Saturday, March 31, 2018

More children being diagnosed with Type 1 diabetes in India

More children being diagnosed with Type 1 diabetes in India
With certain precautions, it is possible for kids with this condition to lead a normal life
New Delhi, 30th March 2018: The incidence of Type 1 diabetes is on the rise among children today with about 97,000 of them affected in India alone. About 32 per lakh children are affected in Delhi alone. Type 1 diabetes is also called juvenile diabetes as it affects children primarily.
Type 1 diabetes is caused when the immunity of a person turns against the body killing insulin-producing cells in the pancreas. Life can be traumatic for children with this condition as they need to regularly take insulin injections, which can become a reason for their stigmatization.
Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA),said, “There are many myths surrounding Type 1 diabetes which can hinder effective treatment. For instance, there is lack of awareness about better ways to track and manage glucose levels, such as that by a Glucometer or insulin pumps. It is imperative to educate the society that children with this condition can lead very normal lives and be as active as others. Type 1 diabetes is not caused due to high intake of sugar. Although diet, activity level, and weight have not been found as a causative factor for the onset of Type 1 diabetes, it is always better to exercise and eat a balanced diet as precaution. Parents have a large role to play in leading by example.”
Some symptoms of Type 1 diabetes include excessive thirst, frequent urination, hunger and tiredness, weight loss, slow-healing sores, dry and itchy skin, tingling sensation in the feet, and blurry eyesight.
Adding further, Dr Aggarwal who is also the Vice President of CMAAO, said, “Type-1 diabetes cannot be cured. Insulin helps to control blood sugar levels and is key to lifelong management of this condition, along with regular blood sugar monitoring. It is important for parents to teach and help their children take their insulin and educate teachers and caregivers about it too, especially when children are at school or away from home. With proper treatment and care, they can have a normal childhood and a full adult life.”
HCFI tips for Type 1 diabetes
·       Make a commitment to manage your diabetes.
·       Take your medications as recommended.
·       Learn all you can about type 1 diabetes.
·       Make healthy eating and physical activity part of your daily routine.
·       Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.
·       Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren't meant to replace yearly physicals or routine eye exams.
·       Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year.

Friday, March 30, 2018

The battle is still far from being won; the struggle must continue

Dr KK Aggarwal
Padma Shri Awardee

The Union Cabinet has cleared some amendments to the proposed National Medical Commission (NMC) Bill, which will now be debated in both Houses of the Parliament. Will they pass the amended Bill or will the Bill be passed by vote of voice remains to be seen. IMA and all doctor MPs should continue their efforts to get more amendments done before the Bill is passed.

·         Final MBBS Exam to be held as a common exam across the country as an exit test called the National Exit Test (NEXT): This is a victory of all. IMA had proposed last year. Now, the students would not have to appear in a separate exam after MBBS to get license to practice. NEXT would also serve as the screening test for doctors with foreign medical qualifications to practice in India. It will make more doctors available to practice. The next debate ….Who will conduct the exam?

·         Provision of Bridge course for AYUSH practitioners to practice limited modern medicine has been removed. But it has been left to the State Governments to take necessary measures for addressing and promoting primary health care in rural areas. This is a win for both Modern medicine and AYUSH systems of medicine. Ayush will now be able to continue research in their disciplines. If they had entered modern medicine, as had been earlier proposed, their very existence would have been at stake.

·         Fee (including all charges) regulation for 50% seats in private medical institutions and deemed universities. More details are needed, or the private institutions will increase the fee for 50% of seats in crores. A solution to this can be to increase number of government and district medical colleges.

·         Number of nominees from States and UTs in NMC increased marginally from 3 to 6. The NMC will comprise of 25 members of which at least 21 will be doctors. Not been able to increase the seats of registered medical practitioners is a major failure on our part.

·         Only 5 representatives from the registered doctors in states, as suggested to be 9 by the parliamentary committee, is too low a number. It seems that the government does not want IMA or professional representatives to be a part of it. It will be our collective failure if we are not being able to challenge it. Only one representative from each zone or all five from all India elections will make it interesting?

·         Monetary penalty for a medical college non-compliant with the norms has been replaced with a provision for different penalty options (warning, reasonable monetary penalty, reducing intake, stoppage of admission leading up to withdrawal of recognition etc). This needs to be studied in detail.

