Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 22th June, 2019

Save Muzaffarpur’s children by repairing its broken primary health care

I agree with a TOI blog today which exposed the broken primary health care in Bihar.

Where is the Pradhan Mantri Jan Arogya Yojana for these children?

As per official norms of one PHC for every 30000 population and given its population of a little over 5.1 million, Muzaffarpur should have over 170 PHCs. But a health ministry database shows only 103 PHCs.

Worse, all but five of these failed the mandatory requirements so badly that they were not considered fit even to be graded in the 2018-19 evaluation. The five that were, were rated zero.

The ground reports about PHCs from several parts of the country reinforce this point: there is shortage of medical staff and shortfalls even in electricity, water, hygiene.

The answer

Make acute malnutrition a notifiable disease in India and let it be treated at primary care with standard protocols including prevention of refeeding syndrome.

Yoga Prescription By Dr KK Aggarwal

Safer nicotine products

  • E-cigarettes are estimated to be 95% safer than smoking cigarettes

  • Snus is not inhaled, so there is no risk of respiratory disease which accounts for nearly half of all smoking-related deaths; and no risk to bystanders. There is no significant association with premature deaths, diabetes, pancreatic and oral cancers, heart disease or strokes

  • It is estimated that by 2021, over 55 million people will be using e-cigarettes or heat-not-burn tobacco products and that the global market will be worth USD $35 billion

  • Use of heat-not-burn products in Japan has seen cigarette sales fall by 27% in two years, an unprecedented national decrease in smoking

  • In Sweden snus has been instrumental in reducing smoking related mortality to the lowest in the EU

  • If the EU ban on snus is lifted, then around 320,000 premature deaths a year could be prevented in the EU

  • As Norwegian smokers switch to snus, the smoking rate among young Norwegian women has dropped to a world record of 1%

  • Over 50% of the UK’s 3 million e-cigarette users are ex-smokers

  • 39 countries have inappropriately banned SNP including countries whose smoking prevalence is predicted to rise

  • 62 countries regulate e-cigarettes under tobacco legislation.

(Source: No Fire, No Smoke Global State of Tobacco Harm Reduction, 2018 (2018). London: Knowledge-Action-Change)

4-day-old girl died at a government hospital in Bareilly after being shunted between different departments

There is a need for a transparent policy on hospital admissions

A 4-day-old girl died at a government hospital in Bareilly after being shunted between different departments for 3 hours, reported India Today on Thursday.

The Chief Medical Superintendent (CMS) of the men's wing at the government hospital was suspended after the death of the four-day-old girl, an official release stated. Departmental proceedings have also been ordered against CMS, women's wing. "A critically ill child was brought to the men's wing of the hospital, where paediatricians were available. Instead of stablising the child, her family was sent to the women's wing, from where the child was sent back," officials said.......read more

Healthcare News Monitor

Cardiovascular outcomes similar for generic and brand-name drugs for hypothyroidism

Business Standard- ANI

Cardiovascular event rates were similar for generic and brand-name levothyroxine drug used to treat hypothyroidism, with lower pharmacy costs for the generic drug, finds a study. The study to be published in the journal 'Mayo Clinic Proceedings' suggests that generic or brand-name levothyroxine may be used to treat hypothyroidism due to benign thyroid disorders. The average 30-day cost of the generic drug was about half the cost of brand-name medication for patients and insurers. "More than 90 per cent of thyroid prescriptions are for levothyroxine, and there has been disagreement as to whether generic levothyroxine and branded thyroxine preparations are equivalent," said Robert Smallridge, the study's principal investigator. "These findings suggest that generic and brand levothyroxine therapy are similar as related to cardiovascular events risk," said Dr Smallridge. Dr Smallridge said the findings require confirmation with longer-term follow-up and study of subsets of patients, such as those with a history of thyroid cancer, who frequently receive higher doses of levothyroxine.

Pharma firm expands Foot & Mouth Disease vaccine production

The New Indian Express

Last month, the Union Cabinet with Prime Minister Narendra Modi approved a scheme with a total outlay of Rs 13,343 crore to fully control diseases like Foot and Mouth Disease (FMD) amongst the livestock in five years and subsequently eradicate the disease. Keeping that in mind, Biovet Private Limited — a veterinary vaccine company — is expanding its manufacturing capacity of FMD vaccines from 200 million doses to 500 million. The company stated in a press conference on Thursday that the move makes them the largest FMD manufacturer in the world and second Bio Safety Level 3-PlusAg vaccine manufacturing facility after the UK. As of now, the company is manufacturing the vaccines at Malur, Kolar District and distributing to various parts of the country as well as export. “Our main focus are the small farmers, whose livelihood depends on cattle, and dairy farming, since agriculture farming is coming down,” said Dr Krishna Ella, founder of the company.

Glenmark Pharma gets USFDA nod for menopause symptom relief drug

The Economic Times- PTI

Glenmark Pharmaceuticals NSE 1.57 % has received final approval from the US health regulator for generic version of Nordisk Inc's VAGIFEM, used for providing relief from menopause symptom. "Glenmark Pharmaceuticals Inc., USA has been granted final approval by the United States Food and Drug Administration (USFDA) for Estradiol Vaginal Inserts USP, 10 mcg," the company said in a regulatory filing Monday. The approved product is a generic version of Novo Nordisk Inc's VAGIFEM. Quoting IQVIA sales data for the 12 month period ending July 2018, Glenmark said VAGIFEM, 10 mcg, market achieved annual sales of approximately USD 286.3 million. The company's current portfolio consists of 139 products authorised for distribution at the US marketplace and 61 abbreviated new drug applications (ANDAs) pending approval with the USFDA.

Merck CEO sees legal challenge if U.S. adopts drug pricing based on other countries

ET Healthworld- Michael Erman

Merck & Co Chief Executive Ken Frazier said on Thursday a rule to base the price the U.S. government pays for some prescription drugs in it Medicare program on lower prices in other countries would face legal challenges if adopted. U.S. President Donald Trump said last year that one way his administration would seek to lower drug costs to consumers could be through an international pricing index (IPI) that would determine what Medicare pays for certain medicines based on the prices set in a handful of other countries. A proposed version of the rule is expected in August. Other developed nations with single payer systems typically pay far less for drugs than the United States, which Trump called "global freeloading." "I think there will be challenges to the rule," Frazier told reporters following the drugmaker's investor day in New York. "A lot of people have objections to that rule. It's not just pharmaceutical companies." Frazier, a lawyer by trade, did not say whether Merck would launch its own legal challenge to the proposed rule. The company was one of three U.S. drugmakers that sued the U.S. Department of Health and Human Services this week over a new government regulation requiring them to disclose the list price of prescription drugs in direct-to-consumer television advertisements.

CDSCO conducts raid on 2 API suppliers’ premises in Chennai for supplying spurious drugs manufactured by Chinese companies

Pharmabiz- Peethaambaran Kunnathoor

The sleuths of the Central Drugs Standard Control Organisation (CDSCO) in Delhi conducted simultaneous raids in the godowns of two suppliers of active pharmaceutical ingredients (APIs) in Chennai and seized huge quantity of raw materials, which were found to be contravening various provisions of the Drugs and Cosmetics Act and the Rules. Kawarlal & Co, located at Park Town in Chennai and Nutranol Ingredients functioning at Ponnappa Chetty Street in Chennai are the two raw material distribution companies found to be violating various provisions of the drug laws in their drug business. In the raid at Kawarlal company’s premises, the central regulatory officers seized APIs such as erythromycin stearate, verapamil hydrochloride, megestrol acetate, trimetazidine dihydrochloride,silymarin 70%, folic acid and calcium D pantothenate for contravention of various provisions of the drug act and rules. According to CDSCO sources, these two API dealers were supplying spurious and misbranded drugs manufactured by some Chinese companies which are not registered with CDSCO in India. Further, in some other cases, the sources of certain drugs distributed by these firms could not be ascertained by the central drug regulators. The accused companies were distributing large quantities of raw materials to various formulation manufacturers in India.

IPA's 'Vision 2030' defines roadmap for Indian pharma industry to grow from US$ 38 to 120 billion by 2030


The Indian Pharmaceutical Alliance (IPA) has released a report on ‘Vision 2030’ that defines the growth and aspiration for the Indian pharmaceutical industry, discusses the challenges & opportunities and outlines the actions needed to achieve Vision 2030. To achieve the Vision 2030, the IPA stresses that the stakeholders need to work to accelerate the goal of universal healthcare across India and the world by providing access to high-quality affordable drugs; emerge as an innovation leader to build a globally recognized position for India by aspiring for three to five new molecular entities and 10–12 incremental innovation launches per year by 2030; become the world’s largest and most reliable high drugs supplier and achieve 120-130 billion US$ by 2030 growing at a CAGR of 11 to 12 per cent; and continue to contribute to the growth of the Indian economy through foreign exchange earnings and additional employment opportunities. Achieving these four goals will help the Indian pharmaceutical industry improve its global market share to 7 per cent from current 3.6 per cent by value. It will also mean the Indian pharmaceutical market will break into top 5 markets in the world from its current ranking of 11th, by value.

Herbaceuticals is a holistic approach to integrate evidence-based modern medicine: Dr V Prakash

Pharmabiz- Nandita Vijay

Herbaceuticals is a science with a holistic approach to integrate modern medicine with an evidence-based identity, said Dr. V Prakash, distinguished scientist, CSIR-India and former director, CFTRI, Mysore. There is considerable importance on the science of Herbaceuticals for the Indian pharma industry. In an age of integrated healthcare where Ayush therapies are being accepted along with the modern medicine, we see that these are separate compartments in theory and practice. However, there is an increasing need to combine modern and traditional medicine, he added. In his recently launched book titled Herbaceuticals, Dr. Prakash along with his co-editor Dr. DBA Narayana, expert member, Indian Pharmacopoeia Commission, stated that it was important to highlight the indispensability of Herbaceuticals which is also referred to as nutraceuticals and Ayushceuticals. “This book published by IFFRIFANS and Ayurvidye Trust offers a holistic approach in an integrated way where the basic concepts of Ayush perhaps is paving the way for a new acronym called ‘Ayusha’, where the last ‘A’ is Allopathy,” Dr Prakash told Pharmabiz.

Mumbai: Drunk woman assaults doctor, nurse, cop; hospital staffers strike for four hours

The Times of India- Nitasha Natu & Sumitra Debroy

Medical services at BMC-run Babasaheb Ambedkar Municipal General Hospital in Kandivli were paralysed for nearly four hours on Thursday after a woman in an inebriated state allegedly assaulted a doctor, nurse and staffers. The hospital employees went on a flash strike from 7am in protest and brought OPD as well as emergency services to a halt, said a patient's relative. Late on Wednesday, Himani Sharma (29), a BPO employee, approached Bangur Nagar police with a complaint that she had been harassed and assaulted. She was in an inebriated state. The police took her to the hospital for a check-up and the drama began at the emergency ward around 5.30am. Police sources said an argument broke out following which Sharma hit a nurse and then a doctor. "She grew violent and the hospital staff alerted us," said an officer from Kandivli police station. "When a female constable, Mhatre, went there, Sharma assaulted her too. After a hospital staffer lodged a complaint against her, Sharma was arrested." Sharma also vandalised the hospital.

Ruckus at Mumbai's civic hospital after doctors manhandled by patient's kin, medical services briefly hit

The Times of India-Sumitra Debroy

Medical services at the civic-run Babasaheb Ambedkar Municipal General Hospital in Kandivali was suspended on Thursday morning after doctors alleged that they were manhandled by the kin of a pregnant woman. Patients, including pregnant women, suffered the most as not just the OPD but even the emergency services were also shut down. "From 7.30 am, none of the services were available. Hundreds of patients were waiting to see a doctor but the hospital had shut the main gate. How can a public hospital do that," said Khalid Shidhique, a local. He added that no exception was made even for pregnant women.

In Etawah hospital, doctor stitches wounds in mobile torch light

The Times of India- Faiz Rahman Siddiqui

A video rapidly doing the rounds in the city is of an incident in the operation theatre (OT) of Etawah’s Bhimrao Ambedkar hospital where two patients’ injuries are being stitched up under the thin beam of mobile phone torches held aloft by the patients’ families. There was no power, sources said, adding the hospital’s three generator sets are usually nonfunctional due to lack of fuel. Rahul and Sunil, both residents of Hiranpur village under Ekdil police jurisdiction in Etawah, sustained head injuries, hospital sources said, following a clash between two groups on Wednesday and were brought to the hospital, among Etawah’s oldest and largest government hospitals. As power went off briefly and the generator was not working, I wasted no time to stitch up and bandage their wounds,” said Dr Jaydesh Yadav. Hospital chief medical superintendent (CMS) Dr S S Bhadauria confirmed the incident but said “it is not a routine affair”. “This happened on Wednesday at around 6 pm. Power supply was disrupted due to heavy rain. In the meantime, two patients arrived with head injuries. To provide immediate relief to the patients who were in pain and bleeding profusely, Dr Jaydesh treated them in the light of mobile torches,” Dr Bhadauria informed TOI on Thursday, denying the claim by hospital insiders that the generators “never work”

Junior government doctors boycott duties, hunger strike today

The Times of India- Amrita Didyala

Outpatient services at Osmania General Hospital (OGH) and Gandhi Hospital were severely hit on Thursday as junior doctors boycotted elective services to protest the government’s decision to increase retirement age of teaching doctors from 58 to 65 years. Days after a nationwide strike over assault of a doctor in Kolkata crippled healthcare services in Hyderabad, doctors again stayed away from work forcing patients and their attendants to stand in queues at the emergency ward for up to four hours. Inpatient services were also affected at state-run hospitals due to staff crunch. Apart from boycotting elective duties, junior doctors at teaching hospitals, including Niloufer Hospital, Government Maternity Hospital in Petlaburj, Sarojini Devi Eye Hospital, MNJ Cancer Hospital and Chest Hospital, also joined the protest. Only two doctors were available at Government Maternity Hospital in Petlaburj. The doors for emergency wards at OGH and Gandhi were frequently being shut to prevent the entry of large number of patients. Many patients were also seen arguing with security guards. “We came all the way from Warangal but were not allowed to enter the casualty ward for almost four hours,” said Razia Begum, who came with her husband. In fact, many families were putting up at hospitals for the last three days or more. Around 10 attendants, who came with a patient from Harshaguda, were putting up at OGH for the last three days. “We brought our niece here after she developed fits. She is being treated at the hospital but there are very few doctors available,” said Lashamma, one of the relatives.

GMCH pulls up its socks to produce globally relevant doctors

The Times of India

The Government Medical College and Hospital (GMCH) held a meeting to discuss the implementation of the revised curriculum for first year MBBS course at APB hall, physiology department on Thursday. The new curriculum introduced for the first time by the Medical Council of India (MCI) is designed to create doctors with a more patient oriented and community-based approach, GMCH dean Kanan Yelikar said. Thursday’s meeting saw heads of all departments of the state-run medical college participating in the meeting. The meeting was held under the guidance of dean Yelikar and saw head of medical education unit Sarojini Jadhav explain the new pattern. Head of department of biochemistry Reshakiran Shendye gave details about the one-month foundation course. In a bid to increase the competency of Indian doctors and making them globally relevant, the MCI has introduced a new curriculum for MBBS from the academic year 2019-20 in colleges across India. The students enrolled for the MBBS course (2019-20), which commences from August 1, will be the first in India to be trained under the curriculum inspired from the west. TOI has been reporting extensively about the need and plans of the government to implement a curriculum which stresses on communication skills, ethics and attitude.

Docs’ chat sessions with patients’ kin boost ties

The Times of India- Sumati Yengkhom

At a time when the lack of trust between doctors and patients has a hit a record high, the gynaecology & obstetrics department at Calcutta National Medical College (CNMCH) sports a different scene altogether. A room, beside the gynaecology emergency, works as the ‘patient party meeting room’. It is a place where the patients’ families can speak about their grievances, seek information and get the status of patients with the doctors themselves attending to each query. “Maa, tomar patient er bleeding kyano hochhe, amra chhobi tule dekchhi aaj (We are investigating why your patient is bleeding),” department head Dr Arati Biswas, tries to reassure Nikita Paik of Paschim Choubaga, whose niece was admitted there on Thursday night. “Once the report is out, we shall decide whether she will undergo normal delivery or caesarean section,” she tells the worried woman. The department has been maintaining this kind of relations with patients for quite some time now. The ‘patient party meeting’ is held twice a day. The morning interaction begins around 11.30am. Patients’ relatives who have queries are requested over the public address system to go to the room. Detailing of all admitted patients is done prior to the meeting. If the department head is not available, senior faculty members and doctors like Mrinal Kanti Kundu and Mallika Datta are present. The presence of senior doctors makes the families feel that the patients are being looked after well. “My sister-in-law was four months into pregnancy when she started bleeding. We were worried as why the treatment was getting delayed. Doctors explained to me that since this was her first pregnancy, they wanted to ensure that she did not lose the child and will discharge her only after they were certain that she was safe. I feel very reassured,” said Buluma Biwi, from Ghatakpukur.

Noida hospital penalised for flouting norms on smoking in public places

Business Standard-PTI

Jaypee Hospital here was penalised by the Gautam Buddh Nagar administration Thursday for flouting norms on smoking in public place, officials said. A team of experts from the district Tobacco Regulation Committee had carried out a surprise inspection at the hospital in Sector 128 when the violations surfaced, the officials said. The action has been taken in compliance with the Cigarettes and Other Tobacco Products Act (COTPA) 2003. According to a statement by the administration, the law prohibits smoking in a public place and calls for compulsory anti-tobacco advertisements in hospitals. "But during the inspection, it came to light that no anti-tobacco advertisements were in place in the hospital while several people were smoking in its parking area," the statement read. "For the violation of Section 4 of COTPA, a notice was issued to the hospital for a total of 150 violations and a penalty of Rs 30,000 imposed on them," it said. The notice was sent to the chief executive office of the hospital, who has been given seven days time to respond and warned of action if the violations were repeated, the statement said.

New techniques help avoid limb loss: Doctors

The Hans India

In a bid to address the problem of the growing number of limb losses in the country, 'LoveYourLimbs' campaign was launched at CARE Hospitals, Centre of Excellence (CoE) here on Thursday. A campaign aimed at spreading awareness around limb loss and the treatment available to help save the limbs. According to WHO there are more than one million amputations performed every year, with up to 70% of these amputations related to diabetes. Moreover, as per other estimates, below the knee amputations are the most common, representing 71% of dysvascular amputations. About 1,85,000 people undergo amputation each year, meaning 300 to 500 amputations are performed every day. Doctors emphasised the need for adopting Drug-Coated Balloon (DCB) technique for treating Peripheral Artery Disease (PAD) which can help patients save their limbs and avoid amputation. PAD is most common with patients suffering from diabetes and they show extreme pain usually in leg while walking. With 69.2 million diabetics in the country, of these 36 million not even diagnosed, India tops the world ranking in terms of a maximum number of people living with the diabetes. This increasing number of diabetes cases is also leading to a rise in the number of diabetic foot patients which is a matter of grave concern.