Indian Health Care Sector

SaiK · Post by **SaiK** » 23 Nov 2004 01:35

An unhealthy trend

ASHA KRISHNAKUMAR

The quality of public health care delivery in India remains woeful while the private health care sector attains impressive heights thanks to the government's privatisation drive.

http://flonnet.com/fl2124/stories/20041203008012300.htm

Pulikeshi · Post by **Pulikeshi** » 23 Nov 2004 01:51

krsna wrote:An unhealthy trend

ASHA KRISHNAKUMAR

The quality of public health care delivery in India remains woeful while the private health care sector attains impressive heights thanks to the government's privatisation drive.

http://flonnet.com/fl2124/stories/20041203008012300.htm

The title of this article is just plain irresponsible! Does private health attaining impressive heights have anything to do with the poor quality of public health care delivery in India? Even if it does, perhaps the slacker, public sector, could use a few lessons from the winner, private sector. Lest you pelt me with sensitive lefty stones for having the gall to suggest privatization of health care - can't see any large country that has made public health care system work efficiently!

Guest · Post by **Guest** » 08 Jan 2005 18:55

The prices of medicines are going up and up. It is unfortunate that the medical industries see this as an opportunity to make money on the health of Indian public. The tax system is also funny - multi level taxes and so prizes in the medical shops are fixed accoring to one's own convenience. This has literally killed many people who were sick and not able to pay the amount for their medicine or made the people debtors.

I would suggest someone in the government to look into the possibility of setting up a Medical Regulatory Authority in India (MRAI) like TRAI keep a watch over the medical industries as well as on the medical shops.

If we are tallying our medicine prices along with the international level then the income of the people also should be raised to tally according to international level. This is not possible for the Indian government and so deregulate the medical production altogether. Allow any dependable companies to discover medicine within India and produce in a competitive manner and thus reduce the prices. Or just pass an amendment saying medical and food categories cannot raise their prices in India according to the IPR system and prices. In other words under IPR signatory system these basic things should not be allowed to raise their prices. IF they do so then the government will produce in large scale and distribute at free costs. For example HIV/AIDs medicine will be sold at very high price one we sign up IPR agreement. Then there must be a protective clauses to either maintain the prices or to reduce the prices.

The second issue the MRAI can look into - is the mal practices of many medical hospitals in India. To your knowledge many so called doctors do not have proper medical degrees and are appointed as doctors. Many of these hospitals have a lot of mal practices against which there is no law in India. See for example a lady doctor injected an young boy in one of the well known hospitals in Chennai and the boy had lukhemia after that. The parents took him to Australia and treated him there. He was simply admitted for simple injuries on his face and this injuction was given and now he is no more. Though the hopital recognised the problem and though the boy is one of the rich man's son but he could not take any action against the hospital because of the lack of regulatory systems.
Second issue is that selling of kidneys and donating blood for money is continuing in many of hospitals in India.

For this what can we do? This regulatory system should give star standard and also see whether in these special cases doctors were careless or not if the doctors and nurses were careless then they should be held responsible for this and the hospitals should be fined.

As we are in the process of liberalisation unless these things are maintained and kept the people at large will suffer.

Katta

George J · Post by **George J** » 09 Jan 2005 00:15

Katta:
There is a National Pharmaceutical Pricing Authority. Here is the link http://nppaindia.nic.in/

Gotta run now...but will give you more details on recent developments when I get back. Also do a search on the Ram Vilas Paswan and Sandhu Committee. There is stuff happening in the right direction, but there is also a lot of pressure to de-regulate.

IssacB · Post by **IssacB** » 02 Mar 2005 22:13

I saw this today and thought I would like to share this with you all as it does in some way relate to India, its healthcare and China. It also relates to another India luminary, his opinions and that of the UN policies that he is helping to mold.
_______________________________________
http://www.opinionjournal.com/editorial ... =110006320

An 'Annie Hall' Moment
A Nobel Prize-winning economist spouts off, and a Chinese survivor sets him straight.

Monday, February 21, 2005 12:01 a.m. EST

In the Woody Allen movie "Annie Hall," a character is sounding off about the Canadian media theorist Marshall MacLuhan when the subject himself appears and says: "Excuse me, I'm Marshall MacLuhan. You know nothing of my work." Woody Allen then turns to the audience and asks, "don't you wish life were like that?"

In Hong Kong last week it was Nobel Prize economist Amartya Sen doing the sounding off, praising the state medical system in China under the Cultural Revolution. Mr. Sen asserted that Maoist China had actually made great strides in medicine, bringing down child mortality rates and prolonging life expectancy. Moving to a privatized system was making the system less fair and efficient, said the Nobel laureate, who's behind many U.N. economic works, such as the much-heralded "Human Development Index."

To back up his remarkable claim, Mr. Sen said that the rate of growth in life expectancy in China was slowing down. Or at least it was doing so compared to India, which is catching up with China in life expectancy. "The gap between India and China has gone from 14 years to seven [since 1979] because of moving from a Canada-like system to a U.S. like system," said Mr. Sen, adding that he thought this change by China was a mistake.

But, alas, there was someone in the audience who actually had lived through the Cultural Revolution in China, and had been one of Mao's "barefoot doctors." He didn't see things quite the same way as Mr. Sen. In fact, he said the comments had quite surprised him.

"I observed with my own eyes the total absence of medicine in some parts of China. The system was totally unsustainable. We used to admire India," said Weijian Shan, now a banker in Hong Kong. Mr. Shan then added an anecdote that tickled the audience, telling how when he first visited Taiwan in the 1980s and saw young medical school graduates serving in the countryside, he thought to himself, "China ought to copy Taiwan."

