Indian Health Care Sector

krisna · Post by **krisna** » 13 Aug 2010 07:31

^^^^
Bacteria develop resistance to antibiotics whenever they are used for treatment. It can occur anywhere in the world.
Misuse of antibiotics is rampant everywhere in the world including the western world. I have seen many docs in USA/UK prescribe despite lack of evidence of infection. clostridium difficile and MRSA are common.
1) Mainland europeans(scandinavians and dutch etc) treat UK patients as if they have got MRSA before they handle them.
2) Many of the superinfections like MRSA, flesh eating streptococcus, C. difficile, HIV etc originated in western world
MRSA History, C.difficile history,HIV history,necrotising fascitis caused by streptococci first documented in canada
3) MDR TB and XRTB are present in south asia and in africa and Russia.
Blaming India for everything does not behove well of its own people. criticise rightly so not for the sake of it.
naming an enzyme after India/indian city smacks of fear mongering.
bacteria does not discriminate.
Please read about the new bug. there were already reports of the resistance in different countries like UK/USA/Greece/Israel and mediterranean countries having it. There are 3 types of resisitance and the new one is the fourth.

Question to be asked is
--1) Why did the authors name it as NDM-1 and not other ones found in other countries.
2) why single out India
3) Article is shoddy in Lancet which is supposed to be a medical publication. it smacks of a hatchet job.
4) It is easy to insinuate that it is likely to have originated from india due to lack of health care facilities etc and indiscriminate use of abx. This can occur when data is lacking as in this case. Just blame the entire country because of improper studies.
Reminds me of the Aryan invasion- give a statement without any proper evidence and some Indians will think it is the gospel truth and defend it to the very last.

Kumaraswamy said he had not written many of the interpretations in the report; they were added later without his permission or knowledge.
He is a research scholar and the authors are profs from UK. Obviously they have the upper hand and can screw the data as desired.

We should not score self goals.

SSridhar · Post by **SSridhar** » 13 Aug 2010 07:40

Diabetes prevention strategies need more money

With rising costs of Diabetes predicted to reach the 1000 billion mark (in Rupees), diabetologists stress the urgent need for policy makers to allocate resources for strategies to prevent diabetes and manage its complications.

An earlier WHO estimate predicted that India will lose $237 billion, in national income due to diabetes, stroke and heart disease in the next decade.

A total of 4,677 subjects were screened, and 718 participated in the survey. The authors estimated the average expense based on calculations of direct and indirect costs incurred by the participants. Direct costs (that form 83.7 per cent of the total costs) were defined as the costs of medical care in relation to diagnosis and treatment of diabetes and its complications. “Of all the cost components, this is the least controversial measurement and easily assessable measure,” says Dr. Vijay.

Indirect costs are loss of income from workday lost due to absenteeism related to the disease. The total direct cost per annum was estimated to be Rs.25,391; of which hospitalisation was the highest contributor at Rs.12,992. This was followed by the spending for drugs and monitoring diabetes – Rs.8,595. The total cost is also inclusive of Rs.2,932 for outpatient visits.

It is no secret that India is among the nations with the highest per capita out-of-pocket spending on healthcare.

This study established that the expenditure of patients for treatment and management of diabetes in India was met mostly through the personal savings account (60 per cent). About 39 per cent of patients paid with money culled from selling or mortgaging property and borrowing loans at high rates of interest.

Further, Dr. Vijay adds that the economic costs of undiagnosed diabetes are beyond the scope of the study, and may underestimate the results.

vish_mulay · Post by **vish_mulay** » 13 Aug 2010 07:49

If you read my posts here you will realize that I am not supporting western world to demonize India. I fully agree that we all are in it together and there should not be any figure pointing at India. But just because everyone does it, does not mean it is correct. I am pointing out serious problems we have in India. Irrespective whether we developed NDM-1 or not, we will have to face the consequences of multi drug resistance in India. I am worried that we are not at all prepared for it.
Self goal might be a right terminology but I am more concern about impact of this development on morbidity and mortality of Indians. Rest of the world can cocoon itself from India but our people have to live within it. I can clearly see political angle of defaming India and honestly I don’t give rats’ ass about it. If western population does not want to come to India, its fine with me as development of 5 star hospitals is not the immediate need of India. We need more basic medical care and we need better training of medical man power. As far as this mischief fear mongering is concern, I will just say use it to betterment of India since our govt. does proper thing only when they have to face “ Lok Kya Kahenge”. Peace.

