#India lags in transparency laws on drug firm-doctor dealings #healthcare



Rema Nagarajan,TNN | Jun 10, 2013,=
The trend towards greater transparency in interactions between the healthcare industry and healthcare providers, including doctors, is catching on globally with France being the latest in enacting a law to make disclosures of relations between healthcare professionals and industry.

The French law, dubbed Strengthening of Health Protection for Medicinal and Health Products, was brought into force in the last week of May laying down disclosure obligations, which affect all agreements concluded between healthcare professionals (HCPs) and companies, as well as every benefit in kind or in cash exceeding 10 euros. According to the decree implementing the law, a free public website with all the disclosures will be maintained by a public authority. This law is similar in intent to the US Physician Payment Sunshine Act, which came into force earlier this year.

Several other countries are ramping up their transparency laws regarding payments between healthcare companies and physicians even as India continues to have no laws to regulate companies that give doctors freebies. If caught, only doctors are penalized, not companies.

Disclosure under the French law will include all contracts such as R&D contracts, contracts for clinical trials or observational studies, consultancy agreements for being speakers or on advisory boards and invitations to scientific or medical events for which the costs such as registration fees, travel costs, meals and accommodation expenses are paid by the company. This disclosure obligation applies to every payment and contract issued from January 2012 onward.

The US law requires the healthcare industry to report annually to the secretary of health and human services certain payments or other transfers of value to physicians and teaching hospitals. All the information is to be posted on a public website expected to be ready by next year.

Slovakia, too, is reported to have enacted a similar law. Belgium is looking into the possibility of introducing a similar law. Already, in Belgium, companies that have marketing authorisation for medicines have to keep a record of all gifts or benefits offered to doctors.

In Germany, there are no similar transparency laws but insurers are demanding prison sentences of up to three years for doctors who accept bribes or other favours. This demand followed cases of doctors being allegedly paid to prescribe a company’s drugs and the publicizing of many doctors earning huge amounts of money for supposedly conducting observational studies, where pharmaceutical companies pay doctors to observe the side effects of new drugs, often a cover-up for paying them to prescribe certain drugs.

In the midst of this clamour internationally for greater transparency in drug industry ties with healthcare providers, the Indian government continues to ignore recommendations of the parliamentary committee on health, the Medical Council of India and several doctors

“To those who believe in resistance , who live between hope and impatience and have learned the perils of being unreasonable. To those who understand enough to be afraid, and yet retain their fury”

 

Refashioning the Breast- Angeila Jolie #Breastcancer


Modern Medicine and Dispensable Female Body Parts

Vol – XLVIII No. 20, May 18, 2013 | G Arunima

Expressing unease with the celebration of Angelina Jolie’s double mastectomy, this article argues that the medical industry has played a masterstroke by casting the mastectomy debate in terms of an older “rights discourse” of the women’s movement. It suggests that the feminist and progressive movement hit back by asking questions to the scientific establishment about access, costs, and the necessity of specific forms of treatment. That may be the way forward towards not only accountability to “consumers”, but actually for equitable health-care for all.

G Arunima (arunima.gopinath@gmail.com) is with the Centre for Women’s Studies, Jawaharlal Nehru University, New Delhi.

In this last week, social media, blogs, websites, and news sites have been awash with reports, and opinions, about Angelina Jolie’s preventive mastectomy. Apparently falling in a genetically high risk category, she chose this procedure for both breasts, so that she would be there “for [her] children”. She, as the tagline goes, chose life over cancer. Mostly enthusiastic, reports are also describing this as something “brave”, applauding her for “coming out” about this, in order to help other women.

Consuming Health

So I ask myself – why am I not responding to this with the requisite amount of enthusiasm, indeed euphoria, that seems to be accompanying the media coup of the week. In part, this is to do with an instinctive mistrust of the manner in which modern technology in the last few decades has invaded and displaced all other forms of medical care, creating simultaneously a kind of pseudo scientific common sense.

The Jolie case itself reveals many elements of this. For instance, the liberal references to percentages, without ever clarifying sample sizes, racial or national contexts, or age profiles, is a classic instance of the misuse of statistics. Most reports mention hitherto unheard of genes (except presumably in medical circles) and within a mere forty eight hours or so the BRCA gene has achieved a resounding degree of notoriety. The combination of math and science in this fashion, needless to say, is a noxious cocktail. And as marketing strategy, not entirely unfamiliar.