Mr. Shan added, about Mao's medicine, "If they had made the system optional, nobody would have opted for it."

Mr. Sen might have thought he was going to have an easy audience. He was, after all, introduced by a local American resident--a member of Democrats Abroad--who praised his work as something President Bush should read, so he would learn that supporting freedom required more than just sending in the Marines.

And indeed, after Mr. Sen's observations--NATO is partly responsible for Third World debt and for turning back Africa's democratic evolution; more people died of AIDS on Sept. 11, 2001, than in the terrorist attack; Social Security, the U.S. pension system, is not at a crisis point--it seemed that it was going to be a one-sided afternoon.

Except for the man in the audience who actually had lived through that glorious Maoist era, and who provided the Annie Hall moment.

________________________________________

Did not know that this guy, Nobel Prize economist Amartya Sen, admired Maoists.

Vasu · Post by **Vasu** » 22 May 2005 21:44

A `pocket-friendly' ambulance service

Ever had an emergency and dialled to call an ambulance, only to hear the number ring incessantly, or worse, be told by an automated voice that the line is busy?

In the absence of an emergency access number like England's 999 or the United States' 911 — a group of young entrepreneurs with support from the London Ambulance Service (LAS) have launched Ambulance Access for All (AAA) in Mumbai.

The service has a single access number 1298 and plans to establish a national footprint in the long-term. Touted as the country's first variable-fee emergency service, the patient pays depending on their economic background.

The project implementation — in terms of designing the call-centre support and planning where the ambulances would be stationed etc — has been guided by India's telecom-man, Dr Sam Pitroda, said Mr Shaffi Mather, AAA's Director.

A Mumbai-based corporate is supporting the service, besides a group of other corporates including State Bank of India, Hindustan Petroleum and Playwin Foundation of Essel World, he said. Even the single access number was made possible by MTNL, he said.

Explaining the variable-fee concept, Mr Mather said, there was a fee of Rs 500. But, it would be subsidised or waived depending on the patient's ability to pay. The ambulance would take the patient, depending on the emergency, to the nearest Government or private hospital. The hi-tech ambulances are equipped with medical devices and professionals, global positioning system and real-time tracking.

Having trained the crew of the new service and worked with them during the pilot-run over the last 10-months, Mr Russell C. Smith, LAS' Assistant Chief Ambulance Officer, told Business Line that the aim should be to reach the patient at the earliest and administer aid in the right manner. He also warned of crank calls and underlined the need to prioritise response.

AAA's first phase of the Rs 6.5-crore project, with 10 ambulances covering Mumbai, was launched by the Maharashtra Chief Minister, Mr Vilasrao Deshmukh, on Saturday. Mr Mather said the service got about 25 calls per day during the trial run. The second phase, with 40 more ambulances, will become operational if the service continues to get a good response.

Manu · Post by **Manu** » 02 Jun 2005 04:33

Around Asia's Markets: U.S. snags hurt drug producers in India
- Mrinalini Datta Bloomberg News

THURSDAY, JUNE 2, 2005

Shares of Indian drug makers are among the nation's worst performers this year because of stiffer competition and a failure to expand sales in the United States. Some investors say they may fall further.

"It looks tough to make a buck in that space right now and it seems to be getting tougher every week," said Jon Thorn, a fund manager at India Capital Fund in Hong Kong. "We don't think that Ranbaxy looks particularly rosy."

Ranbaxy and Dr. Reddy's Laboratories are competing with Teva Pharmaceutical Industries of Israel, Mylan Laboratories of the United States, and at least 13 other makers of drugs with expired patents. Indian drug makers have failed to win U.S. approval to sell copies of medicines made by companies including Pfizer.

Shares of Ranbaxy, India's biggest drug maker by sales, have fallen 12 percent this year. The company's profit dropped 63 percent in the quarter that ended March. Stock in the No. 3 producer, Dr. Reddy's, which posted a loss in the period after five quarters of sliding profit, has declined 16 percent.

Dr. Reddy's is the fourth-worst performer and Ranbaxy the seventh-worst this year in the Sensitive index, which has risen 1.7 percent. Shares of Cipla, India's second-biggest drug maker by sales, have fallen 8.8 percent. The losses contrast with a 3.7 percent gain for the MSCI World Health Care index, the second-biggest advance among the global benchmark's 10 groups. Only energy stocks have risen more.

"In terms of the stock price, I don't see too much of an upside within this year," said Sandip Sabharwal, a fund manager at SBI Asset Management in Mumbai. Valuations of Ranbaxy and Dr. Reddy's "are pretty rich."

Ranbaxy's shares are trading at 29 times estimated earnings this year, while Dr. Reddy's is at 33 times, according to Rohit Bhat, an analyst with Batlivala & Karani Securities in Mumbai. The ratios compare with 19 times for Cipla and 21 times for Mylan, whose earnings fell 49 percent in the latest quarter.

The Mumbai stock exchange's health care index has dropped 11 percent this year. Only the Indian unit of Pfizer, Wockhardt and Glenmark Pharmaceuticals have risen.

Indian companies get the highest prices for their medicines by challenging patents in the United States, where Ranbaxy sells more than 80 drugs and Dr. Reddy's sells 11.

The U.S. Food and Drug Administration, which approves drug sales, allows successful challengers to sell their treatments for at least six months along with the original patent holder before competitors are allowed to enter the market.

Ranbaxy's profit soared after the New Delhi-based company won permission to sell its version of Ceftin, a GlaxoSmithKline antibiotic, in the United States beginning in March 2002. Prices plunged after the entry of rival versions in July 2003.