SSridhar · Post by **SSridhar** » 13 Aug 2010 20:30

Life without antibiotics

Last September, Walsh published details of a gene he had discovered, called NDM 1, which passes easily between types of bacteria called enterobacteriaceae such as E. coli and Klebsiella pneumoniae and makes them resistant to almost all of the powerful, lastline group of antibiotics called carbapenems. The August 11 paper revealed that NDM 1 is widespread in India {this is what the Indian researcher, part of the team, is questioning} and has arrived here {i.e. the UK} as a result of global travel and medical tourism for, among other things, transplants, pregnancy care and cosmetic surgery.

The biggest threat now, experts believe, is from multi drug resistant Gram negative bacteria, such as NDM 1-producing enterobacteriaceae and an enzyme called KPC which has spread in the U.S. (and in Israel and Greece) which also gives bacteria resistance to the carbapenems, the most powerful group of antibiotics we (once) had.

But Professor Richard James, director of the centre for healthcare associated infections at the University of Nottingham, central England, warns that bugs don't stay in hospitals (indeed, the NDM 1-producing bacteria appear to be widespread in the community in India, passed on through contaminated water, in which people bathe, wash clothes and also defecate).

There have now been a couple of interesting papers suggesting a Pigouvian tax — which he defines as one levied on an agent causing an environmental problem as an incentive to mitigate that problem — for antibiotics.

Like oil, he points out, antibiotic usefulness is finite. And the cost of drug resistance is not reflected in the price of the drug. “If you consider antibiotic sensitivity as a resource like oil, you want to maintain that by introducing a tax,” he says. It would be worldwide and the proceeds could fund new drug development.{Accuse a country of such a problem, tax that country and fund Western drug companies. That's the motive here considering that this project was funded by two drug companies}

SSridhar · Post by **SSridhar** » 14 Aug 2010 07:32

Intra-hospital committee to look into the 'superbug' issue: Apollo Chief

Speaking to media persons on Friday, Dr. Reddy said, “We are not sleeping over the issue. Specialists are at it already.” He said this in response to a question from journalists about the involvement of microbiologists from two Apollo Hospitals - Hospital, Kolkata, and Apollo Hospitals, Chennai – as co-authors in the Lancet study.

He went on to add that the hospital continues to monitor MRSA infections and share this information with partners and collaborating institutions. The data is part of Apollo's Clinical Excellence parameters. “But we have never faced what we are talking about now,” Dr. Reddy stated.

“It is atrocious to have named a bug over a country/city. Infections are every where,” he said in agreement with the views of the Indian Council for Medical Research chief V.M. Katoch. “We feel it is motivated to affect medical tourism in India, which is growing at a rapid rate. We have results on a par with some of the best health institutions in the world and have very strict quality control standards,” he added.

At the same time he urged the Central government to standardise hospitalisation procedures and to bring in Quality Control of India to monitor standards in hospitals. Doctors too, he concurred with some of the studies published after the Lancet study, would have to be continuously educated on antibiotic usage. {And, medicines should not be dispensed by Drug stores without a valid and current prescription. This is already the law but is unenforced.}

International experts from the United Kingdom, who were in Chennai to participate in Apollo's conference on bariatric surgery, also spoke on the implications of the Lancet study. Abeezar Sarela, senior lecturer in surgery, University of Leeds, said the Indian medical system was held in high regard in the U.K. “MRSA is a big issue in hospitals in the U.K. and infections are a concern the world over. We have to view this in that context.”

Torsten Olbers, senior consultant, Imperial College, London, added: “The problem is global management of the disease. The name is probably just to indicate origin. {His name sounds Nordic. He is simply defending another Western colleague.}The good news here is that it is reversible if we reduce antibiotic toxicity in the general population.”

SSridhar · Post by **SSridhar** » 14 Aug 2010 07:44

vish_mulay wrote:Just read the original paper published in 2009. It is named NDM-1 because it was isolated from a Swedish national of Indian origin who was treated for peri-anal abscesses as a complication of uncontrolled DM.

Indian medical journal first documented the 'superbug'

the first formal documentation of NDM-1 — dubbed the ‘superbug' because of it being resistant to most antibiotics — was done by the P.D. Hinduja National Hospital and Medical Research Centre in Mumbai last year. The study was published in the Journal of the Association of Physicians in India (JAPI) in March 2010, with an accompanying editorial on the “worrisome” outcome calling for an end to the indiscriminate use of antibiotics.

