August 31, 2007

Fortis to set up six medical colleges

Fortis Healthcare, a leading private health service provider in the country, will set up six medical colleges in as many states with an investment of approximately Rs 10 billion.

"We are setting up six medical colleges and they will cater to the lower end of the social pyramid," Shivinder Mohan Singh, CEO and managing director of Fortis Healthcare, said here on Monday.

Daljit Singh, president (strategy and organisational development) of Fortis, said they were negotiating with the states for land not less than 50 acres at one place.

"I think the investment on these medical colleges would be around Rs 10 billion. The medical colleges will be run under a new trust," Daljit Singh said.

Elaborating on the mega plan, CM Bhasin, chief executive (projects and consultancy) of the company, said they were in talks with six states for this initiative.

"We are in talks with Haryana, Punjab, Uttar Pradesh, Gujarat and Madhya Pradesh and Rajasthan. We are ready to start the educational hubs as soon as we get a go ahead from the state governments," Bhasin said.

"Talks are in an advance stage with Uttar Pradesh, Haryana and Gujarat. They (colleges) will provide not only postgraduate degrees but will also have facility for higher studies.

"The medical college will have a 500-bed hospital for the treatment of patients and hands-on practice for our students as well. Apart from the regular course, we will have a nursing training school, a technician training school and a bio-medical centre," Bhasin added.

Though the proposed colleges will be operational within 10 years, those at Ahmedabad (Gujarat), Lucknow (Uttar Pradesh) and Gurgaon (Haryana) may come up first.

Bhasin said that thee medical colleges would provide "unique courses that will fulfil the contemporary demand" of our country.

"We will have courses like Bio Kinetics, which will help sportspersons recover fast. I just saw this in a medical college in South Africa and have decided to start here.

"How many colleges have course for producing dialysis technicians? I think, there are two dozen technical courses relevant to our time, which are required in India. Since we are coming up with a number of super-speciality hospitals across the country, these medical colleges will help us in getting the manpower," he added.

Fortis has currently 12 hospitals under its umbrella.

Speaking about the Medical Council of India (MCI) permission, Bhasin said,"We are following the MCI regulations and once we are ready with all the required permissions from the state governments and local civic authorities, we will give a presentation to MCI on it."

Fortis plans expansion

Ranbaxy promoter group company Fortis Healthcare plans to invest Rs 1,800 crore for a pan-India expansion, including setting up a medicity in Gurgaon, and additional 28 hospitals by 2010.

"In the next three years, our plan is to become a national player from a north India-centric player, with 12 hospitals at present across 7 states. For this purpose, we intend to have 40 hospitals under the Fortis group across 14 states by 2010," Fortis managing director and chief executive officer Shivinder Mohan Singh told reporters here on Monday.

The medicity project at Gurgaon will entail an investment of Rs 800 crore, while the balance investment will be used for setting up or acquiring 28 hospitals.

It may be pointed out that Dr Naresh Trehan who quit Fortis-run Escorts hospital recently over differences with the management, is also setting up a huge medicity project in Gurgaon.

The total outlay for the expansion at Fortis, which includes greenfield facilities, management contracts and acquisitions, could be to the tune of half a billion dollars. Of this, the company's contribution would be around Rs 1,000 crore, he said.

"Presently, the company operates 12 hospitals, of which four were acquired, four under management contract and similar number are own-developed facilities. Going forward, we intend to maintain this ratio," Singh said, adding that going forward the company will maintain a debt-equity ratio of 1:1.

The company plans to tap western and southern parts of India market by the end of this year. Post-expansion, the company is targeting to have 7,000 beds, treat 17.5 lakh patients and perform two lakh operations and surgeries annually.

Canada declares neem toothpaste unsafe

Canada has asked people to stop using the Indian-made Neem Active toothpaste with calcium because it contains dangerous levels of a poisonous chemical and harmful bacteria.

Manufactured by Calcutta Chemical Co. Ltd, the toothpaste is sold in small Canadian grocery stores though it has not yet not approved for sale in Canada.

The Canadian government has directed shops to take the toothpaste off the shelves. Consumers of the brand have been asked to discontinue use immediately and ensure the toothpaste remains out of the reach of children. People have also been asked to return the product to the store they bought it from.

Officials at Calcutta Chemicals, which was renamed Henkel India after a merger with Henkel SPIC India in 2004, say they are surprised by the findings.

“The company is 90 years old and Margo and Neem Active are its flagship brands. They have been in the Indian market for decades and we have never had any complaints of toxicity,” said Partho Banerjee of Henkel India.

This new Canadian directive follows an earlier warning issued last month that found unacceptable levels of diethylene glycol (DEG). This toxic organic compound is an industrial solvent and a prime ingredient in some antifreeze.

Swallowing DEG causes nausea, abdominal pain, dizziness, urinary problems, kidney failure, breathing problems, lethargy, convulsions, coma and death.

“Toothpaste is not meant to be swallowed, but young children often ingest it. Potential health risks from chronic exposure to DEG are a particular concern in children, the elderly and people with kidney or liver disease,” says the warning.

Health experts in India say DEG is not a component or derivative of Neem, which has proven anti-microbacterial properties. “DEG has no business being found in toothpaste and if it was, it is probably a manufacturing defect. Anti-freeze or DEG poisoning is very rare in India because the chemical is not used here, unlike in cold countries where it used extensively to defrost cars,” said D J N Pande, former head of medicine, All India Institute of Medical Sciences and currently a consultant with Sitaram Bhartia Institute.

Further tests also found Neem Active with Calcium contained high levels of harmful bacteria that can cause fever, urinary tract infection, and gastrointestinal symptoms such as vomiting, diarrhoea and abdominal pain. “This poses additional significant health risks, especially to children and individuals with compromised immune systems,” warned Health Canada, a Canadian federal government’s health department.

