The modern thinking Indian

Swine Flu (or more correct, H1N1 flu) is now spread all over the world, declared a pandemic by the World Health Organization. It has been reported from countries all over the world, with people contracting the disease, and a majority of them recovering; for a small fraction of them, the disease worsens to the point that the afflicted person dies. One of the major factors that has helped prevent a higher number of deaths is the fact that the virus has not mutated into a virulent form. Currently, the virus is treated by the drug called oseltamivir or Tamiflu. However, like many other diseases, there will be a form of the virus that is resistant to this drug, and because they are more difficult to treat, this strain of the virus spreads.
Scientists are worried about a strain of the virus spreading that is resistant to the drug, and hence are tracking these cases. As an example, there are many forms of other bacteria caused diseases such as TB that have multi-drug resistant strains and which are of major concern to medical personnel the world over (link to article):

An increasing number of countries, including some in Asia, are now reporting Tamiflu resistant H1N1 virus. The worrying development, according to WHO, has seen 12 countries including China and Singapore. India has not reported the mutation in the virus so far. The changes in the virus reported in samples are making these strains of swine flu resistant to oseltamivir or Tamiflu - the antiviral of choice globally. Such cases have also been found in Japan, US, Hong Kong, Denmark and Canada.
Going by available data, majority of the resistant cases were reported where oseltamivir was given as preventive medication to people exposed to the flu but who had not tested positive themselves. Some cases were a result of treatment of mild illness as well as "immuno-compromised" patients or persons whose immune systems were working imperfectly.

This was the main worry in the case of earlier diseases where antibiotics were given for any problem, including treating the common cold. In the current case, health authorities are trying to prevent such a case by not allowing Tamilflu to be sold over the counter, and the dispensation of which has been restricted to either patients, or to those who are in high risk situations such as medical personnel, screening personnel.
Barring any mutation that causes the virus to become more virulent, the expectation would be that swine flu will be like any other flu, which spreads like the common flu, and patients recover after treatment. Initially, the media also went overboard, but now it seems like that there is some sense of responsibility and carefulness being exhibited by media all over the world.

Labels: H1N1 Flu, Health, Infection, Media, Medical, Swine Flu, Tamilflu, Treatment, Virus

Image the situation; a private college in a state run by a political party; the college is owned by a member of the same political party who is now also a central minister of the Government of India. The same college demands money for admitting students (and not some small sum, but the sum of Rs. 20 lakhs). A media team plans a sting and shows the administrative officer of one of the colleges (the college is Shree Balaji Medical College owned by Union minister of state for information and broadcasting S Jagathrakshakan); in the other college, the registrar asks for Rs. 40 lakhs for students to be allowed admission into the medical college.
This seems perfectly realistic, inspite of Supreme Court judgments and Government policy, capitation based admission is a reality which the Government and the education ministry is perfectly fine to let happen. After all, for Governments that are able to sniff out the movements of opposition parties through their internal intelligence agencies, how hard would it be to find out which all colleges are charging capitation fees ? But when you consider that colleges are owned by politicians and important people, there is no effort that is going to happen to stop such practices from happening.
Why is it important to curb capitation ? Capitation means that a person will enter an important institution such as a medical college or engineering college without a validation of their basic ability to be capable of completing the course. These are colleges that will turn out doctors and engineers, all important elements of society (and if a college can charge Rs. 40 lakh for entry, it would charge a bit more and let these people also complete the course). In addition, poorer but capable students would not be able to pay these huge amounts. And if they took money from somewhere, the huge amount of repayment required would mean that they would bend corners to make the required money.
With this sting, the Government has sprung into action and promised all sort of actions (refer this article):

The Times of India's shocking expose of medical seats being put on sale for Rs 20-40 lakh by medical colleges in Tamil Nadu has triggered a probe into the scam by the Union government. Both HRD and health ministries on Wednesday said that they were examining the expose, and if found correct, would take action against these colleges, including their derecognition.
Union health ministry secretary Naresh Dayal said the two colleges would be derecognised if the veracity of the evidence is established. The Medical Council of India, the regulator for medical education, called the sale of medical seats an "unpardonable act" and has called a meeting of its executive committee next week to discuss the issue. Meanwhile, the Tamil Nadu health department decided on Wednesday to issue show-cause notices to Sri Ramachandra University (SRU) and Shree Balaji Medical College whose officials were caught on camera asking for capitation fees of Rs 20-40 lakh, for violating the Tamil Nadu Educational Institutions (Prohibition of Collection Capitation Fee) Act 1992 and Supreme Court rulings against capitation fee.

Sounds like action is immediate, right ? Well, one is really not sure. For colleges belonging to important people, especially those close to parties that are part of the Government, I am skeptical that the Congress will take this a step further and actually take action. After some time, the college would claim that the sting was a fake sting and then the case would move into different circles.

Labels: College, Education, India, Media, Medical, Money, Policy, Sting

Medical negligence is something that is penalized the world over. When a patient goes in for a medical procedure, the person is entrusting their lives to the doctor (s) attending on them. It used to be said earlier that a Doctor is a very respected person, and that it would be unfair to penalize a doctor for some problem that occurs during a medical procedure; this is now countered by the argument that modern hospitals and the medical industry charges market rates for their procedures, and hence are not doing any favors to patients. Further, how do you compensate a patient for a case when the hospital has goofed up or indulged in medical malpractise ? Consider this case where a bright IT person was paralyzed and confined to a wheelchair after a medical procedure (link to article):

In the highest compensation ordered by an Indian court in a medical negligence case, a techie who found himself paralyzed waist down after a surgeon damaged his spinal chord during an operation to remove a tumour in the chest, was awarded Rs 1 crore in damages by the Supreme Court on Thursday. The victim, Prashant S Dhananka, 39, who spiritedly argued his case from a wheelchair he has been confined to since the operation 19 years ago, had sought a compensation of Rs 7 crore.
Dhananka, a senior manager with Infosys earning Rs 1.5 lakh a month and residing in Bangalore, gave vivid details of the gross negligence he suffered at Nizam's Institute of Medical Sciences (NIMS), Hyderabad, and demonstrated the inadequacy of the compensation awarded by the high court. NIMS, a semi-government set up, is rated as one of the premier hospitals in the country. While increasing the compensation to Rs 1 crore, the bench comprising Justices B N Agrawal, H S Bedi and G S Singhvi showed both its disgust at blatant attempts by NIMS to wriggle out of its responsibility for the victim's condition and acknowledged the need to provide for the huge medical expenses that Dhananka has had to incur every month since 1990.

It was only some years ago that the Supreme Court had almost refused to penalize the medical fraternity for mistakes made; even now the Court expresses worry at the increasing tendency of bringing medical cases into the legal system, yet there is a necessity to do this, as the Court itself acknowledges - when the institution makes blatant mistakes and then tries to cover up, there is no other option than to order the required punishment.

Labels: Compensation, Consumer, Court, Judgment, Legal, Medical, Punishment, Supreme Court

Diabetes has been called a lifestyle disease, one that affects people who have moved onto a richer lifestyle (their food has got richer with more starch, more sugar, and lesser amount of direct physical work). As a consequence, the incidence of diabetes in countries (that are moving from a poor state to a state of rapid economic development) is increasing at a rapid pace. India is one such example - there is a huge section of the middle class and upper class that have more money than previously, have a more sedentary lifestyle, and also have aspirations to a richer living model. This would include stuff such as higher consumptions of fatty foods, colas, etc.
This increase in the number of diabetes affected people has many negative implications. Diabetes is currently a non-curable disease, and with a lot of potential complications all over the body. If the number of diabetes affected people in society increases, there will be a much higher need of diabetes treatment for all sections of society, and a much higher level of medical costs. The Government and other bodies should take a note of this trend, and try and educate society as to how to prevent this spread of diabetes from reaching alarming trends:

The fast transition of India to western lifestyle has made the country a hub for the disease and diabetes is fast emerging as one of the most common chronic ailment to affect children. Lifestyle changes and awareness of the disease can help many people to live safely with diabetes. “Obesity and inactivity among children have increased cases of diabetes among people of age 12-20 which was earlier prevalent only in those above 35 years of age,” says Dr Shailesh Lodha, senior consultant endocrinology, Fortis-Escort Hospital.
The incidence of juvenile diabetes caused due to genetic factors in children less than seven years is also rising by nearly 3%, whereas for mature patients it is rising by 5%. Meanwhile, the number of diabetes patients among grown-ups is also rising at a similar pace. Diabetes in itself causes less harm, but it can cause permanent damage to vital organs if remains undiagnosed for a long time.

Diabetes is a disease that has the potential of causing major long term harm to the health of society; and this will happen unless there are a number of measures taken to make society more aware of the need to prevent / control diabetes. The way forward should be to:
1. Educate people to reduce the current rate of people who are contracting diabetes.
2. For those who already have diabetes, they need to be properly aware of the normal safety measures to be taken, and follow them adequately.

Labels: Diabetics, Health, Medical

A very sensitive subject indeed. Mercy killing, or allowing a person to take his own life (or a team of doctors to do so) is a dilemma that raises ethical questions all over the world. For a world that has derived many of its laws and regulations from religious backgrounds (Ten Commandments / The Gita / The Koran / etc..), mercy killing is something that raises the hackles of a large section of the world's population. It is only permissible in some countries, and that too under strict control. In many other countries (even one such as the United States), mercy killing has run against a moral hard rock and many physicians have been sentenced for helping in carrying it out. In a recent case of Terry Schiavo (Wikipedia), the case went through major conflict, with people at all levels (politicians, religious figures, family rights groups, etc) getting involved.
The basic premise for mercy killing is simple: There are many medical conditions that are terminal, and there is no established medical treatments that can cure the disease or prevent death. And unlike movies, people don't dance or sing till almost just before death, they go through horrible phases of steadily declining abilities - losing control of vital motor abilities, losing control of their mental faculties, unable to fend for themselves and being dependent on others, and a steadily increasing pain. In such cases, there has been the logic that given that their condition is terminal (that is, they have reached a condition where death is confirmed and they no longer have a life that seems meaningful in any way), they should be allowed an option to end their life when they still can command control of their life.

Taking the first step towards legalizing euthanasia or mercy killing, the Law Commission has decided to recommend to the government to allow terminally ill to end their lives to relieve them of long suffering. It allows those whose death is virtually certain to avoid their painful journey to the end.
The core of the recommendation to make euthanasia legal stems from several SC judgments which ruled that 'life does not mean animal existence’. "If a person is unable to take normal care of his body or has lost all the senses and if his real desire is to quit the world, he cannot be compelled to continue with torture and painful life. In such cases, it will indeed be cruel not to permit him to die," says the report, receiving final touches from Commission chairman Justice A R Lakshmanan.

However, aside from the moral and ethical problems that this issue comes up with, there are many other problems that arise when such a discussion comes up:
- There are a host of new treatments that are arising as we experiment more with genes and new areas such as stem cell technology, so is it right to assume that a condition that is treated as terminal now could not become one where a treatment is possible in a few years
- Who decides whether the condition is terminal ? If it is a team of doctors, who do you trust ? How do you prevent misuse, especially when we have seen so many new cases whereby elderly people are dumped because of the effort of taking care of them
- Will this become a poor vs. rich thing ? Suppose that a very expensive treatment is available abroad, and a poor person cannot afford to get this done for the terminal condition ?
- How will the actual logistics of carrying out the termination of a medically terminally affected patient be carried out ?
- In a country where there are many more needy people than hospital beds, would this become a misused thing ?
What do you people think ? Is India ready for something like mercy killing ?
I agree that we need to do this, subject to some stringent checks and balances.

Labels: Health, India, Law, Medical, Morality, Policy, Reform

Well, the real name of the amendment brought in by the Government at the urging of the DMK Health Minister Anbumani Ramadoss was actually the AIIMS Amendment Act; it should have been called the anti-Venugopal Act since though the law fixed the upper age of retirement of the AIIMS Director to be 65, based on which the noted heart surgeon had to resign. However, since Parliament, in a new low for the Government, actually spent time in passing a law that was directed specifically at one person; it was very easily challenged in court as being discriminatory and meant only to retire him. Venugopal challenged the Act, and even during the initial discussions, the SC had some strong words to say to the Government.

The Central Government on Thursday received a major setback with the Supreme Court striking down the law that enabled premature retirement of noted cardiologist P Venugopal as the Director of All India Institute of Medical Sciences (AIIMS) after a raging row with Health Minister Anbumani Ramadoss.

The net effect of the Supreme Court action has been that the health minister has suffered a severe reversal in his battle with the AIIMS Director. And of course, questions must be asked of the Prime Minister Dr. Manmohan Singh, this was after all the Bill of his Government and the Government has suffered the setback.
In other steps, the Health Minister has lead a campaign against drinking and smoking, and he is justified to that extent since these 2 are a cause of a large number of casualties. However, there are far more severe problems that the Minister and the Government don't seem too enthusiastic to tackle, since they are not glamorous. Take a look at this cover page article of TIME magazine that blows a hole in the quality of India's health services:

It's not hard to find people caught in the gap between India's dreams of greatness and the awful reality of its broken health system. Most of the country lives there. Sixty years after independence, India remains one of the unhealthiest places on earth. Millions of people still suffer from diseases and ailments that simply no longer exist almost anywhere else on the planet. Four out of five children are anemic. Almost one in four women who give birth receives no antenatal care.
The truth behind the glossy advertising is less incredible: India remains the sick man of Asia, malnourished and obese at the same time, beset by epidemics of AIDS and diabetes, and with spending levels on public health that even Prime Minister Manmohan Singh has conceded "are seriously lagging behind other developing countries in Asia." The sorry state of India's medical services might not matter so much if tens of millions of Indians weren't already so sick.

I would advise people to read the whole article, it is is no way complimentary and displays a state of health that a lot of us, who now depend on the private health care system, don't know about and don't care. And in the midst of this, we have successive Governments who care about things that make political logic; trying to spend the long time and effort to overhaul a broken health care system does not matter anymore.

Labels: BJP, Congress, Court, Development, Health, Medical, Policy, Reform, Responsibility, Welfare

Sometimes one comes across cases where you start wondering as to whether regulations are meant to help humans or to thwart them ? What purposes are rules that only lead to the death of humans or hinder them when they are in need. An example of this is seen in what happened in Delhi on the 7th of April, 2008. For a long time, movies and television have been propagating the prospect that any accident or other such grievous case victim cannot be treated unless there is a police case. Further, normal people are also worried about the same thing; nobody wants to get involved in cases dealing with accidents, even to the extent that if you see an accident happen in front of you, most people would look the other way and not try to get involved. This gets doubled if the injury is criminal in nature, say if a person gets shot or knifed.
But is this avoidance only because of the worry of getting involved ? Or is it because we are so involved in our own selves that we would rather not get involved - how many times have you seen young kids being exploited as labour and looked the other way; or seen an accident victim lying on the road and continued on ? We continually see examples of this kind of behavior:

Harshal ran to his father's car. "I saw the bullet had gone in right under his ear into the neck and there was blood spilling all over the seat. Because the seatbelt was still fastened, he was sitting upright. A crowd had gathered there and kept looking at me while I unfastened his seatbelt and put him on the back seat. No one even offered to help and when I asked for it, they just didn't," said Harshal.

Similarly, the distraught son has claimed that the hospitals that he went to refused to admit him because of it being a medico-legal case, and that is a real shocker. Even though the hospitals involved have refused that such a thing happened, how many of us think that such a thing could have happened ?

Forty-seven-year-old Arun Gupta, a businessman who was shot in the neck, died of his injuries after battling for life for nearly three hours on Monday morning. In fact, his son, Harshal, has alleged that the first hour — considered to be the golden hour for such victims — was spent in rushing him from one hospital to another which turned him down though a prominent hospital has denied any such incident.
According to two SC judgments, no doctor or hospital can deny life-saving emergency treatment to a patient. In two landmark judgments — Parmanand Katara vs Union of India and Paschim Banga Khet Mazdoor Samiti vs State of West Bengal — the Supreme Court upheld every person's right to life.

I see this everywhere, and maybe I am as guilty of this as anyone else. Even though I recall a case where we had helped a biker who had crashed into our case, one cannot be really sure about the response when we are confronted with a person who is severely injured or has just been shot. In addition to the human nature that is concerned with helping others, there is now a contrary nature that deals with avoiding any sort of trouble.

Labels: Medical, Morality, Responsibility

India's public hospital and medical system is in a mess. Government hospitals are in a mess, catering to a massive number of patients, having doctors who are not exactly enamoured of the low salaries and bad working conditions (in fact, many doctors work to get a good experience and then parlay this experience to pick up much better salaries in the private sector), with funding constraints. One cannot even begin to compare the conditions at Government hospitals vs. private hospitals, although there are many Government hospitals that still retain a good name. However, no matter what are the reasons that have led to this condition, one expects Government hospitals to cater to the poor, the needy and not turn away anyone in need:

Twenty-seven-year-old Hemanti could not be saved but justice might still be done. Serious action has been taken against three doctors held responsible for the shocking case of medical negligence in Swami Dayanand Hospital on February 16. Hemanti, who was refused admission by the doctors on duty on Saturday night, passed away after she was forced to deliver outside the premises of the MCD hospital. Her baby, however, is reportedly in good health, a hospital source said.
Following a departmental inquiry, the Municipal Corporation of Delhi (MCD) has terminated the contract of Dr Mamta Tyagi, senior resident gynaecologist, on February 19. Two other doctors on duty at the hospital — Dr Deep Sikha, senior resident casualty officer, and Dr D K Padhy, emergency medical officer — have been handed show cause notices.

This is horrific news. Catering to a pregnant lady, poor, needy, bringing a new life into this world, is one of the most important objectives of the health system, and it has failed when such things can happen. One can only hope that the inquiry goes into the root of the matter, and also figure out what caused such an incident to happen. Typically doctors do not let such a thing happen, but the condition of doctors in Indian Government hospitals in pretty bad. They are forced to work for long hours, dealing with a number of patients that would make a doctor in the developed countries run away, and are many times man-handled by relatives of patients, and even by the support staff.
It is better that the health minister, Dr. Ramadoss focus on making sure that the health system is over-hauled, with better allocation of funds, making hospitals responsible for apathetic staff, bad maintenance and cleanliness, and the like rather than trying to make a name for himself in the newspapers.

Labels: Health, Medical, Punishment, Responsibility