The identification of NDM-1 being present among Enterobacteriaceae has the potential for further dissemination in the community, said the study “New Delhi Metallo-b lactamase (NDM-1) in Enterobacteriaceae: Treatment options with Carbapenems Compromised” by Payal Deshpande, Camilla Rodrigues, Anjali Shetty, Farhad Kapadia, Ashit Hedge and Rajeev Soman of the Hinduja hospital.

The study conducted in the hospital itself found 22 patients having NDM-1 bacteria of a total of 24 carbapenem (a strong antibiotic) organisms that were collected in a period of three months. This made the hospital come up with an antibiotic policy that did not allow indiscriminate use of carbapenems. However, being a tertiary centre, the researchers claimed the hospital received transfer cases and referrals from other hospitals.

The bacterium was identified in 2008, but it was given an official identity in December 2009.{Is that what you are referring to, vish_mulay ?}

The publication of the study was followed by an editorial in the same issue of JAPI by Dr. Abdul Ghafur K., consultant in Infectious Diseases and Clinical Mycology, Apollo Hospital, Chennai, who said the study was an eye opener on the deep trouble India was in.

“If a single hospital can isolate such a significant number of bacteria with a new resistant gene in a short period of time, the data from all the Indian hospitals, if available, would potentially be more interesting and shocking than the human genome project data, which is considered as a discovery more important than the moon landing itself.”

The Indian medical community has to be ashamed of the NDM-1 gene, Dr. Ghafur wrote. Even though we have not contributed to carbapenem development, we have contributed a resistance gene with a glamorous name. The overuse of antibiotics is embedded in our Indian genes. Accusing Indian physicians of adopting an “ostrich-like” approach to the problem, Dr. Ghafur says the easiest way of tackling the superbug problem is to deny the existence of the problem: stop looking for these bugs, stop looking for the hidden resistance mechanisms and close your eyes even if you find them.

“It is an Indian tradition. Why should we Indians worry? We can always depend on honey, yogurt and cow's urine,” his editorial piece says.

According to Dr. Ghafur, we come across multi-drug resistant or even pan-resistant Gram-negative bugs quite often and such bugs are reported in almost all major centres in India and most international centres, though to a lesser extent than in India. “We Indians are the leaders in antibiotic resistance. Many multidrug-resistant superbugs are from bacterial cultures taken at the time of admission to the hospital. By the time a patient is being admitted to a tertiary care centre, that patient has already visited many other hospitals and doctors and has received multiple courses of different antibiotics. These patients are literally walking culture plates of superbugs and you don't have to be Nostradamus to predict their clinical outcome,” he says in the editorial.

Criticising the indiscriminate use of antibiotics in India, Dr. Ghafur also blames international and Indian pharmaceutical companies for contributing to this resistance saga. The lack of restriction on the usage of newer antibiotics with specialist spectrum has given fertile ground for companies to exert their excessive pressure on doctors to increase prescription of antibiotics.

Further, the medical curriculum lacks importance on the teaching of infectious diseases to undergraduate and post graduate students. According to him, a general medicine candidate can clear his or her examination without reading the chapter on infectious diseases and antibiotic usage.

SSridhar · Post by **SSridhar** » 14 Aug 2010 08:24

Superbug study, a bid to tarnish Indian image

The Indian Public Health Association has condemned the ‘superbug study' linking it with India and called for a national voice against such baseless speculations.

It also urged the Government of India to fight till the name New Delhi was removed from the study, which linked a drug-resistant superbug, detected in Britain, to this country.

“An emergency meeting of the Indian Public Health Association was held on Thursday immediately after we came to know about the superbug controversy. It was condemned in unequivocal terms and our association sees it as an attempt to tarnish India's growing image in the health sector,” S. Elango, national vice-president of the association, said.

Talking to The Hindu here on Friday, he said the association strongly felt that a scientific study should not be named after a city or town and should have been based only on biological names without dragging the Indian capital.

“Naming the enzyme New Delhi Metallo Beta Lactamase (NDM-1) and linking the superbug bacteria to India was highly disturbing. Some of the developed countries do not want India to be successful in medical tourism,” Dr. Elango alleged.

