January 31, 2009

Compulsory rural posting for doctors from next year: Ramadoss

The much controversial proposal for compulsory rural posting of doctors after completing their MBBS would be implemented from next year, Union health minister Anbumani Ramadoss said here on Friday.

Speaking at a press conference here, after a meeting of the Central Council of Health and Family Welfare, Ramadoss said, it was done in an effort to augment health facilities in rural areas.

"The proposal has been cleared by all the states today and would be implemented from next year," he said.

The provision entails a mandatory rural posting of doctors who have completed their MBBS and want to pursue post-graduate studies in medicine.

The proposal had run into much controversy with medical students
protesting over the lengthening of the course.

January 27, 2009

Regulatory hurdles in US, UK hamper diagnostics outsourcing

The outsourcing of diagnostics and lab-testing services to India has proved to be a non-starter as regulatory hurdles in the US and UK make it mandatory for the companies to establish labs in the country and even employ local doctors.

High-end tests such as genetics and molecular biology, which are labour-intensive, are sent to India as they can be serviced at nearly one-eighth the costs of developed markets. Several Indian diagnostic chains have vied for outsourced tests which account for 1-2% of the estimated $50-billion US diagnostic market. However, accreditation of labs, pathologists and technicians to international standards has ensured that only 3-4 big companies are able to address this opportunity.

“The need to have direct lab presence in the target country to service medical reimbursements and insurance claims is a roadblock,” CEO of Dr Lal Pathlabs, Dr OP Manchanda said. In addition, companies are expected to employ international doctors which pushes up costs further. Dr Lal Pathlabs, however, plans to address this market by entering into a revenue-sharing alliance with US-based Ssure Pathlabs.

Many diagnostic chains are now betting big on the markets of Middle-East, South Asian and South-East Asian markets. “US regulations and lobbying due to fear of job loss has put pressure on our entry, and the focus is now on emerging markets as the return on investment is high,” said Dr GSK Velu, managing director of Metropolis Health Services. He expects his company’s outsourcing revenues to go up from around 20% currently to almost 50 over next two years.
Apart from the US, even UK is a tough market to address because of certain regulations.

“Invisible trade barriers in the UK, where samples cannot easily be sent out of the European Union, is a limitation,” CEO of SRL Ranbaxy, Dr Sanjeev Chaudhry said. Meanwhile, experts such as Ajit Mahadevan, partner- Healthsciences Practice, Ernst & Young India say that despite challenges with outsourcing, regulations are important for the export markets. “The need for regulatory compliance and standardisation becomes important as faulty diagnosis can create a political uproar in regulated markets,” he said.

January 26, 2009

Medicine sales rise by 10%

Sale of medicines to consumers grew 9.8% to Rs 34,000 crore in the calender year 2008, compared with 13.4% in 2007. The slowdown is largely due to consumers shifting to cheaper brands and stockists not keeping enough products. Also, drug companies did not spend as much as on marketing initiatives in the second half of 2008, as they did in the same period previous year.

For the December month, industry sales rose 13.3%. This is the second consecutive monthly growth after the industry witnessed possibly its first sales decline in the October last year. In October, sales declined by 1.2%, but bounced back to register a 6.8% growth in November, according to figures compiled by research-based consultancy firm ORG IMS.

These figures are compiled from the data collected from wholesalers and represents the trend of the industry, and not the actual sales of over five lakh retailers across the country. The slowdown in drug sales in 2008 comes despite the popular perception that the drug industry is recession-proof and is an attractive investment opportunity during downturns.

Incidentally, the global sales of prescription generics drugs has also slowed down significantly to 3.6% in the October 2007-September 2008 period, compared with 11.4% in the same period a year ago, as per data available with the US-based IMS Health.

During the year, cardiovascular system recorded a 14% value growth in the Indian market, while anti-infectives registered a growth to the tune of 10%.

There is no change in the ranking of the top three companies from past year. Cipla continues to maintain its market leadership, followed by Ranbaxy Laboratories and GlaxoSmithKline (GSK). Delhi-based Mankind Pharma broke into the top 10, registering a growth of over 32% during the year.

Among the top products, Pfizer’s cough syrup Corex is the top selling drug in the country with over Rs 160 crore annual sales. Novartis painkiller Voveran is the second best selling drug, while Piramal Healthcare (earlier Nicholas Piramal’s) cough drug Phensedyly takes the third spot. However, ORG IMS maintains that the industry is independent of the global slowdown. Indian firms expect a strong domestic demand with a 11-14% growth in the next few years.

January 24, 2009

China: Death for two in tainted milk case

A Chinese court has handed down death sentences to two men implicated in a tainted-milk scandal that killed at least six infants and sickened hundreds of thousands of others.

The Intermediate People's Court in Shijiazhuang issued the first verdicts in a nationwide scandal surrounding milk powder tainted with the industrial chemical melamine.

Two men, Zhang Yujun and Geng Jinping, were sentenced to death. Zhang ran a workshop that allegedly was China's largest source of melamine used in the tainted dairy products. Geng was convicted of producing and selling toxic foodstuffs.

The court sentenced Tian Wenhua, the former head of the dairy company at the center of the scandal, to life in prison and fined her nearly $4 million. She was found guilty of making and selling fake or substandard products.

Her company, the now-bankrupt Sanlu Group, was fined more than $7 million. Six other former Sanlu executives were sentenced to jail, for five to 15 years.

The court had announced it would also sentence 21 defendants implicated in the scandal later.

Some parents are disappointed that no Chinese officials have had to face formal charges.

The scandal involving tainted milk broke in September, although Sanlu authorities knew of problems with their company's products months earlier.

Middlemen who sold milk to dairy companies had watered down the raw milk and then mixed it with melamine, which gives an artificially high reading for protein.

Melamine is normally used to make plastics and fertilizer. If ingested in large amounts, it can cause kidney stones and kidney failure. The Ministry of Health said it was likely the tainted milk scandal with Sanlu Group at its centre killed at least six babies. Another 2,96,000 infants suffered kidney stone and urinary problems.


When would we see such quick judgments against corruption happening in India?

January 22, 2009

Health insurance scheme for the poor in TN this year

The government will launch an insurance scheme for the poor and low- income groups to get the best medical treatment in government and private hospitals, Governor Surjit Singh Barnala said on Wednesday. It would benefit about one crore families. The insurance cover would be up to Rs.1 lakh.

In his address to the Assembly, Mr. Barnala said the government was aware that it was not possible for the poor to pay the cost of treatment in private hospitals, especially for cancer, heart diseases, kidney failure, brain and spinal problems and life-threatening accidents.

“Considering these facts, a new scheme, the Chief Minister’s Insurance Scheme for Life Saving Treatments, will be launched this year.” It would enable the poor to get treatment in government as well as private hospitals for serious ailments. “Each family will be insured for availing itself of free treatment up to Rs.1 lakh. The government will bear the entire premium.”

January 21, 2009

US Govt pushes electronic family tree for good health

It happens all the time: Filling out that clipboard at the doctor's office, you can't remember what cancer killed Aunt Sally or when Dad had his heart attack.

A good family health history is far more important than a gene test in predicting your future medical needs, but it's hugely underused. On Tuesday, the government began offering a free new service to try to change that ---- helping people compile one at home, e-mail it to relatives who can fill in the gaps, and even pop it straight into their doctors' computers.

Quiz enough extended family about who battled what disease, and you can fill it out in as little as 20 minutes.

"That is an amazingly positive investment," Acting Surgeon General Steven Galson, whose office spearheaded the new initiative, told The Associated Press. "You're going to help your doctor learn a lot more about you by spending those 20 minutes, and you can share that invested time around your family and with your physicians way into the future."

The goal: Just as people create ancestral family trees, create a family health tree. It may sound old-fashioned in this era of gene discovery. But genetics specialists use these "pedigrees" to look for patterns of inherited illnesses that can provide a powerful window on someone's brewing health risks.

"Family health history is the first genetic test, but it encompasses much more than genes," says James O'Leary of the nonprofit Genetic Alliance.

A family's shared environmental or lifestyle factors are key, too. Add that together, and a family health tree "is the way you identify what is important to pay more attention to," he explains.

Consider: Maybe Dad's deadly heart attack at 60 isn't his 40-something son's top risk, much as he focuses on that tragedy. The real red flag might be the prostate cancer that Dad survived at age 48 and that killed his own father and brother in their 50s.

Yet between patients who don't know relatives' intimate health details and rushed doctors who don't push for it, family health histories too often are brushed aside. A survey by the Centers for Disease Control and Prevention found fewer than 30 percent of Americans have ever collected health information from relatives to compile one. And some surprising recent research suggests that when people do, accuracy varies by disease: They do much better at listing which relatives had breast cancer than who had ovarian cancer, for instance.

"It's terribly frustrating and I'm sure it's prone to many errors," Dr. Doug Henley of the American Academy of Family Physicians says of the clipboard-in-the-waiting-room ritual.

Nor do patients necessarily know what ailments to list. Heart disease or cancer, sure. But what about Mom's string of miscarriages? That your grandmother and her three sisters share osteoporosis' classic hunched back? Or the blood clot that made your sister have to give up oral contraceptives?

The surgeon general's office issued the first attempt to guide creation of family health trees in 2004, with a form patients could print out and carry to the doctor.

On Tuesday, the site reopened ---- at https://familyhistory.hhs.gov ---- after a high-tech face-lift to make it not only more in-depth but truly electronic.

It's private; users download the information to their own computers. Then they can e-mail a tree-in-progress to family members to fill in missing information.

And with a simple keystroke, relatives can "re-index" the tree so that instead of showing the biggest health risks for Cousin Sue who started the project, Cousin Bill can see what risks are more common to his side of the family.

Finally, the tool is readable, even customizable, by many of the computer systems that doctors are using to create "electronic medical records," something Health and Human Services Secretary Mike Leavitt calls key to ushering in better quality health care.

The family physicians' Henley says even if your doctor hasn't gone digital, keeping a printout of the tree's detailed information in a patient's chart still provides crucial information, such as steering someone away from gene tests they don't really need.

But a small pilot study at Partners Healthcare in Boston suggests the digital potential. Embedding the e-family tree straight into software that adds in a patient's test and exam results produced a personalized report on cancer risk in minutes.

"This is the new frontier," says Leavitt, who points to a family that discovered a pattern of inherited colorectal cancer and now is exploring earlier colonoscopies to prevent death. "Information is at the root of good health."

January 20, 2009

Gujarat increases medicos' retirement age to overcome staff shortage

Faced with an acute shortage of staff, the Gujarat government has decided to increase the retirement age from 58 to 62 years of teachers and doctors serving in the government-run medical and dental colleges and hospitals across the state.

Although an official statement issued on Monday claimed that Chief Minister Narendra Modi took the decision in view of the fast pace of development in medical education and services, a senior official in the state Health Department termed it as an attempt to tide over staff shortage in these institutions.

The official told Newsline that there was a 25-30 per cent shortage of teachers in government medical colleges, while a 35-per cent shortage of doctors in hospitals across the state. In fact, there is an acute shortage of speciality doctors — over 45 per cent — in civil hospitals and community health centres in Gujarat, he said.

“The decision will help us ease the present staff shortage. We have also decided to increase the frequency of holding walk-in interviews of medicos to tide over the staff crunch in government hospitals,” the official added.

According to sources, there are 1,214 teachers doing the academic job in the six government-run medical colleges across the state, as against the requirement of over 1,400 teachers.

India to help set up Bhutan's first medical college

Bhutan will soon get its first medical college
, thanks
to India.

A three-member team of experts from the All India Institute of Medical Sciences (AIIMS), which returned to India on Sunday night, told TOI that the college would be ready by February 2011.

To be attached to the 350-bed Jigme Dorji Wangchuk National Referral Hospital Complex, the college will have an intake capacity of 50 students for MBBS.

Suggesting the name `Bhutan Institute of Medical Sciences', the team led by Dr Shakti Gupta said it is being modelled on AIIMS.

According to Dr Gupta, the medical degree that will be awarded by the college will be recognized by India. Its faculty will involve its present pool of doctors besides visiting lecturers from AIIMS and other Indian medical colleges.

At present, students from Bhutan travel to countries like India, Bangladesh and Sri Lanka to complete their medical education.

India has already spent Rs 110 crore to set up the Jigme Dorji Wangchuk National Referral Hospital Complex. The medical college will cost an additional Rs 30 crore.

"At present, the hospital has 17 departments. So we have added three more pre-clinical departments -- anatomy, physiology and biochemistry -- for it to start the medical college. We visited Bhutan on the request of the external affairs ministry and will submit the detailed proposal of the medical college soon," Dr Gupta said.

According to officials, the team asked Bhutan to ensure the college was an autonomous institution just like AIIMS, set up by an Act of Parliament.

"Bhutan already has great infrastructure and equipment. It will require manpower. The present doctors in the hospital will now also be given a teaching designation depending on their seniority. The departments which will face a shortage of trained faculty will have visiting faculty from India," Dr Gupta, who held discussions with Bhutan's health minister Zangley Dukpa to formalise the project, added.

A team from Bhutan is expected in India shortly to study how the medical college at AIIMS runs.

India had recently said that it would help Bhutan in improving health facilities with the construction of the Gelephu Regional Hospital, reconstruction of Samtse Hospital and the construction of a Public Health Laboratory in Thimphu.

Besides Dr Gupta, the expert team comprised AIIMS sub-dean (examinations) A K Dinda and sub-dean (academic) Dr Sunil Chumber.

January 18, 2009

High stress turning doctors into patients

It looks like doctors are sitting on the other side of the table. Physicians across specialties in Bangalore are seeking help from
other physicians or psychiatrists for depression, anxiety and various health problems.

Psychiatrists are seeing more cases where the patient is another doctor seeking counsel and treatment. The trend is being attributed to the trauma of being in a profession where there's a lot of stress and constant contact with misery and death, worries over remuneration and easy access to drugs.

According to psychiatrists, many doctors suffer from chronic fatigue wherein disturbed sleep, loss of appetite and headache are a few symptoms. It is commonly seen among ICU specialists, who work for long hours or do night duty. Consultant psychiatrist B R Madhukar says many doctors first try self-medication before opting for consultation.

Oncologists, who come across patients with advanced stages of cancer, sometimes feel helpless as there's a limit to what they can do to help. This, in the long run, can lead to depression among physicians.

Another cause of concern is the slow rate of career progression. To be successful and survive in the metros, doctors aim for specialization. After six years of MBBS, they can go for three years of post-graduate courses (MD/ MS), followed by super specialization for another three years (DM/MCh). For admission to these courses, they have to clear tough entrance examinations. Failure also leads to depression in many ambitious doctors.

Moreover, a doctor takes 12 years to become a specialist. By then, he would have crossed 30 years and started his family. When they compare their salaries and lifestyle with people from high-paying sectors, they feel depressed and frustrated. In India, doctors at the early stages (after MBBS) are not paid well compared to those in other countries. It is only around 30 years that they actually start earning well.

Assistant professor in the department of psychiatry, NIMHANS, Shivarama Varambally, says suicide rate among doctors and pharmacists is particularly high. "One reason is that both have easy access to drugs. They know the exact dosage of these drugs that can prove fatal. The rates of alcohol and other substance abuse are also quite high among doctors."

CASE STUDY

A cardiac surgeon in a reputed hospital operated on at least five patients a day. Working for long hours and handling many cases at a time, he couldn't remember patients' names or case history. This also affected his health and couldn't handle the pressure. When he got an opportunity to practise abroad, he opted for it.

POLICY

Given the seriousness of the issue, central and state medical councils along with the government need to evolve a policy for providing evaluation and support for ill doctors. This is in place in many countries already. For instance, the medical board of the state of Victoria in Australia has a well-developed policy. It is important not only for the safety of doctors but also the patients they treat.

TREATMENT

Physicians who seek help are counselled, advised for psychotherapy and lifestyle modification for milder forms of depression. In more severe forms, they are put on medication along with supportive therapy.

WORK-RELATED PROBLEMS

* Chronic fatigue among doctors working late hours, ICU specialists or those working night shifts

* Depression, anxiety and stress, especially among those who work in areas like cancer and psychiatry

* Orthopaedicians and surgeons who operate long hours suffer from back pain

* Dentists who stand for long hours suffer from spine
problems

January 16, 2009

Doctors to tailor dose by your smart card

You may have heard of a smart card with biometric features, but soon those visiting a physician will carry one bearing their genetic
profile, making it possible for the doctor to prescribe the medicine best suited to the patient.

So those suffering from hypertension, and whose blood pressure can't be controlled, won't have to consult a doctor time and again until a medicine and dosage works for them.

It's goodbye to the hit and trial method of trying out various drug combinations. This controlled method of medicines being tailor-made according to the genetic make-up will also mean the end of allergies associated with particular drugs.

KK Kohli, professor, department of biochemistry, PGI, has studied working of an enzyme and its effect on how a drug works on patients with diabetes, epilepsy, depression and gastritis. Explaining the process, he said the recovery from a disease depends on the level of drug absorbed. And more the absorption, better the chances of recovery. Those individuals who have a faster rate of metabolizing drugs have lower absorption of medicine as compared to people with slow rates.

Kohli found that 88% of North Indians had less absorption of drugs in blood and 12% had slow rate of drug assimilation in the blood stream. And, the enzyme responsible for drugs and rate of their absorption and efficacy of medicines is cytochrome P450 2C19. "This enzyme affects the working of antidepressants, antiepileptic and antidiabetic drugs," he added. This in turn implies that levels of this enzyme in the body determine how effectively it will work on patients.

As every patient responds in a different way to medicines, the genetic design can help doctors decide the right dosage and drug as per requirement.

"This is futuristic medicine whereby it is expected that a smart card of genetic profile carried by the patient can help the physicians prescribe medicines," added Pallab Ray, department of microbiology, PGI. Kohli has worked on this enzyme for gastritis patients in collaboration with the hepatology and gastroenterology department, PGI. Now, he is planning a similar study on hypertension and heart patients.

Enumerating the benefits of personalized medicine, especially for cancer patients, Kohli pointed out that if the metabolic status of an individual is known prior to chemotherapy, optimum dose can be prescribed for better therapeutic outcome

January 15, 2009

Every patient’s medical history on an ID card

It will not be long before an ambitious Rs 273-crore project has government hospitals electronically connected. The pilot project had a successful run at Mumbai’s Grant Medical College and J J Hospital; now Pune’s B J Medical College and Sassoon Hospital will get the software within two months.

“It’s a unique project and has taken nine years for preparation,” says Dr Sanjay Bijwe, state project coordinator of the Hospital Management and Information system (HMIS) project. Every patient visiting a hospital will be given a unique health identity number and will have access to his or her medical history at any hospital across the state, including prescribed drug records, diagnostic tests related information, X-ray, CT Scan, MRI and allergies.

“Initially the cost was worked out to Rs 180 crore. However we realised that a lot of work will have to be done including installation of fibre optic cables and computers. For that we need an additional Rs 93 crore,” says Bijwe, who is also officer on special duty for the state’s medical education and drugs department.

All 14 government-run medical colleges and 19 affiliates will be linked though an integrated software and the move is expected to bring with it transparency in accounts as well as an increase in administrative accountability.

The software, designed by Amrita Technologies, Kochi, is a powerful one based on open source technology.

The work of laying underground cables and installing computers has started at Sassoon Hospital, and will formally come under the HMIS project in the next two months. The remaining hospitals and medical colleges in the state will get electronically inter-connected with an electronic medical records (EMR) facility in the next two years.

Though efforts to computerise all the hospitals have been on since 1998, things started rolling only in 2003. This time around, a steering committee, comprising secretaries of finance, planning, IT, medical education and drugs departments, has been formed to oversee and review the work time and again. It is expected that even the inventory management of hospitals will become more effective and transparent with HMIS.

“The storage and purchase of drugs, surgical equipment and the status of other clinical paraphernalia of hospital will come on an integrated software which can be viewed from anywhere in the state,” said Bijwe.

January 10, 2009

Doctors protest ‘baseless statement’ by A.P. Human Rights Commission chief

B. Subashan Reddy, chairman of the Andhra Pradesh Human Rights Commission (APHRC), has called for legislation to prosecute parents with diseases such as tuberculosis, HIV, leprosy and dyslexia should they, knowing that they have the disease, have children.

His remarks in Hyderabad have drawn a sharp response from three doctors who say that “the statement is devoid of any substance or rationale” and that “making irresponsible and ill-considered statements like this could lead to further stigmatisation and ostracisation of an already marginalised population.” This is the text of the response:

It was with great concern and disbelief that we read the statement made by the chairman of the Andhra Pradesh Human Rights Commission regarding criminal prosecution of persons with diseases such as tuberculosis, HIV, leprosy, or dyslexia if they had children. We would like to give reasons why this statement is devoid of any substance or rationale and point out that making irresponsible and ill-considered statements like this could lead to further stigmatisation and ostracisation of an already marginalised population.

Neither tuberculosis nor leprosy is a genetic or inheritable disease. Further, both are curable with drugs and patients become non-infectious within a few weeks of starting treatment.

Children with dyslexia, a common learning disability, only need recognition of their problem and educational and social support to be able to function as normal, self-reliant members of the community.

Tuberculosis is an air-borne infection and anyone can get the disease at any stage in life.

Half of adult Indians have latent TB infection, which can flare up to active TB in later life. Should all these people abstain from having children for fear that they may develop TB one day?

HIV infection spreads by sexual contact, mother-to-child transmission, and use of unsafe needles and blood or blood products. Mother-to-child transmission accounts for less than 4 per cent of new infections in India — even these can be prevented by screening and timely treatment of pregnant women. HIV is now a treatable chronic illness and no longer the death sentence it used to be.

While all efforts should be made to prevent HIV infection in men, women, and adolescents in this country, we should remember that most women who acquire infection get it from their husbands to whom they have been completely faithful.

Women often are also not aware that they are HIV positive till they are tested during pregnancy — MTPs may not be possible at that stage and the best option is to provide anti-retroviral drugs to prevent transmission to the foetus.

We stress that it is the responsibility of the State to protect and help these women, not criminally prosecute them. — Dr. Soumya Swaminathan, Senior Deputy Director, Tuberculosis Research Centre, ICMR, Chennai; Dr. Nalini Krishnan, Resource group for Education and Advocacy for Community Health (REACH); Dr. M. Mathews, Consultant in Leprosy, formerly with the German Leprosy Relief Association (GLRA) and Gremaltes.

January 09, 2009

Journalist-doctor Gupta Obama pick for Surgeon General

merica's most famous television surgeon, Sanjay Gupta, is poised to take his black bag and microphone to the White House as President-elect Barack Obama’s choice for US Surgeon General.

A neurosurgeon who is also a correspondent for CNN and CBS, Gupta was chosen as much for his broadcasting skills as his medical resume, suggesting that the incoming administration values visible advisers who can drive a public message. He has also been offered a top post in the new White House Office of Health Reform, twin duties that could make him the highest-profile surgeon general in history.

A practising physician and one of People magazine’s “Sexiest Men Alive”, Gupta met for more than two hours with Obama in Chicago on November 25, according to two sources with knowledge of the talks. Gupta, 39, later spoke with several Obama advisers, including Tom Daschle, who will run the new White House policy office and the Department of Health and Human Services.

The globetrotting doctor has told Obama aides he wants the job, which involves overseeing the 6,000-member Commissioned Corps of the US Public Health Service. When reached on Tuesday, Gupta did not deny that he plans to accept the offer but declined to comment.

Transition officials refused to speak on record about his selection, but several Obama allies praised Gupta as the sort of highly visible, articulate physician who might restore the lustre that the position of “the nation’s doctor” once had.

A representative of the Commissioned Corps, however, said Gupta will face a “credibility gap” because he has never served in the uniformed Public Health Service.

“I am unaware of any public health experience or qualifications he has to be the leader of the nation’s public health service,” said Gerard Farrell, Executive Director of the service’s Commissioned Officers’ Association. “This would be akin to appointing the army chief of staff from the city council of Hoboken (NJ)”.

If he is confirmed by the Senate, Gupta would provide the administration with a skilled television personality to help market what is planned to be a massive reorganisation of the US health system.

The Obama team already has initiated a public relations campaign aimed at mobilising grass-roots support for eventual health reform legislation. Last week, Daschle appeared at town-hall style meetings in Indiana and Washington to solicit public inputs.

The son of Indian parents, Gupta has always been drawn to policy-making. He was a White House fellow in the late 1990s, writing speeches and crafting policy for then first lady Hillary Clinton. He is currently associate chief of neurosurgery at Grady Memorial Hospital, Atlanta’s busy downtown hospital. His appointment would give the administration a prominent official of South Asian descent.

Gupta’s jobs as journalist and physician have sometimes overlapped. During the 2003 Iraq invasion, he was embedded with a Navy unit called Devil Docs and, while covering its mission for CNN, performed brain surgery five times, the first of which was on a two-year-old Iraqi boy.

“I’m a doctor first,” he told The Washington Post in a 2006 interview. “If I had to choose one today, I’d choose medicine.”

Gupta hosts House Call on CNN, and in October aired a special report on presidential health called Fit to Lead. Once CNN became aware of the negotiations with Obama, the network barred Gupta from reporting on health policy. His only hesitation in taking the post involved the financial impact on his pregnant wife and two children if he gives up his lucrative medical and television careers. The surgeon general’s post pays between $143,500 and $196,700.

The experience of the last surgeon general, Richard Carmona, may serve as a cautionary note for Gupta. The outspoken Vietnam Veteran accused the Bush White House of muzzling him and suppressing important public health information because it did not align with the administration’s political views.

To survive a job in Washington, Carmona famously observed, get two dogs because “one of them will turn on you”.

But like Carmona, who had been a SWAT team member, Gupta would arrive in Washington with some unusual survival skills. Four years ago, in a series titled Life Beyond Limits, the television doctor walked on glass shards.

“I couldn’t bring myself to jump,” he said on air, “but at least we both walked away without a scratch.”

January 06, 2009

National Urban Health Mission to be launched next month

Union Health Minister Anbumani Ramadoss today said the National Urban Health Mission covering over 400 cities will be launched by next month.

The mission will cover cities with a population of more than 1,00,000 and will be implemented by various cadres of health workers and personnel including urban social health activists (USHA), he said at a function organised to mark the upgradation of the Bangalore Medical College and Research Institute here.

“We hope to launch the programme by end of the month or next month”, he said.
Also on the cards was the National School Health Programme whereby school students would be screened for ENT problems, skin diseases, diabetes, cardiac health problems among others, he said, adding the programme will be implemented in all private and public schools.

Health will be made a mandatory subject in school curriculum and will cover topics relating to nutrition, hygiene, environment, sanitation and HIV, he said.
Yoga will also be made mandatory in all schools, he said while lauding Karnataka for taking steps in this direction.

Stressing the need for augmenting the number of health workers, he said currently the country has 7,00,000 doctors but as many as 8,00,000 more are needed. As for nurses, there are one million at present although another 1.5 million more are still required, he said.

Online medical consultancy gives MedSphere the market edge

Imagine this: An accident victim is rushed to hospital in the middle of night. There’s no radiologist on duty and a diagnosis is delayed, increasing chances of a fatality.

Now imagine this: A radiologist, alerted on the phone, log ins to the Internet from wherever she is and provides a diagnosis in minutes.
That is what MedSphere Technologies Pvt. Ltd, a 20-month-old start-up, is trying to do through its suite of teleradiology products, which allow electronic transmission of patient images of X-rays, CT scans or MRIs.

The key differentiator, says radiologist Jagadish Prasad, is the streaming technology that allows an expert to view the images without downloading them completely. The data is viewed in real time, says Prasad, who’s been an early user of MedSphere products after the company set up teleradiology infrastructure at Narayana Hrudayalaya hospital in Bangalore.

The firm was started by a group of six whose experiences range from those at medical equipment firms such as General Electric Co., Siemens AG or Philips Electronics NV, tech pioneers such as Yahoo Inc. and Motorola Inc. to international consultants such as Arthur Andersen Llp. The mixed bag of expertise has ensured that the first product was approved by US food and drug administration, “though we haven’t sold our product in that market yet,” says Sanjeev S., co-founder and CEO of MedSphere.

That’s primarily because the founders believe India is a tough market and if they succeed here, cracking other markets won’t be difficult. The company has 154 installations in the country and the products cost between Rs1 lakh and Rs80 lakh. “We saw the demand-supply gap and decided to fill it as some of the players had ridiculous solutions with mind-boggling prices,” he says. “Those who build Rolls-Royce don’t want to build (the) Nano.”

Globally, the US, Europe and Japan constitute 88% of the market share, according to research and consulting firm Frost and Sullivan, but the Asia-Pacific region now offers growth opportunities.

According to Abhishek Dutta, research analyst, technical insights and health care practice at Frost and Sullivan, the competitive landscape is tough but still has moderately low number of firms, Hence, firms such as MedSphere will have a high bargaining power, he said. “There are no substitutes for teleradiology and the only alternative is the general imaging techniques with no telemedical provision.”
He warns that the firms will have to deal with the high costs of equipment, which could end up swaying end-users to stick to conventional methods.

Not quite impacted by the slowdown, which the founders say has actually lowered the threat of attrition, MedSphere does consider entry into the US market as one of its biggest challenges.

January 05, 2009

Public Private Partnership model may inject more funds into medical education

Medical education may soon become a profit-making venture and private players investing in it would have to pay tax on the profit they
make from it. The government is considering a proposal to allow private sector investments in medical education under the public-private partnership (PPP) model. The idea is to encourage investment in the sector to meet the shortage of medical professionals in the country.

At present, only governments, universities, trusts or charitable societies can set up medical colleges. Private companies, which want to establish medical education centres, can do so only through a not-for-profit organisation and are exempt from income tax.

With the changed norms in place, private players are likely to face lesser entry barriers while making big investments in the medical education sector. “We have finalised the proposal to relax the norms for setting up medical colleges. The new guidelines include private sector participation through PPP model among other things. We have already submitted the proposal to the Medical Council of India,” a health ministry official close to the development told ET.

E&Y partner (risk advisory services) Kali Prasad said: “The move will attract private sector participation including private equity into medical education. This will help companies to make investments and make reasonable returns over time while the government will also benefit as companies will have to pay tax.”

The new guidelines seek to relax other rigid regulations such as land area restrictions and the teacher-to-student ratio. “The proposals also suggest that medical colleges may be allowed to have minimum 25 acres in two locations within 12 km, instead of the 25 acres of contiguous land required now,” the official said.

The move came after the Planning Commission had recommended opening of the medical education sector for private sector participation to increase the supply of human resources at all levels while the country is facing an acute shortage of professionals in the healthcare sector. According to a Planning Commission report, for every 10,000 Indians, there is one doctor. India is short by around six lakh doctors, 10 lakh nurses and two lakh dental surgeons.

“A group headed by the secretary of health has examined and actively considered relaxing the norms for investing in medical education. We are looking at an option to completely open up private sector participation and also easing infrastructure norms. A notification to this effect may be made soon by the health ministry,” a senior Planning Commission official said.

The move is expected to boost corporate chains, most of which have planned to set up medical education hubs to meet its human resources need. Delhi-based Fortis Healthcare has plans of setting up 10 medical cities in the next 10 years with an investment of over Rs 5,000 crore.

January 04, 2009

Indian doctors abroad may get permission to practise back home

With India facing a shortage of about 600,000 doctors, the central government is now considering granting permission to Indian physicians abroad to practise in their homeland.

"The government would soon initiate talks with Medical Council of India (MCI) and Indian Medical Association (IMA) to work out modalities to help Indian specialists and experts in various disciplines practise medicine in their homeland," Minister for Overseas Indian Affairs Vayalar Ravi said on Saturday.

Ravi was addressing the second Indo-US Healthcare Summit organised by American Association of Physicians of Indian Origin (AAPI) in the capital.

"Several Indian physicians who have made a mark abroad are willing to return and we should use their expertise given the shortage of doctors in India. Licensing issues should not come in the way of using their knowledge," Ravi said.

According to the Planning Commission, India faces a shortage of about 600,000 doctors, one million nurses, 200,000 dental surgeons and large numbers of paramedical staff.

Emphasising that there is a shortage of physicians in rural areas lacking latest diagnostic and treatment procedures, Ravi said: "By granting permission to overseas Indian doctors to practise in the country, we will not only get the best brains but also committed physicians whose only goal is to serve and not make money."

The Ministry of Overseas Indian Affairs is working closely with AAPI and Indian medical associations in various countries and would extend all assistance to NRI physicians to either set up practice or serve the rural poor, the minister said.

"Prime Minister Manmohan Singh is keen on setting up knowledge bank to draw the expertise of people of Indian origin and physicians as they could play a key role in knowledge transfer."

Ramesh Mehta, president of British Association of Physicians of Indian Origin (BAPIO) said about half the population of Britain was being treated by Indian doctors.

"There are about 40,000 Indian physicians in National Health Service and Indians constitute more than one third of all physicians in the UK. We are very keen to do our best for India and willing to volunteer time and expertise to make India a robust nation," Mehta said.

Sanku Rao, president of AAPI, said the summit would help in preparing a monograph at the end of the two-day session and submit reports and recommendations to the government to improve healthcare in India.

January 03, 2009

Log in to consult your doctor

Medical consultation is going the _e' way. In a two-pronged approach to make their services always available and retain patients, doctors are taking to technology. Hospitals claim this is an ideal way to improve efficiency and control costs, as an increasing number of patients are willing to pay doctors to check reports and reply to their queries by e-mail. Though most doctors don't charge for e-mail services, they say they are able to retain the patient base, who return for annual check-ups. And it is not just the private hospitals that are on the net the Government General Hospital here will soon launch its e-consultation services.

Targeting tech-savvy doctors and hospitals, a private company has now launched call cards for consultation. "It works like any phone card, priced Rs 10 upwards. The customer is given a unique number with which he or she can call any doctor across the country. While the call charges would be according to the plan offered by the service provider, the consultation fee would be fixed by the doctor. Doctors charge Rs 10 to Rs 75 per minute," said Sunil Kulkarni of Oxigen, which recently launched the service.

The case of Dhananjay Mukherjee (name changed), 37-year-old techie, is an example of how the trend is gaining ground. Mukherjee was diagnosed as a diabetic two years ago at Dr Mohan's Diabetes Research Centre. "I told them I live in Kolkata and would not be able to come for follow-ups every three months. The hospital offered to do the follow-ups on the internet. They gave me a testing kit that provides an average reading for three months. I send them my blood sugar reports based on home tests. The doctor reads the report and revises my prescription," says Mukherjee, who is in Chennai for an annual follow-up.

His doctor, diabetologist Dr V Mohan says: "We don't charge patients for e-mail consultations yet. We provide it as an extended service because the patient feels another consultant would mean revision of drugs and possibly repeat of tests. When we do email consultations, they are confident and we retain the patient," he said.

Chennai's MV Hospital for Diabetes too has started an online service to tell diabetics if they are at risk of sexual dysfunction or problems of the foot. The hospital will soon introduce a facility that will enable patients to chat live with doctors. "We think it is essential because sexual dysfunction, particularly erectile dysfunction, can be the beginning of other problems," says Dr Vijay Vishwanathan who heads the hospital.

Most follow-up of surgeries is also done on the phone. Pilot studies have showed that an average phone consultation takes up to five minutes. On most occasions, calls were either for follow-up or second opinion.
After cardiac surgery at Apollo Hospitals, a patient based in Madhya Pradesh sent a mail to the doctor recently asking if it was time to reduce the dosage of a medicine after his cholesterol level came down to normal.

"I replied that he should continue the medicine for some more time. Had he not got the option of emailing me the result, he would have stopped taking the medicine," said a senior cardiologist, who feels that the time doctors spend on replying to patients' e-mails should be included as consultation hours. "Emails have become part of the job. For the patient, it saves time and energy," he said.

January 02, 2009

National Council in offing to check hospitals

A five-year-old Mumbai child, who recently fractured his wrist, waited overnight to get it attended to, at a private hospital. This instance highlights the urgency for accountability among hospitals. If all goes well, consumers could finally access quality medical service. A senior official in the ministry of health and family welfare hopes the Clinical Establishments (Registration and Regulation) Bill, 2007, will be cleared in a few months. As mentioned earlier in these columns, the proposed legislation provides for both registration and regulation of clinical establishments in the country, as also prescription of minimum standards for medical facilities and services.

For the purpose, the bill proposes a National Council, which will not just formulate standards for the segment and classify clinical establishments, but also compile, maintain and update their national register. The official says, “We have done lot of groundwork (on the council), with the expectation that the bill would be passed soon. We have started preliminary work on the body, which is currently purely technical in nature.’’ In another fortunate development, many states have responded positively to the bill.

“It will be applicable to those states, which request for it,’’ says the official, considering health is a state subject. Currently, each state has its own regulatory mechanism for hospitals. In Mahashtra, Mumbai’s corporation and private hospitals are monitored by the executive health officer; and those at the district and rural level by the director of public health. The new bill, if passed, will ensure a uniform country-wide body for regulation of hospitals in the form of the National Council.

As Dr Sujit Chatterjee, CEO at Mumbai’s L H Hiranandani Hospital, says, “Health may be a state subject, but healthcare is the responsibility of the state of India.’’ Hiranandani Hospital is one of the 23 hospitals to have secured accreditation from the National Accreditation Board for Hospitals & Healthcare Providers (NABH), a constituent board of the Quality Council of India. NABH was set up to establish and operate accreditation programme for healthcare organisations. The NABH website adds, “The board is structured to cater to much desired needs of consumers and set benchmarks for progress of health industry.’’

Till the new standards are in place, NABH accreditation appears to be the only national mark of assurance of a hospital’s quality. Other than hospitals, nursing homes and blood banks can also apply for voluntary accreditation. Dr B K Rana, deputy director at NABH, says currently applications of nine blood banks and about 55 more hospitals are in the pipeline. To popularise the initiative among medical establishments and consumers, the board holds awareness programmes in cities and in districts, through the year. “We try to amalgamate the process through media, websites and seminars. It (an NABH accreditation) is not an expensive process.’’

However, accreditation depends on a total of 530 criteria. Says Chatterjee, “It is an Indian standard. But fact of the matter is NABH is a member of ISQUA, which is the International Society for Quality in Health Care.’’ ISQUA is an international body that grants approval to accreditation bodies in healthcare. “It is the gold standard for healthcare in the world.’’ Besides, NABH accreditation is not a one-time process. It is reviewed every 1.5 years, he says.

January 01, 2009

Private hospitals to aid public health

The question of quantity versus quality tends to dog health care initiatives of administrations around the world.
That often leads to government hospitals not having enough facilities to handle the patient load as they have to offer services at a lower cost.
Under such conditions, privately owned health facilities gain public trust, as they can provide all necessary facilities by charging more.

Soon, city residents will be able to get facilities like those available with private health care providers at charges similar to those at a government hospital. UT intends to create a panel of such clinics and diagnostic centres in January.

People visiting these chosen facilities will be charged less and the remaining amount will be reimbursed by the administration.

Director (health services) MS Bains said this was being done to harmonize standards at private and public health care centres.

This is the first step towards the public-private partnership. The objective is to enhance medical facilities without needing to set up more hospitals. These clinics will share the load of primary health centres, he added.
The system will provide diagnostic facilities like X-ray, CT scan and ambulance services.

It is not possible for us to make ambulances available all the time. Under this system, private players can offer facilities for a bit more than what they cost in government hospital.

Private clinics will be roped in for delivering babies if government hospitals are full.

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