Sunday, July 24, 2011

MCI and its right

RE: [Quality_of_Medical_Education] Re: Six months pharmacy course for AYUSH! ! ! ! !

Dear All
I do not understand why an ayurvedic practioner should be allowed to to prescribe medicines
from allopathic pharmacopia.Let them enroll in MBBS if they want to do it.


With warm regards

Yours sincerely

DR ANUP DHIR
Senior Consultant Apollo Hospital
Secretary Indian Association of Aesthetic Plastic Surgeons
101 ANSAL TOWER
38 NEHRU PLACE
NEW DELHI 110019 INDIA

To: Quality_of_Medical_Education@yahoogroups.com
CC: hosp_admn_india@yahoogroups.com
From: bondwithash@...
Date: Mon, 18 Jul 2011 00:17:29 +0530
Subject: Re: [Quality_of_Medical_Education] Re: Six months pharmacy course for AYUSH! ! ! ! !



Dear Dr Sushama Anil

I would request you to kindly broaden your vision. Some points to consider are

1. MCI was established to regulate the colleges that were dishing out degrees in "MODERN MEDICINE" . It defines Medicine as ""medicine" means modern scientific medicine in all its branches and includes surgery and obstetrics, but does not include veterinary medicine and surgery;". The Supreme court in the case referred below, observed that Allopathy was referred to "Modern" only in terms of age and NOT in terms of superiority.

The MCI was not established to monitor or regulate AYUSH streams of medicine. So it has no scope to talk about AYUSH. And it stating that only Allopathy medicine should be allowed to be practiced would be the attitude of a big bully and can be challenged for monopoly tactics. Fortunately it has not claimed so, but everyone assumes it to be so.

2. The Government DOES recognize these streams of medicine. Please do visit the link http://india.gov.in/sectors/health_family/ayush.php and understand that efforts are being made to develop them.

3. Please dont trivialize this issue by saying that a six month pharmacology course can be taught to panchayats and they can work in lieu of doctors. I would also request you to go through the curriculum of the AYUSH courses before you equate them with psychologists, physiotherapists and of course Panchayats.

4. Your attitude and response does acquaint me with the way Gallileo felt when he claimed Earth was round and circled the Sun....he was punished for it. This happened 500 yrs back and if you know the Indian history, Aryabhatta 2500 yrs ago had proved the same thing. India in history was known for its scientific awareness and Ayurved was also a product of that era. It is just that we indians somehow allowed foreign influence to brainwash ourselves to forget this and accept the western ideology.

Regards

Maj(Dr) Ashwin Devanahalli

Thursday, July 21, 2011

Delhi Govt to tighten checks on sale of banned drugs in medical stores

Delhi Govt to tighten checks on sale of banned drugs in medical stores
Joseph Alexander, New Delhi
Friday, July 22, 2011, 08:00 Hrs [IST]

Amid reports of continued sale of banned drugs and in the wake of recent raids mounted in the chemist shops in the National Capital, the Drug Control Department under the Delhi Government has decided to strengthen the vigil and action against the sale of banned drugs.

As part of bolstering the steps, the Government on Thursday came out with public notices in the leading newspapers in the city to alert the consumers and also to warn the chemists against sale of banned drugs. “This is the first step to raise awareness and we will now take sterner actions like regular raids and registration of cases in the coming weeks,” an official of the Drug Control Department said about the advertisements.

The public notice has listed 88 drugs, including the fixed dose combinations, besides announcing the links to the Department and CDSCO links for the comprehensive list. The roaster also included banned drugs like rosiglitazone, gatifloxacin and tegaserod which were prominent among those seized in the recent raids.

The office of Drugs Controller General of India (DCGI) had conducted raids in 130 places including hospitals and medical stores recently in the National Capital Region and found that 85 of them (accounting for 65 per cent) were offering the prohibited drugs. This has mainly prompted the Delhi Government to strengthen the steps, sources said.