SSridhar · Post by **SSridhar** » 14 Aug 2010 09:01

Conflict of interest in 'superbug' report: Azad

Health ministerGhulam Nabi Azad pointed to a conflict of interest behind the controversial Lancet report of an "Indian" superbug, saying the research was part funded by pharma majorWyeth that had developed an antibiotic meant to combat high resistance bacterial infections.

Speaking to media on Friday, he said not only had one of the report's authors disagreed with its findings, it was unclear whether the patient in London who was infected by the superbug had contracted it in India. "It was funded by one pharma company and associates of pharma companies," he said.

Wyeth has developed a drug Tygacil, meant to help doctors treat hospital infections that need a special type of broad spectrum antibiotics. "This bug can be present in the instestines of humans and animals. There is no reason to believe it is specific to India," he said.

According to ICMR, bugs with similar plasmids — a DNA molecule that replicates independently within a suitable host — have been reported from Israel, US, Greece and Scotland. Therefore, to link the bug's existence and spread to surgeries taking place in India was wrong. What's most interesting is that many of the authors of the study have declared a conflict of interest. The health ministry on Thursday said the study was funded by the European Union, Wellcome Trust and pharma company Wyeth which produces antibiotics for treatment of such cases.

The ministry said while Karthikeyan K Kumaraswamy, the scientist who was heading the study in Chennai received a travel grant from Wyeth, David Livermore, another scientist, received conference support from numerous pharma firms.

krisna · Post by **krisna** » 14 Aug 2010 18:36

Cross posted from Indo UK thread

Reading thru the Lancet article-- it is surprising that the article could go thru various stages before being accepted for publication. It is not easy to get it published the way it is written. definitely daal mein kuch kaala hai. But the damage is done. we will have to fight defensively now.

Lalmohan wrote:^^^ good find on the big-pharma connection
the story seems to have died out now

This is not enough. It is lull before storm
Now it is more or less now known to medical community. It will be written incorporated and guidelines issued in the coming weeks to months. it will become permanent.
The main issue is wrt naming on an Indian city which is atrocious and likely deliberate.(can guess any number of reasons-easiest is already mentioned here)

1) Active efforts should be undertaken by GOI and Indian medical boards to get the name erased and substitute with proper scientific name according to nomenclature
generally naming after common names is not allowed or frowned, they prefer scientific names. It is likely it will enter into medical jargon.

2) ESKAPE bacteria of western origin. This is due to indiscriminate use of antibiotics. India is not responsible for this. How come no cities or countries named.
MRSA originated in UK- why was it not called UK strain or london strain etc. Smacks of double standards
hope all Indians irrespective of who it is not self flaggellate ourselves saying it is India responsible for resistance.
3) bugs resisitant to antibiotic.
according to this medical article,

Results.Overall, 463 hospitals reported 1 or more HAIs: 412 (89%) were general acute care hospitals, and 309 (67%) had 200–1,000 beds. There were 28,502 HAIs reported among 25,384 patients. The 10 most common pathogens (accounting for 84% of any HAIs) were coagulase‐negative staphylococci (15%), Staphylococcus aureus (15%), Enterococcus species (12%), Candida species (11%), Escherichia coli (10%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (6%), Enterobacter species (5%), Acinetobacter baumannii (3%), and Klebsiella oxytoca (2%). The pooled mean proportion of pathogenic isolates resistant to antimicrobial agents varied significantly across types of HAI for some pathogen‐antimicrobial combinations. As many as 16% of all HAIs were associated with the following multidrug‐resistant pathogens: methicillin‐resistant S. aureus (8% of HAIs), vancomycin‐resistant Enterococcus faecium (4%), carbapenem‐resistant P. aeruginosa (2%), extended‐spectrum cephalosporin‐resistant K. pneumoniae (1%), extended‐spectrum cephalosporin‐resistant E. coli (0.5%), and carbapenem‐resistant A. baumannii, K. pneumoniae, K. oxytoca, and E. coli (0.5%). Nationwide, the majority of units reported no HAIs due to these antimicrobial‐resistant pathogens.

You already have the bugs resistant in USA and Europe in 2007 and earlier. How come they are naming a new gene with similar resistance to antibiotics and name it after Indian city. why not name it after some goddamn contry or city in western world.

4) Was the superbug imported into India?

Out of the 37 samples collected in UK, only 17 samples had history of travel to India or Pakistan. So, a question arises as to where did the rest 20 people contract this superbug?

