May 31, 2007

China's top drug regulator given death penalty for corruption, negligence

China's top drug regulator was sentenced to death on charges of corruption and negligence, state media said Tuesday, the latest development stemming from growing alarm over the country's poor food-safety record.
Zheng Xiaoyu was convicted and sentenced "on charges of taking bribes and dereliction of duty" at the Beijing Municipal No. 1 Intermediate People's Court, the Xinhua News Agency said in a brief dispatch. No other details were given.

Zheng was fired in 2005 on charges he took up to $780,000 in bribes to approve medicine that had not been tested to ensure its safety.

State media have reported that drugs improperly approved by Zheng's agency included an antibiotic that killed at least 10 patients last year before it was taken off the market.

President Kalam's five-point vision for medical fraternity

Unveiling a five-point vision for the medical fraternity, President A P J Abdul Kalam on Friday asked the doctors to treat at least 20 rural patients a year.

"The doctors should treat at least 20 rural patients a year at minimum rates by going to the rural areas," Kalam said in his address at the convocation ceremony of the B D Sharma Post Graduate Institute of Medical Sciences here.

Stressing on improving the standard of rural healthcare, the President, who presented the new medical graduates with their certificates, said the doctors should give their time to those patients who cannot afford medicare.

"You should take up rural health care as a challenge," he told the medical graduates.

"The primary health centres (PHCs) and other health centres must be revamped and improved in Haryana and other parts of the country," he said.

Kalam also underlined the importance of medical research and said the country must develop its indigenous medicines and equipments to cure deadly diseases like HIV/AIDS.

"Some of you may participate in research, development and use of vaccines against HIV, malaria and even against cardiac diseases," he told the students.

As part of his five-point mission for the medical fraternity, the President said young doctors must engage in research so that India can develop indigenous medical equipment.

Expressing concern about the rise in cases of HIV/AIDS in the country, Kalam said, "Some medicines have come which can control the growth of HIV virus in the human body. But they are still not affordable to the common man. The medical fraternity should make use of these medicines so that further cost effective methods can be evolved."

He also told the students to work towards eradicating diseases such as tuberculosis and malaria.

"According to Vision 2020, HIV, TB, malaria and water borne diseases will be main concerns in India. We must keep this in mind," he said.

The President also asked the doctors to further decrease the infant mortality rate (IMR) in India. A total of 467 pass-outs in both the Bachelor's and Master's courses of the PGIMS received their certificates on Friday.

Wockhardt to set up 30 hospitals by 2012

Mumbai-based Wockhardt Hospitals plans to set up 30 hospitals in the country in five years.

The company plans to raise the funds needed through an IPO planned early next year.

According to management sources, the hospitals would cover almost every city of the country.

“We are in the process of preparing the blueprint for the project. It will run into several hundred crore rupees. The expansion will be a mix of greenfield projects and management partnerships,” sources informed.

Wockhardt is one of the major corporate hospitals groups in the country with over 1500 beds in 10 hospitals in Mumbai, Bangalore, Calcutta, Gujarat and Nagpur. Its pan-urban presence would be complete once the current expansion plans take off.

The company is planning a new facility in central Mumbai.

Work on a 400-bed hospital in Bangalore has just begun.

A 250-bed hospital, the second in Calcutta for Wockhardt, is to be ready by 2008.

Next year will also see Wockhardt’s Delhi hospital ready for operations, sources informed.

Wockhardt had announced a tie-up with Ayushman Medical Diagnostics last year to set up a 120-bed super specialty hospital in Bhopal.

Wockhardt is to construct additional facilities, upgrade existing facilities and invest in the latest technologies to provide super speciality treatment in cardiology, cardio-thoracic surgery, neurology, neurosurgery, high-end orthopedic surgery and minimal access surgery.

The new hospital will have four state-of-the-art operating theatres and a critical-care facility with a 25-bed intensive care unit.

Wockhardt’s strength lies in its exclusive association with Harvard Medical International, the global arm of Harvard Medical School, the world’s leading medical institution.

This association provides Wockhardt access to the latest clinical protocols, innovations and patient care practices from 17 prestigious Harvard-affiliated hospitals in the US, including the Massachusetts General Hospital, the Brigham and Women’s Hospital and the Beth Israel Hospital.

May 10, 2007

AIDS medicines to cost less

Come July, the second line of anti retroviral drugs will become cheaper.

After negotiations facilitated by the Clinton foundation, companies like Cipla and Matrix have decided to cut prices by half.