Indeed, the steady shift to technological interventions, and medical procedures involving multiple levels of assessments (“tests”) has been undergirded by what can be termed as the ‘genetic turn’ in popular scientific discourse. As someone untrained in any kind of science, medical or otherwise, it would not be my place to mount a critique of developments in the field. However, having been reduced to being a “consumer”, like millions of others, my response to these trends is primarily one of bewilderment, accompanied by mistrust of a medical system that’s clearly making huge profits whilst subtly introducing anxieties about possible health risks that one might embody, utterly unbeknownst to oneself.

Living in a country with practically no public, or affordable, health care, the growth of the medical industry and new accompanying technologies holds frightening prospects. Other than the fact that the emerging “super specialty” hospitals price the average Indian out, it also successfully instils in everyone’s minds that this is the only form of health care that could provide medical solutions. In an almost caricatured version of neoclassical economic logic of supply creating demand, the profusion of technologies has resulted in a mindless multiplication of tests, where a body becomes the sum of its test results. In this light, the case of women’s health, and bodies, becomes particularly relevant.

The Economy of Predictive Interventions

A frightening dimension of this is the manner in which women’s health has so easily been reduced to reproductive health. In part a UN inspired move, it has, certainly from the 1990s been accompanied by large amounts of focused funding and the emergence of a cottage industry apparently generating research in this area. Two correlates of this phenomenon – albeit leading in opposite directions – have been huge money spinners. One is the increasing medical common sense of preventive intervention in the form of hysterectomies; the other has been in the area of assisted reproductive technologies. Here I want to dwell briefly on the hysterectomy, and what this trend signifies.

Purely impressionistically speaking (and this is an area in which detailed, and reliable statistics would be very welcome) hysterectomies have been increasing at an alarming pace in this country. In states like Kerala, women are routinely advised to remove their uterus, sometimes ovaries, after about 40. The assumption here is that a woman who’s had her children, or past “reproductive” age, doesn’t require this organ. The justification is normally provided on the basis of the existence of uterine fibroids, which could, within this new language of science as dire prediction, eventually lead to malignancy.1

Needless to say, other than the costs and fear that accompany such procedures, most women are also not advised about the short or long term after effects that such surgery could have. The idea of woman as reproductive vessel – with use value during menstruating years – is at least as old as organised religion. Yet there is something else that appears to be happening at this moment of (reproductive) organ dispensability. It is about the manner in which medical discourses are inflected by industry concerns, in which the fear that is generated reaps fine dividends. It is therefore quite educative to see the nascent preventive mastectomy industry emerging, complete with its gene patenting, testing and surgical costs.2

The Gaze on the Breast

In possibly what was one of the earliest feminist reflections on mastectomy, the poet Audre Lorde wrote movingly of her experience in Cancer Journals.3 Far more than Angelina Jolie’s highly publicised “brave” disclosure, Lorde’s quiet voice had powerfully engaged both the trauma of fighting cancer, the then prevalent surgical interventions, and the ‘solutions’ that were on offer. Going to the heart of the economy, and gender politics, of the mastectomy industry Lorde, rejecting prosthetic solutions, asked why “looking normal” would help any woman heal? How unlike Jolie, who has probably given millions to her plastic surgeon for “reconstructive surgery”,4 and has been selected poster girl for the medical industry. This then brings me to the last set of issues I wish to raise here – about the woman’s body, its parts, and the contemporary moment in “disease management”.

In her insightful, and racy, A History of the Breast, Marilyn Yalom rightly points to the need to read the breast not merely as unmediated biological fact, but also as a site of multiple discourses.5 She tracks the manner in which the biological or nurturant function of the breast has been inflected by the erotic, as indeed the scientific and medical. Posed perilously at the intersection of differing, and often competing, attention the breast has constantly evoked desires, fears, and fantasies.

The breast, unlike the uterus (which too has been the produced via multiple discourses) has increasingly been fetishised as a potent, and complex, sign of a woman’s beauty. This has led to its being subject to intensive commercial onslaughts, from the corset industry, silicon implants, to nipple piercings. It looms large in both ideas of motherhood and in pornographic representation. Predictably, such excessive attention to particular body parts, and its place in producing ideal womanhood (reproductive and sexy) has led to a certain kind of feminist unease with women’s bodies.