Suggestions that India is the fountainhead of this drug resistant bug are probably erroneous.

You read the above article (3)

Moving on to the other part: If medical tourism is to blame for the spread of this super bug, how come Rohtak, Guwahati, and of all places Port Blair, are home to the bug and find mention in the research? They are not certainly hot destinations for medical treatment.

"India is definitely not the source of origin of this so called superbug, it is omnipresent across the globe," Katoch said

Indian medical experts say the researchers may have flagged an important emergent problem, but to blame it on India's health system was stretching it too far. Health ministry is now planning to write a strong formal rejoinder to the journal refuting these findings

This is like -- put the blame on India and ask India to disprove it. Shameless B**st*rds.

SSridhar · Post by **SSridhar** » 15 Aug 2010 08:08

All authors approved the final version - claims Lancet

A day after reports on the superbug broke out in the Indian media, the lead author of the paper, Karthikeyan K. Kumarasamy of the Department of Microbiology at the Dr. ALM Post Graduate Institute of Basic Medical Sciences (PGIBMS), University of Madras, was quoted in a newspaper as saying: “I do not agree with the last paragraph which advises people to avoid elective surgeries in India. While I did the scientific work, [the] corresponding author Timothy R. Walsh of Cardiff University was assigned to edit the report.” He was quoted by another newspaper as explaining that “some of the interpretations” found their way into the paper “without my knowledge.”

His research guide and co-author, Padma Krishnan, was also quoted in the press as complaining that “the research was taken up in the interests of patient care, but the report has projected a negative image of India.”

This is a lesson for Indian authors. They must be more careful because even scientists and researchers in the Western world are adept at playing realpolitik. They have a holistic approach whereas we do not. Kapil Sibal must sensitize universities to this possibility.

krisna · Post by **krisna** » 16 Aug 2010 07:39

SSridhar wrote:All authors approved the final version - claims Lancet
A day after reports on the superbug broke out in the Indian media, the lead author of the paper, Karthikeyan K. Kumarasamy of the Department of Microbiology at the Dr. ALM Post Graduate Institute of Basic Medical Sciences (PGIBMS), University of Madras, was quoted in a newspaper as saying: “I do not agree with the last paragraph which advises people to avoid elective surgeries in India. While I did the scientific work, [the] corresponding author Timothy R. Walsh of Cardiff University was assigned to edit the report.” He was quoted by another newspaper as explaining that “some of the interpretations” found their way into the paper “without my knowledge.”

His research guide and co-author, Padma Krishnan, was also quoted in the press as complaining that “the research was taken up in the interests of patient care, but the report has projected a negative image of India.”
This is a lesson for Indian authors. They must be more careful because even scientists and researchers in the Western world are adept at playing realpolitik. They have a holistic approach whereas we do not. Kapil Sibal must sensitize universities to this possibility.

Agree with you. many of the Indian researchers are poorly aware of the final/end product of the all hard work. They work hard and do the work. manuscript writing is an art. many Indians are poorly equipped in it. In fact there should be taught about research and writing during their graduation days.
many of the youngsters today are aware but do not have the requisite skills in research.
Issue is also with the system(seniors like the teachers,guides, profs etc) who have limited exposure to this art. they themselves were poorly trained.
whatever it is -- a start has to be made asap so that in the coming years we have people better trained in these aspects.

vish_mulay · Post by **vish_mulay** » 16 Aug 2010 08:23

SSridhar, NDM-1 name appeared first in the 2009 paper mentioned in the news article. Just saw another article dated 10th Aug 2010 got published in Lancet (mentioned in one of the news articles posted here) and it deals with multiple isolates identified from India (Still labeled NDM-1). I will read it when I have time to digest it and put the critique. Quick glance tells me that they have identified multiple clusters indicating multiple origins of this resistance plasmid which refutes the whole origin in India theory but authors are still insisting on the name. Despite the politics, important thing to remember is we have India specific cluster i.e. we developed our own unique resistance plasmid in India due to indiscriminate use of antibiotics. I have still not ruled out the possibility that western patients might have brought this bug when they traveled to India but based on unique India specific cluster, it seems unlikely. I need to read this paper in details to understand how they define clusters.