“All concerned are directed not to manufacture, stock, sell or distribute the banned drugs. Non-compliance or violation of the order shall invite strict action under the provisions of rules without further notice, by competent authorities of Drug Control Department,” said the notice signed by Drug Controller Madhu K Garg.

The list of banned drugs includes amidopyrine, fixed dose combinations of atropine in analgesics and antipyretics, FDC of strychnine and caffeine in tonics, FDC of yohimbine and strychnine with testosterone and vitamins, phenacetin, nialamide, practolol, methapyrilene, methaqualone, chloral hydrate as a drug, dovers powder I.P, fixed dose combination of analgin with any other drug, fixed dose combination of dextropropoxyphene with any other drug other than anti-spasmodic and/or non-steriodal anti-inflammatory drugs (NSAIDS), fenfluramine and dexfenfluramine, rimonabant, nimesulide formulations for human use in children below 12 years of age, cisapride and its formulations for human use, phenylpropanolamine and its formulation for human use, sibutramine and its formulations for human use, and R-sibutramine and its formulations for human use.

Tuesday, July 19, 2011

NRHM loot in UP may be over Rs 3700cr

NRHM loot in UP may be over Rs 3,700cr
Pravin Kumar & Shailvee Sharda, TNN | Jul 19, 2011, 06.50am IST

Read more:NRHM loot|national Rural Health Mission
LUCKNOW: The money 'saved' was money 'swindled' in the jargon of National Rural Health Mission bounty hunters in UP. The central fund --meant to uplift the rural health parametres -- has been an open field for plundering for the past six years. An NRHM activities list circulated among the CMOs (family welfare) – though, of course, not officially – narrates the story of the rampant loot. TOI is in possession of the list which functioned as a working guideline for district and block level health officials.

The list, apart from the activity heads and their respective budget, also has a crucial column: 'saving'. The range of the budget saved for each activity is between 5% and 100%. And saving in this case was a euphemism for the money that was siphoned out of the system.

It was understood that all CMOs would 'save' as per instructions given in the list and pass on to the higher-ups. The average saving from the 54 activity heads mentioned on the list is approximately 50%. UP received nearly Rs 8,200 crore under NRHM and spent Rs 7,450 crore during the past six years. Now, considering that this document was the template for 'savings', the money that leaked out of the system could be as high as Rs 3,700 crore. Besides, as acentral study points out, there was no recovery of unspent funds. So, the volume of loot could be even higher.

This also explains the clamouring for the post of CMO (family welfare), created in May 2010 to handle the fund, involvement of mafia, and a spree of killings of CMOs – with one of them being killed in judicial custody. One of the murder cases has finally reached the CBI for probe and heads of two ministers have rolled.

"This was how much CMOs passed on straight away. Their own cut was over and above this," says a former CMO (family welfare). Many CMOs TOI contacted for verification, confirmed the existence of such a list, but none of them was willing to be quoted. They also confirmed that senior government doctors paid hefty sums to get the coveted post of CMO (family welfare ), when it was created last year.

Many of them could be termed as 'honestly' corrupt, says another ex-CMO . "After 'saving' for the higherups , they released a part of the remaining for some actual work to be done. But, in many cases almost the entire remainder was consumed without spending a single paisa on the heads the budget was meant for," he said.

"When I was working, 70% of the funds was spent for public health while the remaining siphoned off. Today, it appears that the case is just the reverse ," a health director-level official, who retired a few years ago, said on condition of anonymity.

DMA approaches HC against quacks

17/07/2011
DMA approaches HC against quacks practising allopathy

New Delhi, Jul 17 (PTI) In a bid to tighten the noose on 40,000 quacks and graduates of Indian systems of medicine, the medical association of the national capital has approached the Delhi High Court, seeking to restrain them from practising and prescribing allopathic medicines.