Often when some feminists speak of throwing away their uteruses or breasts, they are rejecting the tyranny, and consequences, of such an overdetermined gaze on particular female organs. Yet frighteningly, the market savvy medical industry feeds off precisely such views, and produces new regimes of health care that will deliver, rather cold bloodedly, precisely such results at prohibitive costs. Not only that, it also produces an apparently apolitical “scientific” rationale for its marketing strategy.

What is Normal?

Needless to say, this trend of preventive surgical science coexists quite comfortably with heteronormative and patriarchal ideas about women, their bodies, and sexuality in general. Writing of the complexity of trans lives, the historian Afsaneh Najmabadi’s nuanced discussion of the Iranian context maps how sex change surgeries are framed within the utterly objectionable language of “curing” abnormality and deviance.6 Similarly, trans artist James Cameron’s work, with great irony and power, unmasks ideas, and desires, that undergird dominant notions of masculinity. His triptych “God’s Will” where he parodies body builders, using props of syringes, knives and light bulbs, also constantly references the body as ‘performance’ and its being reconstituted continually through acts of self-fashioning.7

I think it is extremely urgent that we engage, and utilise profitably the insights gained from trans experience, with its critique of “normal” bodies, sexuality, and indeed patriarchy. Yes, women must take charge of their bodies and selves. Yet this cannot happen in the absence of a demand for greater accountability and transparency from the medical scientific empire whose solutions are invariably industry driven.

Genetic focus, and folding back into specific women, and their personal histories, needs to be offset by a wider understanding of growing numbers of new cancers, often in people with no identifiable genetic disposition. In other words, its time that we demand that governments, and the medical establishment, invest money and research in understanding the relationship between food, lifestyle, environment and changing global health trends. Can this happen without rethinking development, economy and the very nature of the political process?

Casting the mastectomy debate in terms of an older ‘rights discourse’ of the women’s movement is a masterstroke by the medical industry. I would suggest we hit back by asking feminist inspired questions to the scientific establishment about access, costs, and the necessity of specific forms of treatment. That may be the way forward towards not only accountability to ‘consumers’, but actually for equitable health-care for all.

References

1.Many oncologists, and researchers, would now agree that myomectomy is a far cheaper, and easier, way of dealing with uterine fibroids. This, however, is rarely suggested to patients by the medical establishment. Nor does it engage productively the completely foolproof natural health care regimes that have proven histories of fibroid management.

2. http://jezebel.com/angelinas-cancer-gene-is-actually-patented-by-a-compa…

3. Audre Lorde,(1980) Cancer Journals, Aunt Lute Books.

4. “Angelina Jolie’s story boosts awareness of breast reconstruction, local plastic surgeon says” The Record.com, 17 May, 2013.

5. Marilyn Yalom, A History of the Breast.

6. Afsaneh Najmabadi, “Transing and Transpassing across Sex-Gender Walls in Iran”, WSQ: Women’s Studies Quarterly, 36:3 & 4,(Fall/Winter 2008).

7. Melanie Taylor, “Peter(A Young English Girl): Visualizing Transgender Masculinities”, Camera Obscura, 56, Volume 19, No. 2.

#India-State sponsored competition works -Pharmacies to sell medicines at 60% less #goodnews



11 December 2012
statesman news service

SILIGURI, 11 DEC: All medicine-shop owners around North Bengal Medical College and Hospital (NBMCH) have decided to sell generic drugs at 60 per cent less than the maximum retail print price.
The shops’ owners displayed a notice in this regard in front of their shops today. The medicine shop owners’ association affiliated to the Bengal Chemists and Druggist Association, Darjeeling district, adopted the resolution on Sunday after they came to know that NBMCH would open a fair price medicine shop.
The Zonal Secretary of the association in Siliguri, Mr Atul Roy, said: “In order to survive in competition with the government’s fair price shop, the medicine sellers have decided to sell generic drugs at 60 per cent less than the printed price.”
Mr Roy also said: “Several companies supply generic products to us at 80 per cent less than the printed price. If we deduct 60 per cent, the profit of margin would be 20 per cent. People will be able to buy medicines at even lesser price from us than the state-run outlet.”

 

(The tussle between NBMCH and Chemists’ and > Druggists’Association is providing medicines at cheaper rates. Is it going
to be for a short time or would it be continued continuously. Any how patients have  benefited.

 

4 patients die in ICU of Sushruta Trauma Centre #Delhi #medicalnegligence


By Durgesh Nandan Jha, TNN | Dec 5, 2012, 04.28 AM IST

Four die in ICU of Delhi's trauma centre as oxygen fails

Four die in ICU of Delhi‘s trauma centre as oxygen fails
NEW DELHI: Hours before a mega drill began across the capital to check the city’s preparedness for medical emergencies, four patients in the ICUof the state-run Sushruta Trauma Centre in north Delhi died because the oxygen supply suddenly stopped.

The trauma centre was established in 1998 to provide critical care to victims of serious accidents.

But what happened on Tuesday was critical failure due to sheer negligence. The alarm indicating oxygen supply shutdown went off at 6.40am but the supply could not be restored for 30 minutes — a delay that allegedly led to the death of four of the five patients in the ICU at that time.

The prolonged shutdown happened despite the administration being fully aware of the problem — since it had been recurring for the past few days. In a shocking admission, hospital medical superintendent, DrRicha Dewan, said there was a single, untrained person to manage the oxygen supply in violation of the agreement between the hospital and supplier.

“We have outsourced the gas manifold system to a private contractor which is responsible for maintenance and supervision. As per the contract, there should be at least one technician and a helper but on Monday there was only one person who was not trained to manage oxygen supply,” said Dr Dewan.

‘Malfunction had been on for many days’

Dr Dewan revealed other glaring mistakes in the way oxygen was being supplied.

“The manifold system has two sets of oxygen units consisting of 11 and 10 cylinders. When one set is finished the other automatically resumes supply. But in this case, the technician was running one cylinder at a time which led to the malfunction,” she said, adding that the hospital had registered a police case in the matter. The hospital pays close to Rs 1.5 lakh monthly to the private contractor managing the gas manifold system for maintenance and salary of the technical staff.

However, the city’s medical community felt the hospital too had to take responsibility for the failure, since there was no back up arrangement for oxygen supply.

Dr M C Misra, chief of the AIIMS trauma centre, said deaths due to oxygen supply failure in an ICU setting was unheard of. “Usually there is enough back-up and even if that fails we have ambu-bags to give the patient oxygen support temporarily,” said Misra.

“This is a complete failure of administration. One cannot get away by blaming the technician. Those responsible must be punished appropriately,” said Dr Sushil Sharma, senior orthopedic surgeon at a private hospital.

“There were five patients in the ICU. Of these, Rihana, Javed, Rajkumari and an unidentified man (36 years old) brought by the police died within minutes of the oxygen supply being stopped.

Vikram, another head injury patient, was resuscitated by the attending nurse but his condition is still critical,” said a source. He added that the ventilator alarm went off as the oxygen levels reduced. “I rushed to the ICU on hearing the sound and but the nurse did not let me inside. A few hours later I was informed about my mother’s death,” said Golu, the eldest son of Rajkumari.

According to sources, failure in oxygen supply at the trauma centre had been going on for several days. “At 3am on Tuesday, three hours before the incident took place, another surgery was interrupted due to lack of oxygen supply. We first called the technician and then an OT technician was rushed,” said a doctor.

The families of victims kept protesting outside the hospital all day but they claimed not a single doctor came forward to explain matters. State health minister A K Walia said an FIR is being lodged against the technician who was operating the gas manifold system and a three-member committee headed by special secretary S B Sashank has been formed to investigate the matter. “The enquiry would look into the causes of the incident and would also suggest measures to avoid recurrence of such incidents,” said Walia.

He added that the committee has been directed to submit its report within three days. On Wednesday, Walia has called medical superintendents of state-run hospitals for a review meetin

 

India moving from providing healthcare to only managing the services #wakeupcall


Govt ready with radical health plan

State’s role to diminish from provider to manager, making way for private firms, individual practitioners

Vidya Krishnan, livemint.com

 New Delhi: The government is set to relinquish its role as a provider of primary healthcare, making way for private companies and individual medical practitioners to take the lead in offering clinical services, and focus on preventive interventions such as immunization and HIV testing.

The move is in line with the government’s approach of outsourcing its responsibilities in key social sector areas such as health and education.

The objective? Universal healthcare.

 

A file photo of the AIIMS in New Delhi

A file photo of the AIIMS in New Delhi

 

The Union government has approved healthcare delivery through a “managed network approach” where payments for health services will be made to a network of service providers on a per-patient basis, said a person familiar with the development. The scheme, this person said, is part of the five-year plan for health. India’s apex planning body, the Planning Commission, puts out five-year plans that set goals across areas and decide on ways to achieve these targets. The current Plan (2012-17) is the 12th of its kind. 

Planning Commision deputy chairman Montek Singh Ahluwalia said the issue is still being discussed with the health ministry and that no decision has been taken.

Under the plan, the government’s role will diminish from that of a provider of health services to the manager of the network.

State governments will recruit a network of healthcare service providers in each district or area for clinical services. These healthcare service providers, who could be government hospitals and clinics, independent practitioners, or small or large privately owned hospital chains, will register residents onto the network.

Healthcare services will be provided to this pool of patients at a cost negotiated by the government, and the service providers will be reimbursed per medical prescription. The Planning Commission’s plan seems to draw heavily from a report on universal healthcare submitted by a high-level expert group (HLEG) set up by the Prime Minister.

The plan is not aimed at saving money for the government. The Planning Commission has approved a health ministry proposal to increase the allocation for public health to Rs. 4.04 trillion in the 12th Plan from Rs. 70,986.76 crore in the preceding five-year period.

“I agree with the HLEG that universal healthcare is perhaps best delivered if we move away from the present system, in which public healthcare providers are funded by the budget, to operating a network of primary, secondary and tertiary providers, where the network is paid on a per-capita basis depending on the number of people registered with it. The network could consist of pure public sector providers, or it could include some private providers on suitable terms. This certainly incentivizes the network to minimize costs and to emphasize preventive care since the total payment is fixed,” said Ahluwalia.

The plan will require other radical changes, especially in budgeting and organization, he added. “Whoever manages the network will have to divide the total receipts between levels. Remuneration to doctors may have to be linked to patients actually seen. People will not be able to go straight to higher levels of the network, but will have to go through on a referral basis,” Ahluwalia said.

He explained that as a result, the plan cannot be implemented soon, “especially because the health network is actually run by the states”. He added: “This is not something the Centre can decide; healthcare is a state subject constitutionally.”

The person cited in the first instance said the government plans to try out its new plan through small projects in each state.

Ahluwalia admitted that it would be practical to “strengthen the existing system and increase public spending for health, but to experiment with the network concept in, say, one district”. He said even the HLEG had said that a complete move to the new system it recommended would take 10-15 years.

“The HLEG had suggested a package of essential health services, which includes preventive, promotive, curative and rehabilitative services. The provision of these services has to be free of cost, and public sector facilities should be the main provider,” said K. Srinath Reddy, chairman of the HLEG.

“Where necessary, private providers may be contracted-in on clearly defined terms. This should be done directly by the public sector without recourse to an insurance intermediary. For universal healthcare to succeed, with respect to public health and clinical services, it is essential that the public healthcare delivery system is strengthened all the way from the sub-centre to the district hospital.” Reddy said.

Private healthcare companies stand to benefit from the move, although getting onto the network could require some of them to expand and almost all to start charging lower fees for their services, especially from network patients.

The person cited in the first instance added that the Planning Commision has divided health interventions into two categories to approach universal coverage. The first involves public health issues such as immunizations, births and HIV testing that the government will fund and deliver.

The second will be the delivery of clinical services through the managed network system that will be bankrolled by the government, which may or may not deliver the service.

Activists are suspicious of the plan.

“It looks like the government is moving from providing healthcare to only managing the services. This will increasingly shift responsibility to private providers, and there is increasing global evidence that wherever a government has attempted to divorce financing from provision and convert healthcare into something purchased by state, costs have gone up and quality has gone down,” said Amit Sengupta of the People’s Health Movement.

“ Health is a public good…” Sengupta said.

vidya.krishnan@livemint.com

A long shadow: Nazi doctors, moral vulnerability and contemporary medical culture #SundayReading


 

Animated map showing German and Axis allies' c...

Animated map showing German and Axis allies’ conquests in Europe throughout World War II (Photo credit: Wikipedia)

 

ABSTRACT
More than 7% of all German physicians became members of the Nazi SS during World War II, compared
with less than 1% of the general population. In so doing,these doctors willingly participated in genocide,
something that should have been antithetical to the values of their chosen profession. The participation of
physicians in torture and murder both before and after World War II is a disturbing legacy seldom discussed in medical school, and underrecognised in contemporary medicine. Is there something inherent in being
a physician that promotes a transition from healer to murderer? With this historical background in mind, the
author, a medical student, defines and reflects upon moral vulnerabilities still endemic to contemporary
medical culture.

 

Read full article here genocide

 

 

 

Doctor, Heal Thyself ! # Satyamevjayate #Aamir khan


 

Doctors asks Aamir Khan to apologise for his recent show on Satyamev Jayate

 

Rediff.com, Last updated on: June 06, 2012

The latest episode of Aamir Khan‘s [ Images ] television showSatyamev Jayate probed into malpractices that some doctors follow, looking at the way they dole out wrong treatments for monetary gains. It has understandably not gone down too well with the medical fraternity.

Dr Sanjay Nagral — a consultant surgeon, department of surgical gastroenterology , Jaslok Hospital and Research Centre, Mumbai [Images ] — explains what exactly has hurt the doctors. 

Satyameva Jayate‘s recent episode on healthcare in IndiaImages ] has created quite a stir within my fraternity. What began as benign posts on social media and closed door conversations has snowballed into a movement against what is being described as a ‘diatribe’ by Aamir Khan against the medical profession.

In an additional bizarre twist, the Indian Medical Association, the apex body of medical professionals in the country, is asking Aamir to ‘apologise’ and, in what can only be termed as an acute case of silliness, has called for ‘boycotting’ him.

The issues raised in the show, and the profession’s response to them, have important lessons. Lest they get lost in the din and drama, here is a contrarian view for the record.

What is it exactly in that episode that has hurt my colleagues?

From my reading of the various statements, it seems there are some common themes that many are upset about.

First, the show ‘exaggerated’ the extent of unethical practice in the profession. Second, it showed only the ‘bad’ side of the profession, not the ‘good’. Third, it was factually incorrect at times.

There were those who wanted to know why doctors are being targeted when the entire society is corrupt.

Finally, the one below the belt: Who is Aamir Khan to pontificate about service to the poor when he charges crores of rupees for the show?

The last one, though probably the most superfluous, is the most emotive of all.

Is it really a revelation that ‘stars’ like Aamir charge such amounts for television serials? If Aamir declares he has not charged for the show, will it in any way alter the response to the show?

Post your comments on Satyamev Jayate here.

Now, we come to the more substantive issues.

What was one of the unethical practices that the show highlighted and ‘exaggerated’? The episode talked about the practice of ‘cuts’ and ‘commissions’ that are offered by doctors, labs and hospitals for referral of patients. These are cash transactions; they are not revealed in official documents and are arbitrary in amount.

Although there is no documentation of the extent of this practice (Not surprising! How many would admit to it?), having had a ringside view in a large metropolis for many years, I would suggest it involves a large majority of referrals.

We can quibble over the precise extent, but that would just serve to obfuscate the issue at hand.

Hasn’t such ‘fee splitting’ become so commonplace and institutionalised that, as a young doctor, if you don’t participate in it, you are effectively ostracised? Isn’t this activity non-transparent and doesn’t it increase the cost of health care and affect quality? Has any medical association ever tried to build internal resistance or opposition to such a patently corrupt practice?

The show talked about the shocking state of the Medical Council of India and how its president, Dr Ketan Desai, was arrested by the CBI in 2010 on charges of corruption. He was thereafter removed from the post of MCI president by the government and is now cooling his heels in Tihar jail.

Desai amassed crores (one estimate pegs the amount of money recovered from the raid on his home at Rs 1800 crore (Rs 18,000 million)) from the lucrative business of recognition of medical colleges.

The episode also showed how Desai, who had been indicted by the courts and temporarily sacked in 2002, staged a return. What the episode did not mention is that the same individual was also the national president of the Indian Medical Association.

Thus, a convicted individual not just survived but actually thrived for an entire decade at the highest levels in the Indian medical establishment both as the president of the Medical Council as well as the IMA. Isn’t this a reflection of the permissiveness and ambivalence medical professionals have developed towards corruption in their own representative bodies?

The current president Dr K K Talwar, who appeared on the show, had no credible answer when asked why not a single doctor in India has had his licence cancelled when the General Medical Council of the UK figures showed substantive numbers every year.