·         Stringent punishment for unqualified medical practitioners or quacks: The punishment for any unauthorized practice of medicine has been made severe by including a provision for imprisonment of up to one year along with a fine extending up to Rs. 5 lakhs. It’s good that it is ‘AND’ and not ‘OR’. Once convicted the imprisonment is a surety. We need to study the loop holes further.

Our struggle was not only against NMC…It was but one of our many demands.

The battle is still far from being won.

We were also fighting for suitable amendments in the Clinical Establishment Act (replacing police representative from DRA with a representative of the association; exempting single doctor establishment; doing away with NABH inspection, suggestion with respect to standard treatment guidelines to be provided by IMA and to define the change in the word ‘to stabilise’) and PCPNDT Act (graded punishments and non penal provisions for clerical errors).

A stringent central act against violence and capping of compensation (to be based on the lines of Drug and cosmetic rules in a clinical trial and not based on annual income of the patient) have been on the forefront of our agenda.

We also need to continue to voice our demands for increasing the health budgetary allocation to 5% of GDP; introduction of IMS on the lines of IAS and implementation of MCI Code of Ethics 8.6 to decide professional negligence and misconduct and MCI-IMA recommendations on police actions as recommended by the Hon’ble Supreme Court in any alleged criminal negligence.

Our demands of omission of penal provisions on doctors during practice, uniform pay scale for service doctors across the country and better service conditions for doctors and patients in government hospitals still remain unresolved.

Any government listens to pressure.

Events like IMA Dilli Chalo or IMA Mahapanchayat should be a part of our annual calendar of events and should become the extraordinary general body meeting of IMA and FOMA.

We should continue to fight for our rights as well as that of our patients till we achieve what we set out to do when we embarked on this journey. Even Rama, Krishna, Jesus had to fight for their principles.

What shape the NMC would ultimately take may well depend on how steadfast we are.

All resolutions must be adopted and fought for till they are achieved.

IMA will be taking further call on its plan of action on 2nd April after meeting with the Health Minister. 

Thursday, March 29, 2018

Combating medically important antibiotic use in food-producing animals

The use of antibiotics in the food industry is a less-recognized, but rapidly emerging cause of global antibiotic resistance.

About 80% of use of medically important antibiotics occurs in the animal sector in some countries, primarily to enhance growth in healthy animals. They are used in food-producing animals to treat and control bacterial infections in the presence of disease (therapeutic use), and for disease prevention (prophylactic use) and growth promotion (subtherapeutic use) in the absence of disease.

The widespread misuse and indiscriminate use of antibiotics in agriculture is a major contributor to antibiotic resistance in humans. Development of antibiotic-resistant bacteria in food-producing animals, which can then be transmitted to humans via food and other transmission routes.

Some of the antibiotics that are used in animals are usually the last line of treatment for critical infections in humans or are one among the very limited number of treatment options available for serious infections in humans.

According to the World Health Organization (WHO), “Antimicrobial use in food-producing animals can lead to selection and dissemination of antimicrobial-resistant bacteria in food-producing animals, which can then be transmitted to humans via food and other transmission routes.”

The WHO published new guidelines last year on the use of medically important antibiotics in food-producing animals and has recommended that farmers and the food industry stop using antibiotics routinely to promote growth and prevent disease in healthy animals.

The new WHO guidelines call for the following actions regarding the use of medically important antibiotics in animals:

·         Overall reduction in use of all classes of medically important antimicrobials in food-producing animals
·         Complete restriction of all classes of medically important antimicrobials for purposes of growth promotion in food-producing animals
·         Complete restriction for prevention of infectious diseases in healthy animals that have not yet been clinically diagnosed unless animals in close vicinity have been diagnosed with a disease that requires such use
·         Medically important antimicrobials should not be used to either to treat or control dissemination of a clinically diagnosed infectious disease identified within a group of food-producing animals
·         Testing of sick animals, when possible, to determine the most appropriate antibiotic for their infection
·         Selection of antibiotics from the WHO list of those that are considered “least important to human health” and avoidance of those considered “highest priority, critically important”
·         Additional recommendations include vaccination of animals to reduce the need for antibiotics, as well as improved production, processing, and hygiene practices.

There is also increasing attention toward the identification and development of alternatives to antibiotics for use in animals.