A bench of Chief Justice Dipak Misra and Justice Sanjiv Khanna, which has heard brief arguments on the issue, has now fixed the petition of Delhi Medical Association (DMA) for hearing on September 9.

The DMA''s anti-quackery cell has also sought implementation of a Supreme Court verdict, delivered in 1998, prohibiting quacks, ''vaids and hakims'' (persons who graduated in Ayurveda, Unani, Homoeopathy and other Indian medical system) from practising and prescribing allopathic medicines.

V N Sharma, chairman of the anti-quackery cell, said, "The Delhi government and others, including the Drug Controller, be asked to ensure that no transgression is made by the practitioners of Indian systems of medicine into practise of modern scientific system of medicine/allopathic system."
Curently, around 40,000 quacks and 7,000 people, having degrees in Ayurveda, Unani and other Indian medical courses, are practising allopath and prescribing medicines in the national capital, the petition said.

It said the Anti-Quackery Act of 1998, prescribing prosecution of quacks and other ineligible persons for practising and prescribing allopathic medicines, is still pending with the Select Committee of the Delhi Assembly.
The petition has also sought initiation of contempt proceedings against the Delhi government, drugs controller, police commissioner and others for not implementing the Supreme Court v

Monday, July 18, 2011

Bill shield for Bihar doctors

Bill shield for Bihar doctors
- Protection for genuine practitioners, quacks in net
ANAND RAJ

Patna, July 16: The Bihar cabinet today gave a green light to the Medical Service Institution and Personal Protection bill and Clinical Establishment (registration and regulation) Act.

The former would provide legal protection to doctors whereas the latter, the Clinical Establishment Act, would regulate private practitioners and nursing homes across the state.

The cabinet, which decided to repeal the earlier Clinical Establishment Act passed in 2007, decided to adopt the central legislation of Clinical Establishment Act, 2010, in the state, sources confirmed though it is not clear whether the Clinical Establishment Act would be implemented in toto in Bihar or have amendments.

Sources said all old and new nursing homes would be given permission to run their institutions for one year during which they would have to fulfil all requisite criteria in the act.

The proposed medical protection bill incorporates the provision of making an attack on doctors a cognisable offence and those indulging in vandalism against doctors and nursing homes would have to pay double the amount of damage caused during the protest, sources said.

Welcoming the cabinet decision, Bihar Health Services Association (BHSA) general secretary Dr Ajay Kumar told The Telegraph: “The Medical Protection Act was long awaited and the government has finally accepted that doctors in Bihar need a special act to protect them. The government has assured us that the act would be modelled on the Andhra Pradesh Act.”

Citing newspaper reports about pre-conditions imposed in the proposed medical protection bill, Kumar said: “We hope there will not be any kind of pre-conditions in the bill to be presented in the Assembly for approval. Putting conditions will create obstacles in smooth discharge of their duty.”

According to reports, there might be pre-conditions like doctors would have to treat patients in a better way besides behaving in a decent manner. Doctors would have to give right reasons for referring patients to other medical institutions, Kumar said.

“All these clauses or pre-conditions in the protection bill, if implemented, is not going to serve the purpose, rather it would be detrimental to the profession,” he said. He added: “These clauses give ample power to patients and investigating officers which could go against the doctors.”

So far as the Clinical Establishment Act was concerned, Kumar said the Indian Medical Association has already opposed the act and even BHSA has reservations on some of the provisions of the central legislation act, which is to be adopted in the state.

The association has serious objections on some points such as the district magistrate has been made the authority for clearing the registration of nursing homes which would increase bureaucratic control, Kumar said and added that the fine of Rs 5 lakh is exorbitant particularly for a newcomer in the profession.

Kumar said there is a clause which says that if an emergency patient comes to any doctor running a private clinic or nursing home, the doctor available at the clinic or nursing home would have to stabilise the condition of the patient before referring him/her to any other hospital or medical institution.

“There should be a regulatory body to monitor the nursing homes but it should be friendly to both patients and doctors. But except a few, no hospital or nursing home is in a position to implement such a clause as they lack medical and paramedical employees and infrastructure to bear the cost incurred on the treatment,” Kumar said.

“There are about 7,000 to 8,000 private clinic and nursing homes being run in the state by qualified doctors or corporates,” Kumar said before adding that another 10,000 illegal and unauthorised clinics and nursing homes are being run in the state by non-professionals.

Nod given to Medical Service Institution and Personal Protection bill and Clinical Establishment (registration and regulation) Act

The former would provide legal protection to doctors whereas the latter, the Clinical Establishment Act would regulate private practitioners and nursing homes across the state

All old and new nursing homes would be given permission to run their institutions for one year during which they would have to fulfil all requisite criteria in the act

There might be pre-conditions like doctors would have to treat patients in a better way besides behaving in a decent manner. Doctors would also have to give right reasons for referring patients to other medical institutions

Indian Medical Association has already opposed the act and even BHSA has reservations on some of the provisions of the central legislation act, which is to be adopted in the state

The association has serious objections such as the district magistrate has been made the authority for clearing the registration of nursing homes which would increase bureaucratic control

There is a clause which says that if an emergency patient comes to any doctor running a private clinic or nursing home, he would have to stabilise the condition of the patient before referring him/her to any other hospital or medical institution



indian express.........
The Cabinet also gave nod to ‘Clinic Ki Sthapana (Nibandhan aur Niyaman) Vidheyak 2011’, making registration for private clinics mandatory, but hassle-free.

Thursday, July 14, 2011

Traditional Medicine

Traditional Medicine

BHU to come up with guidelines on ayurvedic medicines
Naveen Kumar, TNN Jul 13, 2011, 09.29pm IST

VARANASI: The Department of Rasa Shastra, Faculty of Ayurveda, Banaras Hindu University, is all set to come up with consumer guidelines for appropriate use of ayurvedic medicines. The guidelines would be developed under a short-term WHO project, sponsored by the Department of AYUSH, New Delhi, to promote rational use of ayurvedic medicines across the globe.

"It is the first of its kind project in the university that intends to develop reference documents for promoting the rational use of traditional medicine in primary health care, as emphasised in the collaborative work plan of the WHO and the Government of India," informed Anand Chaudhary, principal investigator of the project. Saying that the project has been planned in view of the emerging concerns of quality, safety and efficacy of ayurvedic medicines, he also emphasised that it would generate the need for public awareness for rational use of ayurvedic medicines. "It strongly advocates the consumer's right to be informed of the proper use of ayurvedic medicines and also intends to develop awareness generative tool for promoting appropriate use of remedies of ayurveda, which is one of the officially recognised systems of health care widely used in the country," he added.

It may be mentioned here that a consultation meeting with a number of ayurveda experts in the country, including representative of WHO, New Delhi, representative of Department of AYUSH along with representative of NIA, Jaipur, IPGTRA, Jamnagar, national and state ayurvedic colleges, is proposed for finalisation of guideline after literary survey under the project.

Similarly, a host of local experts from the university including RH Singh, Professor Emeritus, Department of Kayachikitsa, BHU, M Dwivedi, Department of Prasutitantra, VK Joshi, Department of Dravyaguna, M Sagu, Department of Shalyatantra and Neeraj Kumar from the Department of Rasa Shastra are also involved in setting up reference guidelines in the project.

Wednesday, July 6, 2011

Nizamia Historic structures on their last legs

Historic structures on their last legs?
TNN Jul 5, 2011, 01.06am IST

HYDERABAD: The decades-old Nizamia General (Unani) Hospital and the Old Jail building of Hyderabad could soon lose their heritage tag. If the latest buzz among heritage activists is any indication, the Andhra Pradesh government is planning to delist these ancient monuments, which are in their custodianship, but have been lying in shambles for several years. Activists see this proposal as a move by the government to demolish these structures to make way for modern constructions.