Children and vulnerable populations such as the elderly, hospitalised patients and people with compromised immune systems are more sensitive to the harmful effects of DEG. “Severe vomiting and diarrhoea could lead to potentially life-threatening dehydration,” said the warning.

August 28, 2007

'Medical textile' with military applications in offing

A "medical textile" that uses shrimp shells to promote rapid blood clotting and has military applications is being developed by a research body here.

The research done by the Ahmedabad Textile Industry's Research Association (ATIRA) could prove to be a boon for the military, as more than half of all combat deaths are caused by blood loss. The US Army currently uses similar shrimp-derived trauma dressing bandages in Iraq.

Mohammed S Rahman, ATIRA's assistant director, said, "The shells of shrimp are a waste material of the seafood industry but they are one of the best sources of chitin. When chitin is purified, we get chitosan which has wide usage in the pharmaceutical field.

"In India there are some companies that can develop chitin. But at ATIRA, we have developed a chemical process by which chitin can be purified and turned into chitosan," Rahman said.

Chitosan is a very effective "haemostatic" or blood clotting agent and accelerates wound healing. "Oozing of blood from minor cuts stops immediately when chitosan is applied and it also heals the wound quickly," he said.

ATIRA has entered into an agreement with Ahmedabad-based pharmaceutical company Meck Pharmaceutical and Chemicals for commercial production of chitosan-based products in India.

"Once it is commercially produced, we can work on the development of a 'medical textile' by using the material," Rahman said.

The US Army is using bandages made of chitosan in Iraq as they have the capacity to help clotting in bullet wounds in two to five minutes, he said.

Clinical trials on chitosan's dental applications have also been conducted in the US. Chitosan-based bandages stopped bleeding after tooth extractions in two minutes or less, in comparision to 10 to 15 minutes for other medication, Rahman said.

"The quality of chitin and chitosan is of prime importance for its use in the pharmaceutical field. India has a very long coastline and its shrimp production is nearly four lakh metric tonnes and this ensures the availability of shrimp shells," he remarked.

Experts did not rule out possibility of developing bandages with chitosan that can help rapid clotting of blood and can be used for high-risk medical procedures.

ATIRA has not yet approached the Indian Army with its research. "Our research is open to all. We want this thing to be used commercially. If the army finds this to be useful it can also approach us," said Rahman, who has designed clothing that can protect soldiers in the event of chemical warfare.

Apart from pharmaceutical uses, chitosan has cosmetic and agricultural uses. Chitosan can also be used to treat osteo-arthritis and joint pain, Rahman said.

August 27, 2007

Overseas medical degrees to be recognised

India will recognise postgraduate medical degrees offered by universities in the United States, the United Kingdom, Australia, Canada, New Zealand and Singapore soon.

“In three months’ time, doctors from these English-speaking countries will be recognised here, enabling them to work in Indian hospitals. At the moment, only unilateral recognition has been accorded. We are talking with these countries to urge them to grant bilateral recognition to enable Indian medical degrees to be recognised abroad,” Union Minister for Health and Family Welfare Anbumani Ramadoss told reporters on Sunday.

He was inaugurating the Dr. A. Ramachandran’s Diabetes Hospitals and India Diabetes Research Foundation.

India was moving from being the epicentre of the Big Three diseases — HIV/AIDS, malaria and tuberculosis — to the Big Five diseases — diabetes, cardiovascular diseases, mental health disorders, stroke and cancer. Educational policies had to be modified accordingly to cope with this and the Union Health Ministry was in talks with the Human Resources Development Ministry to make physical education a compulsory subject in school curriculum. Talks were also on with the Urban Development Ministry to make it mandatory for all public parks to have tracks for walking, to encourage physical exercise as a means to cope with diabetes. The prevalence of HIV/AIDS had come down in Tamil Nadu over the last three years, with Andhra Pradesh topping the list.

The Ministry had also written to all Chief Ministers and Vice-Chancellors of universities to ban the sale of junk food on campuses.

August 25, 2007

Post-natal kit for kids in Karnataka

If the cost of post-natal treatment in private hospitals appears prohibitive, here’s a remedy. The government, in a move to encourage delivery at its hospitals, will provide post-natal kits to all mothers.

Health and family welfare minister R Ashok on Friday said the scheme, ‘Madilu’, will take care of post-natal requirements of the mother and baby. Babies born after August 15, 2007, in government hospitals will be provided a kit costing Rs 825. The government has restricted these benefits to two children, and anaemic mothers will be given iron-content tablets.

The government announced Madilu in this year’s budget. The products included in the kit are manufactured in state-owned public sector units.

A sum of Rs 14.38 crore will be spent annually on the scheme.

Post-natal kit includes mosquito net, thick mattress, bedsheet, blanket, four body soaps, washing soap, a comb, coconut oil and a towel. Also, rubber sheet, bedsheet, mosquito net, blanket, four baby soaps, six diapers, six clothes, warm clothes, socks and woollen gloves

10 lakh deliveries take place annually. Of these, 7 lakh are from BPL families. Only 3.5 lakh deliveries happen in hospitals. Of 1,000 births, 50 children die within a year of birth. Of 1 lakh deliveries, 228 mothers die during delivery.

The government aims to increase deliveries in hospitals to 90% by 2010. By 2012, it aims at scaling down mortality rate to 30 children and 90 mothers.

August 24, 2007

Tamilnadu Dr. MGR Medical University plans e-library

The Tamilnadu Dr. MGR Medical University will shortly commission an e-library that will house medical literature in electronic format instead of books.

The project is being undertaken on the university’s Guindy campus under a Rs. 25-crore funding from the Planning Commission, according to Vice-Chancellor K. Meer Mustafa Hussain.

Addressing a CME on ‘Emerging trends in medicine’ organised at the Madras Medical College on Tuesday, he said the e-library would be useful to students and faculty, besides benefiting the 242 affiliate institutions.

Urging students to update knowledge, Mr. Mustafa reminded them that a norm proposed from the next academic year would make it mandatory for postgraduate students to participate in a minimum of two CMEs for their examination hall-tickets to be issued.

The Vice-Chancellor urged medical students and teachers to keep themselves abreast of developments and pursue research in areas of relevance. The university, he said, was keen on promoting research at all levels.

Over 10,000 UK junior doctors face bleak future

Thousands of doctors in Britain, including Indians, face prospects of joblessness within weeks with 33,000 applicants already lined up for the 22,000 National Health Service (NHS) training posts. The deadline to fill 22,000 NHS training posts has been extended to October 31 this year but with 33,000 applicants there are renewed warnings that thousands could face exclusion from the job.

Indian doctors trying to migrate to Britain should think twice as more than 10,000 junior doctors in the UK are now facing prospects of unemployment soon. Junior doctors who do not get a post under the Medical Training Application Service face taking non-training jobs, emigrating to Canada, Australia or New Zealand or leaving the NHS.

The government has created 1,000 extra training posts that will be allocated after October 31 to unsuccessful candidates who are especially qualified. But critics have said that many doctors who have already been assigned training posts have found their salaries cut or that they are overqualified. "This failed experiment has condemned some of our brightest young clinicians to a lifetime of being short contract supply doctors," said Matthew Jameson Evans of the campaign group Remedy UK.

A Department of Health spokesperson said that more than 12,000 applicants were already in non-training posts and promised support for doctors who have so far been unsuccessful. "If we want to maintain the quality of medical training for junior doctors in this country, it is important that there is an element of competition for jobs," the spokesperson said.

August 21, 2007

Singapore seeks Indian medicos

India could soon be the answer to Singapore's shortage of skilled medical experts. A 15-member delegation, consisting of India's top doctors and healthcare sector honchos, is leaving for Singapore on Monday.

The delegation, led by cardiac surgeon Naresh Trehan, will not only offer Indian help in filling up the shortage of neurosurgeons, cancer specialists, renal physicians and geriatricians in Singapore, but will also hard sell India's expertise is conducting clinical trials, diagnostic and pathology services, medical devises and tele-medicine.

A report prepared by CII on the eve of the visit said that Singapore aimed to serve a million foreign patients a year by 2012, generating $3 billion in revenues and creating at least 13,000 jobs.

"Singapore is potentially a huge market for Indian healthcare companies. We are very optimistic about the upcoming visit. We hope Singapore will provide us an opportunity to share our medical expertise," Trehan told TOI.

The trip follows the Indo-Singapore CECA (Comprehensive Economic Cooperation Agreement) signed in 2005 which has already resulted in the increase of bilateral trade between the two countries by 70% to more than $13 billion in 2006.

Health services, estimated to be worth over $4 billion in India, was recognised by the CECA as a key area with significant promise. The report says Singapore needs skilled personnel like physiotherapists, speech therapists, radiologists, clinical scientists, medical social workers, discharge case coordinators, investigators.

"This would necessitate that the existing sources of medical talent in Singapore be supplemented by new alternatives," said the report which highlighted the areas where skill of the two economies could be effectively harnessed for mutual benefit.

A new look for primary health centres

Flowers of myriad hues and miniature lush green lawns beckon visitors. Illuminated name boards catch their eyes. A waiting shed with chairs and benches provide them comfort.

A UPS to ensure uninterrupted power supply, water filter for safe drinking water, fire extinguishers, a colour TV and DVD, and also LPG stoves with gas refills for sterilisation are some of the other amenities that have been given. Of course they are not corporate hospitals in the metros, but the modest Primary Health Centres (PHCs) of rural Tamil Nadu.

These facilities along with life-saving drugs and medical equipment, including semi auto analysers for blood testing and ultra sonogram scan machines for anti-natal care, have literally transformed the PHCs and Sub Health Centres into throbbing healthcare units. The National Rural Health Mission of the Union Ministry of Health is the motivating force behind such a fairy-tale transformation in the delivery system of the State’s rural health care and particularly in Salem district.

Under the programme, the PHCs are being upgraded to elicit community participation through Patient Welfare Societies. The members are from local bodies, rural development, non-Governmental organisations and gram sabhas, who in co-ordination with medical staff, ensure an effective functioning of PHCs in their localities.

August 18, 2007

Life term for making, selling fake medicines proposed

Those producing and selling counterfeit and spurious drugs will face life imprisonment and/or fine of Rs 10 lakh. On the other hand, scientists violating and conducting unsafe and unethical clinical trials may soon face imprisonment of five years and a fine of Rs 20 lakh. The health ministry will table the amended Drugs and Cosmetics Act, 1940, in the current Parliament session.

While one part of the amendment will create the Central Drug Authority (CDA), the other envisages strict punishment for violation of the ethics related to clinical research and spurious drugs. Health Minister A Ramadoss said, “The Bill to provide for stricter penalties, provision for special courts for speedy trial of drug related offences and making all drug related offences cognizable and non-bailable was referred to Parliament's Standing Committee. Its recommendations have been incorporated in the revised Bill."

He added, “A Bill is also being introduced in this session providing for the creation of CDA for strengthening the regulatory system for licensing and control of drugs.”

Even though India is becoming a destination for clinical research for pharma groups looking for faster and more efficient ways to test drugs, with the country's total market for clinical research activities expected to touch $2 billion by 2010, there is at present no law to monitor the research and drug trials being conducted within the country. “The CDA Bill will also propose centralisation of licensing system with the Central government,” Union Health Secretary Naresh Dayal said.

August 17, 2007

Tracking diseases through technology

The TAMIL NADU State Government’s ambitious project of utilising online technology for disease surveillance at grassroots level took shape on Thursday with health authorities at the district level starting to feed data into a specially created website.

An online reporting format has been devised to throw light on the pattern of occurrence of communicable diseases, including vector borne, to create a database for State-level health planners to take steps for prevention and control.

“From today, data will be updated on a daily basis under the Effective Disease Surveillance Information System (EDSIS),” R. Varadaraj, Madurai District Malaria Officer, said at a demonstration held for medical officers.

The system functions under the aegis of Directorate of Public Health and Preventive Medicine, generating data from primary health centres, urban dispensaries, health posts, taluk hospitals, district headquarters hospitals and Government/private medical college hospitals.

According to A. Palanichamy, Deputy Director of Health Services, the district health authorities have been asked to get data from the ‘points of origin’ such as paediatric wards, casualty, male/female out-patient and in-patient wings, covering private hospitals.

“Documentation of patient details and diseases is deficient to an extent right now. Amalgamation of reports at the State-level is tough without a proper database,” a DPH note sent to districts said.

If an online mechanism is in place, the surveillance of 14 ‘notified diseases,’ including malaria, dengue, chikungunya, leptospirosis, measles and typhoid, will become easy.

Block Medical Officers will receive reports from PHCs and arrange for transmitting data by 11a.m. the following day on

website: http://intra.tn.nic.in/edis.

DD plans health channel at Rs 180 crore

To add to the worries of the cable operators and broadcasters, the government is set to launch a 24-hour “must carry” health channel called DD-Health at an annual outlay of Rs 180 crore.

According to sources, the DD-Health will be jointly funded and promoted by the Ministry of Health and Family Welfare and Prasar Bharati and will cater to the needs of medical students across India.

The DD-Health channel will be operational next year, sources said, but the “must carry” rider makes it mandatory for all cable operators to carry the channel in the prime band-a frequency band.

“The list of must carry channels of Doordarshan has been increasing causing worries to broadcasters and cable operators as these channels are not as popular as sports channels or entertainment channels but because of government diktat have to be carried thereby leaving less slots for popular channels,” a senior executive of a cable distribution company said.

Technically, the prime band can only host up to 12 channels in the current analogue mode of cable distribution in the country. Therefore, leading channel genres like entertainment, news and sports broadcasters pay a large sum of money (carriage fees), to the cable operators to carry their channels in this band.

Six Doordarshan channels including DD-National, DD-News, Lok Sabha TV, and Rajya Sabha TV have to be mandatorily carried by the cable operators according to the government order.

“The DD-Health channel is an extension of similar projects undertaken by the Prasar Bharati in the past including its ongoing narrowcast transmission of agriculture series across various districts,” a source in Prasar Bharati said.

“If DD-Health is must carried then it will become popular and useful to millions of people who require health or medical related advice,” a source in Doordarshan said.

For making DD-Health a “must carry” channel, the information and broadcasting ministry will have to amend the Section 8 of the Cable Television Networks (Regulation) Act, 1995.

DD plans health channel at Rs 180 crore

To add to the worries of the cable operators and broadcasters, the government is set to launch a 24-hour “must carry” health channel called DD-Health at an annual outlay of Rs 180 crore.

According to sources, the DD-Health will be jointly funded and promoted by the Ministry of Health and Family Welfare and Prasar Bharati and will cater to the needs of medical students across India.

The DD-Health channel will be operational next year, sources said, but the “must carry” rider makes it mandatory for all cable operators to carry the channel in the prime band-a frequency band.

“The list of must carry channels of Doordarshan has been increasing causing worries to broadcasters and cable operators as these channels are not as popular as sports channels or entertainment channels but because of government diktat have to be carried thereby leaving less slots for popular channels,” a senior executive of a cable distribution company said.

Technically, the prime band can only host up to 12 channels in the current analogue mode of cable distribution in the country. Therefore, leading channel genres like entertainment, news and sports broadcasters pay a large sum of money (carriage fees), to the cable operators to carry their channels in this band.

Six Doordarshan channels including DD-National, DD-News, Lok Sabha TV, and Rajya Sabha TV have to be mandatorily carried by the cable operators according to the government order.

“The DD-Health channel is an extension of similar projects undertaken by the Prasar Bharati in the past including its ongoing narrowcast transmission of agriculture series across various districts,” a source in Prasar Bharati said.

“If DD-Health is must carried then it will become popular and useful to millions of people who require health or medical related advice,” a source in Doordarshan said.

For making DD-Health a “must carry” channel, the information and broadcasting ministry will have to amend the Section 8 of the Cable Television Networks (Regulation) Act, 1995.

Maharashtra also alerts against foreign varsities

Close on the heels of the Medical Council of India (MCI) making it clear that it does not recognise any foreign medical degree, the Maharashtra Directorate of Medical Education and Research (DMER) has prominently displayed the council's note of caution on its website (www.dmer.org).

While director W.B. Tayade was unavailable for comment, officials at the directorate said the public notice was posted after receiving complaints that agents were trying to lure medical students to foreign universities. "We don't want any student to fall prey to this," said an official.

The official said there have been instances where "unknown institutions or agents" have organised seminars to lure prospective medical students to take admission to foreign universities.

In June, Bharatiya Vidyarthi Sena (BVS) members had disrupted a seminar, which was organised by a local educational foundation here to recruit students for medical studies in the Philippines.

The MCI, while issuing a public notice recently, said that it has come to their notice that that certain entities have issued misleading advertisements for MBBS admissions in foreign universities.

"It is also mentioned in such advertisements that recognition of degree by the MCI would be in accordance with the MCI Act 13 (4B) through screening test," the notice said, adding that the MCI has not permitted any foreign university to establish a campus in India for imparting medical education.