One of the ‘errors’ repeatedly pointed out by those outraged by the show is the numbers that were quoted about private and public medical colleges in India. One wonders, though, what is more important — the precise number or the fact that India can be counted among the countries that have the highest number of private medical colleges in the world? Isn’t the crass commerce of medical education in these colleges, where seats are sold at high prices, the real issue?

Isn’t it true that private medical college empires have grown because they have managed to hire and retain medical teachers, set up arrangements with hospitals to provide ‘clinical material’ in the form of patients and get recognition for postgraduate courses from inspection teams consisting largely of doctors?

Of course, there is a large industry supported by politicians at work here but the collusion of the profession is substantial.

Did the episode show examples of ‘good’ doctors and the positive side of things?

To be fair, the show did profile alternative models quite extensively. The issue of generic drugs and the work of Dr Samit Sharma in Rajasthan [ Images ] were highlighted in some detail.

That they predictably chose media favourite Dr Devi Shetty, when they could have profiled any of the hundreds of brave, committed doctors who have chosen to work under harsh  conditions in rural India to come up with alternative models of people-centric health care, is a pity. But some of this is inherent to the medium and its compulsions.

And, finally, a very old complaint — why should doctors be ‘targeted’ when the entire society is commercial and corrupt?

It is obvious that, unlike other professions, health care has a huge social dimension and hence will inevitably be scrutinised more intensely. But it is exactly this aspect that also gives doctors more visibility (don’t many of our colleagues enjoy a lot of media publicity on a regular basis?).

Historically medicine has a social contract which allows it a unique form of self-regulation in the form of medical councils, a front on which we have failed miserably. So whether it is the killing of the female foetus or the sale of kidneys, the state has had to step in with new laws because self-regulation failed.

The principle of market economics have been rejected by most societies, including western nations, as inappropriate to health care. In a strange paradox, India has one of the most privatised of health care systems.

Now, before my colleagues say that this is a result of state policy, which it essentially is, we have to admit India’s medical profession is a willing and enthusiastic participant in this process. Witness in the current boom of market medicine a new entrepreneurial spirit that is sweeping the profession. But the same market medicine, which uses media and television to sell its wares, is disturbed when the medium turns around and asks disturbing questions.

Was the show free of blemishes? Of course not.

There were occasional moments, like when the rather improbable allegation of a ‘liver transplant’ being advised for gastroenteritis was made by a member of the audience. Or when a family alleged that they did not know that a pancreas would be transplanted with the kidney in a large private hospital in Bengaluru [ Images ]. But these aberrations should not distract from the big issues that the show managed to raise.

Rampant commercialisation of the practice and of medical education, hard selling by pharmaceuticals, the high cost of drugs and the shocking price differences for the same drug from different brands are all highly disturbing parts of our healthcare policy.

That a popular film star with a huge audience articulated on prime time television what health activists have been saying for years is perhaps what has disturbed some in my fraternity.

Organisations like the IMA should actually seize the moment and ask Aamir to commit to a sustained public campaign on universal health coverage and the right to health. That would also test Aamir on a charge that has been made about him; that he raises social concerns transiently to stimulate interest in an ongoing release.

As for the boycott call, I would suggest that Aamir doesn’t really need to worry on that count. He has to just sneeze or cough and there will be a bevy of doctors running to attend on him.

After all, being a film star’s physician counts a lot in a doctor’s professional trajectory in India.

Indian Hospital: Episode 1


This unique observational documentary series shines a light on Indian society as it is rarely seen. In six one-hour programmes it illuminates the complexities and dilemmas of modern India through the extraordinarily varied lives of patients and medical staff working at the Narayana Hrudayalaya Hospital Complex in Bangalore.

A series by Paul Roy, Aljazeers English, May 4,2012

India has the world’s second-largest population but more than 40 per cent of the people live below the poverty line and there is no government-funded welfare system or safety net.

So with only $4 per person spent on public healthcare each year, falling sick in India can be a death sentence.

Narayana Hrudayalaya, meaning ‘Temple of the Heart’, is a hospital with a difference that is determined to make a difference. Here, making a profit and offering free medical care go hand-in-hand.

This hospital is the brainchild of Dr Devi Shetty, one of the world’s top cardiac surgeons.

And 10 years on from its founding, it has become a hugely successful and profitable business. But this is not what drives Shetty. His goal is to provide high-end affordable healthcare to rich and poor alike.