"Every heritage building, by the virtue of its age, is bound to be frail. But instead of sanctioning sufficient funds for their upkeep, the government is looking at destroying them. And de-notification is the first step towards that," said heritage activist Manatosh Mandal, who has over the last few months submitted a bunch of appeals to the state authorities to look into the failing health of Hyderabad's architectural heritage.

The Unani Hospital, opposite Charminar, was listed as a heritage structure in 1995-96 (along with 136 other ancient buildings) for its magnificent Indo-Saracenic architectural style and for its contribution to Unani medicine. A similar recognition was given to the Old Jail building in Secunderabad around 2006; a structure that served as the civil jail during the British rule. However, despite their being listed, a status which should ideally ensure that a building/site of historical significance is protected and preserved, the two structures have failed to attract any government attention. As a result, these monuments now wear a dilapidated appearance, with a good part of them being damaged beyond repair. It came as no surprise when a female attendant recently lost her life after a weak minaret of the 200-year-old hospital came crashing down on her. The roof of the 80-year-old (approx) jail building, now used as a local market, had also collapsed in 2008 due to lack of maintenance, a state of events that gave tenants the jitters. Fortunately, no casualties were reported in that incident.

Sunday, July 3, 2011

doctors in India

Let us rescue our healthcare from the sick bed
Dr. M. J. Kuruvilla
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Health service in our country is in bad shape. It is impossible to conceal and ignore it any longer. The withdrawal of the government from the service sectors has created havoc. It has resulted in untold miseries to millions. It has left the healthcare sector high and dry. Private enterprises and corporate bodies have grabbed this sector. The hardest-hit in this game are the poor. The supreme challenge before us today is the provision of reasonable healthcare for one and all.

When the Chinese faced a shortage of medical personnel, they produced a large number of barefoot doctors. It did not work because the training imparted to them was inadequate and inappropriate. We are on the verge of committing the same mistake. The Central government plans short-term medical courses to produce half-baked doctors for our rural poor.

However, China has come up with a $124-billion plan. This is intended to correct the existing chaos over the next three years. There are additional steps to provide healthcare to all by 2020. They plan 29,000 new local medical centres and 2,000 new country-level hospitals; additional training for 1.37 million village-level and 160,000 community-level doctors; and caps on drug prices.

Obviously in India, there are not enough primary and secondary health centres. They are not distributed evenly through the length and breadth of the country. Further, the health centres are not equipped well, nor are they manned by adequately trained staff. We have to build more primary and secondary health centres, locate them in appropriate places and enhance the treatment facilities.

Then there is the question of management of these new health centres. The key person in charge has to be the doctor. Luckily, we have no dearth of doctors. One would be surprised to know that in Kerala, with a population of 3.33 crore, there are 43,260 MBBS qualified doctors registered with the Medical Council and practising, i.e., one doctor for less than 800 people (not patients). Kerala is not alone in this matter. The MBBS qualified apart, there are quite a number of doctors practising other well-established systems (ayurveda, unani, homoeopathy, etc). We have also to reckon with a number of quacks doing the healing art with impunity, disastrous to patients and detrimental to the public interest. Thus, the problem is not one of numbers, but of quality and their uneven distribution.

The present generation of doctors needs additional training. The Chinese are doing it. They give additional training for 1.37 million village-level and 160,000 community-level doctors. This has become all the more necessary because training has deteriorated in India over the years. This deterioration runs parallel to what is happening to primary education. The four Rs (reading, writing, arithmetic and reasoning) emphasised universally at the primary level are being neglected.

Likewise, the study of the structure and functioning of the human body and the derangements thereof (anatomy, physiology and pathology) has been put on the back burner. The net result is the production of doctors whose knowledge of the basic medical sciences is scanty. However, I will not subscribe entirely to Voltaire's view (1694-1779). He described doctors as men “who prescribe medicines of which they know little to cure diseases of which they know less, in human beings of whom they know nothing.” But Voltaire has a concealed cardinal message which we shall not miss. He exhorts doctors to learn pharmacology, pathology, biotechnology, anatomy and physiology.

