Sunday, September 30, 2018

The Board of Governors taking over was inevitable

The Niti Aayog had always wanted to change the structure of MCI for long. However, it was getting postponed either by pressure from the medical community including IMA or by the opposition political parties.

The NMC Bill had been put before the Parliament twice but had not been passed. It may not get passed in the winter session too. After that it will be National election time.

The bureaucracy is very adamant in making this change. The term of the MCI was getting over on 5th November. If the govt. had started the MCI re-election period, this would mean being elected for five years.

The Supreme Court had already consented to an overarching control of a 5-member committee.

So, the best way for the government was to not continue with the MCI beyond 5th November and run it with a 5-7 member Board of Governors as the Congress had done in the past with the same members who had been running it for the last one year with additional two members.

Most of these members nominated to the Board of Governors have proven integrity. Dr Sanjay Shrivastava, who has been appointed the Secretary General has a wide experience of the MCI.

The whole procedure has been advanced by one month with an idea that by the time the next parliament sits, they will have had enough time to adjust. The government is hoping to get the NMC Bill passed in November. If not, continue with the Board of Governors for the next one year.

Till the NMC comes, the present infrastructure and staff of MCI continues.

MCI Take-over: Malafide and Scheming (Team IMA 2018)

In an emergency session in Mumbai, the IMA Action Committee condemned the supersession of the Medical Council of India (MCI).

This action of the Government, at a juncture when the election to MCI has been announced, is unwarranted and malafide. The composition of the Board of Governors (BOG) itself is unacceptable. Directors of major National institutions would scarcely find time to administer more than 450 medical colleges and their UG and PG courses. Moreover, there is no representation to women and Registered Medical Practitioners.         
The Indian Medical Association (IMA) is convinced that supersession of MCI is only a smoke screen and ploy to prepare the ground for NMC and sabotage the democratic process of MCI. Why the Government was in a hurry to scuttle a democratic process needs an answer.     
 IMA’s concerns remain. Bringing MCI directly under the government control seems to be the plan to implementation of Bridge Courses, crosspathy and registration of non medical persons.

IMA demands that the BOG should refrain from taking any major policy decisions or amendments changing the character of the IMC Act.

IMA also demands that the election process in progress in MCI should be allowed to continue.   
IMA will continue its resistance to NMC Bill. Any intentions of the NMC Bill implemented through the appointed BOG will be fought with determination. 

  • This is the fourth time that BOG is being appointed. All the previous attempts were an abject failure. 
  • The eminent clinicians appointed have little exposure to the day-to-day administration of MCI. 
  • The Government has not cited any reason for superseding MCI.                     
  • MCI Election process is on.  It was inappropriate for the Government to supersede at this stage. This betrays a malafide intention. 
  • BOG should conform to the basic tenets of IMC Act and refrain from tinkering with its fundamental structure. 
  • Crosspathy, registration of non medical persons, bridge courses and mixing of syllabi are core concerns. The fidelity, identity and the privileges of the profession will be defended at any cost.       
  • 184 private medical colleges are awaiting recognition due to strict norms of the outgoing MCI team.  IMA, media and the people should keep vigil in this regard.
  • IMA foresees a highly difficult period ahead when checks and balances have been removed.
  • A generation of substandard doctors will be the legacy of this action.
  • IMA will keep its tryst with destiny and redeem the profession from dark forces. Every single challenge thrown at the profession will be repulsed with single minded. 

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Saturday, September 29, 2018

The spiritual heart: Your heart and my heart are one

“My Heart, Your Heart” … this is the theme for the World Heart Day this year, which happens to be today. This means to not only look after our own hearts but also of our loved ones.

It’s important to lead a healthy lifestyle, not only as individuals, but also make sure that people we care about do the same.

This is what our Vedas also expound.

“Tat tvam asi” is a mahavakya in the ancient Sanskrit texts of the Upanishads. It translates as “I am that” and means that “You and I are same” or “your heart and my heart are one”.

Whenever we point to our own self, we put our hand on our heart;  we also put our hand on our heart when we say “I love you from the bottom of my heart”.

Does the consciousness reside in the celiac plexus (manipura chakra) or thymus plexus (anahata chakra)? We do not know. Manipura chakra is associated with fire and the power of transformation. The Anahata Chakra manifests unconditional love, forgiveness and patience.

Our ancient scriptures and the Bible say that the heart is the size of a thumb and it is in the heart that our consciousness (soul) resides.

