Healthcare for all not possible with the present budget

In his speech when presenting the budget, the Finance Minister said that health for all and education for all is his priority but the budget allocation is only Rs. 37330 crores, which is an increase of only 7.5% in the last years allocation (planned and non-planned budget together). Medical fraternity expected it to be at least 2-3% of the GDP. Even allocation to AYUSH is only 1069 crores against 1650 crores allocated to six AIIMS-like institutions. If the Government really wanted to do something for promoting healthcare, they could have allocated for six AIIMS-like AYUSH institutions whose purpose should have been prevention so that people do not require allopathic tertiary care.

There are no tax holidays or tax exemptions for doctors living in rural areas in the present budge. Also, there was no relief for making VISA easy for medical tourism.

The Rs. 110 crores allocated for disability is not sufficient. Rs. 6000 crores should have been allocated for providing free generic drugs for people coming to government hospitals. This announcement was lacking in the budget.

Rs. 150 crores have been allocated for the care of the elderly, who constitute 8% of the total population. Elderly people usually do not have insurance as insurance companies do not give them a cover. At least 8% of the total health budget should have been allocated for the elderly.

Allocations to National Health Mission (NHM) (which covers both rural and urban population budget) is only Rs. 21200 crores, which is less than the amount used last year for which rural mission. It aims to provide urban mission money from the money received from the rural mission project. Separate budget should have been allocated for the urban mission.

Rs. 4727 crores allocated for training, education and research is also inadequate as unless you patent your own equipments and drugs, you are going to be dependent on foreign market.

India Medical Association in its recent meeting with Economic Advisor, Ministry of Health, Government of India had offered that every private doctor should be incorporated for providing healthcare facilities across the country, where the Government only had to invest on the human resource.

The government can start MD in Rural Medicine with a curriculum that teaches the art of treating the patients in limited resources. After that people can choose and do their respective post graduation. This way the doctors will not feel that it is a burden on them. There will be additional degree in MD in Rural Medicine Surgery. Such doctors serving in rural areas should be given income tax-free income.

What is the importance of Agni in pooja and in the Phera ceremony?

What is the importance of Agni in pooja and in the Phera ceremony?

In Hinduism,  fire as the symbol of purity, and the fire deity is called Agni Dev who is worshipped in all Hindu rituals, like havans, yagnas, ahutis, sankalp, marriage ceremonies (seven pheras around the fire). Fire destroys impurities without itself being affected.

In the Kathopanishad, the second boon asked by Nachiketa to Yaksha was about Agnividya. In the Holy Bible, the authorized King James Version – Exodus 3:2, The Lord took the form of fire (agni) to deliver the Ten Commandments to Moses: “And the Angel of the Lord appeared unto Moses in a flame of Fire out of the midst of bush… and the bush was not consumed.”

Holi celebration is the victory of fire (Agni Dev) who destroyed the evil in the form of Holika. In Ramayan, Sita had to give the proof of her chastity by going through fire. The three-faced (tri-mukhi) Rudraksha also represents Agni Dev.

“Shanti agno mrityate” (“without Agni the person dies”) is a common Ayurveda saying. Out of the five elements that we are made up of, Agni whether internal or external is the most important. Its deficiency as well as excess, even in a small quantity, is harmful to the body.

Agni plays the utmost role in the evolutionary process. Every object once burnt is reduced to ash. Agni is the fire burning inside the body and, if not managed properly, can cause harm to the body. Prana, Agni and Ojas are the three main pillars of the body described in Ayurveda texts. Prana is the essence of vata; Agni of pitta andojas of the kapha dosha.  To worship fire also means to respect the agni and pittadosha of the body. Any vow taken in front of the fire is considered equivalent to that taken in front of God and therefore are considered to be unbreakable.

Heart patients beware of bhang

Heart patients beware of bhang

Heart patients to avoid bhang or consult cardiologist. Indiscriminate use can increase heart rate and BP. Pretreatment with beta-blocker can help.

Heart patients should not take bhang as it can precipitate an increase in heart rate and sudden rise in blood pressure, said Padma Shri & Dr. BC Roy National Awardee,Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Those who are socially committed should consult their doctor. Pre-treatment with propranolol a beta blocker can block the cardiovascular effects of marijuana. It can prevent the learning impairment and, to a lesser degree, the characteristic subjective experience.

Marijuana is known to induce typical subjective state (“high”) with marked increases in HR, BP and conjunctival infection. It impairs performance on a learning test without significantly affecting attention.

About Bhang

• Bhang is a traditional Indian beverage made of cannabis mixed with various herbs and spices, which has been popular inIndiafor ages.
• Bhang is a less powerful preparation than Ganja, which is prepared from flowering plants for smoking and eating.
• Charas, more potent than either Bhang or Ganja, consists of cannabis flower tops harvested at full bloom.
• Dense with sticky resin, Charas is nearly as potent as the concentrated cannabis resin preparations called hashish.

Ask Dr KK:How often to repeat BMD test for osteoporosis?

• Assessment of fracture risk in all adults is important.

• BMD-independent risk factors are advanced age, previous fragility fracture, glucocorticoids, risk of falls, smoking, alcohol, and family history of fracture. 