Dr. Reddy's sold its 40-milligram dosage of Prozac, Eli Lilly's antidepressant, for six months starting in August 2001 after successfully challenging Lilly's patents. The company, based in Hyderabad, had to cut prices after competition arrived.

Neither company has overturned a patent since then, while research and administration costs have increased.

"The whole generics sector in general has had some troubles," said Robert Kalin, a fund manager at DWS Investment in Frankfurt. Drug companies have "been very aggressive on legal protection."

Ranbaxy's chief executive, Brian Tempest, said in April that earnings per share would be similar to last year's 37.48 rupees because of pricing pressure in the United States and Europe. Profit will pick up in the second half as the company introduces more drugs in the United States, he said.

link

Gerard · Post by **Gerard** » 05 Jun 2005 07:30

Young, female, Asian - Britain's favourite doctor

The traditional image of the British family doctor as a serious, besuited white middle-aged man is out of date. As far as patients are concerned, the 'perfect' general practitioner is his polar opposite: young, female and Asian.

Dr Reena Shah, 41, a London GP who came up with the idea for the study, said that coming from a British-Indian background she had often wondered about people's first impressions of their family doctors.

"I didn't have any preconceived ideas, so I was surprised at how well the young female Asian GP did.

Katare · Post by **Katare** » 06 Jun 2005 04:17

I liked that ambulance thingy, wish they had a website where people can donate small amount of money or adopt an ambulance or something like that. Hats off to these folks for bringing basic amenities of 20th century to India’s largest metropolis!

vinodv · Post by **vinodv** » 19 Jun 2005 05:32

More evidence on why Communists are morons.

Bird Flu Drug Rendered Useless: Chinese Chickens Given Medication Made for Humans

Chinese farmers, acting with the approval and encouragement of government officials, have tried to suppress major bird flu outbreaks among chickens with an antiviral drug meant for humans, animal health experts said. International researchers now conclude that this is why the drug will no longer protect people in case of a worldwide bird flu epidemic.

China's use of the drug amantadine, which violated international livestock guidelines, was widespread years before China acknowledged any infection of its poultry, according to pharmaceutical company executives and veterinarians.

Since January 2004, avian influenza has spread across nine East Asian countries, devastating poultry flocks and killing at least 54 people in Cambodia, Thailand and Vietnam, but none in China. World Health Organization officials warned the virus could easily undergo genetic changes to create a strain capable of killing tens of millions of people worldwide.

Although China did not report an avian influenza outbreak until February 2004, executives at Chinese pharmaceutical companies and veterinarians said farmers were widely using the drug to control the virus in the late 1990s.

The Chinese Agriculture Ministry approved the production and sale of the drug for use in chickens, according to officials from the Chinese pharmaceutical industry and the government, although such use is barred in the United States and many other countries. Local government veterinary stations instructed Chinese farmers on how to use the drug and at times supplied it, animal health experts said.

Amantadine is one of two types of medication for treating human influenza. But researchers determined last year that the H5N1 bird flu strain circulating in Vietnam and Thailand, the two countries hardest hit by the virus, had become resistant, leaving only an alternative drug that is difficult to produce in large amounts and much less affordable, especially for developing countries in Southeast Asia.

"It's definitely an issue if there's a pandemic. Amantadine is off the table," said Richard Webby, an influenza expert at St. Jude Children's Research Hospital in Memphis.

Health experts outside China previously said they suspected the virus's resistance to the medicine was linked to drug use at poultry farms but were unable to confirm the practice inside the country. Influenza researchers at the U.S. Centers for Disease Control and Prevention, in particular, have collected information about amantadine use from Chinese Web sites but have been frustrated in their efforts to learn more on the ground.

China has previously run afoul of international agencies for its response to public and agricultural health crises, notably the SARS epidemic that began in 2002. China's health minister was fired after the government acknowledged it had covered up the extent of the SARS outbreak by preventing state-run media from reporting about the disease for months and by minimizing its seriousness.

In interviews, executives at Chinese pharmaceutical companies confirmed that the drug had been used since the late 1990s, to treat chickens sickened by bird flu and to prevent healthy ones from catching it.

"Amantadine is widely used in the entire country," said Zhang Libin, head of the veterinary medicine division of Northeast General Pharmaceutical Factory in Shenyang. He added, "Many pharmaceutical factories around China produce amantadine, and farmers can buy it easily in veterinary medicine stores."

Zhang and other animal health experts said the drug was used by small, private farms and larger commercial ones. Amantadine sells for about $10 a pound, a fraction of the drug's cost in Europe and the United States, where its price would be prohibitive for all but human consumption.

Two months before China first reported a bird flu outbreak in poultry to the World Animal Health Organization in February 2004, officials had begun a massive campaign to immunize poultry against the virus. They have now used at least 2.6 billion doses of a vaccine.

But researchers in Hong Kong have reported that the H5N1 flu virus has been circulating in mainland China for at least eight years and that Chinese farms suffered major outbreaks in 1997, 2001 and 2003. Scientists have traced the virus that has devastated farms across Southeast Asia in the last two years to a strain isolated from a goose in China's Guangdong province in 1996.

The U.N. Food and Agriculture Organization has long recommended that countries try to eradicate infectious animal diseases by slaughtering infected flocks and increasing safety measures on farms. Last year, the FAO also suggested that countries consider vaccinating their poultry against bird flu. But the guidelines never recommended the use of antiviral drugs such as amantadine, which, unlike vaccination, has been proven to make viruses resistant, officials said.

In 1987, researchers at a U.S. Department of Agriculture laboratory demonstrated that bird flu viruses developed drug resistance within a matter of days when infected chickens received amantadine.