  • In Svetasvatara Upanisad (5.8, 5.9). " Soul is the size of a thumb, bright as the sun, when coupled with conception and ego. But with only the qualities of understanding and soul, it appears the size of the point of an awl. This life is the hundredth part of the point of a hair divided a hundred times, and yet in it is infinity". Here the sruti is speaking metaphorically, because actually the soul is atomic in size. Therefore in the next verse (Svet. U. 5.9) the soul is compared to a fraction of the tip of a hair. These comparisons are meant to indicate that the individual soul is atomic rather than all-pervasive.

  • According to Vedanta Sutra, the idea that God resides in the physical heart the size of the thumb is for the sake of conceptualization during meditation, and is thus a metaphorical description. The size of the thumb refers to the size of the human heart. God is in reality all pervading and atomic at the same time.

  • Atharva Veda: the soul is a particle of God.

  • Jain metaphysicists refer to it as of varying sizes, small in a child, big in adults and old people and very big in elephants.

  • Nemi Chandra in Dravya sangrah -2: soul is characterized by knowledge and vision, has the same extent as its own gross body.

  • Katha Upanishad (1.2.20): Spirit, the size of a thumb "angush matra", is the inner soul, always seated in the heart of creatures.

Katha Upanishad Part Fourth XII. The Purusha (Self), of the size of a thumb, resides in the middle of the body as the lord of the past and the future, (he who knows Him) fears no more. This verily is That. The seat of the Purusha is said to be the heart, hence It “resides in the middle of the body.” Although It is limitless and all–pervading, yet in relation to Its abiding–place It is represented as limited in extension, “the size of a thumb.” This refers really to the heart, which in shape may be likened to a thumb. Light is everywhere, yet we see it focused in a lamp and believe it to be there only; similarly, although the life–current flows everywhere in the body, the heart is regarded as peculiarly its seat.

  • Garuda Puran: Ultimately, the soul, which is not more than the size of a thumb, reluctantly comes out from the body as the attachment with the world exists even after his.

  • Gaudiya acharya Sri Baladeva Vidyabhusana in his Govinda Bhasya commentary on the Vedanta Sutra. (1.2.7, 1.3.24-25.): During meditation Paramatma does appear to the yogi or devotee as a localized form in his heart, but in general Paramatma is all-pervasive and all-knowing.

  • Unknown: According to some Vedic scholars the soul enters the human form like 4-8 weeks after conception, like when the fetus is the size of a thumb.

  • Bhagavad Gita 15.15: I (soul) am seated in everyone's heart, and from Me come remembrance, knowledge, and forgetfulness. By all the Vedas, I am to known. Indeed, I am the compiler of Vedanta, and I am the knower of the Vedas."

  • Vedanta Sutra II, 6,17: 'The person of the size of a thumb, the inner Self, is always settled in the heart of men. Let a man draw that Self forth from his body with steadiness, as one draws the pith from a reed. Let him know that Self as the Bright, as the Immortal'.

  • Swami Muktananda, Play of Consciousness, p.85: The whole body is like a lotus which has four petals of four kinds, colours, and sizes....The first is the gross body, its colour is red. The second petal is the subtle body, in which we sleep and experience dreams. It is the size of a thumb, and its colour is white. The third petal is the causal body. It is the size of the tip of third finger, and its colour is black. The fourth petal is the supracausal body, which is as small as a sesame seed. Its colour is blue.... It is very brilliant; it is the foundation of sadhana; it is the highest inner vision."

  • Matthew 5;8: Soul resided in the heart: "Blessed are the pure in heart, for they shall see God."

When we meet somebody and form a relationship with another person, we go through five stages: Euphoria, reaction, adjustment, liking and loving.

The stage of euphoria is due to release of phenylethylamine, dopamine and norepinephrine. Dopamine makes them feel good and norepinephrine stimulates the production of adrenaline, which makes the heart beat faster. The stage of reaction is based on release of adrenaline and noradrenaline.
Adjustment is the balance of all hormones. Endorphins and serotonin abound in the stage of liking. The endorphins or opiate-like peptides calm and reassure with intimacy, dependability, warmth, and shared experiences. The last phase is the real spiritual love or the state of ‘rasa’, where your emotions are one with the other. This is “made for each other” and denotes a parasympathetic state of mind.

Only the beta-blockers have been proven to reduce mortality in heart disease. They block the sympathetic response of the body and convert it to the parasympathetic state, the relaxed state.