• Screen with BMD in all women 65 years of age and older

• Screen with BMD in postmenopausal women less than 65 years if one of the above risk factors is present

• Do not perform 

• routine BMD measurements in premenopausal women 

• Do not perform routine BMD measurements in all men.

• Measure BMD in men who have clinical manifestations of low bone mass, such as radiographic osteopenia, history of low trauma fractures, and loss of more than 1.5 inches in height, as well as in those on long-term glucocorticoid therapy, androgen deprivation therapy for prostate cancer, hypogonadism, primary hyperparathyroidism, hyperthyroidism, and intestinal disorders

• For screening BMD use DXA

• Go for DXA of hip and spine

• Measurement of the hip alone could be sufficient in older individuals. 

• In women and men with low bone mass (T-score -2.00 to -2.49) at any site or who have risk factors for ongoing bone loss (steroid use, hyperparathyroidism) do follow-up BMD every two years as long as the risk factor persists 

• In women 65 + years at baseline with low bone mass (T-score -1.50 to -1.99) at any site, and with no risk factors for accelerated bone loss, go for follow-up DXA in three to five years

• In women 65 years + of age with normal or slightly low bone mass (T-score -1.01 to -1.49) at baseline and no risk factors for accelerated bone loss go for follow-up DXA in 10 to 15 years 

• A 65-year-old woman with a femoral neck BMD T-score of -1.01 to -1.49 and no clinical risk factors for fracture has 10-year absolute risk of hip fracture of only 0.9 percent.[Source Uptodate] 

Why do we put on Tilak on the forehead?

Why do we put on Tilak on the forehead?

The Tilak is a mark of auspiciousness and invokes a feeling of respect in the wearer and others. It is recognized as a religious mark. Its form and color vary according to one’s caste, religious sect or the form of worship of the person in question.

Tilak is applied on the forehead with sandal paste, sacred ash or kumkum, a red turmeric powder. In a wedding, a Kumkum tilak is applied on the forehead of both the bride and groom.

In earlier times, the four castes (based onvarnaor color) – Brahmana, Kshatriya, Vaishya and Sudra – applied marks differently. The Brahmin applied a white chandan mark signifying purity, as his profession was of a priestly or academic nature. The Kshatriya applied a red kumkum mark signifying valor as he belonged to the warrior race. The Vaishya wore a yellow kesar or turmeric mark signifying prosperity as he was a businessman or trader devoted to creation of wealth. The Sudra applied a black bhasma, kasturi or charcoal mark signifying service as he supported the work of the other three castes.

Also, Vishnu worshippers apply a chandan (sandalwood) tilak of the shape of “U”, Shiva worshippers, a Tripundra (of the shape of “º”) of bhasma; Devi worshippers a red dot of kumkum and so on. The tilak is applied in the spot between the eyebrows, which is the seat of memory and thought. It is known as the Aajna Chakra in the language of Yoga.

The Tilak is applied with the prayer – “May I remember the Lord. May this pious feeling pervade all my activities. May I be righteous in my deeds.” Even when we temporarily forget this prayerful attitude, the mark on another reminds us of our resolve. The tilak is thus a blessing of the Lord and a protection against wrong tendencies and forces.

The entire body emanates energy in the form of electromagnetic waves – the forehead and the  spot between the eyebrows especially so. That is why worry generates heat and causes a headache. The tilak cools the forehead, protects the wearer and prevents energy loss. Sometimes the entire forehead is covered with chandan or bhasma. Using plastic reusable “stick bindis” is not very beneficial, even though it serves the purpose of decoration.

The devotees of Siva apply sacred ashes (Bhasma) on the forehead

The devotees of Vishnu apply sandal paste (Chandan)

The worshippers of Devi or Shakti apply Kumkum.

The scriptures say:

“A forehead without a Tilak, a woman without a husband, a Mantra the meaning of which is not known while doing Japa (recitation), the head that does not bend before holy personages, a heart without mercy, a body devoid of health, a custom without purity,… – all these are worthy of condemnation. They exist for name’s sake only.”

Should I go for a knee replacement?

Should I go for a knee replacement?

A: Yes if

1. I am no longer able to do my routine work without help

2.  I have pain that keeps me awake at night despite the use of drugs

3. I have pain that keeps me from being able to walk or bend over

4. I have pain that isn’t relieved by rest

5. I have pain that is not responding to non-surgical approaches.

6. I have been told that less-complicated surgical procedures are unlikely to help.

7.  The disease osteoarthritis is wearing me down physically, emotionally, and mentally.

8. I am suffering from severe side effects from the drugs

9. Advanced arthritis is demonstrated on my test

10. If significant joint damage has occurred on my tests.

Ask Dr KK:Does memory impairment means onset of Alzheimer?

1.     First rule out B 12 deficiency and hypothyroidism.

2.     Rule out organic brain disease.

3.     Mild cognitive impairment (MCI) represents a state between normal aging and dementia.

4.     MCI includes patients with cognitive deficits that are insufficiently severe to meet criteria for dementia.

5.     Neuropsychological testing in individuals suspected of having MCI should be done. Those meeting criteria for MCI and those with prominent subjective complaints should have follow-up testing to evaluate for progression between one and two years after the initial assessment.