The landmark decision will help millions of people living with HIV across the world. The price advantage will be available in 66 countries where these drug majors sell anti-aids drugs.

''We announce initial price reductions for second line medicines that will generate average savings of 25 per cent in low income nations, and up to 50 per cent below the price now available in middle income nations.

''This has been made possible by the UN, with which my foundation is partnering in a $100 million program. We're also announcing, in partnership with our suppliers Matrix and Cipla, uniform pricing for all these drugs across these countries,'' said Bill Clinton, Former US President.

In India however, patients are not receiving second line drugs.

Around 70,000 AIDS patients receive free first line treatment in government facilities while 35,000 patients in the private market spend Rs 1200 per month on drugs.

Second line drugs are exorbitant and currently cost between Rs 7,000- 8,000 per month.

The decision to cut prices could help governments in developing countries to procure second line drugs at a much cheaper rate, allowing the roll out of these drugs sooner than planned.

India has 5.4 million HIV positive people, most of whom do not have access to any drugs.

May 09, 2007

Brazil breaks patent on AIDS drug to cut health cost

Brazilian president Luiz Inacio Lula da Silva broke the patent on Merck & Co’s AIDS drug Efavirenz after the company’s offer to cut prices failed to satisfy demands from the country’s health ministry.

Lula, in a presidential palace ceremony recently in Brasilia, signed a law allowing the government to buy a generic version of Efavirenz from laboratories certified by the World Health Organisation. The government would consider a new proposal from Merck, should the company choose to make one, health minister Jose Gomes Temporao said.

The presidential decree marks the first time Brazil has by-passed a patent since the country recognised patent protection for drugs in 1996, Lula said. The government is pushing for lower drug prices to limit the cost of its programme providing free treatment to all 200,000 people in the country infected with AIDS and the HIV virus, he said.

The move highlights a debate among drugmakers over whether to cut prices, sometimes to below cost, in certain countries. Merck, the third-largest US pharmaceutical maker, said Brazil’s move may discourage companies from investing the hundreds of millions of dollars needed to find new treatments for disease in poor nations. Merck does not report sales for the AIDS drug in Brazil, which likely had an insignificant impact on its $23 billion in sales last year.

“Research and development-based pharmaceutical companies like Merck simply cannot sustain a situation in which the developed countries alone are expected to bear the cost for essential drugs in both least-developed countries and emerging markets,” the company said in a statement.

Merck offered to cut the government’s cost for the drug by 30% to $1.10 a pill from $1.59. The health ministry demanded a price of US 65 cents a pill, the same as that paid by Thailand, which has also considered breaking patents on some heart and HIV/AIDS drugs.

Merck shares rose 37 cents, or 0.7%, to $51.92 in the New York Stock Exchange composite trading. The Whitehouse Station, NJ-based company said its offer to Brazil was “the lowest of any country with a comparable wealth and disease burden”. Brazil has the 12th largest economy in the world and its AIDS infection rate is less than 1%, compared with 1.4% in Thailand, Merck said.

Merck cut the price of the drug in February to 65 cents a day at the 600 milligram dose, down from 76 cents, for patients and health-care providers in many countries in Africa and Asia and others where more than 1% of the population is infected. “We cannot pay more for a medicine when the same drug is sold at a much cheaper price in another country,” Lula said.

Brazil will save $30 million this year by purchasing the generic, compared with $42.9 million it would otherwise pay Merck. It will cut $237 million from its AIDS drug bill through 2012, when the patent right would expire, the health ministry said. Efavirenz is the principal component in a 17-drug cocktail to treat AIDS and is used by 38% of AIDS patients.

Brazil will spend 4.2 billion reais ($2.07 billion) on the purchase of all medicines this year, which accounts for 12% of the ministry’s total budget, Temporao said.

Lower prices will free up funds to expand and improve treatment for hepatitis, an illness common among AIDS patients, he added. The government said its decision respects a ruling by the World Trade Organisation, which agreed in 2001 that countries with emergency health issues could, within limits, break patent protection. “At this moment, there’s no other urgent problem but we’ll negotiate whenever we understand our AIDS programme is at risk,” Temporao said.

Brazil is in continual talks with the drug companies that provide nine of the 17 drugs in the AIDS cocktail, he said. The other 8 are produced in local laboratories and are not patented, he said.

In Thailand, which treats 16,000 AIDS patients, health officials will meet with four drug companies, including Abbott Laboratories and Sanofi-Aventis SA, on May 14 in Bangkok to negotiate lower prices, said Siriwat Thiptharadol, secretary-general of the country’s food and drug agency.