The parasympathetic state can also be achieved by doing parasympathetic exercises, which are healing, e.g. progressive muscular relaxation, yoga, pranayama, shavasana (also called kayotsarga, which means total relaxation of mind, body and speech with self-awareness) and meditation by thinking differently, thinking opposite and thinking positively.

A parasympathetic state can also be achieved by neutralizing the noise of attachment, expectations and desires or going through these, but bypassing them.

Increase in physical activity is recommended for a healthy heart. A long walk not only offers physical benefits, one also gets the benefits of nature as one’s inner stimuli are exposed to the outer stimuli during the parikrama. The proximity with nature helps in the inward spiritual journey and shifts one from the sympathetic (disturbed) to parasympathetic (relaxed) mode described by lowering of blood pressure and pulse rate. 

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Friday, September 28, 2018

Saving a death when we cannot save a life in the intensive care unit

There are several situations and/or elective interventions in medicine where the patient is made unconscious, given anesthesia, surgery or sedation especially in terminally ill patients. In these situations, there is a chance that the patient may not wake up. Even though the intervention may have been necessary, it deprives them of their chance to share few last words with their families.

In the June 2018 issue of JAMA International Medicine, Michael E. Wilson - a critical care doctor - has written an account of a woman in intensive care in “Saving a death when we cannot save a life in the intensive care unit”, who was electively intubated for a procedure and then died, without ever having had the opportunity for her loved ones to say goodbye.

This can be somewhat likened to soldiers being sent off to war by their families with a puja and tika or families sending off their loved one on a pilgrimage or tirth yatra with a tika in ancient times as they may not come back alive.

This gives them an opportunity to talk to their families and express their wishes that they want to be fulfilled, knowing that this might be their last chance to hold this conversation.

When I was in Malaysia for the CMAAO general assembly, we went to the Port. There were three temples where fishermen prayed before going out to the sea and also when they returned.

The ritual of performing Shradh is to satisfy the unfulfilled, known or unknown, wishes and desires of the deceased person by the eldest son in the family. Shradhs are also for the unknown unfulfilled desires of our ancestors; unknown to the present family but maybe were known to the past family. These unknown wishes come back as dreams to their descendents through qualia or tanmatras. A mahashradha is performed when all the wishes of the ancestors are fulfilled. Once a mahashradha is performed, then there is no need to perform Shradh rituals thereafter.

 According to the Vedas, every individual has three debts to be paid off, firstly, the Devtas (Dev Rin), secondly of Guru and teachers (Rishi Rin) and, thirdly, of Ancestors (Pitra Rin). Devtas represent people with Daivik qualities; teachers the ones who have taught us and Pitra represent the three generations of our ancestors.
Therefore, it is always better to allow patients some time alone with their families and express their wishes, before any such intervention, or say goodbye in the worst case scenario.

 “My intubation checklist now includes this step…It’s a way to avoid stealing last words from a person”, as Michael E Wilson writes.

Always write down your wishes for your family…

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Thursday, September 27, 2018

Ordinance cleared to set up committee to run MCI until Parliament passes NMC

Just like it was 5 years back, a Board of Governors has taken over the MCI. Dr VK Paul has taken charge of MCI today evening.

The present MCI gets dissolved with immediate effect.

Proposed NMC is in Parliament and has nothing to do with present ordinance.

The ordinance is as below:

The Gazette of India
New Delhi, Wednesday, September 26, 2018/Asvin 4, 1940 (Saka)

(Legislative Department)

New Delhi, the 26th September. 2018/4svina 4, 1940 (Saka)


No. 8 of 2018

Promulgated by the President in the Sixty-ninth Year of the Republic of India.

An Ordinance further to amend the Indian Medical Council Act. 1956.

WHEREAS Parliament is not in session and the President is satisfied that circumstances exist which render it necessary for him to take immediate action;

NOW, THEREFORE, in exercise of the powers conferred by clause (1) of article 123 of the Constitution, the President is pleased to promulgate the following Ordinance:-

1. (1) This Ordinance may be called the Indian Medical Council (Amendment) Ordinance, 2018.
(2) It shall come into force at once.