Why is Gayatri Mantra one of the main mantras in any pooja?

Why is Gayatri Mantra one of the main mantras in any pooja?

Any activity should always engage the 3H model – of heart, the head, and the hand. The same has been advocated by the western scholars. The concept means that while doing any work one should ask the head for choices, then refer these choices to the heart to choose one and finally order the hands to do the action.

Deepak Chopra also talks about this in great detail in his book The Seven Spiritual Laws of Success. He writes that conscious-based decisions are the best decisions. Before taking any decision he recommends asking the body for the signals of comfort or discomfort and if the signals of discomfort are perceived, then one should not indulge in that action.

All of these concepts come from ancient Vedic knowledge. The two main mantras are the Mahamrityunjaya Mantra and the Gayatri Mantra.

The Mahamritunjaya Mantra comes from the Rig Veda. This is the greatest reliever from all evils: ‘Aum Trayambakam Yajamahe, Sugandhim Pushtivardhanam, Urva Rukamiva Bandhanan, Mrityor Mokshiye Mamritat’. It means ‘we worship Shiva – The Three-Eyed Lord; who is fragrant and nourishes all beings; May he protect us (bandhan) from all big (urva) diseases (aarookam). May he liberate us (mokshiye) from death (mrityor), For the sake of immortality (mamritat, amrit); as the cucumber is automatically liberated, from its bondage from the creeper when it fully ripens.’

The manta speaks of the importance of the third eye and its benefits. The two eyes are at the level of the physical body. The third eye means the eyes of the mind and the soul. It also indicates that in difficulty one should look inward with the eyes of the mind and ask for choices. Like the cucumber, one should choose the good ones and drop the bad choices. (‘Jo acha lage use apna lo; Jo bura lage use jaane do’).

The mantra for conscious-based decisions comes from Gayatri Mantra. ‘OmBhur Bhuva Svah Tat Savutur Varenyam Bhargo Devasya Dheemahi Dhiyo Yo Nah Prachodayaat’. It means:‘we meditate on the glory of the Creator; who has created the Universe; who is worthy of Worship; who is the embodiment of Knowledge and Light; who is the remover of all Sin and Ignorance; may He enlighten our Intellect.’

 It talks about the importance of conscious-based decisions and its directions to the intellect to choose the right and not the convenient actions.

The Gayatri Mantra is the Vedic prayer to illuminate the intellect. Gayatri is considered Vedasara or “the essence of the Vedas”. Veda means knowledge, and this prayer fosters and sharpens the knowledge-yielding faculty. As a matter of fact, the four mahavakyas or ‘core-declarations’ enshrined in the four Vedas are implied in the Gayatri Mantra.

Making the right decision from the consciousness was later defined by Buddha. He taught that before any action ask yourself the following four questions and if the answer to any of the questions is ‘no’,  that action should be avoided. These four questions are:

•      Is it the truth?

•      Is it necessary?

•      Will the action bring happiness to you?

•      Will the action bring happiness to others?

Is IAP taking pharma funding illegal?

Is IAP taking pharma funding illegal?

Yes: MCI, No: Association

 Pharma industry funds for IAP: IAP Annual Report 2012

Company Funds given in lakh Rs

Johnson and Johnson (118.4); Merck (98.6); Wyeth (13.3); Sanofi Pasteur (11.4); Zuventus (11); Glaxo SmithKline (5); X-ray Biocom (4.5); Serum Institute (3); Pfizer (2). Total (267.2)

Law Cited: 6.8.1 In dealing with Pharmaceutical and allied health sector industry, A MEDICAL PRACTITIONER shall follow and adhere to the stipulations given below:-

a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives.

b) Travel facilities: A medical practitioner shall not accept any travel facility

d) Cash or monetary grants: A MEDICAL PRACTITIONER shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.

Issue

The Indian Academy of Pediatrics (IAP) has flouted Medical Council of India regulations

1. By accepting funding from the pharma industry

2. Violating code of ethics prohibiting endorsement or promotion of any brand.

Defense

1. MCI regulation is about individual doctors not accepting funds or gifts and not about associations.

2. Under 1860 societies act members of the association are not monitory beneficiary of the society funds.

What MCI says

It was illegal for associations of doctors to take funds from companies.

Conflict of interest

IAP is a member of the National Technical Advisory Group on Immunization (NTAGI) which decides immunization schedule and selection of vaccines to be included in the NIP.

Legal views

1. MCI 6.8.1 does not cover associations and trusts

2. Unless the doctors is proven to be a beneficiary he cannot be implicated

3. In charitable societies members are not suppose to take monitory benefits

4. Societies should not be funded or there activities sponsored by companies I which they have conflict of interest.

5. Endorsement issue in the High Court.

Ask Dr KK: Should I go for a knee replacement?