·         Vaccines that could reduce the use of medically important antibiotics
·         Microbial-derived products, such as probiotics and bacteriophage gene products
·         Non-nutritive phytochemicals, including prebiotics
·         Immune-related products, such as antibodies, microbial peptides, and cytokines
·         Chemicals, including enzymes
·         Regulatory pathways to enable the licensure of alternatives to antibiotics

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Wednesday, March 28, 2018

High bed occupancy rates in hospitals denote inferior quality of care

High bed occupancy rates in hospitals denote inferior quality of care
Dr KK Aggarwal
Padma Shri Awardee

When patients choose a hospital for treatment, they usually judge a hospital by its location, the infrastructure, the amenities and services it provides, quality of care and cost of care.
Bed occupancy rate is an indicator of hospital utilization. It is a measurement of efficiency and effectiveness of a hospital. Bed occupancy rate of a hospital varies at any given point of time. While a ‘full house’ would perhaps appear to be most satisfying, it is not actually so, especially for a hospital.

According to the Australian Medical Association, Irish Medical Organisation, Australasian College for Emergency Medicine and NHS England, a bed occupancy rate above 85% or ‘overcrowding’ is considered to have an adverse effect on patient safety and the operational efficiency of the hospital.

High bed occupancy rate increases the risk of spread of hospital-acquired infections such as MRSA and Clostridium difficile via cross transmission. Such hospitals also run the risk of bed shortages when they are most needed, such as during outbreaks, or disasters. 

Overcrowding means not enough beds for patients from emergency department. A long waiting time for transfer to the appropriate inpatient bed increases mortality and chances of adverse events.

Overcrowding compromises quality of care. Medications may not be administered in time; the chances and frequency of errors increase as well.

Hospitals, in particular Govt. hospitals, have a policy of not denying admission to any patient, even if this means allotting the same hospital bed to two inpatients, or sometimes even three in pediatric wards. The outcome is an inferior quality of care, at the same time, it also creates an impression that we can manage even with inadequate infrastructure and resources available to us.

No hospital, whether Govt. or private, should have more than 85% bed occupancy rate.  Admitting 150 patients in a 100-bedded hospital is not correct. This means that for 50 extra patients, you are compromising care of 100 patients as resources are shared for a much larger number of patients than meant for.

This would also be applicable to govt. hospitals, if they over admit patients in view of the recent govt. notification, which makes it mandatory for all clinical establishments, chemists/pharmacists to notify every case of TB or else face penal provisions under sections 269 and 270 of the Indian Penal Code

Tuesday, March 27, 2018

It’s time to change food labeling policy to tackle the obesity epidemic in the country

It’s time to change food labeling policy to tackle the obesity epidemic in the country

The Health Ministry has made it mandatory for some medicines to have a red vertical line on their strips to sensitize the public to the fact that these medicines are meant to be consumed only with the doctor's prescription. Most notable of these ‘prescription-only’ drugs are antibiotics. This Red line campaign is intended to create public awareness about antibiotic resistance, which has emerged as a major public health problem.  

It is also now mandatory to display pictorial health warnings covering 85% of the tobacco product packages as a means to discourage consumption of tobacco by the people.

There is an upsurge of obesity in India, which is rising at an alarming pace. India has the second highest number of obese children in the world after China. Normal weight obesity is the new epidemic of the society. A person could be obese even if his/her body weight was within the normal range. An extra inch of fat around the abdomen increases the chances of heart disease by 1.5 times.

Overweight and obesity are well recognized as predisposing to lifestyle disorders such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome. Unhealthy diet comprising of foods high in saturated fats, sugar and salt (junk food, processed food) along with a sedentary lifestyle are major contributors to overweight and obesity. Hence, there is an urgent need to prevent and control obesity.

Along the lines of the Medicines with red line campaign and pictorial health warnings on tobacco products, the Heart Care Foundation of India (HCFI) suggests that packages of all food products that contain high levels of sugar, calories, salt and saturated fats should carry a ‘red dot’ or a ‘red arrow pointing upwards” on the food label, which carries the nutritional content of that particular food product as a symbol warning the consumer that the food product contains unhealthy amounts of fats, sugar and salt. 

Chile introduced a new food labeling system in 2016 to tackle obesity. Food packages that are high in sugar, calories, saturated fat, and salt now carry black, stop-sign warnings with the words “Alto en” or “high in.”  “Alto En Calorias” – high in calories, “Alto En Grasas saturadas” – high in saturated fats, “Alto En Sodio” – high in sodium and “Alto En Azucares” – high in sugar.

Such a change in the food labeling policy may discourage the public from choosing such foods products not only for themselves, but most importantly for their children.

Overweight and obesity in childhood also predispose children to lifestyle diseases later in life. Hence, it is important to encourage healthy eating habits early in life.

HCFI has also written to the health ministry for consideration of this suggestion.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Monday, March 26, 2018

Universal Healthcare for All

Dr KK Aggarwal
Recipient of Padma Shri

There is a wide gap in the availability of healthcare service in the country. On one hand, India is fast becoming the hub of medial tourism, whereas in a sharp contrast, healthcare including essential healthcare is still out of reach for many of her citizens.

The private sector provides 80% of healthcare in the country today, while only 20% is by govt. sector. This is because the govt. spends very little on health. Currently, India spends just 1% of its gross domestic product (GDP) on health and is ranked at 180th position out of 192 countries on this. Without spending at least 5-6% of the GDP on health, the basic healthcare needs of the population cannot be fulfilled. Although the National Health Policy, 2017 has provided for increasing public expenditure on health to 2.5% of GDP from the current ~1%, it is still very inadequate to provide universal healthcare.

The highly priced private healthcare is inaccessible to many; yet many seek healthcare in the private sector, and often find themselves in financial trouble.

Very few people in the country have health insurance coverage. India has one of the highest out of expenditures on health in the world, which is over 60%, which contributes to poverty due to exorbitant health expenses resulting in further inequity in health services.

Universal health coverage is the answer to affordable healthcare of quality in developing countries like India. The goal of universal health coverage is to ensure that all people receive the health services they need without suffering financial hardship when paying for them (WHO Online Q&A, December 2014). Universal healthcare provides Affordable, Adequate, Accessible, Available, Appropriate and Accountable quality and safe healthcare to the public.

Achieving universal health coverage is a target under the Sustainable Development Goal (SDG 3) “to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all (3.8)”.

The World Health Organization (WHO) has chosen “Universal health coverage: everyone, everywhere” as the theme of the World Health Day this year.

Every citizen in the country has a right to receive safe and quality medical treatment. Right to health and medical care has been recognized as a fundamental right covered by Article 21 by the Hon’ble Supreme Court of India.

It is the constitutional duty of the govt. to provide quality healthcare for all. In this day and age, when medicine has made tremendous advances, nobody should die just because they cannot afford treatment.

Stop Press Breaking News

IMA Resolutions at Mahapanchayat

1. Medical students to go on strike on 2nd April 

2. IMA members to go on indefinite strike if NMC is passed by the government

Sunday, March 25, 2018

Join the Mahapanchayat today

“Unity is strength... when there is teamwork and collaboration, wonderful things can be achieved” said Mattie Stepanek.

The unity of lawyers, way back in 1990, made sure that Kiran Bedi, then the deputy commissioner of police for northern Delhi was transferred from her post.
Public unity saw the creation of Nirbhaya Fund by the Govt.

The unity of the ‘aam janta’ saw the emergence of Arvind Kejriwal as the Chief Minister of Delhi.

Such is the strength of unity.

A critical mass of only 1% of professionals is required to stand united and act the same way at the same time to make any nation-wide movement a success.

More than 25,000 doctors will gather today in Delhi for the Mahapanchayat at the Indira Gandhi Stadium, New Delhi between 10 am and 2pm, where they will deliberate on the various issues faced by the medical profession in the country.

Important decisions and future strategy will be announced after a consensus is achieved.
This is a once in a lifetime opportunity… not to be missed

Join the Mahapanchayat today even if you have to miss your morning walk, your breakfast and/or lunch - have breakfast and lunch with us at the Mahapanchayat - or even if you have to miss your Sunday morning clinic.

It does not matter whether you are a GP, a specialist, a super specialist or resident, medical student (undergraduate/post graduate)… this Mahapanchayat is for all of us.

Saturday, March 24, 2018

It is time to revisit the ‘GTN’ approach to end TB

Dr KK Aggarwal
Padma Shri Awardee

TB is a preventable and curable disease and yet despite advances in TB care, India continues to have the highest burden of both TB and MDR TB patients and accounts for about a quarter of the global TB burden. An estimated 1.3 lakh incident multi-drug resistant TB patients emerge annually in India, which includes 79000 MDR-TB Patients estimates among notified pulmonary cases. India bears second highest number of estimated HIV associated TB in the world (TB India 2017).

Globally, the incidence of TB has been declining at about 2% per year. But, this decline is not enough to achieve the first 2020 milestone of the End TB Strategy and the target of ending the TB epidemic by 2030 under the Sustainable Development Goals (SDG 3). TB cases have to decline by 4-5% to achieve this target.

