Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 18th June, 2019

“Enough is Enough: Time for the Cabinet to intervene and bring an urgent ordinance against violence”

Doctors across the country are protesting the violence against their colleagues in West Bengal. This takes me back in time to the movements organized by the IMA to bring to the attention of the nation the plight of the medical profession.

Cases of violence have particularly increased in the past few years with alarming frequency all over the country; hospitals and medical establishments are ransacked. This latest incident has only added to the growing list. The risk of physical assault has created fear for their safety and security among doctors.

What is worse is that an attempt is often made to put the blame on the medical profession itself as being the cause of this violence.

Doctors are professionals. Becoming a doctor is not easy. The road to becoming a doctor is long one; five and half years of gruelling undergraduate MBBS studies, 3 years of postgraduation and then 3 years of super specialization. There are no short cuts to success in medicine. Being a doctor demands lot of hard work, long hours, dedication and personal sacrifice because for the doctor, the patient comes first.

No doctor practices medicine with an intention to harm the patient. But, despite all care, sometimes errors may happen inadvertently. To err is human and every doctor is likely to make mistakes.

Where is the accountability for the civic authorities for failure to maintain facilities or penal provisions, for that matter, in cases of civic negligence, which are being reported almost every day?

Yet, everybody, including the general public is a silent spectator to the violence against doctors.

The then Health Minister, Shri JP Nadda had constituted an Inter-Ministerial Committee, which had promised to soon enact a central Act for violence against doctors. But sadly that remained a promise on paper only.

The present Health Minister has again given an assurance. But will this assurance come to fruition? Or, are they mere words to appease the agitating doctors? This would be most unfortunate.

The general public is a direct stakeholder in this. It is they who suffer because violence against doctor may result in death of other patients who may be unattended. Doctors cannot discharge their duties in an atmosphere of fear. It is therefore in the their interest too that such cases of physical violence against doctors must be condemned in the strongest words and must not be allowed to happen

We say “enough is enough”.

The ministries directly concerned are Health, Ayush, Home and Law. A solution to violence cannot be found by any one of them acting alone. The entire cabinet should meet and bring out a comprehensive act for violence ( which talks about the possible safety solutions at the earliest on the lines of one enacted in 19 states. Violence against doctors should be made a non-bailable offence punishable. A

Can one use expired injections?

EpiPens and other autoinjectors filled with epinephrine to treat severe allergic reactions may still be potent enough to work many months past their labeled expiration date, according to a new study in online May 28 in the Journal of Allergy and Clinical Immunology.

The US FDA requires autoinjector expiration dates to ensure that the devices never contain less than 90% of the original dose of epinephrine.

For the study, researchers tested the contents of 46 different autoinjectors to see how much epinephrine remained after the expiration dates on the labels. Half of the devices were tested at least two years after their labeled expiration date. At this point, 80% of the devices still retained 90% or more epinephrine, indicating they were still effective under the FDA rules.

Devices six months past their labeled expiration date in the study still had 100% of the original epinephrine dose. One year after the labeled expiration date, devices still had 95% of the original epinephrine dose.
And all of the autoinjectors tested that were up to 30 months beyond their labeled expiration date still had 90% of the dose remaining.

The authors also note that they did not test the expired injectors' effectiveness in stopping an anaphylaxis episode.

Right now, the expiration date is 18 months from the time the product is manufactured, a duration that is shorter than the expiration date for most other medications.

Legal implications

Supreme court of India any violation of the manufacturer’s warning and recommendation is not to be done (Balram Prasad vs Kunal Saha & Ors on 24 October 2013).But in life threatening situations in absence of any other available alternative there are exceptions

  1. Section 52 in The Indian Penal Code: Good faith”.—Nothing is said to be done or believed in “good faith” which is done or believed without due care and attention.

  1. Section 92: Act done in good faith for benefit of a person without consent “ Nothing is an offence by reason of any harm which it may causes to a person for whose benefit it is done in good faith, even without that person’s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit;

  1. IPC 88: Act not intended to cause death, done by consent in good faith for person’s benefit.—Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm. Illustration A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z’s death and intending in good faith, Z’s benefit performs that operation on Z, with Z’s consent. A has committed no offence.

Supreme court to hear pil seeking protection for doctors today

The Supreme Court has agreed to hear a petition on 18th June filed seeking security for doctors in government hospitals across the country.
In the wake of strikes called by doctors across the country to protest the attack on a doctor in West Bengal, PIL has been filed in Supreme Court seeking protection for doctors.
The PIL seeks a direction to the Central government to deploy uniformed security personnel at every government hospital to ensure the safety of doctors. PIL has also prayed for a direction to the government to formulate guidelines for the safety of doctors and for the same to be implemented in "letter and spirit". ...read more

Do not equate big risks, small risks and hypothetical risks under one umbrella as unsafe

When the government warns us about the risks of fats, salt, sugar, alcohol or electronic cigarettes, they equate big risks, small risks and hypothetical risks under one umbrella as "unsafe." No one talks about potential risks against potential benefits.
Cigarettes contain nicotine, tar and carbon monoxide. Of these tar and carbon monoxide are known carcinogens.
Electronic cigarette devices create a vapor (aerosol) people inhale, providing nicotine without the carcinogenic tar....read more

The Skill of Controlling Anger

Cynicism is a recognized major risk factor for coronary artery disease (blockages in the channels supplying blood to the heart). And, anger, jealousy and irritability form the triad responsible for this. Anger is the enemy of peace, knowledge and devotion. According to Ayurveda, anger is a manifestation of Pitta (metabolism) imbalance and is a predisposing risk factor for causation of heart attack, paralysis, gall bladder stone, kidney stone, acidity, ulcer and cancer......read more

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 16 June, 2019 to 0830 hrs IST 17 June, 2019)

Heat Wave:

Heat Wave Conditions were observed at some places with severe Heat wave at isolated places over Bihar. Heat Wave Conditions were observed at many places over Vidarbha, Coastal Andhra Pradesh & Yanam and Telangana and in isolated pockets over Gangetic West Bengal, Jharkhand, East Uttar Pradesh, Marathawada, Chhattisgarh and Tamilnadu, Puducherry & Karaikal.

Maximum Temperature

Maximum temperature departures as on 16-06-2019: Maximum temperatures were markedly above normal (5.1°C or more) at most places over Jharkhand; at many places over Bihar, Telangana and Coastal Andhra Pradesh & Yanam; at a few places over Chhattisgarh and at isolated places over East Uttar Pradesh, Gangetic West Bengal, Vidarbha and Tamilnadu, Puducherry & Karaikal; appreciably above normal (3.1°C to 5.0°C) at most places over Marathawada, North Interior Karnataka and Rayalaseema; at many places over Coastal & South Interior Karnataka and Kerala & Mahe; at isolated places over Madhya Maharashtra; above normal (1.6°C to 3.0°C) at most places over Lakshadweep; at many places over Konkan & Goa; at a few places over Madhya Pradesh and Odisha and at isolated places over Sub-Himalayan West Bengal & Sikkim and Nagaland, Manipur, Mizoram & Tripura. Yesterday, the highest maximum temperature of 45.3°C was recorded at Allahabad (East Uttar Pradesh).

Temperatures Recorded at 1430 Hours IST of Yesterday, the 17th June, 2019

  • Shanti-Niketan(West Bengal) recorded the maximum temperature of 42.4°C

  • Temperatures recorded at 1430 hours IST of Yesterday rose by 3-5°C in many Parts over Punjab and at some parts over Odisha, Chhattisgarh and Uttarakahand; by 1-3°C in many Parts over Gujarat region and in one or two pockets of Jammu & Kashmir, Himachal Pradesh, Rajasthan, Madhya Pradesh, West Uttar Pradesh, Coastal Andhra Pradesh and Tamilnadu & Puducherry.