Anyone who is interested in understanding this massive problem please read D Raghunath’s (Principal Executive, Sir Dorabji Tata Centre for Research in Tropical Diseases, Innovation Centre, Indian Institute of Science Campus, Bangalore) excellent article in Journal of Bioscience, 2008 (http://www.springerlink.com/content/h6w714mt43l5l33m/). I have PDF if anyone wants it or can’t access the paper.

Krishna has a point that western world is unethically targeting India but the fight is not who is blaming whom but how to control this mess (IMHO, and being argumentative SDREs everyone has their priorities). If you read D Raghunath’s paper it’s a good starter to understand the miserable situation we are in. He has also written an editorial about these problems in 2010 and he recommends specifically for India and I quote:

“
a. Spread the knowledge regarding antibiotics from authoritative sources rather than commercial pamphlets.
b. Standardize antibiotic resistance testing to ensure comparability.
c. Have mandatory institutional mechanisms to regulate antibiotic prescription and control drug resistance,
d. Have a national policy for treating community infections.
e. Establish a National Institute to study antibiotic resistance in the nation as a whole.”

I am not suggesting that India should be blamed alone for this mess. My point is that we have contributed to this mess and need to start putting our house in order. Just fighting western interest to erase NDM-1terminology alone will not solve our problems. We need to start thinking how to improve medical delivery system in India that utilizes the best practices world over. My 2 paisa. TIFIW.

vish_mulay · Post by **vish_mulay** » 16 Aug 2010 08:56

I have no ideal how the first author was not involved in paper writing. Even when the corresponding author has done editing, final proof has to be verified by all authors but especially the first author since paper is cited "first author" et al. I can spare KK Kumarsamy since this is his first publication (seems like since no other paper spouts out on PubMed) but his mentor should have taken care of these differences before it went for publication. We have first salvos fired here down under in the land of bogans about this mess. lot of people go to India for dental work. This might impact it.

SSridhar · Post by **SSridhar** » 16 Aug 2010 09:44

See the kind of scare it has already created among foreign patients in Chennai
As vish_mulay says, a lot of patients come here for dental works. Chennai's dental hospitals receive a large number of them.

Ever since the superbug scare began last week, Dr S M Balaji has been trying hard to calm down foreign patients who he has been treating as the director of Balaji Dental and Cranofacial hospital. “Should we get a superbug test done?” a patient called up and asked him on Sunday, while a few of them have mailed him seeking to know more about the whole issue and about their safety. All this when all of his patients are otherwise healthy after treatment.

sanjaykumar · Post by **sanjaykumar** » 17 Aug 2010 00:17

http://www.thestar.com/news/world/india ... s-in-india

Of course it helps that this patient is a nurse and is familiar with MRSA, VRE, ESBL etc

Ameet · Post by **Ameet** » 17 Aug 2010 01:48

Superbug fears not deterring medical tourists

http://www.cbc.ca/canada/calgary/story/ ... india.html

'I just believe it's not going to happen to me.'—Susan Nieboer, medical tourist

vish_mulay · Post by **vish_mulay** » 17 Aug 2010 07:31

http://timesofindia.indiatimes.com/indi ... 321245.cms

For a change Toilet paper is providing honest news about situation in India. The general apathy which we have needs a big jolt to function properly. I don’t know about rest of India but my home town Pune has major problem of malaria and dengue. In addition we have major outbreak of diarrheal diseases. This is a common picture around monsoon and getting worst each year. These diseases are preventable with better environmental management. To date, I have not heard any major program which is being implemented to control these diseases. I know lot of schemes which are on paper but do not exits on field. Such is the sorry condition of one of the progressive city in a prosperous state. Gods only knows what the situations are in other poorer states in India.

SSridhar · Post by **SSridhar** » 17 Aug 2010 10:01

We didn't meddle with the superbug study: Wyeth

Wyeth, one of the funders of the study on the emergence of the New Delhi metallo-beta lactamase (NDM-1) bacteria or the superbug, on Monday said it did not influence the independent investigator-initiated research studies or their conclusions.

Denying reports in the media suggesting that the firm might have influenced the study on “Emergence of a new antibiotic resistance mechanism in India, Pakistan and the UK: a molecular, biological, and epidemiological study” published in the online edition of The Lancet Infectious Diseases on August 11, the statement said the referenced article was a publication of independent research by a panel of international investigators, also funded by the Wellcome Trust and the European Union.

“This panel of investigators is the sponsor of this study. The article clearly acknowledges that funding agencies had no role in the study design, data collection, data analysis, data interpretation or writing of the report.”