A: Yes if  

1. I am no longer able to do my routine work without help

2. I have pain that keeps me awake at night despite the use of drugs

3. I have pain that keeps me from being able to walk or bend over

4. I have pain that isn’t relieved by rest

5. I have pain that is not responding to non-surgical approaches.

6. I have been told that less-complicated surgical procedures are unlikely to help.

7. The disease osteoarthritis is wearing me down physically, emotionally, and mentally.

8. I am suffering from severe side effects from the drugs 

9. Advanced arthritis is demonstrated on my test

10. If significant joint damage has occurred on my tests. 

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA [ blog.kkaggarwal.com]

Direct all your energy towards the should and nor the ego

Direct all your energy towards the should and nor the ego

The epic Mahabharata can also be understood as a science of inner Mahabharata happening in everybody’s mind.

Lord Krishna here symbolizes with consciousness and the five Pandavas with five positive qualities of a person and they are – righteousness (Yudhishthir), being in focus (Arjuna), power to fight injustice (Bheem), helping others (Sahdev) and learning to be neutral in difficult situations (Nakul). Panchali indicates 5 senses which can only be controlled when these five forces are together.

Dhratrashtra symbolizes with ignorance, Duhshasan with negative ruling quality ( dusht while ruling) and Duryodhana (dusht in yudh) with one who is not balanced in war.

To kill the negativity in the mind, one has to take conscious based decisions. Every action, if directed towards the consciousness or the soul, is the right action. To kill the 100 Kauravas (the 100 negative tendencies a person can have) controlled by Duryodhan and Duhshasan along with Shakuni (the negative power of cunningness), one has to redirect one’s positive qualities towards the consciousness and take right decisions.

The five Pandavas (positive qualities) made soul (Lord Krishna) as their point of reference (Sarthi) and won over the evils (Kauravas).

Bhishma Pitamah, Karana and Draunacharya, all had winning powers individually but they all gave support to the negative thoughts and made Duryodhana as their point of reference and ultimately had to die.

The message is very clear – if one directs his or her positive powers towards ego as the reference point in long run, they will be of no use and, in fact, will be responsible for one’s destruction.

In Ramayana, Ravana was a great scholar but he directed all his energies and powers towards his ego and ended up in misery.

One should cultivate, therefore, positive mental attitude, positive thoughts instead of directing them towards desire, attachment or ego and should direct them to soul/consciousness for a positive outcome.

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA [blog.kkaggarwal.com]

Use accessible, affordable and safe quality medicines in India

Use accessible, affordable and safe quality medicines in India

I was invited to be a part of inaugural session on the subject ‘pen House Consultation on Accessibility to Quality Medicines in the Supply Chain’ organized at India Habitat Centre on Friday, 15th February, 2013 by the Partnership for Safe Medicines India (PSM).

The symposium was inaugurated by Mr. Keshav Desiraju, IAS, Health Secretary, Government of India.

Apart from me, those who participated in the inauguration function were Mr. Praful D. Sheth, Vice President International Pharmaceutical Federation; Dr. Dilip G. Shah, Secretary General, Indian Pharmaceutical Alliance, Mumbai; Dr. G.N. Singh, Drug Controller General India (DGCI), Government of India; Padma Shri awardee Dr. Ranjit Roy Chaudhary, Founder Delhi Society for Promotion of Rational Use of Drugs;  Mr. C.P. Singh, IAS, Chairman, National Pharmaceutical Pricing Authority; Ms Mridula Jain, Joint Secretary, Ministry of Commerce, Government of India and Ms Reena George, Lawyer, Supreme Court of India.

The meeting was organized by Mr. Bejon Misra Founder, Partnership for Safe Medicines India.

Introducing the seminar, Mr. Sheth said that as on date, substandard drugs only constitute 5% and spurious drugs constitute 0.5% of drugs.

Dr. Ranjit Roy Chaudhary focused on the importance of rational use of drugs. He said that misuse of drugs and side effects of drugs are enormous but can be prevented; if not they can cause death. He said people go to hospital to get well and not to get sick.

Mr. Shah said that if in two words I have to define the role of pharma, it would be ensuring a supply chain of quality drugs.

Dr. GN Singh, Drug Controller General India said that any drug which is approved by DGCI, whether popular brand, unknown brand or drugs sold under a chemical name, is same as far as quality and standard of drug is concerned. He said that substandard drugs used to be 8-10% about 10 years back but because of good manufacture practices, now they have been brought down to 4-5% and we aim at reducing it to 1% in another five years.

Mr C P Singh said that every process in making a drug costs money. But affordability is an issue inIndia.

Ms Mridula Jain, Joint Secretary, Ministry of Commerce, said that more and more of exports of medicines in other countries are by default controlling the quality and safety. Today, Indian pharmaceuticals are present in trade over 220 countries.

Inaugurating the conference, Mr. Desiraju said that all stake holders need to work in symphony with each other with an objective to provide safe quality drug. He said that everybody knows that making a spurious medicine is a criminal act. What is important is to improve the quality and make sure that substandard drugs are not sold. He said that word ‘generic’ does not mean that the drug is substandard. He also showed concern on the rising problem of drug resistance. He also expressed concern that medical colleges today are producing doctors who are not as trained as they used to be in the past. The art and science of diagnosis is missing in them.

I participated in the symposium as the National Vice President (Elect), IMA and elaborated on the role of medical practitioner in accessible and affordable medical care to the community.