The Thai government will consider any discounts offered as an alternative to so-called compulsory licensing, Siriwat said recently, referring to a regulation usually reserved for extreme situations like wars and pandemics.

Last week, Lula declared the medication ‘of public interest’. The designation, which gave the president power to issue a compulsory licence for three years, wasextended to five years today and allows the government to purchase the generic version from laboratories certified by the WHO, said Mariangela Simao, the head of the ministry’s AIDS treatment programme. All three of the laboratories are in India. The government agreed recently to pay Merck 1.5% of the price of the generic drug as a royalty for three years, a position Lula reiterated.

Indian doctors perform twin transplants: A First

For the first time in the world, Indian doctors have conducted two transplantations simultaneously on a 15-year-old boy.

Ganesh Nehru, a Grade 9 student from California got a kidney and liver transplant done at the same time.

This is a one of its kind surgery done by Indian doctors, where the teenager's mother donated a kidney and his uncle the liver.

Ganesh was diagnosed with Primary Hyperoxaluria, a condition caused by the shortage of an enzyme in the liver that prevents the buildup of oxalates or stones in the kidney, resulting in the failure of both his kidneys.

But that wasn't all. His liver too was badly affected since it wasn't producing the enzyme needed to prevent the build up in the kidneys. Desperate, his parents brought him to India.

''Our liver produces an enzyme called ADT that detoxifies the oxcillate. In his case, his body didn't have the enzyme. Only solution was to change the kidney but if you gave a new kidney it would choke again because the culprit was the liver. We had to change the liver,'' said Dr Neelam Mohan, Paediatric Hepatologist, Sir Ganga Ram Hospital.

In what's being seen as a new chapter in medical history, Ganesh is the first patient in the world to successfully undergo a simultaneous liver and kidney transplant from two live donors.

And for the first time in the world, doctors got together to operate two donors and the patient all at the same time.

NASA begin undersea mission to test medicine, techniques

A flight surgeon, two astronauts and a Cincinnati doctor began a 12-day NASA mission to depths of the ocean off the Florida coast on Monday to test space medicine concepts and moon-walking techniques.

Aboard the National Oceanic and Atmospheric Administration Aquarius Underwater Laboratory, the crew of the 'NASA Extreme Environment Mission Operations 12' (NEEMO 12) will conduct a variety of advanced medical technology experiments, including robotic telesurgery on simulated patients.

It is the first undersea mission to include a NASA flight surgeon.

"Flight Surgeon Josef Schmid's unique experience in space medicine will benefit the mission itself as well as the future development of crew care techniques for long-duration human space flight missions," NEEMO Project Manager, Bill Todd, said in a statement.

Hands-on telesurgery demonstrations and robotic tele-surgery technology developed and refined within this mission will help surgeons overcome interplanetary communication lag time.

Technologies such as surgeon-guided automatic robot function could improve the care of astronauts on future missions to the moon and Mars.

May 08, 2007

Ayurveda in US medical school curriculum

American medical schools will for the first time teach students the goodness of Ayurveda with visiting Indian specialists offering a 12-hour crash course programme on the medical system based on herbs.

Schools in the United States are offering the course taught by Dr Palep under the aegis of Complementary Alternative Medicine and include topics like Ayurveda philosophy, anatomy, physiology, pathology, pharmacology, clinical exam and treatments.

It also teaches Yoga, meditation and panchkarma therapy (process of detoxification and rejuvenation).

The project was initiated by Maryland-based urologist Dr Navin Shah who has been working for the cause for the last four years.

"Former Prime Minister Atal Bihari Vajpayee wanted me to propagate Ayurveda in the US. I told him that the best way to go about is through medical schools," Dr Shah said adding the final enabling action came after a meeting with Prime Minister Manmohan Singh who acted on a request to send two experts.

While Dr Palep will do the course work in some 12 medical schools in Baltimore (Maryland), Philadelphia, New Jersey and in Boston, the other expert Dr T Nesari's
programme has been centered around the Connecticut area during their six-week US trip.

The first of the series of the Ayurveda course has been conducted at Howard University Medical School Washington DC over the weekend, Shah said. It dwelt on the benefits of Ayurveda treatment either by itself or in conjunction with modern medicine based on the documented scientific evidence.

May 06, 2007

China to Panama, a trail of poisoned medicine: Diethylene glycol adulterant for Glycerine

The kidneys fail first. Then the central nervous system begins to misfire. Paralysis spreads, making breathing difficult, then often impossible without assistance. In the end, most victims die. Many of them are children, poisoned at the hands of their unsuspecting parents.