SSridhar · Post by **SSridhar** » 18 Aug 2010 15:13

The 'superbug' fallout

With reports of the NDM-1 superbug getting stronger every day, India’s business from medical tourism looks set to take a serious dip, as per medical consultants and hospitals. If that turns out to be true, Tamil Nadu probably will take the biggest beating as its capital has been the city that hosts maximum number of medical visas.

The average number of medical visa cases that Chennai receives a month is 600, which is double the corresponding figure in metros like Delhi and Mumbai. In the case of Bangalore, it is 400.

Dr Mahesh Vakamudi, COO of the Sri Ramachandra Medical College, says his establishment is fearing the onset of a huge growth curb. This, when the number of international patients at the college hospital already crossed 300 this year as against 365 treated last year. “The figures were set to double this year, but the international media is hyping up the superbug issue in a way that our medical tourists figures will slow down for some time before the damaging reports die. In fact, I have been getting calls from my friends in the US to verify the truth behind the superbug report,” he adds.

Nakun Jain of Delhi-based Healthline India says they usually receive 20-30 queries a day from residents abroad, but lately the numbers have dropped by half.

Bharat Wankhede, CEO of Mumbai-based Med Access India, voices a similar concern. Wankhede’s firm was able to bring in 5,000 patients last year and had already brought almost 4,700 patients this year.

SSridhar · Post by **SSridhar** » 22 Aug 2010 09:54

The Stanley Hospital at Chennai to start hand-transplantation procedure

The Government Stanley Hospital in the city will launch a hand transplantation programme, Principal Health Secretary V.K. Subburaj said here on Saturday. Releasing the souvenir of the first Indian symposium on hand transplantation at a function organised by the Institute for Hand and Reconstructive Microsurgery of the hospital, he said the procedure was challenging, requiring a team of professionals from various disciplines. Only around 40 surgeries have happened world-over as it requires expertise from various medical specialities, he said.

The hand transplantation programme was aimed at the 3,000 to 4,000 persons in the State who have lost their hands in accidents, he said. A team of medical professionals from Stanley Hospital will go to the University of Pittsburgh to study the programme conducted there.

Hand Transplant surgeon Vijay Gorantla, who is associated with the programme in the University of Pittsburgh, is the chief faculty for the Indian programme.

SSridhar · Post by **SSridhar** » 24 Aug 2010 08:12

Child mortality under-estimated

Eight out of 10 people among the middle class do not know that nearly two million children under five die every year of diseases and conditions that are easily treatable and preventable, says a new survey.

One-third of all malnourished children live in India and 44 per cent of Indian children are underweight. More than two-thirds of the infants die in the first month and 92 per cent of these deaths are due to easily preventable diseases like pneumonia and diarrhoea.

While child mortality is undoubtedly still high in several pockets of India, some of the above statistics seem dubious to me.

SSridhar · Post by **SSridhar** » 26 Aug 2010 10:45

New Technique to Repair Corneal Damage developed at LV Prasad Eye Instt., Hyderabad

A new technique to grow stem cells on the eye itself, instead of in the laboratory, to repair corneal damage has shown promising results in a preliminary study.

Following remarkable success of the study conducted by the L.V. Prasad Eye Institute (LVPEI) here, it is now proposed to scale up the research project to provide further proof and scientific evidence. Once the proof of concept is established, the technique would revolutionise stem cell therapy for corneal damage and reach the masses at a drastically reduced cost, according to Virender S. Sangwan, associate director, LVPEI and head, cornea & anterior segment service.

He told The Hindu here on Wednesday that normally, the stem cells used in corneal treatment would be cultured in the laboratory after taking a small tissue from the eye of the patient.

The tissue containing the stem cells would then be grown in an amniotic membrane and the entire process would take a fortnight. Describing the new technique as simple, practical and effective, he said the natural environment of the eye would be used to grow the cells.

The lab-associated expenses of Rs.15,000 per culture for a patient would be eliminated. Besides, the patient would not be required to make a second visit for undergoing the procedure. He said that some private companies were charging Rs.45,000 per culture.

SSridhar · Post by **SSridhar** » 27 Aug 2010 13:07

From, 'This Day That Age' section of The Hindu dated Aug 26, 1960
Came at an apt time.

The Daily Express said on August 25 that British scientists have made a great medical breakthrough by developing a new drug, super-penicillin, which kills germs that have become resistant to ordinary penicillin.