August 16, 2007

PM promises old age pension, health insurance

Prime Minister Manmohan Singh Wednesday promised that his government would provide an old age pension to all citizens above the age of 65 years and living below the poverty line.

Speaking at the Red Fort on India's 60th independence day, he also pledged to provide life and disability cover to the heads of all poor families or to one earning member in each family "so that they and their families can get over the consequences of injury or death.

"We are also working on a health insurance model so that our people do not have to bear the high cost of medical care. These programmes will be launched shortly."

August 15, 2007

US pharma lobby rues court ruling

The Pharmaceutical Research and Manufacturers of America, a representative body of US drug firms, has lambasted the Indian court's decision on the Glivec case, saying it will weaken incentives for new innovations. The association CEO Billy Tauzin said, "We are disappointed the Indian court dismissed the challenge to Section 3 (d) of India's 2005 Patent Law. We are concerned that the result is likely to be reduced patient access to better medicines discovered through incremental innovation."

Tauzin added, "Breakthrough innovations are important but rare in medical research. Most medical advances like in other technological fields happen by incremental innovation; that is, innovation that builds on previous inventions."

The Pharmaceutical Research and Manufacturers of America (PhRMA) members alone invested an estimated $43 billion in 2006 to discover and develop new medicines. Industry-wide research and investment reached a record $55.2 billion in 2006.

"In this industry, incremental innovation means continuous improvement of medicines that have been key to delivering therapeutic advances to patients worldwide. Incremental innovation requires large-scale research and development before the new product can be offered to patients," the CEO said.

MCI asks DNB qualified professors to quit Medical education

At a time when medical colleges are facing severe faculty shortage, the Medical Council of India has dropped a bombshell: remove teachers with Diplomate of National Board (DNB) qualification.

Ironically, a majority of the medical teaching staff have only DNB qualification. Following the MCI directive, colleges have been giving teachers the pink slip. "Professors, who have worked with deemed universities for 10 years, have been asked to resign due to lack of coordination between the MCI and the health ministry on rules," said a professor, who quit last week from a reputed medical college.

What's shocking is that the MCI's directive is contrary to the rules laid down by the health ministry which have been upheld by the Supreme Court. The ministry has made it clear that DNB holders should be treated on a par with MD/MS/DM/MCh for teaching posts such as assistant professor or for recruitment as senior residents. In its March 27, 2007, letter to teaching hospitals, the National Board of Examinations has directed them to give equal opportunities to DNB candidates for training and employment purposes in their colleges.

A student with an MBBS degree undergoes the DNB for three years, while a diploma holder studies the course for two years. But the MCI teams currently inspecting medical colleges have told them to remove faculty with DNB qualification as they do not have the mandatory one-year research experience.

Caught in this confusion over rules are colleges too. "We're short-staffed. If we ask experienced teachers to quit, how do we run the institutions? After investing so much, we cannot close down the institutions," a principal argued.

But the MCI would have none of it. "The council is a regulatory authority for all medical colleges in the country. And we will have the final say," an MCI official stated.

Rajasthan invites private groups to run govt health centres

At a state cabinet meeting in Jodhpur, the Rajasthan government decided to invite private participation in healthcare services.

Voluntary organisations, religious trusts and private medical colleges can now take up the management of government health centres on contract.

"The scheme would be reviewed every three months," Parliamentary Affairs Minister Rajendra Singh Rathore told IANS.

To get a contract, organisations would have to furnish a bank guarantee of Rs.100,000. The contractor would have to provide the same services at the same prices as was being provided by the government, the minister added.

August 10, 2007

US backed India on Glivec patent

A day after the Madras High Court struck down the petition of pharma giant Novartis on Glivec, civil society organisations, including Medecins sans Frontieres, celebrated the ruling at Basel and delivered a petition with half-a-million signatures to the Swiss company urging it not to challenge the decision. Read about Novartis loosing case against Indian Patent Law

The petition underscores the growing support for the developing countries’ right to take steps for the well-being of their people. In fact, India has also been backed by the US on this vexed issue.

In February, Henry A Waxman, chairman of the House committee on oversight and government reform, wrote to the Novartis chairman requesting him to withdraw the petition. The letter stated that “Novartis and its colleagues in the pharmaceutical industry should respect countries’ rights to take measures that balance the protection of innovation and the promotion of public health”.

Senator Waxman expressed his concern that the attempt of Novartis “to influence domestic Indian law could have a severe impact on worldwide access to medicines”. India’s robust generics market supplies “affordable, essential drugs both to its citizens and to poor nations around the world” and its laws “contain safeguards designed to preserve a balance between protecting innovation and promoting public health”.

This “crucial supply of medicines” could be threatened if India is put under pressure to make its patent laws “more stringent than its obligations under international trade law.”

Waxmann slammed Novartis for challenging the public safeguards of Indian law instead of appealing against the Indian Patent Office’s rejection, calling the grounds for the challenge as “questionable”.

He points out that in 2001, at Doha, 142 countries, including the US, declared that international intellectual property obligations “can and should be interpreted and implemented in a manner supportive of WTO members’ rights to protect public health, and in particular, to promote access to medicines for all.”

According to Waxman India’s law appears to protect innovation, by providing for a 20-year patent protection for innovative products. Even if in the eyes of the pharmaceutical industry the Indian law has shortcomings, patent holders continue “to enjoy stringent protection in the US and other wealthy nations, where they make the bulk of their profits.”

Related: Novartis looses battle against Indian Patent Law

Rural service compulsory for doctors

The Kerala Government has decided to impose one-year Compulsory Rural Service (CRS) on students passing the MBBS/ Medical PG degree/DNB or Diploma from Government-run Medical Colleges.

It will be mandatory for those students also who secure admission for medical PG/DNB or Diploma courses under Government quota in self-financing and cooperative medical colleges.

