Showing posts with label AYUSH. Show all posts
Showing posts with label AYUSH. Show all posts

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. 


Monday, March 19, 2018

No news story about any system of medicine should be published in media without first verifying from the experts



Ministry of Ayush recently published a reply to a news story titled "Ayurvedic Med Poses Life Threat" published in The Pune Mirror newspaper on 25th December, 2017.
The letter said that “the title of the news item was so generalized that it may lead to an overall distrust in the minds of the readers at large regarding the safety, efficacy and overall credibility of Ayurveda in general and Suvama Bhasma- an important Ayurvedic medicine in particular… It is pertinent to note that one bad example cannot be allowed to tarnish the credibility of the whole system of Ayurveda. In view of the above, 'The pune Mirror' may consider publishing a corrigendum *rand apology at the earliest to enlighten the readers and explain to this Ministry the basis of publishing the news in such an irresponsible manner, within two weeks of this communication failing which, the matter will be taken up with PTI and PIB. Also, the newspaper may abstain from publishing such derogatory reports which tarnish the credibility of time tested medicines”.
As per Vedic knowledge when the matter is converted into non-matter in the form of energy, it is used either as potentised drug in homoepathy or a bhasma in Ayurveda.
 During the processes of potentisation or trituration in homeopathy and bhasma formation by the process of homa in Ayurveda, when the matter converts  into non matter (non measurable), it changes its properties. It is non-measurable at this stage by any current investigational criteria. 
If any matter is detected, it indicates adulteration or inadequate trituration or potentisation.
There are regulators in all respective fields, as are experts. Hence, any complaint should be referred to them rather than addressing them in the media without any expertise in that field. 
No such news story should be allowed to be published in media  without first verifying facts or fact checking. It may not be the truth.
This is equally true for all systems of medicine.

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 16, 2018

Employing Ayush doctors in ICUs is professional misconduct




On Wednesday night, CNN-News18 broadcast a story which showed ICUs in some private hospitals in both Indore and Bengaluru did not have an accredited intensivist or a critical care physician, in charge and instead were being managed by Ayush doctors.

Employing Ayush doctors in ICUs violates the Code of Ethics Regulations as prescribed by the MCI in several ways and is a professional misconduct.

There are no ICUs in Ayush systems of medicine. Hence, their practitioners are inexperienced and/or ill-equipped in managing critically ill patients even with Ayush therapies.

Critical care medicine is a highly specialized field that requires skills to diagnose and manage life-threatening conditions in patients who may be already severely ill. Minimum standards for ICUs to be adopted throughout the country have been suggested by a committee in 2012 under the chairmanship of Prof MK Arora, Dept. of Anesthesiology at AIIMS, New Delhi as below.

Director / Incharge

·         Ideally an ICU must have a full time director or in charge, with full time appointment or at least dedicates 30%- 50% of professional time in ICU (2.1.1).
·         Senior accredited specialist in intensive care medicine with Postgraduate degree (PG) or equivalent   degree   in anesthesiology or internal medicine   or surgery   or critical care medicine.  He  should  have  formal  education/  training  and  experience  in intensive  care medicine  with preferably  5 - 7 years (full time) work experience  in intensive/  critical care medicine. Available upon request on notice in the hospital during "off duty hours (2.1.3).

Consultants

·         Should possess MCI (Medical Council of India) recognized postgraduate degree in (PG) or  equivalent  degree  in  Anesthesia,  Medicine  or  Surgery  or Physicians  qualified  in intensive care medicine (2.2.1.1).
·         Should have minimum 3 years experience after post-graduation of which 3-6 months experience in intensive/ critical care medicine  (One with teaching experience  in critical care medicine is preferred (2.2.1.2)

Resident doctors (Academic or non-academic or fellows)

·         A minimum of two resident doctors must be on duty in an ICU and they must be on duty for 24 hours x 7 days (2.2.3.1).
·         One of the resident doctor must be a postgraduate in anesthesia or medicine or surgery with minimum of 3 months (preferable   6 months) full time working experience in ICU. The other resident doctor can be a trainee (Academic or fellow trainees after 1 years of training in their primary specialty and within the frame of their specialty, work in an ICU under clearly defined supervision) (2.2.3.2).
·         One resident doctor to take care of not more than five patients (2.2.3.3).


Any doctor who employs an Ayush practitioner as an assistant is responsible for his/her actions. This has been clearly stated in Regulation 7.18 of MCI Code of Ethics “In the case of running of a nursing home by a physician and employing assistants to help him / her, the ultimate responsibility rests on the physician.”

While 7.18 does not “restrict the proper training and instruction of bonafide students, midwives, dispensers, surgical attendants, or skilled mechanical and technical assistants and therapy assistants under the personal supervision of physicians”, it does not allow issuing directions to Ayush doctors with regard to patient care in ICUs during rounds or otherwise. This would amount to training of training of Ayush doctors in critical medicine and violates the provisions of Regulation 7.10, which says, “A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non-medical person”.