As per WHO, one in 10 hospital admissions leads to an adverse effect and one in 300 admissions in death. As per American Medical Association, 2000 death occur every year from unnecessary surgery, 7000 from medication errors in hospitals, 20000 from other errors in hospitals, 80000 from hospital acquired infections, 1.06 lakh deaths from adverse effects of drugs. In total, 2.25 lakh deaths occur every year in US due to unintentional medical errors. The incidence is between 10-17% in all cases.

As per CDC, 7 lakh people visit hospital emergency department every year because of wrong use of medication. Till 1994, one lakh people used to die every year in US alone because of preventable medical errors. When compared to Alzheimer’s, less than 50% people die in a year and only 17,000 people die of illicit drug used in the same year.

US has been able to prevent one lakh deaths every year under 1,00,000 campaign.

A point was raised that it is the duty of DGCI to inform every doctor on regular basis about new introductions on drugs, banning of drugs. It was also said that doctors should write cheapest drugs maintaining the quality and safety.

Ending the seminar, Mr. Bejon Misra said that most important is focus on consumer education.

Ask Dr KK: Why it is said to avoid adding sugar and milk to black tea

Black tea and coffee are the best. Also as per Ayurveda never add sugar taste to astringent and bitter taste. It will neutralize its benefits.  Also do not add artificial sweeteners they will have the same effect.

Health Sector is demanding and is not a 9 to 5 Job: P K Pradhan

In an interaction with IMAS, Sh P K Pradhan Former Health Secretary Govt. of India said that MCI should be reconstituted this year, reports Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal National Vice President Elect IMA.

The interaction was held on Wednesday at IMA 20^th Feb IMA hall and was moderated by Dr Narender Saini Secretary General IMA. I too was present at this interaction.

Other present were Dr D R Rai, Dr Atul Arora, Dr   S Roy, Dr V K Narang, Dr Ajay Gambhir, Dr Ghulam Abbas Zaidi and Dr Zainab Zaidi.

Following is the gist of the interaction.

About the health budget

1.      Government of India under NRHM and other schemes gives 75% grants to the States and 25% has to be raised by them. Many states are not being able to utilize the funds quickly and avail their grant in full.  Bihar has come up very well in healthcare infrastructure during last few years. Performances as well as health care in UP, Chhatisgarh and Jharkhand are still a matter of concern.

2. When it comes to release of funds under health schemes, the releases are made purely on performance and no other considerations. If money is not used by the states, it is due to lack of performance and inefficiency. There are no political considerations.

3.    Many States like Madhya Pradesh, Orissa, Tamil Nadu, Karnataka, Haryana, Himachal Pradesh, J & K and Rajasthan were provided additional funds under NRHM during the last few years.

4.  Most of the Plan budget of the States, even up to 80%, goes towards salaries.

About health infrastructure in different states

1.      Tamil Nadu health services are one of the best in the country. Health care is available at the lowest cost.  Governance is a good factor for implementation of healthcare services. Assam, Madhya Pradesh, Rajasthan and Orissa among the high focus states have picked up very well. Andhra Pradesh needs to improve the primary healthcare system.  

2.      The quality of services in medical colleges needs to improve substantially. In some of the district hospitals, the care may be better than medical colleges as senior doctors in medical colleges are often busy in private practice.

About vacant posts at rural setups

Wherever medical officer posts are to be filled by state PSCs, there is considerable delay. Many States have started doing selection directly to overcome this problem and to place doctors in position.

 IMA image

1.      It is not correct that IMA has an image of anti-governance.

2.      It is only that IMA representatives and documentation do not reach the right people in the right time.

3.      In the eyes of the government, IMA is at a high standing image.

4.     Since IMA is taking up various projects, it should build a stronger partnership with Government both at the Center as well as State level to build capacity and improve the health care in the country.

About MCI

As things stand, Medical Council of India should be reconstituted after the term of the present BoG is over. There is need for two amendments in its old format.

1. One will not be able serve for more than two terms.

2.  More representation from state health science universities where there are a large no. of medical colleges.

About Dr B C Roy Awards

Dr. BC Roy Awards issue needs to be raised with the Medical Council of India.

About Capacity building and BSc community health courses

1. Everybody in the hospital, from ward boy, person doing waste disposal and other service providers need to be skilled and can be provided six months courses by accredited institutions.

2.  The need is to constitute a paramedical council. IMA can facilitate this, prepare a draft and approach the health ministry.

3. The Government today is proposing BSC Community Health Programme to create mid level health providers who can be groomed as public health personnel.

4. IMA point of view is that MCI or DNB should not develop the curriculum and become an accredited institution to impart such courses and register them. Government however is envisaging the same as there is no council at the moment available for the same. The government is choosing them on the philosophy unless you register you cannot be de-registered. IMA feels that a separate paramedical council should be made to recognise them.  

5. A community health worker will provide better preventive health care than an ANM.

6.  The introduction of the courses will depend on States. It is possible that southern and western States may not go for BSC Community Health Courses.

7.  The BSc Community Health workers will be required more in the remote rural areas to strengthen the public health and where it takes more than few hours to reach for primary care.

8. IMA approved paramedical courses can be recognized by states and the centre.

About public health

1.   Non-doctors should also be allowed to become public health professional.

2.   The burden of diabetes, old age problem and mental health are going to assume very high proportion in the coming years and it is time be fully prepared to cope with the situation.