The doctors will be given a monthly pay of Rs.15,000 with an additional Rs.5,000 for those serving in difficult rural areas. The decision was taken at a high-level meeting convened by Health Secretary Vishwas Mehta here on Tuesday.

The Government has also decided that it will send advisory to the State Public Service Commission to debar candidates who have not fulfilled the CRS obligation, from seeking employment in either State or Central Government service. Doctors will not be considered eligible to appear for any higher examination unless they have completed one-year CRS.

The diploma students, however, need do rural service of only six months this year. From next year onwards, this will be for a year.

The Government has also made it clear that it may enforce the regulation of the Medical Council of India, which says that action be taken against a physician posted in a rural area, if he is found to be absent on more than two occasions during inspection by Health Department authorities.

Legal action and cancellation of registration will also be considered against those doctors who fail to fulfil the bonded obligation to serve in rural areas, the Government has warned.

The decision to cut short the CRS for medical PG students from two years to one year has been welcomed by the Junior Doctors’ Forum, which had been actively campaigning for this.

The bonded obligation on PG doctors to work for two years for the Government on a monthly pay of Rs.15,000 had met with stiff resistance.

August 08, 2007

Now, Indo-Chinese rivalry in medical world?

Is the India-China rivalry spilling over into the medical world? The question is being asked because with over 4000 Indian medical students studying in China, New Delhi will soon have to decide whether to ask China to change their registration rules for doctors to practice or amend the Medical Council of India (MCI) Act to allow them to sit for screening tests here before they are allowed to practice.

Currently, Indian medical students trained in China face an uncertain future when they return, as the MCI Act stipulates that only those who are enrolled as medical practitioners in the country of their study can go through the screening test and be included in the Indian medical register. On the other hand, Beijing does not encourage internship for foreign students in their country ~ a prerequisite for medical practice license.

The problem came out during the visit by a 15-member delegation of officials from the ministry of health and family welfare and senior administrators of government medical colleges, led by the joint secretary in the Union health ministry, Mr K Ramamoorthy, to 11 medical universities in China in June. It was reportedly the first foreign government team that had gone to inspect medical education facilities in China, after the mega medical universities started to recruit foreign students aggressively. Chinese universities had hired recruiting agents in India to actively canvas for students since 2004. Since then, the number of Indian applicants to these Chinese courses far exceeds the available seats.

The demand for these courses are due to the price, of course, which is about Rs seven to eight lakh per year, compared to about Rs 20 lakh for a seat in a private medical college in India. It also compares favourably with the cost of the course in CIS countries. But Indian students who met the delegation were worried that their degree would not allow them to practice in India.

The first batch of Indian students will complete their medical courses in China in 2009. Some of them reportedly told delegation members that they were misled by recruiting agents that the eligibility certificate they got from MCI to study in China would also enable them to qualify for the screening test. A member of the delegation said China has separate classes for Chinese and foreign students, with the former also attending courses with political component and on integrated medicine. The member told The Statesman that while the curriculum was very “rigorous” and similar to that in India, the separate classes for foreign students raised concerns.

“The first three years consists of pre-clinical study, which seemed more like an advanced form of zoology, with the fourth year consisting of clinical study,” he said. There is also no standard in the number of years required for the degree, with some universities even having six years of medical training. The last year is for ‘internship’, which is, however, not exactly like the Indian model. The Chinese ‘internship’, which they term as ‘practice’, entails posting medical students to different hospitals, where they have to learn minimum skills by being attached to various departments.

Fortis to float company for medical education

Medicities are set to get a shot in the arm with Fortis Healthcare planning to float a new company which will focus on medical education in its upcoming 10 medicities spread across the country. The new company plans to invest around Rs 5,000-6,000 crore in these medicities.

“Medical education requires separate regulations and therefore there will be a separate new company of the group which will manage the medicities. Each of these medicities will require an investment of around Rs 500-600 crore,“ Fortis Healthcare MD Shivinder Singh told ET.

A blueprint of the proposed company is being prepared and therefore, details have not been finalised, he added. Fortis Healthcare plans to set up 10 medicities over the next 10 years. The company is setting up a medicity in Gurgaon and has also announced that it will set up another 52-acre medicity in Ansal’s upcoming township in Lucknow.

The company is also in talks with several state governments to set up medicities. The final structure of the medicities has also not been finalised as it is awaiting clear guidelines from the Medical Council of India. Sources say that in addition to regulatory adherence, a separate company which focuses on medical education will be more attractive to niche group of long-term investors who would like to invest in medical education.

Fortis Healthcare is aggressively pursuing its growth plan through both organic and inorganic routes. The company has signed a memorandum of understanding to set up around 30 hospitals in DLF’s townships across the country. In addition, the company is also evaluating various proposals from hospitals across the country for management control or acquisition.

During the financial year, the company plans to ramp up some of its existing hospitals also. “Fortis Healthcare will invest around Rs100-Rs150 crore, excluding acquisitions, during the financial year in our new hospitals and also revamping some of the existing hospitals,“ he added.

Fortis Group, which has a laboratory and pharmacy retail chain, does not have immediate plans to foray into the clinics division. Fortis’ expansion plans come even as it says a breakeven is not expected this fiscal. The company registered a loss of Rs 24 crore for the quarter ended June 2007 but operating margin improved to 12%, at the end of the quarter, from 10% in the corresponding quarter last year.

August 07, 2007

Novartis loses battle against Indian patent law

In a much-awaited judgement, the Madras High Court has held as valid a legal provision unique to India, which stipulates that modifications of known medicines cannot be patented unless they make the drug significantly more effective.

On Monday, the court dismissed a petition by Swiss pharmaceutical giant Novartis challenging the constitutionality of Section 3(d) of the new Indian patent law. Novartis has filed another case, an appeal against the rejection of patent for its anti-cancer blockbuster drug Glivec, which is still pending.