Employing Ayush doctors to take care of patients in ICUs amounts to fraud, cheating and impersonification on the part of hospital owners, medical superintendent of that hospital including other doctors, if they are aware that Ayush doctors have been employed. Moreover, this does not have the consent of the patients.

All doctors who assign them duties including those who interview Ayush doctors to hire them in their hospitals are also liable for professional misconduct.  

As per Regulation 1.6 Highest Quality Assurance in patient care: “Every physician should aid in safeguarding the profession against admission to it of those who are deficient in moral character or education. Physician shall not employ in connection with his professional practice any attendant who is neither registered nor enlisted under the Medical Acts in force and shall not permit such persons to attend, treat or perform operations upon patients wherever professional discretion or skill is required”.

As doctors, patient safety and care is our first and foremost concern.

The Govt., Association and Regulators should take suo moto cognizance of this report and take appropriate action.


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, September 25, 2013

Heart disease is the most common cause of death and disability in urban women

Important differences between women and men in the presentation of heart disease make it more difficult to establish a diagnosis in women, said Padma Shri and Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India. He was addressing a press conference as a curtain raiser to the 5th Dil Ka Darbar to be held on Sunday, 29th September. The event is being organized by the Heart Care Foundation of India at Constitution Club of India in association with Ayush, Department of Health, Government of NCT Delhi, LIC, MTNL, Central Bank of India and GAIL.

Special Guests of Honour were Padma Shri & Rajiv Gandhi Khel Ratna Awardee Yogeshwar Dutt, a Bronze Medalist at the 2012 Summer Olympics in the  60kg Freestyle wrestling, Dronacharya Awardee Yashbir Singh (Wrestling coach) and Arjuna Awardee Dharmendra Dalal, a Bronze Medalist in in 120 Kg Greco-Roman style wrestling at the 2010 Commonwealth Games.

Dr KK Aggarwal said:
1.    Women generally present 10 years later than men and with greater risk   factor burden.
2.    Women are less likely than men to have typical angina.
3.    Women in the emergency department with new onset of chest pain are approached and diagnosed less aggressively than man.
4.  Women are more likely to present initially with chest pain than a more clearly defined event such as heart attack.
5. Symptoms of heart attack in women differ from those in men.
6.  Many cases of heart attack in women are unrecognized.
7.  In women, treadmill exercise has a higher false positive rate.
8.  Small vessel disease is more common in women than in men.
9.  Established risk factors in women are: Presence of history of heart blockages; age over 55 years; high LDL (bad) or low HDL (good) cholesterol, diabetes, smoking, high blood pressure, peripheral artery disease or family history of heart disease. 
10.  Risk factors, which are more potent in women than in men are: Smoking is associated  with 50% of all coronary events in women; diabetes confers more prognostic information in women than in men.

Prevention in Women
For all Women
·        Moderate intensity physical activity for at least 30 minutes and for 60 to 90 minutes for weight management on most days of the week.
·        Avoidance and cessation of cigarette smoking and passive smoking
·        Keep waist circumference less than 35 inches.
·        Take a heart-friendly diet.
·        Presence of high triglyceride levels.  One should add Omega 3 fatty acids to diet.
·        Control cholesterol level, high blood pressure and diabetes.
·        Women who smoke should avoid oral contraceptive pills.
·        Aspirin 80 mg in more than 65 years of age should be added
·        Treat underlying depression.

 Women at high risk
·  Aspirin 75 to 150 mg, as prevention
·  Control of blood pressure.
·  No use of anti oxidant vitamin supplement.
·  No use of folic acid support.
·  No Hormone Replacement Therapy.
·  Lowering of LDL cholesterol of less than 80.


Co-addressing the Press Conference, Mr GP Sinha GM (Mktg) MTNL said that the best gift we can give to our wives, mothers and sisters is an annual heart check up.  Dr NK Yadav, MHO, South Delhi, Medical Corporation; Dr. PK Sharma, MOH, NDMC; Dr NV Kamat, Director, Health Services, Delhi; and Sr representatives from Central Bank of India in a joint statement said that our concern in women should shift from breast cancer to heart awareness as the lifestyle adopted to prevent heart disease would also prevent breast cancer.

Thursday, February 28, 2013

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.