About IMA as NGO

IMA can think of building dialyses centers and blood banks in different district and can approach State Govt. and Center for support.  The government is planning to have diagnostic centre in each district hospitals.

About Generic Drugs

The MRP of drugs is not controlled by the government. Government is trying to regulate prices of only essential drugs.

About Medical colleges

Several reforms have been undertaken to facilitate setting up new medical colleges and augment both UG and PG seats. This includes rationalization of land and infrastructure requirements, having colleges in two campuses etc. The no. of seats should go up substantially now.

What about an offer to be a friend of IMA

I can support activities of IMA to improve health care in the country as “Friends of IMA”.

Requirement of Health Sector

1.      Health sector is extremely complex, demanding and is not a 10 to 5 job.
2.      It requires passion and commitment to work for long hours.

Ask Dr KK:A person last week was told is executive heart check up is normal. He died next week suddenly. How can it be possible?

A: Sudden death is invariably due to heart attack which occurs after a soft vulnerable blockage in the heart artery suddenly ruptures. Treadmill test can only detect blockages of up to 70%. The blockages which are vulnerable to rupture are the ones which are less than 50%. Now days the executive health checks have no meaning as they only detect clinically evident diseases. Analysis and managing risk factors are more important than evaluation with a treadmill test. If you have risk factors you are at risk and manage them irrespective of your reports. We treat the patient and not the reports.

Why do we regard trees and plants as being sacred?

Why do we regard trees and plants as being sacred?

The upper part of the plants, the leaves, flowers and fruits are worshipped as sacred and offered to God. As per the Bhagwad Gita, these have satvik properties. Roots of any plant are tamsik and not offered in pooja or eaten during pooja days. The same is true for the stems of plants, which have rajsik properties.

Fresh and live fruits have the same spirit and life force as in the human beings and are considered sacred the same way as any human being.

Human life also depends on plants and trees. They give us the vital factors that make life possible on earth: food, oxygen, clothing, shelter, medicines etc.

Ancient scriptures suggest the planting of a minimum of ten trees. We are also urged to apologize to a plant or tree before cutting it to avoid incurring a specific sin named soona.

Many trees and plants like tulsi, peepal etc., which also have medicinal value, are worshipped.

Stay Away From Stress during Examination Days

Stay Away From Stress during Examination Days

Exam stress can lead to depression and suicide. Prescriptions for anti depressant drugs, so called ‘happy drugs’ increase amongst teenagers in the age group 16-18 years in full time education during exam days. This figure crosses 20% in school population in the West.

To create awareness about the rising problems of stress in the Indian context, Dr Aggarwal said that the fear of failure, fear of letting down are the two most common factors leading to suicide and depression.

Children also use drugs to keep awake during exams and end up with addictions. Anticipatory anxiety peaks before exams resulting in adverse affects on the body and mind and therefore, a suboptimal performance. Stress not only causes palpitations and tense muscles but also reduces the ability to make decisions, act or express oneself including organization of thoughts. Stress during exam makes it difficult to read and understand questions and even to recall terms and concepts.

A study has shown that 45 minutes of afternoon nap improves the declarative memory. Declarative memory is the memory of events learnt and understood earlier during the year. Not taking an afternoon nap or night sleep may cause the child end up with transient loss of declarative memory. Sleep appears to help “set” these declarative memories and makes them easier to recall. The other type of memory is “procedural memory,” which applies to skills and has no impact with the midday nap.

Free writing can clear mental stress: By spending 30 minutes each day for four days to write out your innermost thoughts and feelings, one can significantly boost mental and physical health. In expressive writing therapy, students are encouraged to express whatever is on their mind, letting their hopes and fears flow out in a natural, unrestrained way. It’s akin to keeping a journal, but more focused on the things that might be bothering you or triggering stress. While writing, the students need not worry about the punctuations. It’s all about stepping back and thinking about things in a different way, making linkages. Writing out emotions eases stress and, in turn, boosts the immune system.

Memories of traumatic events are not suppressed by the people who have experienced them and can be clearly recalled. In a five-year study, scientists atDalhousieUniversityinHalifaxfound that pleasant events were more difficult to recall than unhappy ones.

HCFI Tips

1. Children should   not be compared: it can lead to anger or depression in the child.
2. Appreciate unconditionally whatever the child has achieved.
3. Avoid giving false promises such as “if you come first, you will get a bike”. When that happens, “You are not yet 18 – so you can’t get a license. This time, settle for a bicycle and later we’ll get that bike”. Broken promises hurt the child.
4. Avoid anger chain. For example, the father unleashes his anger on the mother (because she does not answer back), and she takes it out on the child (because of the same reason). And the child takes it out on books or studies or younger sibling or hired help at home!
5. Do not force your expectations on the child. For example, you should only become a doctor.
6. Avoid giving the child two conflicting messages like mother asks child to study and father says – “do not force him.”
7. Make   your   child   exercise   daily,   learn   pranayama   and meditation.
8. Provide your child with balanced and nutritious diet.  Avoid overeating or long hunger periods. Restrict caffeine, give more water.
9. Ensure adequate sleep with a consistent schedule to improve concentration, memory and mood, it also reduces irritability.