Just as “the seed and the soil determine the yield” or “the quality of a product depends on the material and the workmanship in its makeup,” the quality of medical men we produce depends on choice of the right candidates as well as their proper training. Merit, aptitude, character and temperament should be the basis for selection.

A few simple substantial changes in the training programme are needed:

(1) Include mathematics as an additional mandatory subject for admission to the medical course.

(2) Extend the period of preclinical study to two years and cover the basic subjects viz. anatomy, physiology, biochemistry and pathology more thoroughly and comprehensively. Set apart two hours every day for dissection work. This will enable the doctor to have a first-hand knowledge about the structure and function of the human body.

(3) Clinical training should be for three years, of which the last year should be in general hospitals rather than in collegiate hospitals. This will enable the medical graduates to diagnose and treat patients based on the physical findings and clinical judgment with minimal support from sophisticated and invasive investigations and procedures. While the collegiate hospital training imparts skill in the management of rare and uncommon diseases and their tertiary care, the district and taluk hospital training will give them a good grounding in the primary and secondary patient care of common ailments. Doctors should be kept fit and proficient throughout their professional life. Recertification of the medical degrees and re-registration for continued practice are a sine qua non.

Improving infrastructure and their management by competent, committed staff are not enough. There should be a proper mechanism for healthcare delivery. The benefits should reach the needy. For guidance in this matter the best place to turn to is the U.K., where there is the National Health Service. Healthcare is open to everybody there, free of cost. (Contribution to national insurance is compulsory for all.)

Simply speaking, one does not contribute if one does not earn and yet will reap all the benefits of health service. But there is no freedom of choice for the patient. He does not choose his doctor, the hospital or the modality of treatment.

There is also the British National Institute for Health and Clinical Excellence. Some glorify it as the guardian angel, yet others (particularly, the Americans) have nicknamed it a brutal watchdog of British Health. This body ultimately decides which treatments the nation can afford to buy. In the decision-making process, the general practitioner and the bureaucracy have a big role. This looks fine! But a close examination reveals that the devil's in the detail. The value of life is calculated on the basis of its future utility. There is an undue emphasis on cost-effectiveness. For instance, resuscitation is not encouraged in case of cardiac arrest, if the victim is a cardiac cripple, a known cancer patient beyond cure or if the victim is overaged — so goes the list. However, it is difficult to find fault with some form of healthcare rationing.

We have to learn from the Americans too. They are not immune to healthcare problems particularly as regards their sick, old and poor citizens. That is the reason why three years ago Barack Obama lashed out at the health service. He outlined a plan in which it would be illegal for insurers to drop sick people or deny them coverage for pre-existing conditions. His concern was to ensure a uniform health coverage for all Americans. This he intended to do by making the health service work efficiently and at a minimum cost.

The President said his plan would provide ‘security and stability' to those who have insurance and in addition cover those who do not have it. He repeated his support for a government insurance plan to compete with the private sector (which is profit-oriented and not service-motivated). Still, the sheet anchor in his plan is contributory insurance. This will, however, siphon off a good chunk of money earmarked for healthcare to third parties.

We shall not fall into the insurance trap. What we need is uniform, universal free healthcare for everybody as in the U.K, and not insurance schemes for sections who contribute. In India, there are several health insurance schemes. There is a lot of misuse of these schemes by patients, doctors, hospitals and the insurance companies and their employees.

(Dr. Kuruvilla, FRCS (London and Edinburgh), has held faculty positions in the universities of Kerala; Pahalavi University, Shiraz, Iran; and Arab Medical University, Benghazi, Libya. His email id is kuruvilla_mj@bsnl.in)

Keywords: government healthcare, health service