For many patients, 58-year-old Shetty is as near to a God as a mortal can be.

“The essence of life is helping people,” he says. “We are in a profession where people come, [and] they are not coming to buy a car or a house or a new suit. They are coming here to save their life. And when they come and tell us that they have no money we know if we refuse they are going to die. So if a hospital is not able to help people who come to its doorstep, we believe they should not be doing that job.”

The rapid growth and success of the Narayana health city is unparalleled in India. And the pioneering steps taken by Shetty and his team are offering lessons to the global healthcare industry.

Shetty is beginning to overcome one of medicine’s greatest challenges: offering high-end hospital services to the masses while still turning in an annual profit of nine per cent.

“We decided to adopt all the business principles of Walmart or Henry Ford – the one thing in common is the economy of scale,” Shetty explains.

At the Narayana, approximately 40 per cent of patients pay a reasonable price for their treatment, a small percentage – those who “want the frills of executive rooms” – pay a premium, a majority pays less than the market rate and 10 to 20 per cent pay virtually nothing. For the latter category, the hospital’s charitable wing raises money to help compensate for the material costs of their treatment.

In any other hospital, those who could not afford to pay their medical bills would simply be sent away until they came up with the cash, but at the Narayana the hospital’s charity wing helps them to find the money.

While the charismatic Shetty and his ideals are a draw card, it is the fact that he can offer the surgery cheaper than anyone else that is the main attraction.

In the first episode of Indian Hospital, we follow the story of Akbar and Qurr – a couple who have gone from one state hospital to another trying to save the life of their nine-month-old first-born child, Hatersham.

It is only during their first visit to Narayana Hrudayalaya Hospital that they are told Hatersham needs a liver transplant – a very risky procedure.

“My relatives ask us not to take the risk – and I have a chance to have another,” says Hatersham’s mother Qurr. “But how can we leave him in pain? He is my child.”

For Akbar, Qurr and baby Hatersham this is just the first stage of what will turn out to be a very long journey.

Doctors signed into rural work, Maharashtra can’t place them


Medical students

Medical students (Photo credit: Wikipedia)

Anuradha Mascarenhas : Pune, Thu May 03 2012,

The general reluctance shown by doctors to serve in rural areas has all but disappeared. In Maharashtra, so many medical students have agreed that there are now more willing doctors than the state can accommodate. Maharashtra has 1,500 posts of medical officer vacant; for these there are 3,000 applications, says Dr G S Chinde, director of health services.

It is not that the new crop of students has suddenly become more sensitive to the requirement of rural service. It’s just that should they want to skip a year’s stint in villages, the bond money has become unaffordable.

Maharashtra’s 14 medical colleges yield 2,000 MBBS graduates every year, of whom around 700 enrol in a postgraduate course. After MBBS, a medical graduate is required to sign a bond with the government to serve in rural areas for a year. If they opt to skip this, they need to pay Rs 10 lakh. The payment was Rs 1 lakh initially, raised to Rs 5 lakh in 2004 and doubled in 2010.

From students who signed a bond of Rs 5 lakh, the Directorate of Medical Education and Research has collected barely Rs 50 lakh, compared to Rs 3 crore collected in three years from students who had signed for Rs 1 lakh.

Dr Pravin Shingare, state director of medical education and research, said since the hike to Rs 10 lakh, over 4,000 doctors have enrolled for rural service.

The bond is higher for postgraduate and super-specialty doctors, Rs 50 lakh and Rs 2 crore. Now, the authorities are wondering where to place these highly qualified doctors.

“We are scrutinising the applications so that the doctor’s specialisation can be suitably utilised,” an official said. The delay in doing this has led to several students writing to the DMER that they have not got any response to their applications. Shingare said he has got more than 30 such letters and will write to the health department to start filling the vacancies. “The DMER has in fact listed 400 vacancies at Employees State Insurance Corporation hospitals.”

The health department is also trying to fill vacancies under NRHM, which needs 400 school-level health medical officers.

Medical and Legal Aspects of Providing Care during Political Protests


The Albert Einstein College of Medicine has just posted (in three parts) our social medicine rounds on Medical and Legal Aspects of Providing Care during Political Protests.

It is largely devoted to street medics and we had three excellent speakers: a paramedic, a physician, and a lawyer, all of whom were street medics.