The Basel-based drugmaker had filed a petition with the high court last year, after the Glivec patent rejection, pleading that incremental innovation should be patented in India. While India’s patent law does allow patents for modifications of already-known medicines, Section 3(d) stipulates that these modifications must improve drug efficacy to qualify.

A division bench comprising justice R Balasubramanian and justice Prabha Sridevan, ruled that the Section 3(d) of the Act, as amended in 2005 (along with its explanation), is valid and could not be termed vague, ambitious or unconstitutional.

“The discovery should result in the enhancement of the known efficacy of the substance and the derivatives are significantly differing in properties, with regards to efficacy,” the bench ruled.

In its petition, Novartis had prayed to declare the provision as being non-compliant with TRIPS agreement, vague, arbitrary and in violation of Article 14 of Indian Constitution.

“It is a sad day for innovation,” said Novartis’s vice-chairman and managing director Ranjit Shahani. “Incremental innovation has value not just in improving therapeutic efficacy, but also in providing significant benefits in terms of drug delivery, patient safety and compliance,” he said.

Novartis has also noted that in order to compare the efficacy of the new version of a drug with the old one, clinical trials need to be conducted. But, such trials can start only after the drug is protected by a patent.

However, the court decision should not have any significant impact on the company’s financial performance, said analysts. Drugmakers such as Ranbaxy, Sun Pharmaceuticals, Cipla, Natco Pharma and Camlin Pharma were already selling generic versions of Glivec in India. Even an eventual denial of patent on Glivec would not change the current situation.

Novartis said that while it disagreed with the Madras HC’s judgement, it won’t appeal its decision to the Supreme Court. “However, we have opened an important debate on the value of incremental innovation and the World Trade Organisation may take up the issue. We feel that there are great inadequacies in the Indian patent law,” said Mr Shahani.

The now-famous Glivec case has kept alive the debate over the patentability of pharmaceutical substances. Product patenting was introduced in India two years ago through the third amendment to Patent Act. The question is about ascribing a commercial value (by way of grant of patent or its denial) to new forms, derivatives and delivery systems of existing drugs.

The domestic pharmaceutical industry welcomed the Madras HC judgement. “If Section 3(d) had been removed, a large number of frivolous patents would have been granted, denying patients access to affordable generic medicines,” said secretary general of Indian Pharmaceutical Alliance (IPA), Dilip G Shah. “At least 2,000 out of the 10,000-odd patent applications in India will be disqualified under Section 3(d),” he added.

Ranbaxy echoed IPA’s view. “Ranbaxy has consistently been of the view that the TRIPS agreement can and should be interpreted and implemented in a manner supportive of the rights of the WTO members, to protect public health, and in particular, to promote access to medicines for all,” said executive director - global corporate affairs of Ranbaxy Laboratories, Ramesh Adige.

While Section 3(d) remains unique to the Indian patent law, other countries are considering incorporating a similar provision in their patent law. “Philippines adopted a similar provision a few month ago, and more Asia-Pacific countries such as Malaysia, Bangladesh and Indonesia were waiting for this ruling to amend their patent law,” said Mr Shah.

Health cards for 1.80 crore families in AP

The Andhra Pradesh State Government has decided to issue health cards to 1.80 crore below poverty line families that enables the beneficiaries to utilise medical facilities in speciality hospitals up to a sum of Rs. 2 lakh at Government cost.

Health cards would be issued under the ‘Arogyasri’ health insurance scheme.

This is the first scheme of its kind in the country that aims at helping the poor people in getting costly treatment for cancer, heart problems, renal and neurological disorders.

They could also go in for surgery for burns above 30 per cent, treating deaf and dumbness and blood transfusion, according to a press note issued from the Chief Minister’s Office.

Dr. Reddy said that diagnostic tests would be part of the scheme that is being made available through network hospitals identified by the Government.

The health card contains the details of the family members, their photographs, white ration card, information about eight ailments and toll free number.

The cardholder and their family members can walk into the network hospitals and avail free treatment, he added.

Arogyasri scheme is presently being implemented in Srikakulam, Anantapur and Mahabubnagar districts, where 86-lakh people have been benefitted and 3,300 surgeries performed at a cost of Rs. 18 crores in 69 network hospitals. A sum of Rs. 70 crore has been earmarked for Arogyasri.

The health insurance scheme would be extended to the remaining districts in phased manner. By November next year, all the districts would come under the Arogyasri coverage. Once the scheme is extended to the entire State, the number of network hospitals would run into hundreds, Dr. Reddy said and added that this was not a short term programme but a permanent one.

August 06, 2007

WHO shows AP govt 'Right' way to treat snake-bites

Snake-bite treatment in the state may receive a boost with the Centre having decided to form a protocol for treatment. Due to lack of data and proper training to doctors, every year, out of an estimated 18,000 who get bitten by snakes in the state, 2,500 persons die.

Though our country is neither home to the most number of snakes, nor to the most venomous ones, it records 2.5 lakh bites annually, of which 50,000 prove fatal. After the World Health Organisation (WHO) stepped in, the government is finally giving some attention to this serpentine problem.

"There are about 13 species of snakes in Andhra Pradesh that could cause life threatening symptoms, and we expect that research will reveal at least five more," WHO toxicologist and herpetologist Dr Ian D Simpson said. "Training, advice and research in Indian institutions will be WHO's contribution towards snake bite treatment in Andhra Pradesh," said Dr Ian.

A recent study conducted by WHO revealed that 70 per cent of the doctors did not have enough knowledge about the proper treatment of snake bites. "Western textbooks that Indian doctors study from, are inapplicable in India, which is why most doctors are not confident of the treatment. This makes training very crucial," said Dr Ian. Due to this problem, doctors end up giving snake anti-venom, or antivenin indiscriminately, triggering severe allergic reactions and even death.

