You got to love Indian Judiciary

In our country we try to be very generous to people in need especially when someone else is paying. The fact that ultimately the taxpayers will have to bear the burden escapes attention. The Supreme Court has ruled that insurance companies cannot deny coverage for preexisting conditions. You cannot help but admire ! The audacity!! and the foolishness?

The Supreme Court has ruled that public sector insurance companies cannot refuse to provide medical cover policies to those suffering from pre-existing diseases and said such an action was arbitrary, illegal and unconstitutional.

A bench of Justices S B Sinha and V S Sirpurkar also asked the Insurance Regulatory Development Authority (IRDA) to frame suitable guidelines to ensure that insurance companies, both from public sector and private sector, do not indulge in the unethical practice of denying medical insurance facility to the public.

Read the full article here

I hope there are caveats or it is the long march to bankruptcy for the insurers. Now there will be no need to unnecessarily insure when you are healthy; all you need to do is pay the first installment as soon as you find yourself sick.

Inviting Medicos to India

Joking with fresh medical graduates in Delhi,our health minister informed that doctors from western countries were raring to come and fill the gap in medical personnel in India now that he has recognized their degrees.

Acknowledging the severe crunch India is facing in the number of doctors, nurses and paramedics, Health Minister Anbumani Ramadoss said Friday that since the government recognises the medical degrees issued by five English-speaking countries, including the US, Britain and Australia, it would help tide over the shortage.

He said the government was taking a number of steps to overcome the shortfall in order to ensure that people are able to get quality medical care.

“There is no stop-gap arrangement. Yes, we know there is a shortfall of medical human resources in the country. The need has also been felt because of the expanding population,” Ramadoss told reporters after awarding undergraduate degrees to students at the Lady Hardinge Medical College (LHMC) at its 92nd convocation here.

you can read the full article here.

He was being more forthright when he said

The government is also upgrading the existing infrastructure and setting up new ones.

which is surely a long drawn out process.

I am sure he was joking about the rest. In present day situation fresh doctors prefer serving in the Australian or US outback rather than staying here. Almost all doctors stuck in NHS and UK ‘work permit’ have returned (quite a few of my colleagues as well) and  just a handful are taking their chances. I wonder where the ministry gets such rosy numbers from.

Educating doctors?

Recently there were two pieces of news regarding the relationship between doctors and the pharmaceutical industry. In one the convener of RANZ college of  Psychiatrists(RANZCP)  decided to resign when his attempts to end drug company sponsorship of CME and Conferences was vehemently opposed by fellow members.

Psychiatrists back sponsorship deals | The Australian

A SENIOR member of the Royal Australian and New Zealand College of Psychiatrists resigned as convenor of its 2009 congress after his peers unanimously voted down a proposal to dump drug company sponsorship.

A similar story from Australian papers regarding sponsorship of a weekend seminar for Gastroenterologists is panned here.

“A drug giant spent more than $514,000 on a weekend seminar that included just six hours of “education content”.

The symposium by Australian-based AstraZeneca included gourmet meals, alcohol and two nights free accommodation.

A new report shows “Big Pharma” is prepared to spend millions showering doctors with hospitality in the hope they will prescribe their drugs.

It reveals drug companies spent $31 million on educational events in the second half of last year, including $16 million on meals, airfares and accommodation.

Drug companies funded 14,643 functions during the period, 52 of which are under investigation for possible breaches of new industry rules.

      Read the full article here. How drug companies wine & dine doctors.
       (from herald sun,au)

In general doctors perceive that they can be dispassionate about their clinical decisions even after being sponsored by the drug companies. The situation in India is no different, if not more “inter wined”. As can be witnessed by the reluctance of Psychiatrists; it is not easy to let go of the easy money provided by the pharma companies.

Compulsory Licensing for breast cancer drugs in India?

Stated briefly; in general  the treatment of breast cancer in India at present is suboptimal. I was reading a book regarding evolution and changes in management of breast cancer and what struck me was that we are still stuck in last decade. Most of the patients present very late in disease process. Breast cancer screening is practically non existent. A number of tests which have become routine like ER and PR status are not available even in teaching government hospitals leave alone general hospitals. And not everyone can afford to get it done from private centers given the cost. This problem extends to post operative period as well with a number of patients unable to afford tamoxifen for the long duration prescribed. In this context it is apparent that majority of patients cannot afford more recent and advanced drugs available.

There is this article in today’s Economic Times.

NGO to seek compulsory licensing of cancer drugs- Pharmaceuticals-Healthcare / Biotech-News By Industry-News-The Economic Times

NGO to seek compulsory licensing of cancer drugs.

At this time the prices of anti cancer drugs is out of reach of general Indian population with prices in excess of

Some of the drugs identified by CPPA for compulsory licensing include Genentech’s and Roche’s Herceptin (Rs 1.3 lakh i.e Rs 130,000 per injection, to be taken 10-15 times), Roche’s Mabthera (Rs 1 lakh per injection, to be taken 10-12 times) and Tarceva (Rs 48,000 for 30 tablets, dosage details not known), Novartis controversial drug Glivec (Rs 1 lakh for a month’s treatment), Astrazeneca’s breast cancer drug Arimidex (Rs 3429 for 14 tablets, to be taken for 1-2 years) and Zoladex (Rs 8,910, dosage details not known), GSK’s Hycamtin (price and dosage details not available).

Keeping in mind that per capita income in India is about 580 $ or Rs 23,000 and the fact that health insurance is an exception rather that a norm any disease (leave alone breast cancer) will leave the entire family in penury. Despite these facts a few patients would like to go for these drugs. What I do not understand is the reluctance of pharma majors to market these drugs and at a lower price. They will be making a profit even if 20% of the patients buy their products. Or are they afraid of these drugs undercutting their high value markets back home?

Do you think this move will be justified?

There is a similar news piece regarding HIV drugs and Cipla. From Pharmalot.

Rectal artemisin derivative for initial control of malaria

There is this interesting article in todays BMC Infectious disease which had my attention. the featured article says

Rectal artemisinins rapidly reduce malaria viral load
BMC Infectious Diseases 2008, 8:39

Artemisinins administered as rectal suppositories, particularly artesunate as a single high dose, reduce malaria parasite load within 24 hours without serious adverse effects, offering an alternative to intravenous quinine therapy in remote areas where trained personnel are scarce.

Don’t laugh- but my first thoughts was HOW did they manage it technically!? on reading the whole article I realized they meant malarial parasite load in people not umm… mosquitoes.
you can read the full article here (open access abstract).

From my earlier days i remember there was increasing resistance to artemisin derivatives and I suppose combination therapy is advised to reduce those chances.I wonder how this will have impact on drug resistance in future.

Note: It is not viral.

&ps- i will try to post regularly.

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Health ministry mulls approving foreign degrees.

AT the present moment medical degrees earned in foreign countries are not valid in India and vice versa. Doctors  holding such degrees are not recognized as specialist here and as such cannot practice here. The government is considering a proposal to recognize specialist degrees earned abroad (‘developed countries’) for pracitsing in India in order to aid doctors wanting to come back. Read the news here from IBN live.

The government further hopes that such a move might induce them to “reciprocate.” Fat chance of that occurring when you consider the recent trends in NHS or elsewhere ! However it will be greatly beneficial to many MBBS students who left after internship and now may want to return as specialist. 

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Dr Punching Bags

Doctor and Patient relations may be what it is but the relation between the  doctor and the patient’s attendants is getting more and more acrimonious. Speaking from my personal experience; for every 3-4 emergency shifts that I do at least one is bound to be horrible -not in patient load terms or how critical they are-but the unpleasant interaction with the relatives or patient’s attendants. I find harassing doctors and staff on duty has become a fashion trend; like an index to show how good your  ‘connections’ are or demonstrate your political might. Incidents like these are not new or isolated from BHU doctors on strike.

Varanasi, November 30 An indefinite strike called by resident doctors at the Banaras Hindu University (BHU) from today paralysed operations at the varsity. The doctors were protesting against yesterday evening’s attack on two junior doctors by the sons of a high-profile patient.

This was news about 7 days back. Subsequently the residents had went back to work expecting the hospital and university authorities to pursue the matter further with Police and administration.And what happened ? Nothing! as usual. The matter is now taking the form of circus with all and sundry reminding the doctors of their duty and Hippocratic oath( Damned if you work and double damned if you do not). This is what I read in the news today-

Posted at Friday, 07 December 2007 10:12 IST

Varanasi, Dec 7: The resident doctors of Banaras Hindu University are on an indefinite strike to protest against the assault of junior doctor and two of his associates in the hospital.

The doctors are demanding action against the culprits who had manhandled the medicos.

The Resident Doctors Association (RDA) had alleged that the district administration was trying to save the influential people who were involved in the assault.

They also alleged that no action has been taken against the accused even after 72 hours from the time when the doctors had suspended their strike to given an opportunity to the university.

This is not a single (the hyderabad hospital)or an isolated incident. Numerous such incident must go unreported occurring daily all over the country. I wonder if this malaise is peculiar to our country or happens elsewhere as well. It is not always that the death is totally unexpected or the prognosis or gravity of situation is not known to the people involved. Only one thing is sure-  the culprit will be let off and doctors will continue to be punching bags.

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Barenaked medicos.

barefoot doctor from sinophilia.orgImage from

The proposal for compulsory rural service by graduating medicos has long been in the pipeline. It is already being implemented by some states with variety of carrots and sticks attached. In a move by the parliament all newly minted doctors will be required to spend one year in rural areas in compulsory manner. They will not be accompanied by any support staff as per the proposal. Students are certainly not happy about it

“How can you extend the already long five-and-half-year tenure of the course? With this one-year mandatory rural service and the post-graduation after that, the total medical education becomes of nearly 11 years,” said Anil Sharma, spokesman of the resident doctors’ association (RDA) of AIIMS.

One thing I can say for sure- the amount of ill will in general population towards medicos is increasing. Do your think the targeted population will be benefited? I wouldn’t bet on it. forum discussion at IBN

As for our esteemed Minister- this is what he had to say

“the MBBS degree was not being extended by a year. The students were only being asked to do a year of rural service.”

“This is not a new scheme, as compulsory rural service was in force in the country 30 years ago. Even now, this is in practice in states like Kerala and Maharashtra. This will be only a temporary scheme for a few years to bring down the infant and maternal mortality rates in rural areas”

It is not just the health minister who is of this opinion. Even the mandarins at the planning commission see medicos as cheap plug for the gaping hole that health services is in India; especially in rural areas. In trying to make amends they plan to offer Medicos as the sacrificial goat at the electoral altar. So what do the esteemed gentlemen (&ladies)  propose? well-

The Planning Commission has made a strong case to make a few years of public service compulsory for all graduates from government medical colleges.

This should be at least three years, the apex planning body has recommended in the draft Eleventh Plan that aims to improve government’s health care services to the public.

The idea is to enable students who get state-subsidised education to contribute to the society by serving the tax payer for a few years. The Commission has also recommended that the pay structure of doctors should be improved. read the news here

You might notice that the proposed posting is just for students from government medical colleges. I am sure that the rules will be tweaked in future to include those passing out from private colleges and also provide an escape route for “political proteges.” It will be further tweaked to ensure that the brightest and the most selfless suffer the most.

The commission further notes –

Sources said quoting various national sample surveys that people do not go to public health facilities because medical and para-medical staff, diagnostic services and medicines are not available there. The scene is pathetic in some states. As per a recent government survey, Bihar and Jharkhand have just 0.48 health care professionals per 1,000 people, while the norm is 2.25/1,000 people.

I mean they had to do a sample survey for that! Any medical student knows that the country has been unable to achieve goals for public health set 60 years back!

update I see that the issue has already been well covered by catscanman

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