Ask Dr KK: How often to repeat BMD test for osteoporosis?

Ask Dr KK: How often to repeat BMD test for osteoporosis?

• Assessment of fracture risk in all adults is important.

• BMD-independent risk factors are advanced age, previous fragility fracture, glucocorticoids, risk of falls, smoking, alcohol, and family history of fracture. 

• Screen with BMD in all women 65 years of age and older

• Screen with BMD in postmenopausal women less than 65 years if one of the above risk factors is present

• Do not perform 

• routine BMD measurements in premenopausal women 

• Do not perform routine BMD measurements in all men.

• Measure BMD in men who have clinical manifestations of low bone mass, such as radiographic osteopenia, history of low trauma fractures, and loss of more than 1.5 inches in height, as well as in those on long-term glucocorticoid therapy, androgen deprivation therapy for prostate cancer, hypogonadism, primary hyperparathyroidism, hyperthyroidism, and intestinal disorders

• For screening BMD use DXA

• Go for DXA of hip and spine

• Measurement of the hip alone could be sufficient in older individuals. 

• In women and men with low bone mass (T-score -2.00 to -2.49) at any site or who have risk factors for ongoing bone loss (steroid use, hyperparathyroidism) do follow-up BMD every two years as long as the risk factor persists 

• In women 65 + years at baseline with low bone mass (T-score -1.50 to -1.99) at any site, and with no risk factors for accelerated bone loss, go for follow-up DXA in three to five years

• In women 65 years + of age with normal or slightly low bone mass (T-score -1.01 to -1.49) at baseline and no risk factors for accelerated bone loss go for follow-up DXA in 10 to 15 years 

• A 65-year-old woman with a femoral neck BMD T-score of -1.01 to -1.49 and no clinical risk factors for fracture has 10-year absolute risk of hip fracture of only 0.9 percent.[Source Uptodate] 

Euphoria, reaction, adjustment and liking: The four phases in life

Euphoria, reaction, adjustment and liking: The four phases in life

Dr. Anil Goyal was recently elected as the President (Elect) of Delhi Medical Association. In one of his felicitation function, I said that he is going to be in a euphoric period for some time.

It’s a normal phenomenon and well described in Vedic laws. This phenomenon also explains why there is an ‘elect post’ in any organization. Dr. Anil Goyal is going to serve as President (Elect) for one and I am serving as Vice President (Elect) of National IMA for one year.

People are often elected to serve as an ‘elect’ for one year before they take charge of the main post for which they are elected.  It has some scientific basis.

Whenever you take up any new assignment you go through four phases

1. Phase of euphoria

2. Phase of reaction

3. Phase of  adjustment and

4. Final phase of liking.

When you win, there will be a period of euphoria and this will last till everybody congratulates you. During this period, when you attend a function, you expect people to congratulate you.

This will be followed with a phase of reaction (period may vary) where you start reacting as you will have to give time for the post work for which you are elected.

Over a period of time you adjust. These three phases of euphoria, reaction and adjustment should be over while you are in the Elect post.

Once you take over the main post, you should be able to perform from day one and that is what the last phase of liking is.

Doctors are often blamed that they do not go to rural areas

Doctors are often blamed that they do not go to rural areas

I have the following points to make:

• Open medical college/s, only in rural areas so that a budding doctor does his internship and three years PG in the same area.
• Many young doctors go to Saudi Arabia to earn a tax-free income so that they can start their own clinic or medical setup. These doctors can be convinced to work in rural areas, if they are given income tax-free salary for serving in rural areas for two years.
• All doctors who document 10% of free service should be given incentives that are normally given to any trust or society, which includes income tax rebate, non-commercial rates for house tax etc.
• Every citizen inIndiashould be insured. When driving without insurance is an offence then how come the costliest machinery in the world human body is allowed to walk out of the house without insurance. Government should make insurance compulsory and those who cannot afford, the government should pay for their insurance. Once everybody is insured, hospitals across the country will be automatically established in rural areas.

Love in Ayurveda

Love in Ayurveda

Euphoria, reaction, adjustment and liking are the four fundamental phases of any relationship. When a person gets engaged to a girl, both goes through a phase of euphoria where they can talk to each other for hours. This phase lasts for six months to three years.

The next phase is the phase of reactions and fighting on smaller issues. This phase will end up with adjustment after a variable duration depending upon the family counseling available.

The last phase in any relationship is the real spiritual love and liking for each other.

The first euphoric phase of love relationship is medically called Infatuation. It starts when two persons are attracted to each other and is due to release of adrenaline like neuro-chemicals like phenylethylamine, dopamine and norepinephrine. Dopamine makes them feel good and norepinephrine stimulates the production of adrenaline which makes the heart beat faster. These chemicals also make one feel euphoric, energized, and float on air.

The last chemical oxytocin is the cuddling chemical which makes the women and men calmer and more sensitive to the feelings of others. It plays an important role in romantic love as a sexual arousal hormone that signals orgasm.

The final stage of a relationship usually starts after seven years and is the stage of attachment. The chemicals involve in this are endorphins. These morphine-like opiates calm and reassure with intimacy, dependability, warmth, and shared experiences.

These hormones are not as exciting as phenylethylamine but are more addictive. The longer two people have been in a relationship the more likely it is that they’ll stay in that relationship as they get addicted to the endorphins. It is the absence of endorphins that make long-time partners yearn for each other when apart. Absent endorphins also play a part in grief from the death of a spouse.

Mark Goulston, at theUniversityofCalifornia, said “Adrenaline-based love is all about ourselves, we like being in love. With endorphins, we like loving”.

The stages in between are the stages of reaction and adjustment and represents the normal reactions of the men or women to stress and strains.

As per Ayurveda a person is made up of body, mind (mind, intellect and ego) and soul. Infatuation is at the level of body and the mind. Attachment is at the level of soul and the reactions and adjustments are at the level of mind, intellect and ego.

From Ayurveda point of view a person can have a Satvic mind (calm and poise), Rajsic mind (aggressive) and a Tamsic mind (inertia and destructive). The first infatuation and the last attachment phases of relationship are all Satvic states and the in between states are Rajsic or Tamsic.

This is one reason why newly wedded couples are given Satvic food for the initial few months including a cup of hot milk with sugar before going to the bed.

The relationship of a person can also be classified at the levels of physical body, mind, intellect, ego and the soul. All depends upon the need and the resultant satisfaction.

Rarely the husband and wife will be able to fulfill the role of all the relationships. They may me physically together but not mentally.

It is quiet common for the partners to have separate relationships to satisfy respective needs. They may have multiple relationships apart from the wife who is only for the physical needs. They may have separate friend to satisfy their mental needs (with whom they can open out and share), another for intellectual needs and a guru for the spiritual needs.

Natural foods and not supplements prevent heart disease

Natural foods and not supplements prevent heart disease

One should take seasonal and locally grown natural food and vegetables grown out of organic farms. Eat less, dinner lighter then lunch, eat natural and in moderation- are few of the mantras.

Eating food supplements can be harmful. According to the American Heart Association (AHA), supplementation with beta carotene and vitamin E, either alone or in combination with each other or other antioxidant vitamins does not prevent heart disease.

High dose vitamin E supplementation (400 IU/day) may be associated with an increase in all-cause mortality.

Supplementation with vitamin C does not prevent a second heart attack.

Beta carotene supplementation may be dangerous and should be discouraged.

Vitamin E supplementation may be of benefit for only secondary prevention of heart patients with chronic renal failure who are undergoing hemodialysis.

The AHA concluded that current data do not justify the use of antioxidant supplements for the prevention or treatment of cardiovascular disease risk.

The above recommendations apply to supplementation only. Diets that are rich in natural antioxidants are associated with lower cardiovascular mortality.

Over 2,000 people learnt CPR in a multi-specialty camp in East Delhi

 

In a multispecialty camp organized by Heart Care Foundation of India in association with East Delhi Walkers’ Association, over 2000 people were examined by a team of medical experts led by Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and National Vice President (Elect), Indian Medical Association.

Addressing a gathering of over 2000 people, Dr. Aggarwal said that everybody should walk at least 80 minutes a day and brisk walk 80 minutes in a week. Brisk walking means walking 80 steps per minute.

Dr. Aggarwal also interacted with senior heart surgeons: Dr. Sujay Shad, Dr. Rajesh Kaushar, Dr. Mubeen Mohammad, Dr. Sandeep Singh and Dr. Baldev  Sekhon.

In the discussion, the experts said that sore throat in children should not be neglected, especially if it is without cough and nasal discharge. Streptococcal sore throat can bite the heart permanently. Timely antibiotic in these patients can prevent permanent heart damage. 

Interacting with other experts, Dr. Chanchal Pal, Dr. Shashi Bala, Dr. Prachi Garg, Dr. Pooja Garg, Dr. Varun Arya, Dr. Mini Mathur and Dr. NK Bhatia, Dr. Aggarwal said that it is better to get a swine flu as seasonal flu as mortality and morbidity is low. He said that prevention of flu involves respiratory hygiene, cough hygiene and hand hygiene. Respiratory hygiene means staying 3 feet away from the person who is coughing or sneezing. Cough etiquettes means not to cough in hands or handkerchief but on the side sleeves of the shirt. Hand hygiene means washing hands thoroughly with a soap and water after touching nasal secretion.

Dr. Sanjay Gupta, Sr. Orthopedic, Moolchand Medcity said that people who have joint knee problems should not use Indian latrines.

Dr. Sweta Gupta, infertility expert, said that today with advance techniques, it is possible to deliver a child in every family.

Dr. NK Bhatia, Sr. Transfusion Specialist, said that everybody can donate blood from the age of 16 to 65.

Dr Mini Mehta, Dr Nischal Gupta, Dr Saloni Tomar,  Dr Rashmi Bhaskar, Dr Chetali Jain, Dr  Rohit, Dr Gyanendra, Dr  Shelja and Dr Neeraj Gupta Homeopathic Cardiologists of India said that time has come for homeopathic doctors to specialize in cardiology and practice as homeopathic cardiologists.

Over 2000 people were trained on how to revive a dead person using the technique Hands Only Cardiopulmonary Resuscitation. The Foundation has trained over 30000 people in the last four months.