The syrupy poison, diethylene glycol, is an indispensable part of the modern world, an industrial solvent and prime ingredient in some antifreeze. It is also a killer.

Over the years, the poison has been loaded into all varieties of medicine—cough syrup, fever medication, injectable drugs—a result of counterfeiters who profit by substituting the sweet-tasting solvent for a safe, more expensive syrup, usually glycerin.

Toxic syrup has figured in at least eight mass poisonings around the world in the past two decades. Beyond Panama and China, toxic syrup has caused mass poisonings in Haiti, Bangladesh, Argentina, Nigeria and twice in India.

Researchers estimate that thousands have died. In many cases, the precise origin of the poison has never been determined. But records and interviews show that in three of the last four cases it was made in China, a major source of counterfeit drugs.

Panama is the most recent victim. Last year, government officials there unwittingly mixed diethylene glycol into 260,000 bottles of cold medicine. Families have reported 365 deaths from the poison, 100 of which have been confirmed so far. With the onset of the rainy season, investigators are racing to exhume as many potential victims as possible before bodies decompose even more.

Panama’s death toll leads directly to Chinese companies that made and exported the poison as 99.5 per cent pure glycerin. Forty-six barrels of the toxic syrup arrived via a poison pipeline stretching halfway around the world. Through shipping records and interviews with government officials, The New York Times traced this pipeline from the Panamanian port of Col√≥n, back through trading companies in Barcelona, Spain, and Beijing, to its beginning near the Yangtze Delta in Taixing, a place local people call “chemical country”.

The counterfeit glycerin passed through three trading companies on three continents, yet not one of them tested the syrup to confirm what was on the label. Along the way, a certificate falsely attesting to the purity of the shipment was repeatedly altered, eliminating the name of the manufacturer and previous owner. As a result, traders bought the syrup without knowing where it came from, or who made it. With this information, the traders might have discovered—as The Times had—that the manufacturer was not certified to make pharmaceutical ingredients.

The makers of counterfeit glycerin, which superficially looks and acts like the real thing but generally costs considerably less, are rarely identified, much less prosecuted, given the difficulty of tracing shipments across borders. “This is really a global problem, and it needs to be handled in a global way,” said Dr Henk Bekedam, the World Health Organization’s top representative in Beijing.

May 03, 2007

Health care errors affect one in 10 patients - WHO

The World Health Organization on Wednesday announced nine recommendations for medical facilities to improve their practices in an effort to curb medical errors that contribute to the spread of infections, including HIV, Reuters reports. According to WHO, medical errors affect one in 10 patients worldwide and more than 1.4 million people at any given time develop hospital-acquired infections. WHO reported that unsafe injections with reused and unsterilized equipment are believed to occur most often in South Asia, the Middle East and the Western Pacific. Up to 18% of injections given in sub-Saharan African hospitals involve reused syringes or unsterilized needles, which increase the risk of HIV and hepatitis, WHO said. Experts from more than 100 countries provided WHO with feedback on the draft recommendations.


The recommendations call for improving hand hygiene of medical workers in part by increasing the availability of alcohol-based hand rubs; prohibiting the reuse of needles to prevent transmission of HIV and hepatitis; ensuring quality patient identification; ensuring operations are performed on correct body parts; double-checking similar-sounding medication names and addressing the issue of illegible prescriptions; ensuring medical workers communicate about patients' care and conditions when passing treatment responsibilities to others; and controlling concentrated electrolyte solutions and avoiding catheter and tubing connection problems.

Corruption Catalogue: Government Hospitals

Of those who interact with government hospitals, 26.5% (3 crore households) paid bribes – 19% in rural areas, 49% in urban; average bribe paid per household: Rs 663

Methodology
The study classifies Indian states into high, medium and low performance, based on the UNDP composite health indicator. Kerala, Karnataka, Tamil Nadu, Gujarat and Maharashtra, with low levels of corruption have better health indicators and fall in the first category. Andhra Pradesh, Haryana, Punjab, Assam, Himachal Pradesh and Orissa belong to the medium performance category, while West Bengal, Bihar, Uttar Pradesh, Madhya Pradesh and Rajasthan have the worst health indicators and belong to the last category.