2. In section 3A of the Indian Medical Council Act, 1956,- --

(a) in sub-section (I), for the words, brackets and figures "Indian Medical Council (Amendment) Act. 2010", the words, brackets and figures "Indian Medical Council (Amendment) Ordinance, 2018" shall be substituted;

(b) in sub-section (2), for the words "three years", the words "one year" shall be substituted;

(c) in sub-section (4), for the words "and medical education", the words "and medical education or proven administrative capacity and experience" shall be substituted;

(d) after sub-section (7), the following sub-section shall be inserted, namely: — "
(7A) The Board of Governors shall be assisted by a Secretary General who shall be appointed by the Central Government on deputation or contract basis and he shall be the head of the secretariat in the Council.".


Secretary to the Govt. of India

(To be published in the Gazette of India, Extraordinary, Part – II, Section 3, Subsection (ii)]

(Department of Health and Family Welfare)
New Delhi, the 26th September, 2018-09-26

S.O. – Whereas the President promulgated the Indian Medical Council (Amendment) Ordinance, 2018 (Ordinance 8 of 2018) on 26th September, 2018, which came into force on the said date;

And whereas, on and from the date of commencement of Indian Medical Council (Amendment) Ordinance, 2018 (Ordinance 8 of 2018), the Medical Council of India shall stand superseded and teh President, Vice President adn other Members of the Council shall vacate their office and shall have no claim for any compensation, whatsoever;

And whereas upon the supersession of the Council and until a new Council is reconstituted, a Board of Governors is required to be constituted by the Central Government to exercise the powers and perform the functions of the Council under the said Act;

Now, therefore, in exercise of the powers conferred by sub-section (4) of section 3A of the Indian Medical Council (Amendment) Ordinance, 2018, the Central Government hereby constitutes the Board of Governors consisting of the following persons as its Chairperson and Members, namely: -

Dr. VK Paul, Member, NITI Aayog                                      - Chairman
Dr Randeep Guleria, Director, AIIMS, New Delhi               - Member
Dr Jagat Ram, Director, PGIMER, Chandigarh                     - Member
Dr BN Gangadhar, Director NIMHANS, Bangalore             - Member
Dr Nikhil Tandon, Professsor, Department of                        - Member
Endocrinology & Metabolism, AIIMS, New Delhi
Dr S Venkatesh, Director General of Health Services            - Member ex-officio
Ministry of Health & Family Welfare
Prof Balram Bhargava, Secretary, Department of Health       - Member ex-officio
Research & Director General Indian Council of Medical
Research, New Delhi

Further, in exercise of the powers conferred under section 7A of the Indian Medical Council (Amendment) Ordinance, 2018, the Central Government hereby appoint the Secretary General to assist the Board of Governors to the following person, namely:-

Dr Sanjay Shrivastava, Ex-Deputy Director General, Directorate General of Health Services, Ministry of Health & Family Welfare, New Delhi

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Wednesday, September 26, 2018

Diphtheria death toll in Delhi rises to 20: Anticipation and preparedness key to avert any outbreak

As many as 19 children have died of diphtheria at the North Corporation-run Maharishi Valmiki Infectious Diseases Hospital, one child died at the Delhi government-run Lok Nayak Hospital, taking the death toll due to diphtheria in the city to 20.  “From September 6-24, there have been 157 admissions, of which 128 were from UP. Rest of the cases are from Haryana and Delhi,” a senior North civic body official said. (HT, Sept. 25, 2018).

Diphtheria is a vaccine-preventable disease and is included in the Universal Immunisation Programme (UIP) in India as DPT vaccine. In 2014, the Health Ministry launched Mission Indradhanush as a special drive to vaccinate all unvaccinated and partially vaccinated children under UIP. Mission Indradhanush aims to increase full immunization coverage in India to at least 90% children by December 2018.

The very fact that there has been an increase in the number of diphtheria cases in the capital, this indicates the failure of the primary immunization program. This should be investigated and the unvaccinated children and those who have received incomplete vaccination, in both urban and rural areas, should be identified and covered under the Mission Indradhanush, as was its aim.

There is a shortage of antidiphtheria serum (ADS). We have been told that the facility to produce DPT group of vaccines at the Central Research Institute in Kasauli is undergoing renovation. This shows no anticipation and lack of preparedness on the part of the government.

The government should reimburse all those who have procured ADS from private sector or it should itself procure the same from local sources.

The overall case-fatality rate for diphtheria is 5-10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. These 20 deaths should not have occurred.

There is clearly a gap in immunization coverage rates as well as lack of preparedness of the government. As a result, the concerned authorities failed to mount the level of response needed to contain a probable outbreak of diphtheria, in this case, with 160 reported cases.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA