptions in sections 87, 88 and 89 do not extend to acts which are offences independently of any harm which they may cause, or be intended to cause, or be known to be likely to cause, to the person giving the consent, or on whose behalf the consent is given. Illustration Causing miscarriage (unless caused in good faith for the purpose of saving the life of the woman) is an offence independently of any harm which it may cause or be intended to cause to the woman. Therefore, it is not an offence “by reason of such harm”; and the consent of the woman or of her guardian to the causing of such miscarriage does not justify the act. Was the act done without consent? IPC 92. Act done in good faith for benefit of a person without con¬sent: Nothing is an offence by reason of any harm which it may cause to a person for whose benefit it is done in good faith, even without that person’s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit: Provisos—Provided— (First) — That this exception shall not extend to the intentional causing of death, or the attempting to cause death; (Secondly) —That this exception shall not extend to the doing of anything which the person doing it knows to be likely to cause death, for any purpose other than the preventing of death or grievous hurt, or the curing of any grievous disease or infirmi¬ty; (Thirdly) -— That this exception shall not extend to the voluntary causing of hurt, or to the attempting to cause hurt, for any purpose other than the preventing of death or hurt; (Fourthly) —That this exception shall not extend to the abetment of any offence, to the committing of which offence it would not extend. Illustrations (c) A, a surgeon, sees a child suffer an accident which is likely to prove fatal unless an operation be immediately performed. There is no time to apply to the child’s guardian. A performs the operation in spite of the entreaties of the child, intending, in good faith, the child’s benefit. A has committed no offence. How was the patient communicated? IPC 93: Communication made in good faith: No communication made in good faith is an offence by reason of any harm to the person to whom it is made, if it is made for the benefit of that person. Illustration A, a surgeon, in good faith, communicates to a patient his opin¬ion that he cannot live.The patient dies in consequence of the shock. A has committed no offence, though he knew it to be likely that the communication might cause the patient’s death. Was it a culpable homicide? Was there any intention or knowledge? IPC299: Culpable homicide: Whoever causes death by doing an act with the intention of causing death, or with the intention of causing such bodily injury as is likely to cause death, or with the knowledge that he is likely by such act to cause death, commits the offence of culpable homicide. Explanation 1.—A person who causes bodily injury to another who is labouring under a disorder, disease or bodily infirmity, and thereby accelerates the death of that other, shall be deemed to have caused his death. Explanation 3.—The causing of the death of child in the mother’s womb is not homicide. But it may amount to culpable homicide to cause the death of a living child, if any part of that child has been brought forth, though the child may not have breathed or been completely born. What is the punishment for culpable homicide? IPC 304: Punishment for culpable homicide not amounting to murder: Whoever commits culpable homicide not amounting to murder shall be punished with [imprisonment for life], or imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine, if the act by which the death is caused is done with the intention of causing death, or of causing such bodily injury as is likely to cause death, or with imprisonment of either description for a term which may extend to ten years, or with fine, or with both, if the act is done with the knowledge that it is likely to cause death, but without any intention to cause death, or to cause such bodily injury as is likely to cause death. IMA View: This penal code is not applicable to doctors unless there was intention to harm in the treatment provided or there was knowledge that the treatment can harm but the patient was not informed about the likely harm. Was it a case of gross negligence? IPC 304A: Causing death by negligence: Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.] Who certified the gross negligence? Statutory Rules or Executive Instructions incorporating certain guidelines need to be framed and issued by the Government of India and/or the State Governments in consultation with the Medical Council of India (MCI). So long as it is not done, we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient. A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor. The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation. A doctor accused of rashness or negligence, may not be arrested in a routine manner (simply because a charge has been levelled against him). Unless his arrest is necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make himself available to face the prosecution unless arrested, the arrest may be withheld. [Jacob Mathew vs State of Punjab & Anr on 5 August, 2005: Author: R Lahoti: Bench: Cji R.C. Lahoti, G.P. Mathur, P. K. Balasubramanyan: Case No.: Appeal (crl.) 144-145 of 2004] Dr KK Aggarwal National President IMA & HCFI
Thursday, 25 May 2017
SMAC 206/Tuberculosis REV/Apr2017
Proposed Revision of WMA Resolution on Tuberculosis
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-Guérin) 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 diagnostic
s 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 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 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 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 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 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?