Due to lack of proper research, the exact number of deaths by snake bite as well as data on the variety and population of snakes remain unknown.

Director of Health, Dr P Venkateswara Rao said it is only now that 8,000 doctors are being trained in treatment for snake bites.

Doctors in Primary Healthcare Centres (PHCs), District Hospitals and Tertiary medical centres will be trained to confidently handle snake bites cases. Only cases beyond their expertise will be referred to bigger hospitals. Poor guidelines for treatment and high cost of antivenin, up to Rs 500 per vial, makes first aid the focus of education.

WHO advocates the do it RIGHT method, of Reassuring the patient, Immobilising him or her, Getting to a Hospital immediately and Telling the doctor the symptoms. The conventional methods of tourniquets, cutting and pressure bandages have proved to cause more harm than good.

August 02, 2007

False claims bleeding health insurers

The healthcare insurance industry is suffering losses of upto Rs 600 crore annually, on false claims every year, according to a survey by MediAssist.

MediAssist, a leading third party administrator, estimates the the number of false claims at 10-15 per cent of total claims.

''We found nearly 25 per cent of claim cases that could be categorized under false claims, but as the sample size increases we believe that this percentage would settle at 10-15 per cent of total claims which amounts to Rs 400 cr-Rs 600 cr,'' said B Madhavan, CEO of MediAssist. The survey had a sample size of 600 cases.

The main reasons for these false claim payouts, MediAssist found, were policyholders making claims for pre-existing diseases, or manipulating documents, or availing and providing treatment that is not reasonably warranted.

Hospitals were also over-diagnosing or overpricing the treatment to increase costs, after getting to know that the person was insured.

Moreover, third party administrators (TPAs) are not fully automated across the country and hospitals are not able to verify patient details immediately. Persons, who are not insured, were also found to be getting treatment under an insured person's policy details.

The total premium collection for medical insurance firms in the country is about Rs 4,000 crore, while total claims amount to about Rs 4,300 crore in a year. Less than one per cent of the country's population is covered under medical insurance.

MediAssist said hospitals need to work in tandem with TPAs to eliminate false claims, while TPAs should invest in infrastructure to improve verification and entitlement. It proposed that TPAs also blacklist hospitals that overcharge or over-diagnose.

MediAssist CEO said that health insurance was a bleeding sector and that the survey aimed to find the causes for the high claim ratio and bring about a consensus among stakeholders to work together to minimize malpractices.

Health insurance Cos reluctant to support Ayurveda

Despite its growing popularity across the globe, the Ayurvedic system of medicine is meted out a "step-motherly" treatment by health insurance companies in its land of origin.

"With medical expenses growing day-by-day, health insurance has become a necessity. But as far as Ayurveda is concerned the reimbursement of medical bills by insurance companies is not at all encouraging," said Dr Krishna Kumar, Managing Director of the Coimbatore Ayurveda Trust, one of the leading Ayurvedic treatment centres in the country.

Many insurance companies do not cover Ayurveda and other non-allopathic streams of treatment and a few which provide it keep an upper limit for the amount to be reimbursed.

Royal Sundaram Insurance is one among the many companies whose health insurance policy does not cover Ayurvedic treatment. New India Assurance provides only 20 per cent of the insured amount if it is Ayurveda while Star Health provides 25 per cent.

Dr C Madhusoodanan, the head of Ayurveda wing of city-based Kumaran Hospital, said hospitals providing this system of treatment are not included in the list of institutions offering cashless treatment facility for mediclaim card holders.

Of the around 150 patients of Coimbatore Ayurveda Trust who had applied for medical reimbursement last year, only one or two persons got the bills cleared, that too because they had a "personal rapport" with the insurance officials, said Kumar.

"At the same time, the medical bills of many foreigners who received treatment here were reimbursed by insurance companies in their respective countries," he added.

In many cases, claims are returned saying the treatment was not necessary for the particular ailment, said Madhusoodanan.

Insurance company officials said they faced problems in verifying whether the treatment given was for 'wellness' or 'illness' and whether the treatment and medicines were needed for the particular ailment.
With proliferation of spas providing Ayurvedic oil massages and steam bath, verifying claims have become difficult, they said.

Madhusoodanan agreed verifying wellness and illness treatment was a hurdle. "In that case, the companies should include Ayurvedic doctors in their panel of physicians to verify the documents," he said.
Kumar wants a modification in the policy decision of the insurance companies in favour of Ayurveda. "They should recognise Ayurveda as an effective system of treatment like Allopathy and prescribe a format to submit the relevant documents for claim so as to make the procedure easy for the patients".

"Now the patients are not assured of reimbursement and it is just a matter of chance if the bills get cleared. This situation should change to promote this ancient Indian system", he said, adding this would also help Ayurvedic mode of treatment streamline itself.

ICICI Prudential may offer health cover with fixed Premium

ICICI Prudential Life Insurance, the country’s largest private life insurer, is looking at introducing a level premium structure for health insurance plans.

Non-life insurers use a risk-based pricing for health insurance, which makes coverage expensive as people age. However, there has been objections from policyholders who have been paying premium for years without a claim. ICICI Prudential is looking at introducing a policy where the premium will remain the same year after year as in life insurance.

The company is also building up a suite of health products with the latest being Crisis Cover, which provides for payment on detection of any of the 35 diseases covered. For distribution of health insurance, the company is using its existing agency network. However, the servicing has been outsourced to TTK Healthcare, a third-party administrator.

In the first quarter of the current financial year, ICICI Prudential notched up new business group premiums of Rs 987 crore, posting a quarter-on-quarter growth of 22%. Renewal premium showed a strong growth of 98%.

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