Still, a veterinarian with personal knowledge of livestock practices across China said Chinese farmers responded to the bird flu outbreak by putting the drug into their chickens' drinking water. The veterinarian asked that his name not be published because he feared for his livelihood.

"This would explain why we're seeing such high resistance levels," said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. While various antibiotics have lost their effectiveness because of overuse, he said, the emergence of resistance to amantadine is unprecedented because it is an antiviral.

"This is the first example of an antiviral drug that was used for animal production that has major implications for human health," Osterholm said.

A popular Chinese handbook, titled Medicine Pamphlet for Animals and Poultry, provides farmers and livestock officials with specific prescriptions for amantadine use to treat chickens and ferrets with respiratory viruses. The manual, written by a professor at the People's Liberation Army Agriculture and Husbandry University and issued by a military-owned publishing company, prescribes 0.025 grams of amantadine for each kilogram of chicken body weight.

Farmers also use the drug to prevent healthy chickens from catching bird flu, giving it to their poultry about once a month or more often when the weather is liable to change and chickens are considered susceptible to illness, veterinary experts said. The antiviral is often mixed with Chinese herbs, vitamins and other medicine.

In the United States, amantadine was approved in 1976 by the Food and Drug Administration for treating influenza in adults. Amantadine and it sister drug, rimantadine, known collectively as amantadines, work by preventing a flu virus from reproducing itself. Both are now ineffective against the H5N1 strain.

International health experts stressed that amantadine could have been vital in stanching the spread of the bird flu virus in the early weeks of an epidemic.

Now, the only alternative is oseltamivir and closely related zanamivir, which stop the flu virus from leaving infected cells and attacking new ones. Oseltamivir is easier to use and has far greater sales.

"Amantadine is the cheapest drug against flu," said Malik Peiris, an influenza expert at the University of Hong Kong. "It is much more affordable for many countries of the region. Now, it is clearly no longer an option."

Special correspondents Ling Jin in Beijing and K.C. Ng in Hong Kong contributed to this report.

Singha · Post by **Singha** » 19 Jun 2005 08:22

for a smart and hardworking people, the chinese have a peculiarly headstrong and stupid Govt, always hard at work papering over its mistakes.

Suraj · Post by **Suraj** » 24 Jun 2005 00:10

India to have US FDA-like drug regulator

Katare · Post by **Katare** » 02 Jul 2005 07:59

Forget BPOs, desi docs are in spotlight now

Recently I did some due diligence on financial crises at GM for my investments in its shares. Management and analysts consider future unfunded health care costs as one of the biggest problem for long term survival of GM. The reports goes on and states that total future health care liabilities of 'all the US corporations' put together (including pensioners and their families) would be higher than total current market capitalization of 'all the US corporations'. Total future medical liabilities of US corporations is calculated to be $60 Trillion while current market capitalization of all the US corporation put together adds up to only $20 Trillion.

This piece of data shows how big an opportunity health care industry in western world could provide for India. Serious investment, long-term planning and innovative solutions can bring shiploads of $$, euros, yens, francs and pounds to India and it would simultaneously help US corporate while providing timely and cheap health care for ageing western population. Win-win-win situation if you'll!

All we need is couple of Narayan Murthys to bring in the discipline, professionalism and strategic vision to the industry.

Purush · Post by **Purush** » 02 Jul 2005 13:27

Economic Times

Jubilant to buy US drugs maker

MUMBAI: Jubilant Organosys, one of India's new generation pharmaceutical companies, said Friday it had decided to acquire a US-based pharmaceuticals company with an investment of $24.72 million.

Under the agreement, Jubilant will acquire 64 per cent stake in generics pharmaceutical company Trinity Laboratories and its wholly owned subsidiary Trigen Laboratories, said a company statement issued here.

The company will hold a 64-per cent equity in Trinity and its subsidiary for a cash payment of $12.25 million, of which $8.25 million will be paid to the existing shareholders, added the statement.

Jubilant will invest an additional $8.42 million next year that will increase the company's equity interest in the US drugs maker to 75 per cent. An additional $4.05 million will be paid by Jubilant on conversion of existing share options.

Trigen Laboratories is in the business of generic dosage forms and has a manufacturing facility in Maryland. The facility has an annual production capacity of 650 million tablets and 35 million capsules.

"This acquisition furthers our objective of strengthening our position in the global pharmaceuticals and life sciences industry and facilitates our entry into the high opportunity US market," said Shyam Bhartia, chairman of Jubilant.

"We are now well positioned to enhance our standing in higher end of the life sciences value chain," he added.

George J · Post by **George J** » 03 Jul 2005 00:36

Katare wrote:......... Total future medical liabilities of US corporations is calculated to be $60 Trillion while current market capitalization of all the US corporation put together adds up to only $20 Trillion...........This piece of data shows how big an opportunity health care industry in western world could provide for India...........it would simultaneously help US corporate while providing timely and cheap health care for ageing western population. Win-win-win situation if you'll!...............

The GM healthcare fiasco is only an outcome of an ad-hoc healthcare policies and increasing healthcare costs associated with maintaining benifits. I dont think you can 'outsource' healthcare for all corporate employees to India.

You can outsource components: labs, radiology and back end paperwork. But you can NEVER outsource the delivery of care: you still need american docs and healthcare workers to provide the care. And thats not gonna get cheap: do you know any docs willing to accept less than $150 bucks for a 30 mins physician visit? You can get Indian nurses to take care of the US patients, but you cant get them to work for less than 60K a year (they are willing to work, but the rates are set buy market and Nursing Associations).

So you cant outsources everything, you can cut costs and you these cost savings measures will not solve the systemic problem: pvt industry having to pay for healthcare permiums (unlike govts/nationalized healthcare systems). And the more workers you have (auto/shipbuilding/steel etc) the more you have to dole out.

Uttam · Post by **Uttam** » 08 Jul 2005 20:08

Step in the right direction

Govt to introduce medical visa to all foreign nationals

Government has decided to introduce medical visa to all foreign nationals, including those from China, Pakistan, Bangladesh and Sri Lanka, who come here for medical treatment and are required to live in the country for an extended period.

"The medical visa would be admissible to all foreigners seeking medical attendance in reputed/recognised specialised hospitals/treatment centres in the country," an official release said on Friday.

The initial period of such a visa would be one year or for the period of treatment, whichever is less, it said.

Manu · Post by **Manu** » 05 Aug 2005 00:00

LINK

Boy to fly to India for spine op
A mother who has been told her son may have to wait a year for a spine operation to restore his mobility is to fly him to India for the procedure.
Elliot Knott, 14, of Charminster, Dorset, injured his back in a ice-skating accident on New Year's Eve.

His mother Karen, 44, has opted to pay £4,700 for him to have the work done in Delhi, plus £1,260 on flights.

Southampton General Hospital said she had been told the worst-case wait and hoped things could go ahead soon.

Ms Knott was told by the hospital that Elliot would have to wait 17 weeks to see a consultant, and then, if he was considered an urgent case, would be put on a nine-month waiting list.

The keen swimmer, who is captain of the West Dorset Warriors swimming team, suffers from spondylolisthesis, a condition that develops when a vertebra slips out of position in the spine and presses on a nerve.

He has been housebound since Easter and unable to go to lessons at the Thomas Hardye School in Dorchester, where he is due to start his GCSEs in September.

Mrs Knott, who has the flights booked for 9 August and has taken the summer off work to care for her son, said the waiting time was "ridiculous".

"He can move around the house but if he stands up for more than two or three minutes it's quite painful and you can see by the way he walks that he must be in pain.

'Scarce skills'

"I don't know what state he would be in psychologically if he had to wait for a whole year," she said.

A spokesperson for Southampton General Hospital said the hospital was trying to balance high demand with scarce skills.

"What [Mrs Knott] has been given are the worst-case maximum waiting time targets but hopefully things can happen earlier, depending on the individual clinical issues for Elliot.

"We understand how frustrating the situation feels for patients and their families. We are certainly not either inflexible or unsympathetic."

This, as I understand it, is more a criticism of the NHS rather that a positive article on India's Medical Prowess.

The same story from the Guardian

Yerna · Post by **Yerna** » 05 Aug 2005 00:30

Are the indian hospitals protected from law suits filed by these foreign patients in case anything goes wrong? Law suits are one of the reason why US hospitals charge obscenely high amounts even for simple treatments.

George J · Post by **George J** » 05 Aug 2005 01:04

Yerna wrote:Are the indian hospitals protected from law suits filed by these foreign patients in case anything goes wrong? Law suits are one of the reason why US hospitals charge obscenely high amounts even for simple treatments.

Malpractice is not really a big issue for hospital charges. The main component of hospital cost is human resources: healthcare workers are not cheap to hire and they are certainly not cheap to maintain. Besides if you are insured you dont see any of the "obscenely high amounts". Insurence carriers have negotiated DRG and Per Diem rates, which is quite different from what they would charge you if you walked in with no insurence.

E.G It would cost me no money $50 to walk into an ER for a dislocated shoulder. It cost my cousin who was on a B1 (or L1 dont remember) $3000 which his travel insurence covered. If he didnt have travel insurence....like one of my aquantance...then like my acquaintance it would have cost him $2000 to excise the boil on his butt which my acquaintance had removed.. I am not kidding.

Jagan · Post by **Jagan** » 05 Aug 2005 01:57

George J wrote: ...then like my acquaintance it would have cost him $2000 to excise the boil on his butt which my acquaintance had removed.. I am not kidding.

I had someone who had to get a treatment on his testicles - insurance initially covered it as it involved a 3-4 day hospital stay and i belive the bill was in excess of 9k.. The insurance company later tried to back out, but our guy was 'back in india' by that time...

Vasu · Post by **Vasu** » 06 Aug 2005 08:38

SC raises bar to sue docs, says negligence not enough

The Supreme Court today said that extreme ‘‘care and caution’’ should be exercised while initiating criminal proceedings against medical practitioners for alleged medical negligence and drew up elaborate safeguards for them, including avoiding arrest unless it was inevitable.

Drawing elaborately from established provisions of law and practice, a bench of Chief Justice R C Lahoti, Justice G P Mathur and Justice P K Balasubramanyam said this was necessary ‘‘for, the service which medical profession renders to human beings is probably the noblest of all and hence there is a need for protecting doctors from unjust prosecutions’’.

The apex court also laid down elaborate guidelines to govern prosecution of doctors. These are:

• A private complaint may not be entertained unless the complainant has produced prima facie evidence before the court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.

• The investigating officer, should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion, preferably from a doctor in government service qualified in that branch of medical practice who can give an impartial and unbiased opinion (applying a prescribed test to the facts collected in the probe).

• Unless arrest is necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make himself available to face the prosecution unless arrested, the arrest may be withheld.

The court, however, made it clear that these would operate temporarily, till statutory rules were framed and issued by the Government in consultation with the Medical Council of India.

Div · Post by **Div** » 20 Aug 2005 20:31

New drug regulator on US FDA lines
http://us.rediff.com/money/2005/aug/20drug.htm

George J · Post by **George J** » 20 Aug 2005 22:30

Div wrote:New drug regulator on US FDA lines
The drug authority is going to be modelled largely on the recommendations of the Mashelkar Committee, which gave some far-reaching comments in the fields of regulating spurious drugs menace, besides strengthening drug regulatory structure at both the State and Central level...........The proposed drug authority is expected to remodel the office of Drug Controller General of India with greater autonomy, better infrastructure and larger technical staff. There are likely to be some modifications in the reporting system and organisational structure as well............The attempts would be to eventually come up with a US Food & Drug Administration kind of a structure, commented another official who is informed of the process.

The thing with Drug Reg bodies are that you dont need state level intervention. Spurious drugs can be controlled even in the present structure by more severe penalties: like the one that was proposed a few years ago....death penalty since its akin to mass murder.

Given that we dont have Pharmacies in India...more like "Chemist ki Dukaan" which is staffed by less than qualified individuals it going to be a tough job to for them to notice suprious drugs. Unless they pass very strict rules about packaging...which WILL increase cost of drugs. They cant dispense in India (like count the 30 pills and put in a tamper proof bottles) given that the populace dont always know how to store medicines correctly...let alone take them. Besides each bottle needs to be labled...which is a art thats only taught to pharmacist in India but never really practiced.

To staff at the level of US FDA is NOT a joke. They are HIGHLY paid and very well qualified. Working for the US FDA is considered VERY prestigious. You think you are gonna get IISC/IIT/ISI or Foreign trained scientist (you need them in basic research, all aspects of drug design, all aspect of clinical data analysis (biostatisticians)) to work in drug reg agency that will pay peanuts? Remember unlike drug discovery this is a very thankless job...there are no accolades for the guy who analysed TONS of data and failed a drug..coz he found that the sample size was inadequate to show the minimum expected difference (between Placebo and drug).

Atish · Post by **Atish** » 20 Aug 2005 23:26

Pharmacists all over the world have to have B. Pharma, including any "chemist ki dukaan".

I dont agree with unnessarily exalting the FDA. Its an agency with a very controversial track record. Its near impossible to quantify the cost in lives and money of FDA mistakes, and only the successes are counted.

An FDA job might be prestigious, but the same level of personnel are readily available in India. All it needs is a knowledge of medicine/pharma and stats, impressive but nothing special. A lot of jobs have glamor and prestige - stock researcher, I- Banker, fireman, and in the US, physicians. These are just cultural preferences. I can certify that I Bankers and researchers are nothing special, and I dont think that US physicians are not particularly better qualified than foreign counterparts.

The problem is not lack fo effective regulatory body, but absolute rampant corruption and lack of will to curb spurious drugs. Its no secret where the bulk of spurious drugs are made and sold in Delhi. In spite of adequate laws there are estimated 30,000 (yes 30,000) quacks in Delhi alone.

Atish.

George J · Post by **George J** » 21 Aug 2005 00:49

Umm nope...there is something called a Diploma in Pharmacy (like the diploma in engineering). And you need a Registered Pharmacist (or in reality only his/her registration certificate) to run a pharmacy. So as long as you can read a script you can pretty give out anything. Which is where the problem lies in screening and purchasing non-counterfiet drugs.

Umm the Indian FDA in its current state is pretty much ineffective because all drugs in the Indian market are first approved elsewhere. Its not remotely qualified to judge the massive (and I mean massive) volumes of data that goes into a New Drug Application process.

This massive amount of data needs teams of inter-disciplinary teams to analyse. There is a big difference between prestige and glamour (beyond the scope of this discussion). But suffice to say you cannot have monkeys evaluating the type of data needed for a drug approval process. Its not a skill thats currently exist in India. Remember there are NO DRUGS even in industry that has reached Phase III in India. Clinical research is a very different ball game...we are experts in process improvement and novel drug delivery systems...but on existing drugs. Clinical research on a new drug entity is very different from an existing drug in new dosage form or new indication.

I-Banking is not new to India...but evaluating clinical research for the purposes of regulatory review is very different. Its not just knowing Stats...its knowing the RIGHT stats, data analysis of a Randomized Double Blind Multicenter Clinical Trial is quite different from building forecasting models using panel (observed) data of the stock market etc. The fundamentals of the science exist in India...but not the advanced expertise to impliment methods.

Currently the chief of FDA in India is a Babu...and so are the state controllers. This is not an area where a bureaucrat provide ANY expertise. You need career technocrats (like the US FDA) to head and manage such an organization.

Corruption in the drug approval process is BOUND to happen if you pay people peanuts and dont endow direct reposibilities. But as the recent Vioxx fiasco has shown that even the USFDA is not above such problems (for gods sake they even institutationalized the process of paying money to expidite the approval process-the PDUFA Act in 1992).

Prem · Post by **Prem** » 21 Aug 2005 01:47

ADM please remove if inappropriate.

Guys i need help in finding out where to buy Lycium Barbarum/ wolfberry in India . I cannot find anything on the net.

TIA

Prem · Post by **Prem** » 21 Aug 2005 02:08

George J wrote:
Div wrote:New drug regulator on US FDA lines
The drug authority is going to be modelled largely on the recommendations of the Mashelkar Committee, which gave some far-reaching comments in the fields of regulating spurious drugs menace, besides strengthening drug regulatory structure at both the State and Central level...........The proposed drug authority is expected to remodel the office of Drug Controller General of India with greater autonomy, better infrastructure and larger technical staff. There are likely to be some modifications in the reporting system and organisational structure as well............The attempts would be to eventually come up with a US Food & Drug Administration kind of a structure, commented another official who is informed of the process.
The thing with Drug Reg bodies are that you dont need state level intervention. Spurious drugs can be controlled even in the present structure by more severe penalties: like the one that was proposed a few years ago....death penalty since its akin to mass murder.

Given that we dont have Pharmacies in India...more like "Chemist ki Dukaan" which is staffed by less than qualified individuals it going to be a tough job to for them to notice suprious drugs. Unless they pass very strict rules about packaging...which WILL increase cost of drugs. They cant dispense in India (like count the 30 pills and put in a tamper proof bottles) given that the populace dont always know how to store medicines correctly...let alone take them. Besides each bottle needs to be labled...which is a art thats only taught to pharmacist in India but never really practiced.

To staff at the level of US FDA is NOT a joke. They are HIGHLY paid and very well qualified. Working for the US FDA is considered VERY prestigious. You think you are gonna get IISC/IIT/ISI or Foreign trained scientist (you need them in basic research, all aspects of drug design, all aspect of clinical data analysis (biostatisticians)) to work in drug reg agency that will pay peanuts? Remember unlike drug discovery this is a very thankless job...there are no accolades for the guy who analysed TONS of data and failed a drug..coz he found that the sample size was inadequate to show the minimum expected difference (between Placebo and drug).

Hi Guys ,
I have a team working with FDA to get approvals for some Diagnostic and Surgical euqipments. The FDA folks are very professional and take their job very seriousally. I dont know if GOI can replicate FDA type high stake, high standard institution easily; it will be very great if they can and will add credibilty to Medical Tourism 's capabilty to earn some serious $$$.

George J · Post by **George J** » 21 Aug 2005 03:36

Please dont quote the entire post when replying to posts...it really increases thread length without adding much to the discussion.

Atish · Post by **Atish** » 21 Aug 2005 15:19

Yah George J point remains that there are existing safeguards in terms of education required to run a pharmacy in India. Point remains that nothing you have said is convincing in terms of specialized skill required to run the FDA.

So what if it is double blind trial stats. Yes we need technocrats I agree but those stats are not so difficult to master.Yes there would be an initial learning curve.

But the role and efficacy of the FDA is very controversial. It is not an accepted fact as you suggest. There are problems with unnecessary delays and keeping lifesaving medication due to political concerns and spurious legislation.

But whats the point of an FDA like agency in India. The problems here are much more basic and fundamental.

Literally billions of dollars worth of spurious drugs are made in Bhagirath place in the heart of Delhi. The entire infrastructure exists to make, label and distribute spurious drugs, and it is UNIVERSALLY known.

What bloody use would the FDA be in this situation.

It is like working on Six Sigma or JIT in a factory where half the inventory is stolen, or the bottleneck machine has gone kaput.

Atish.

George J · Post by **George J** » 21 Aug 2005 22:47

I cant convince anyone if they have already made up their mind. But that does not mean that facts can be altered to suit someone's conviction.

You are mixing two very distinct functions: 1) Drug Regulation and 2) Drug counterfeitng.

The manpower needed to evaluate a NEW drug application is very sophesticated and that sort of skill set does NOT exist in India (and evaluation of drugs is done for the country not at the state level). It will...eventually once they start the process...but they will have to collaborate with some outside agency for a few years before they get on their own feet. And such skill sets dont come cheap. If you think otherwise...I really cant convince you about your relative ignorance about this issue.

Counterfeiting is something that can be handled VERY WELL within our current framework at the state level. You dont need advanced skill sets to handle this problem. Depending on the sophestication of packing/security features you can eye-ball fakes packing or you can assay the product (anyone with a BSc Chem can do this). BUT the role of the state level FDA inspectors is to conduct/certify the actual analysis of the spurious product.

If counterfeiting is as rampant as you say then you need to be backed up politically, judcially and with police. Unlike narcotics which the city/state police have expertise in ID'ing and processing, with counterfeit rx its a very difficult job you need an expert to id the product. So unless there is active police cooperation it not safe for a FDA inspector to go into such an established setup on their own. And like you said....if they have been paid off (since they are paid peanuts anyway) they really dont have much of an incentive to risk life and limb. But that has on bearning on certifying the effectiveness and safety of new drugs for the country.

This comes back to our favorite problem on BRF.....you cant blame a one single agency without knowing all facts. FDA in the Delhi might be useless...but in other states they are more than equipped and pro-active in controlling such things. In fact we really need uniform regs ASAP... in Delhi FDA has to deal with fake drugs...in Kerala FDA has to wrestle with the explosion of Ayurvedic Pharmacies and their products.

Atish · Post by **Atish** » 21 Aug 2005 23:28

Who says that an Indian FDA will be easy or cheap to set up. Any specialized agency will have high initial start up costs. But you have given no details or estimates of what this means. Long scientific terms and unqualified assertions are worth as much as other experts such as Cohen. Sure I am ignorant, what makes you think you are not?

You have more experience and expertise in this issue, however your assertions are still unqualified. Its your opinion that the FDA is doing a sterling job, but that is controversial. (Or are you saying its not?)

The whole point of a regulatory body is to ensure that safe drugs are sold to the populace. With a horrible counterfeit drug situation, and even with effective regulation of new drugs/labeling etc the benefit to the public would be low without control of the spurious drug situation.

If the FDA is so great at drug regulation, why dont we let them make the decisions and copy them. There would be a few exceptions for India specific diseases/ drugs, why have an agency at all?

Always willing to learn here.

Atish.

George J · Post by **George J** » 22 Aug 2005 05:41

Atish:
I really dont think you have any clue about what you are talking about. Part of the problem could be that you are not aware of what the roles and responsiblies of the Central Drug Control and Standards Organization-CDCSO (that what they keep calling the Indian FDA). I am sorry if I was not clear about the specifics of the role of CDCSO and that of the STATE LEVEL Food and Drug Administration (FDA).