India also has the dubious distinction of being among the top three countries, where the gap between estimated TB incidence and reported cases is the highest: India (25%), Indonesia (16%) and Nigeria (8%). Ten countries accounted for 75% of the incidence-treatment enrolment gap for drug-resistant TB; again India along with China accounted for 39% of the global gap.

This wide gap in the incidence of TB and the reported cases highlights the IMA End TB Strategy of “GTN”, where G stands for GeneXpert test (sputum diagnosis), T for Trace (contacts) and Treat. N is to Notify the disease at Nikshay (mandatory).

India has set 2025 as deadline to be free of TB. Although preventing and controlling TB is a collaborative effort, doctors are major stakeholders in the control of TB.

Control of TB depends on early detection, which means early and better treatment to prevent further spread of TB. Contact tracing interrupts the chain of transmission of the disease by early diagnosis of cases as well as timely and complete treatment.

All household and close contacts of patients with infectious TB should be traced, screened and treated with a full course of ATT if found to have TB.

A household contact is a person who has shared the same enclosed living space for one or more nights or for frequent or extended periods during the day with the index case during the 3 months before starting the current treatment. A close contact is a person who is not in the household but has shared an enclosed space, such as a social gathering place, workplace or facility, for extended periods during the day with the index case during the 3 months before initiation of the current treatment episode (WHO 2012).

Most of us regularly treat many patients of TB. And, there can be no time better than today, World TB Day, to reiterate our commitment to ‘GTN’ and file our returns.

Ask yourself, how many GeneXpert tests you have ordered… how many contacts you have traced and screened for TB…and how many TB patients you have notified at Nikshay.

You can notify even today, if not done earlier. It is not necessary to notify the day you diagnose the patient as having TB.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Friday, March 23, 2018

Failure to self regulate is an invitation to Govt. regulations with punitive provisions

Failure to self regulate is an invitation to Govt. regulations with punitive provisions

Dr KK Aggarwal

Padma Shri Awardee

Dharma, Artha, Karma and Moksha are the four purposes of life; they are called the Four Purusharthas. Of these, dharma is the most important. The word dharma is derived from dhri, which means “to hold”. Therefore, it literally means “that which holds” i.e. anything which holds people together. Dharma changes according to circumstances, country, religion, community.

Values are our fundamental beliefs, which tell us what is right, good and just. Honesty, integrity, compassion, courage, honor, responsibility, patriotism, respect and fairness are examples of values.

Morals are values which we attribute to a system of beliefs, typically a religious system, but it could be a political system or some other set of beliefs.

Ethics are the principles that govern how we act and take decisions. Acting in ways, which are consistent with our beliefs, whether secular or derived from a moral authority is characterized as acting ethically.

Dharma is the path of righteousness and living one’s life according to the codes of conduct as described by the Vedas and Upanishads. Dharma of a doctor is to treat and save the life of a person at any cost.

The first code of conduct for doctors has been described in the Charaka Samhita “paro bhutadaya dharmamiti matva chikitsaya” i.e. “the physician has to consider compassion as the highest virtue, and proceed to treat patients”.

Then came the “pan-world” Hippocratic Oath, one of the oldest codes of conduct for doctors, which emphasizes self regulation.

The World Medical Association (WMA) also provides standards of ethical behavior for doctors around the world through its International Code of Medical Ethics, the Declaration of Geneva (the Physicians Pledge) and the Helsinki Declaration, which defines ethical principles for medical research involving human subjects.

All these codes propound self regulation. However, not all followed these self regulating standards. So, this brought on regulatory code of conduct with punitive provisions, MCI ethics, the Indian Penal Codes (IPC) and specific laws such as the PCPNDT Act with harsh penal provisions.

The root of these regulations with penal provisions is failure to self regulate.

If we don’t self regulate, then the government will bring laws. These laws will come with penal provisions and imprisonment.

Code of self regulation is made by the people themselves, who make up the individual Associations. The American Medical Association (AMA) Code of Medical Ethics is a classic example.

It’s high time that all stakeholders, including doctors’ association, pharmaceutical industry, health insurers, work out a common code of conduct.

FICCI Health Services Committee has taken an initiative to develop a comprehensive code of conduct, based on MCI Code of Ethics Regulations, Pharma Code of Conduct, IMA-NATHEALTH code.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA