Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 6th June, 2019

National Education Policy 2019: Pluralistic healthcare education with IMC act in place is premature

The government has released a draft National Education Policy 2019, which proposes to make changes in education including healthcare education.

The policy is in the in the public domain, with comments sought from all stakeholders till June 30.

A key recommendation of the new education policy as far as medical education is concerned is pluralistic healthcare education and delivery.

P16.8.2: Pluralistic healthcare education and delivery: “The first year or two of the MBBS course will be designed as a common period for all science graduates after which they can take up MBBS, BDS, Nursing or other specialisations. Common foundational courses based on medical pluralism will be followed by core courses focused on specific systems, and electives that encourage bridging across systems. Graduates from other medical disciplines such as nursing, dental etc., will also be allowed lateral entry into the MBBS course. A medical education qualification framework to achieve this will be developed in conjunction with the NMC...”

This means that after class 12, students aspiring to become healthcare professionals will first take up a common 2 year (or 1 year) course of basic sciences after clearing a common entrance test and then they can choose a system of medicine be it MBBS, dentistry, nursing, Ayush, occupational health, physiotherapy, etc.

What is not clear is how students would be selected for their specific system of choice. Would it be through an entrance exam? Would each system hold its own separate exam or a common exam? Or there will be only one exam at this level and for basic course there will be no common exam.

The initial two-year course may enable a student to take up teaching as a vocation.

Also, the terms “bridging” and “lateral entry” have been used out of context here and have created ambiguity and are therefore open to misinterpretation.

The above thinking is also premature as the IMC act is still not abolished. The MCI ordinance is under challenge under the Supreme Court. You can not start debate on an assumption that if IMC act is replaced by NMC what should be the criteria for education?

There are debatable issues, which need to be discussed in stakeholders meeting and several challenges in their implementation should be anticipated and addressed.

Walk 7500 steps a day instead of 10,000

One can add another goal to formula of 80: walk 80 hudered steps a day

Most people in the United States take on average 4,000 to 5,000 paces a day.

Harvard Medical School researchers have found that older women who took about 7,500 steps a day had the same mortality risk level as their counterparts in the study who walked the entire 10,000 steps.

The results were presented last week at the American College of Sports Medicine Annual Meeting and published in JAMA Internal Medicine.

Nearly 17,000 women with an average age of 72 years were part of the Women’s Health Study, originally created to study the risk of cardiovascular disease and cancer among women taking low-dose aspirin and vitamin E.

The women who averaged about 4,400 steps per day were about 40 percent less likely to die during a four year follow-up period than the women who walked 2,700 steps.

One surprise for researchers was that the benefits of taking more steps seemed to level off at about 7,500 steps per day.

How fast or slow participants walked was not associated with a risk of death.

Healthcare News Monitor

Pharma News

Panel to firms: Prove that 324 combination drugs are safe to use

The Indian Express- Prabha Raghavan

A drug advisory body sub-committee has asked pharmaceutical companies to prove that 324 combination medicines are safe and effective for patients to consume in order to decide whether these drugs should continue to be sold in India. These medicines, known as fixed dose combinations (FDCs), were declared “irrational” by a Health Ministry expert committee set up in 2014 headed by former KLE University Vice-Chancellor, CK Kokate. An FDC is a cocktail medicine with two or more therapeutic ingredients packed in a single dose and administered in various forms, including syrups, tablets, inhalers, injections and skin creams. When an FDC is “irrational”, there may not be a rationale for creating such a combination and it may not be safe for use, effective or required.

Jan Aushadhi stores of little help

Deccan Chronicle- Sandeep Rana

All four Jan Aushadhi stores at the city hospitals have not served the purpose for which these were set up. Shortage of medicines and lack of faith and awareness about generic medicines among people are blamed for these stores getting a poor response. A visit to these stores at the PGI, the GMCH-32 and the GMSH-16 showed that very few people opted to buy medicines from there. The PGI has two Jan Aushadhi stores. The one at the OPD though had some customers, the one in the Gol market had more sellers than buyers. Footfall at the stores at the other two government hospitals was also found to be thin. On the contrary, private medical stores adjoining Jan Aushadhi centres were overcrowded. Most patients Chandigarh Tribune spoke to at Jan Aushadhi stores reasoned that prescribed medicines were unavailable there. The government initiative aims at providing quality generic medicines at affordable prices.

IMA launches D4D initiative to tackle mental health challenges among medical students


Indian Medical Association (IMA) has launched an initiative namely Doctors 4 Doctors (D4D) to tackle the burden of burnout and rising rates of mental health challenges among medical students, residents and clinicians. Dr. Santanu Sen, National President, Indian Medical Association (IMA) said, “through this initiative, we will focus upon preventing burn out, address mental health challenges, reduce the incidents of suicide among residents and clinicians. We will achieve this by creating awareness of the issue and using tools for emotional well-being and also provide training for self- help and offer D-4-D Free Help Lines to those in need.” As the umbrella organisation and the largest association of doctors, IMA believes that doctors must care for all doctors, especially given the global picture of higher risk of depression and suicide among medical professionals.

Ooty: Research on anti-obesity drug from natural products

Deccan Chronicle- B Ravichandran

Ooty’s budding scientist in phytopharmacy, R. Loges, made it to Bulgaria for an International Conference on Natural Product Utilisation (ICNPU) organised at Albena in Bulgaria by the Bulgarian Phytochemical Society, to present his studies on obesity control using phyto-products. R. Logesh, senior research fellow, ICMR, who is pursuing is Ph.D at the Department of Pharmacognosy and Phytopharmacy at JSS College of Pharmacy, was invited to present his research findings in ICNPU which began on May 29. In his presentation at ICNPU, Logesh said that India is the country with the third most obese people as per WHO studies, and added that research in obesity control has gained momentum across the globe, especially in India. For obesity control measures, research on the role of lipids in humans, pharmacokinetic and dynamics of lipids, pathophysiology of lipids and key targets on lipid absorption and metabolism are necessary, he noted.

Drug-resistant tuberculosis reversed in lab

Deccan Chronicle

Scientists have found a compound that prevents and even reverses resistance to a widely used antibiotic for treating tuberculosis—the most lethal infectious disease worldwide. A growing rise in drug-resistant tuberculosis (TB) is a major obstacle to successfully treating the illness. About 1.5 million people died of TB in 2017, making it the most deadly infectious disease in the world. Researchers at Washington University in the US and Umea University in Sweden reversed resistance to isoniazid, the most widely used antibiotic for treating TB.

No research outcome at CCRS even after 10 years of formation


Although the Central Council of Research in Siddha (CCRS) based in Chennai was carved out of Central Council of Research in Ayurveda and Siddha (CCRAS), New Delhi a decade ago, no research activity is being carried out in CCRS for the last ten years, according to retired officials of Ayush department and Siddha experts who initiated efforts for bifurcation of the council. The CCRS is not carrying out any activity to achieve its goal or performing any work mandated as its responsibility after it was bifurcated and shifted to Chennai in 2010, says Dr M A Kumar, former adviser to Siddha in the Ayush ministry. Dr Kumar was instrumental in separating the Siddha research council from CCRAS with a view to carry out efficient research oriented activities. According to him, the money allocated for various research activities and studies remain unutilised every year because of dearth of any project and proper planning. No performance audit is conducted at the council by the ministry and no authority is monitoring the council’s activities.