Under the Drug and Cosmetics Act, the regulation of manufacture, sale and distribution of Drugs is primarily the concern of the State authorities while the Central Authorities are responsible for approval of New Drugs, Clinical Trials in the country, laying down the standards for Drugs, control over the quality of imported Drugs, coordination of the activities of State Drug Control Organisations and providing expert advice with a view of bring about the uniformity in the enforcement of the Drugs and Cosmetics Act.

Drug Controller General of India is responsible for approval of licenses of specified categories of Drugs such as blood and blood products, I. V. Fluids, Vaccine and Sera.

So if they want a US FDA style drug approving entity, they they need to have individuals who have the right skill set, training and experience in the drug approval process. The FY 2005 budge request for the US FDA is $1.9 Billion which is over and above what they will be getting under for evaluating New Drug Apps (NDA) under PDUFA (what PDUFA is...you can google).

The very fact that you trivialized the science behind analysing and evaluating data from a Randomized Double Blind Multi Center Clinical Trial, tells me you are pretty much out of the depth in this particular area. And you dont seem to be in any mood to concede that there is science that is much beyond what "I-Bankers" do, so I am quite helpless in convincing you otherwise.

Now about the issue that vexes you most: spurious drugs. If its not clear to you by now that its a state level Delhi is an NCR is a state and hence it should have its own FDA (I know Maharastra has its own FDA) and this agency is responsible for controlling state level issues (remember mfg and sale is state level issue...drug approval is not *) and if Delhi FDA cannot control it then its just local inefficiences and corruption. Mah. FDA has its own headaches and Delhi has its own, both are supposed to deal with it.

Is is the best way to control spurious drugs? Definately not...so it behooves us to be patient in dealing with what the new fangle US FDA like body is supposed to do and what powers it will have in controlling state level commerce (thats its own can of worms).

If the salient features of this issue is not clear to you and I am still akin to uneven-cohen then I am sorry....

__________________________________________
* remember my mention of the Kerala Pradox??? They cant control drugs at the state level: yet they have all these ayurveda drugs...some very very seedy drugs too....and yet they have to regulate the sale and mfg of these drugs.

Ashok · Post by **Ashok** » 29 Aug 2005 14:52

A news item on patents for lipitor/anti-cholestrol drugs: Ranbaxy challenges Pfizer patent

svinayak · Post by **svinayak** » 02 Sep 2005 21:59

Chennai, Sep 2. (UNI): Thousands of formulations of the Indian Systems of Medicine (ISM) brought out in the country's first of its kind Traditional Knowledge Digital Library (TKDL) would be registered with 11 countries in the next two months, to prevent bogus patenting in future.

Addressing a press conference here today, Union Minister for Health and Family Welfare Dr Anbumani Ramadoss said: "We have produced about 75,000 formulations in ISMs like Ayurveda, 50,000 in Unani and 15,000 in Siddha".

These formulations were put in the TKDL and they would be registered with foreign countries. This would help in preventing unscrupulous patenting of Indian drugs having medicinal values. The formulations would be registered with quotation of secrecy, he added.

He was replying to a question on the patent of turmeric by an Indian abroad, which had incurred huge expenditure for the Union Government.

The TKDL would contain references from all books, scientific journals and ancient scriptures about the ISM and was translated in five languages -- English, Spanish, French, Japanese and German, he said.

The first phase of setting up of the TKDL, costing Rs ten crores, was over and by the end of this year all the formulations would be registered with 11 foreign countries, Dr Anbumani said and added the Centre was giving full focus to this project, which would also help in propagating the ISM abroad.

Purush · Post by **Purush** » 25 Sep 2005 15:53

Westerners Seek Cheap Medical Care in Asia

Yahoo link

excerpt
BOMBAY, India - Bradley Thayer, a retired apple farmer from Okanogan, Wash., traveled 7,500 miles to get his torn knee ligament fixed, and says he paid a third of what it would have cost him in a U.S. hospital. And that included air fare to Bombay.

Thayer, 60, had no health insurance when he fell and injured himself while summering in British Columbia. He says his U.S. doctors told him he would have to wait six months for surgery and pay bills totaling $35,000. So he joined a rising tide of American and European patients heading to India, Thailand and Singapore for top-class orthopedic surgery, plastic surgery, infertility treatment and cardiology that come much cheaper than in the West.

..............
Thayer, the retired farmer, has a suggestion for India: to anchor a cruise ship in international waters off Los Angeles, "One deck for orthopedic surgery, one deck for cardiology. We need a change in America, we need cheaper medical treatment. We need a big hospital ship from India."

Calvin · Post by **Calvin** » 25 Sep 2005 18:17

This cruise ship idea is an interesting one...

Ananth · Post by **Ananth** » 25 Sep 2005 23:04

Calvin wrote:This cruise ship idea is an interesting one...

Something along the lines of Sea code. And guess from where did sea-code got the largest applicants from

SaiK · Post by **SaiK** » 26 Sep 2005 03:54

http://www.hindu.com/seta/2005/09/22/st ... 201700.htm

Div · Post by **Div** » 26 Sep 2005 06:07

MNCs freeze patented drugs launch for now
http://us.rediff.com/money/2005/sep/24d ... &file=.htm

svinayak · Post by **svinayak** » 26 Sep 2005 07:34

http://www.onceuponourtime.com/india
My India Expedience

Bharat Rakshak

Indian Health Care Sector

Setting up Medical Regulatory Authority in India