Monday, September 24, 2012

Dil Ka Darbar inaugurated: Telecardiology a welcome advancement in today's era, Dr Ashok Walia





Dr Ashok Walia, Minister of Health Government of Delhi, in his message to the 4th Dil ka Darbar said that telecardiology should now become a part of the facilities in every hospital.
The Darbar was organized by Heart Care Foundation of India in association with Department of AYUSH and various Departments under Health Ministry, Government of Delhi on Sunday at Talkatora Stadium, New Delhi.
Messages were also received from many dignitaries.
Shri M. Veerapa Moily, Union Minister of Law said that non-governmental organizations should play an important role in healthcare of poor patients who are unable to meet hospital bills and consultation fees.
Shri Beni Prasad Verma, Union Minister of Steel, expressed confidence that this endeavor of the Foundation would provide a platform to thousand of heart patients to avail facilities like free checkups, etc.
Shri Bhoopinder Singh Hooda, Chief Minister of Haryana, said that priority of the government should be to provide free medicines to those people who cannot afford them. Shri Narendra Modi, Chief Minister, Gujarat said that changing lifestyle, stressful event and competitive environment are responsible for most heart diseases. Shri Lal Thanhawla, Chief Minister of Mizoram said that the time has come for the medical fraternity to educate general masses about healthy living.
Shri Akhilesh Yadav, Chief Minister Uttar Pradesh, said that the efforts of the Foundation to provide facilities of free check-ups to the heart patients and interaction with top cardiologists during the programme are highly commendable. 
The Chief Minister of Kerala, Mr. Oommen Chandy said that in our country where cases of heart ailments are on the rise, the activities of Heart Care Foundation of India are truly inspiring.
Shri Raj Kumar Chauhan, Minister of PWD, said that NGOs should come forward to organize free health checkup camps for the public. Prof. Kiran Walia, Minister of Social Welfare, Government of Delhi said that telecardiology consultations should also be used for free health checkup camps.   Shri Arvinder Singh Lovely, Minister of Education, Government of Delhi, said that heart awareness should be the priority of every individual.
Inaugurating the Darbar, Shri B Mandal, General Manager, Central Bank of India said that one should follow the laws of nature to prevent cardiac diseases. He said that wild animals do not get heart attack.
Presiding over the function, Shri AK Ganeriwala, IAS, Joint Secretary, AYUSH, said that the death prevention heart care is when you combine allopathy with other systems of medicines.
Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India, who is also the Vice President-Elect of National Indian Medical Association, said that everyone after the age of 30 should get their risk of getting heart attack in the next 10 years evaluated and take precautions if the risk is more than 10%. He also demonstrated and conducted a workshop on “How to revive a dead patient.” He said that within 10 minutes of death, it is possible to revive a dead person’s heart by following the formula of 10 i.e. within 10 minutes of death, for the next 10 minutes, one should compress the chest of the deceased person 100 times (10 x 10).
Guest of Honour, noted singer and composer Ms Shibani Kashyap, said that music is good for recovery of the heart patients. Chanting various sounds is similar to doing meditation.
Dr Ishwar VB Reddy, Director, Morarji Desai National Institute of Yoga, Dr Ramesh Babu Devalla, DG CHRS, Dr Surender Verma, DG, Dept. of Homeopathy in a joint statement said that blockages in the heart is lifestyle disorder and can be prevented utilizing all systems of medicines.
Dr PK Sharma, MOH NDMC and Dr NK Yadav, Director Health MCD
South in a joint statement said that one should not consume trans fats in diet and reduce amount of salt intake to prevent future heart diseases.
Shri Satish Upadhyay, Chairman, Standing Committee on Education, MCD South said that prevention of heart diseases should start right in school age.
Dr NV Kamath, DHS, Shri PK Jaggi, Head of Office Drug Controller Department of Government of Delhi said that one should believe in natural pharmacy and take medicines only when they are required. Others who were present were Hakim Javed-ul-Haq Director General Central Council for Research in Unani Medicine (CCRUM), Dr RK Manchanda, Director General, CCRH, Dr Surender Verma Dy. Director Dept.of ISM & Homeopathy, Dr PK Sharma Medical Officer Health NDMC, Dr NK Yadav Director (Health) MCD South, Director ISM & H, Govt. of NCT of Delhi and Dr NV Kamat Director Health Services.
Eminent faculty on the dais included : Dr RK Manchanda, Dr PK Sharma, Dr Rajesh Malhotra, Dr NK Bhatia, Dr. SV Tripathi, Dr HK Chopra, Dr Manju Gupta, Dr Anupam, Dr Praveen Chandra, Dr Subhash Manchanda, Dr Sameer Srivastava, Dr Yugal Mishra, Dr Praveen Bhatia, Dr Sujay Shad, Dr Neelam Mohan, Dr Ajit Saxena, Dr Saurabh Juneja, Dr BN Sinha, Dr RK Tuli, Dr ZS Mehrwal, Dr JC Katoch, Dr Ishwar V Basava Reddy and  Dr Ramesh Babu Devalla.
Over 2000 heart patients were given consultations and checkups.