Corruption in judiciary
Corruption in education system
Corruption in Public Distribution System

Key findings:

Total monetary value of petty corruption put at Rs 2,017 crore a year
59% of rural and 51% of urban households sought services of government hospitals. All India figure: 55% (11.3 crore) households
Of those who interact with government hospitals, 26.5% (3 crore households) paid bribes – 19% in rural areas, 49% in urban; average bribe paid per household: Rs 663
Irregularities like non-availability of medicines and unethical practices by doctors are much lower in southern parts of the country
43% of respondents felt quality of service in government hospitals was poor. In low performance states, 53% felt service was poor.
67% felt corruption was widespread in government hospitals.
45% said hospital staff frequently demanded bribes

Use of services
Location% of Households using Government hospitals
Urban 51
Rural 59
Overall 57
·In Himachal Pradesh and West Bengal, a significantly higher percentage of people was availing the services of government hospitals.
·In Bihar, considerably lower number of people were availing the services of government hospitals.

IS THERE HARASSMENT?
In low performance states, only 38% of the respondents received treatment or consultation compared to 66% in the high performance states.
Overall 23% said they did not receive any treatment or consultation during a visit to a government hospital

Reasons for repeated visits
Doctor not available in previous visit: 39%
Failed to get appointment: 21%
Admission to ward not available: 14%
Operation theatre was not free: 13%
Diagnostic lab failed to take sample: 12%

PERCEPTIONS ABOUT GOVERNMENT HOSITALS
Service

Perception about quality of services
Very Poor: 13%
Poor: 30%
Neither Poor/ Nor Good 26%
Good 28%
Very Good 3%

Prevalence of corruption
There is widespread corruption in hospitals
Strongly Disagree 6%
Disagree Somewhat 9%
Neither Agree Nor Disagree 18%
Agree Somewhat 38%
Strongly Agree 29%
In the high performance states, 62% felt that there was corruption in government hospitals, against 77% in the low performance states.

Common irregularities
Medicines unavailable 52%
Doctors suggest a visit to their private clinic 37%
Doctors refer to private diagnostic centers 31%
Over-prescription of medicines 24%
Bribes demanded by staff 20%
Diagnostic tests are done even when unnecessary 18%
Doctors are absent 13%

President Kalam wants modern medicine accessible to all citizens

President A.P.J. Abdul Kalam Wednesday emphasised the urgency of making modern medicines available to the people of the country.

Kalam who was on a day's visit to Uttar Pradesh to attend a function marking the 2,550th anniversary of Lord Buddha attaining nirvana in Kushinagar, inaugurated the Wat Thai poly medical clinic run by Buddhist monks from Thailand.

Emphasising the importance of health care, he said the two major issues were augmenting primary healthcare system and the use of advanced technology to improve healthcare in the country.

"These two efforts will make modern medicine available and accessible to all the citizens of the country," Kalam said.

With the growing threat of HIV/AIDS in the country, the president said, "there was need for creative leaders to eradicate leprosy, tuberculosis, polio, cardio-vascular diseases, HIV/AIDS apart from physical resources."

Addressing Buddhist monks from Thailand, he said there was a need to work towards "building an inclusive society in a world free of violence, terror, war and fear" to recapture in the modern context "the holistic traditions of knowledge creation, acquisition and dissemination as practiced in ancient Nalanda."

May 01, 2007

Doctors hone skill in simulated surgery on pig organs at AIIMS

The All India Institute of Medical Sciences (AIIMS) here is conducting mock surgeries on pig organs to achieve perfection in minimal invasive procedures on humans.

After gaining the expertise from the University of Tuebingen in Germany, the doctors at the top medical research facility of the country are collecting body parts of pigs from slaughterhouses in the national capital for surgical procedures.

"We have begun a new concept in training for minimal invasive surgeries," said M.C. Mishra, head of the department of surgery at AIIMS. "We collect organs like liver, mesentery and gall bladder, from slaughter houses for practice," Mishra told IANS.

The new concept will help them conduct precision operations for breast problems, thyroid, parathyroid and adrenal diseases, as also for laparoscopic procedures of hernia, spleen and common bile duct stones, he explained.

"The unique concept in training is on simulated models so that doctors achieve perfection before touching a human being. The concept is similar to pilots getting trained on stimulators before entering cockpits for actual flights."

Mishra said they have set up five stations in a special lab in their department and at least two doctors are practising on one station for nearly nine hours a day.

"We can't take chance with human bodies so this programme is giving us immense benefits," he said, adding they were getting hands-on skill, in-depth perception of organs, effective use of instruments and a feel of actual human organs.

"The suturing process is very important. You cannot take risks here. In simulation, we are honing the intra-corporeal suturing skills thorough this."

Professors at the department said they were also training doctors from other hospitals in the country.

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