US FDA accepts NDA of Boehringer Ingelheim, Eli Lilly's triple combo tablet empagliflozin, linagliptin & metformin to treat type 2 diabetes


Boehringer Ingelheim and Eli Lilly and Company announced that the US Food and Drug Administration (FDA) has accepted the New Drug Application (NDA) for the investigational fixed-dose combination tablet of empagliflozin, linagliptin and metformin extended release (XR) for the treatment of adults with type 2 diabetes. "Millions of adults with type 2 diabetes take multiple medicines to control their condition," said Mohamed Eid, M.D., M.P.H., M.H.A., vice president, Clinical Development & Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc. "If approved by the FDA, the combination tablet would be one of the first single-pill options with three complementary mechanisms of action to help manage blood glucose in adults with type 2 diabetes who could benefit from having empagliflozin and linagliptin as part of their treatment regimen, in addition to metformin."

Lung cancer rising among youngsters as govt tobacco control policies fail: Experts


Youngsters with lung cancer is rising at an alarming rate besides the fact that 80% lung cancer typically present in stage 3 or stage 4 with no symptoms. Compounding the problem further, Government’s tobacco control policies have also failed to address the problem, according to medical experts. Therefore, it is suggested that guidelines developed by WHO should be followed which are based on the experiences of countries where sophisticated and well-funded enforcement structures exist. Awareness about the negative effects of tobacco consumption is weak in the country. Those who smoke are always at a higher risk to develop the cancer and smoking also damages the lining of your arteries, leading to a build-up of fatty material that narrows the arteries causing angina, heart attack or stroke. Despite, the harmful effects of tobacco being well documented, the city has only seen a rise in tobacco usage.

QI Spine Clinic’s outreach programme POP focuses on office ergonomics, posture correction


Healthcare News QI Spine Clinic through its proprietary community outreach programme POP (Power Over Pain), is now addressing subjects like office ergonomics, posture correction, workplace habits and share insights relating to non-surgical treatment of back and neck conditions. According to Anuj Arenja, CEO of QI Spine Clinic, up to 1/3 of back injuries could be prevented through a better designed job workspace. The clinic is taking the in-demand POP talks to corporates all over India. These include names such as Tata Motors, TCS, Bajaj Alliance, WIPRO, Siemens, Yes Bank, Aditya Birla, ICICI Bank, Religare who have repeatedly shown that they are vested in holistic betterment of their employees. Another version of POP talks is also being rolled up across schools. In June 2016, California-based tech company Apple had given all its employees in its headquarters 100%, standing desks. Google, Microsoft and Facebook have also issued adjustable standing desks to their employees.

Healthcare News

Patient 'denied treatment' in Kottayam hospital, dies

The Times of India- Jaikrishnan Nair

A suspected H1N1 patient died after he was allegedly denied medical care at Medical College Hospital(MCH) Kottayam. The patient from Idukki was brought to the MCH in an ambulance around 2pm. The relatives allege that the MCH authorities denied to admit the person. He was then rushed to the two nearby private hospitals who too denied medical care to him. The relatives rushed him back to the MCH in the same ambulance but he died on the way. According to MCH authorities, the person suspected to be H1N1 affected was referred to the MCH by a private hospital in Kattappana. "From the CCTV visuals we have found that the ambulance came to the MCH at around 2.23pm. The relatives requested for ventilator facility. They also met the PRO of the hospital asking for the availability of the ventilator. However, there were no ventilators available at that time and the PRO informed them,” said RMO Dr Renjin. He also said that by the time doctors came out to examine the patient, the ambulance had already left at 2.40pm.

Mannargudi govt hospital outpatient block sinks

The Times of India- D Vincent Arockiaraj

Panic gripped patients and staff after the outpatient block at the District Headquarters Government Hospital in Mannargudi near Tiruvarur sank on Wednesday morning. The walls and floor of the building developed cracks. Grill on the windows were bent. There was no casualty or injury as all the outpatients, doctors and medical staff left building immediately. The incident happened around 9am. The outpatient block was built in 1971. Joint director of health services, Tiruvarur, Dr D Uma, chief medical officer of the hospital Vijayakumar and deputy superintendent of police, Mannargudi, Karthik and a team of police and personnel from the fire and rescue services rushed to the spot. All the medicines, medical equipment and furniture have been shifted to a newly constructed block. The building has been barricaded.

Haridwar-based hosp siphoned of Rs 29 lakh under Atal Ayushman Scheme

The Times of India- Ishita Mishra

Haridwar-based Arogyam medical college and hospital, which is not even registered under Medical Council of India (MCI), allegedly siphoned of Rs 29 lakh under Atal Ayushman scheme. The medical college, whose affiliation is now under the radar of Uttarakhand health department, performed around 100 surgeries without following proper guidelines of Atal Ayushman scheme. The hospital forged documents and medical history of over 500 patients to fraudulently claim money under the scheme. Abhishek Tripathi, director of Atal Ayushman Scheme in Uttarakhand told TOI that Arogyam Medical college and hospital registered itself under the category of medical college in the scheme even when it doesn’t possess any affiliation of MCI. He added, “The hospital performed surgeries on 18 patients from the date of its registration till 22 May, 2019 and no prior approval for any of them were taken by the concerned department, as per guidelines. Also, 76 other surgeries were performed in the hospital of the medical college.”

A doctor’s death in Mumbai exposes social fault lines

Hindustan Times- Sadaguru Pandit, Faisal Tandel and Dhrubo Jyoti

Sanjay Dabhade moved to Pune from the hinterlands of northern Maharashtra in 1988 with a head full of dreams. The young man from a marginal farming family had struggled through school and college battling a fog of slurs and stigma because of his tribal roots, and standing in front of the 141-year-old Byramjee Jeejeebhoy Government Medical College, he felt his hope of becoming a doctor was within touching distance. But a month in the hostel, the dream turned into a nightmare. Dabhade, and other students who had entered the prestigious college by affirmative action, were singled out for insults, their roll numbers segregated and report cards marked by caste. In class, teachers often made fun of their accent, tone and uneven pronunciation of the English language, and in the hostel, students would taunt them for “stealing” seats.

Mumbai: Lilavati Hospital, doctor asked to pay Rs 16.45 lakh for medical negligence

Daily News & Analysis

The state consumer disputes redressal commission (SCDRC) in an order has directed that Rs 16.45 lakh compensation be paid to a complainant for medical negligence. The order pronounced on May 2 was uploaded this week after a complaint filed by Goregaon resident Shyamalee Gupta. Gupta had made the managing director of Lilavati Hospital and Research Centre and Dr. Ranjana Dhanu as parties alleging medical negligence. Gupta was suffering from menopausal bleeding and was advised to undergo minor investigative procedure - a hysteroscopy and dilation and curettage (D&C). On the same day she was readmitted due to continuous complaint of breathlessness. Her family members were informed that her right uterer was damage and emergency procedure called PCN was performed. She was told that to ensure right kidney is not damaged, another operation would have to be conducted. She was later admitted to Hinduja Hospital and her right kidney removed.

15-hour shifts, no sleep or water: India’s resident doctors cry ‘I Am Overworked’

The Print- Nandita Singh

15-hour shifts, no break rooms, no sleep, food or water — tired of such working conditions, resident doctors with coveted degrees from some of the top medical colleges in India are coming together to tell the central government that they are being “overworked”. The resident doctors have launched an ‘I Am Overworked’ campaign and have been mobilising graduate and postgraduate students in government medical college hospitals “across states like Delhi, Madhya Pradesh, Andhra Pradesh, Kerala”. Dr Harjit Singh Bhatti, former president of the resident doctors’ association, All India Institute of Medical Sciences (AIIMS), told the ThePrint that the doctors will use the campaign to send recently appointed Union Health Minister Dr Harsh Vardhan a letter with their complaints.

Coimbatore: Newborn critical, parents seek action against doctor

Deccan Chronicle- Lakshmi L Lund

An infant that was born on Sunday has been put on life support at a private hospital here. Her parents blame the doctor for medical negligence post delivery. Parents of the infant, Rangaraj (30), who is employed in an IT firm here and R Nithya (25), a homemaker, were reportedly seeking medical advice from Dr M Chandrakala of Genesis Women and Child Care Centre, located on the Puliakulam main road here. On instructions of the doctor, Nithya was admitted to the hospital and she gave normal birth to a female baby, on Sunday. After pain was induced, the baby was born with injuries on the head of which the parents were not informed, a source close to the family told DC.

AAUY issues notice to Haridwar hospital for irregularities

The Pioneer- PNS

The administration of Atal Ayushman Uttarakhand Yojana (AAUY) has issued show cause notice to Aarogyam Medical College and hospital, Bhagwanpur Haridwar for gross irregularities in registering the hospital under the AAUY and making fraudulent medical claims. The AAUY officials were shocked when they realised that though the Aarogyam had claimed that it is medical college and had registered itself with the AAUY as a medical college hospital, it was not in the list of recognised medical colleges of Uttarakhand released by the Medical Council of India (MCI). In another glaring anomaly it was found that the hospital had performed surgery on 18 patients even before pre authorisation approval was received from AAUY. The hospital also claimed the reimbursement for these unauthorised surgeries too. The hospital has treated 518 patients and in 76 cases the treatment was done prior to pre authorisation approval. In many cases the hospital has sought claim enhancement under the scheme in gross violation of norms.

IMA seeks setting up counselling centres in all medical colleges, teaching institutes

ET Healthworld- PTI

The Indian Medical Association (IMA) has sought setting up of counselling centres and a 24x7 helpline in all medical colleges and teaching institutions to help students deal with mental health issues. The move comes days after Doctor Payal Tadvi, 26, allegedly committed suicide after facing harassment by her seniors at a state-run hospital in Mumbai. The IMA has launched an initiative named Doctors 4 Doctors (D4D) aimed at preventing burn out, address mental health challenges, reduce the incidents of suicide among residents and clinicians.

Ahmedabad: Govt hospital nurse cuts baby's thumb instead of bandage, case registered

India Today- Gopi Maniar

A major case of negligence has surfaced from a government hospital in Gujarat's Ahmedabad, where a baby girl lost her thumb. The five-month-old girl was admitted to Vadilal Sarabhai (VS) Hospital, which is considered as the lifeline for the poor in Ahmedabad, as she was diagnosed with pneumonia. However, the day she had to be discharged the nurse was removing the needle in her left arm, and while cutting the bandage she cut the baby's thumb along with it. The five-month-old, who was to celebrate her first Eid on Wednesday, was brought to the hospital by her parents as she had cold and cough. A doctor diagnosed her with pneumonia and admitted her to the hospital.

US doctor charged with killing 25 patients with powerful opioid


A doctor in the US state of Ohio was charged Wednesday with the murders of 25 critically-ill hospital patients for allegedly administering lethal doses of the powerful synthetic opioid fentanyl to hasten their deaths. A grand jury indicted William Husel on 25 counts of murder for the deaths of patients under his care while he was employed by the Mount Carmel Health System hospital network in the Midwestern state's capital Columbus. "I've been a prosecutor for 22 years and I have not seen a 25-count murder indictment," Franklin County Prosecutor Ron O'Brien told a news conference. The indictment was the latest salvo in a case that exposed the failure of multiple healthcare safeguards, raising questions about the roles of the dozens of nurses and pharmacists who worked with Husel. Husel's alleged actions spanned four years and may have involved as many as 35 patients who were near death or critically ill, with most not expected to survive, authorities said.

Revealed: Dissonance between what doctors know and prescribe

The Telegraph- G.S. Mudur

Health researchers have detected a disturbing dissonance between the knowledge held and prescription practices followed by sections of doctors in Bengal’s West Burdwan district in a unique study that probed the use of antibiotics. Their study has also revealed that some pharmaceutical companies are arming quacks and pharmacy shopkeepers who serve as informal but unauthorised health-care providers with tips for prescribing medicines. The researchers at the Calcutta School of Tropical Medicine and Medecins Sans Frontieres have found that although 77 per cent of doctors knew when not to use antibiotics, over 87 per cent prescribed them even in those situations. Their findings come amid long-standing concerns that irrational prescriptions of antibiotics, particularly for upper respiratory viral infections among other illnesses or symptoms, are contributing to the growth of multidrug-resistant microbes.

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 05 th June to 0830 hrs IST of 06 th June, 2019)

Heat Wave:

Yesterday, Heat wave conditions are observed in many parts with severe heat wave in isolated pockets over Madhya Pradesh; heat wave conditions in many parts over Madhya Maharashtra; at some parts with severe heat wave in isolated pockets over West Rajasthan and Vidarbha and heat wave condition in isolated pockets over East Rajasthan, Marathwada, Chhattisgarh and Odisha.(Annexures 1-2)


Maximum temperatures more than 40.0°C were recorded in most parts over Punjab, Haryana, Chandigarh & Delhi, Uttar Pradesh, Rajasthan, Madhya Pradesh, Chhattisgarh, Vidarbha, Marathwada, Telangana; in many parts over Gujarat Region, Madhya Maharashtra, Rayalaseema; in some parts over Saurashtra & Kutch, Rayalaseema and in isolated pockets over Jharkhand, Jammu & Kashmir, Himachal Pradesh, Tamilnadu.

Maximum temperature departures as on 05-06-2019: Maximum temperatures are markedly above normal (5.1°C or more) at many places over East Madhya Pradesh, Vidarbha and Madhya Maharashtra; at a few places over West Madhya Pradesh and Coastal Karnataka and at isolated places over East Rajasthan and Kerala; appreciably above normal (3.1°C to 5.0°C) at most places over North Interior Karnataka; at many places over West Rajasthan and Telangana; at a few places over Himachal Pradesh, Uttarakhand, Haryana, Chandigarh & Delhi, Rayalaseema and Marathwada and at isolated places over Punjab, Saurashtra & Kutch, Konkan & Goa, Tamilnadu & Puducherry, Coastal Andhra Pradesh and Andaman & Nicobar; above normal (1.6°C to 3.0°C) at many places over South Interior Karnataka; at many Places over Chhattisgarh; at a few places over Jharkhand, Gujarat Region and Andhra Pradesh and at isolated places over Odisha, Assam & Meghalaya and Nagaland, Manipur, Mizoram & Tripura. They are markedly below normal (-5.0°C or less) at isolated places over Gangetic West Bengal; appreciably below normal (-3.1°C to -5.0°C) at a few places over Jammu & Kashmir and near normal over rest parts of the country.

Yesterday, the highest maximum temperature of 47.9°C recorded at Nowgong (East Madhya Pradesh).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 06 th June to 0830 hrs IST of 07 th June 2019):-

Heat Wave conditions in many parts with severe heat wave in isolated pockets very likely over Madhya Pradesh and Vidarbha; in some parts with severe heat wave in isolated pockets very likely over West Rajasthan. Heat wave to severe heat wave conditions in isolated pockets n nnnnnnover East Rajasthan. Heat Wave conditions in isolated pockets over South Haryana, south Uttar Pradesh and Chhattisgarh.

Autopsies: Respect Cadavers Too

Reproduced from: http://www.indialegallive.com/health/autopsies-respect-cadavers-too-66037, published May 28, 2019 A move to have CCTV cameras inside autopsy halls was opposed by the Delhi government in the High Court as it violates the constitutional rights of the dead
The Delhi government has opposed installation of CCTV cameras inside autopsy halls in mortuaries, stating that it amounts to a violation of constitutional rights of the dead. The statement was part of the minutes of a meeting held by the Delhi chief secretary on March 28 to discuss the proposed action on the Delhi High Court's directions on management of mortuaries.
This stand opposed the amicus curiae's recommendation of providing a facility to record post-mortem procedures and install CCTV cameras in all mortuaries to check the practices being followed.....read more

Music as a Drug