I am sure the research into super-penicillin had been initiated at least 5 or 10 years before 1960. Obviously, Indian hospitals could not have been the cause for the resistance.

SSridhar · Post by **SSridhar** » 29 Aug 2010 10:14

Ambulances turn into delivery centres

Manjula’s story is not surprising, considering that 1,980 babies in Tamil Nadu have been delivered in ambulances run by Emergency Management and Research Institute-GVK, from September 2008.

More commonly known by the utility number they operate from, ‘108’ services employ paramedics (Emergency Medical Technicians) who are trained to handle deliveries and any emergencies, free of charge. EMT’s are trained specifically to handle natural childbirth at places such as the Institute of Obstetrics and Gynaecology in Chennai. The ambulances themselves are well equipped to handle a ‘complete delivery on the road’. Facilities include a delivery kit with everything from sterilised aprons to necessary knives, and even ‘warming spot lights’ to keep the newborns warm.

Raghavendra · Post by **Raghavendra** » 31 Aug 2010 08:52

India moves ahead with robotic revolution in surgery http://in.news.yahoo.com/43/20100830/86 ... revol.html

SSridhar · Post by **SSridhar** » 04 Sep 2010 04:50

Healthcare industry in Coimbatore has a huge potential

Coimbatore city's health care sector has the potential to see its annual turnover zoom to Rs 5,000 crore from the current level of around Rs 750 crore in two or three years if government joins hands with the industry in promoting the city

The city has also been witnessing a reverse-brain drain with doctors working abroad showing an interest in coming back to work here.

He said five doctors a month come back from countries like the UK, Australia (though reverse brain drain has not happened significantly from America)

krisna · Post by **krisna** » 07 Sep 2010 20:59

Japan confirms its first case of new superbug gene

Japan has confirmed the nation's first case of a new gene in bacteria that allows the microorganisms to become drug-resistant superbugs, detected in a man who had medical treatment in India, a Health Ministry official said Tuesday.

The man was hospitalized in April 2009 after returning from India where he had medical treatment. Nakajima declined to say what kind of treatment the man had received in India, citing the man's privacy.
The man had a high fever while staying at a hospital in Tochigi, north of Tokyo. He was discharged in October last year.
The hospital — Dokkyo Medical University Hospital — kept a preserved sample of the suspected superbug from the man. The hospital examined the sample after the Lancet report.
The Tochigi hospital notified the Health Ministry about the detection of the NDM-1 gene. It told the ministry that no in-hospital infections were found. Following the confirmation of the discovery — Japan's first NDM-1 case — the Health Ministry launched a nationwide survey, asking local health authorities to check on hospitals for evidence of more infections.

krisna · Post by **krisna** » 07 Sep 2010 21:49

Plan to take condoms to every home in India's villages

India's health ministry is preparing a plan to ensure the availability of condoms in each house of the country's six lakh villages in a bid to curb the population explosion, a senior official said Tuesday.

"Azad wants to take condoms to every home in the six lakh villages in India. He thinks that accessibility of condoms at the door-steps of the villagers would help control the population, which is projected to be 1.19 billion in 2011," the official said.

"A condom is needed when it is really required. The plan is being prepared keeping this thing in mind," he said.

An ASHA worker - primarily a woman resident of the village, married/widowed/ divorced, preferably in the age group of 25 to 45 years - is trained to work as an interface between the community and the public health system.
"An ASHA worker, who is a literate woman with formal education up to class eight, will be trained accordingly to spread the message of condoms to the rural households," the official said.

Azad had said India, the world's second most populous country, was against controlling population growth through legislation.
"I firmly believe that equitable, inclusive and sustainable growth of India depends on healthy and stable population. It is a matter of great concern and urgent steps need to be taken to stabilise the population for sustainable development," he said.

krisna · Post by **krisna** » 09 Sep 2010 05:16

Cabinet makes it patient-friendly, strict for trouts

The state cabinet, on Wednesday, amended the Organ Donation Act, making it more patient friendly but at the same time more stringent for the illegal trade of organs

The new amendment makes it possible for the second generation — grandparents and grandchildren to donate their kidney which was restricted to the first generation,” said Secretary, Medical Education, Milind Mhaiskar.

The punishment for organ trading hospitals and medical practitioners, has increased from a minimum imprisonment of two years to anywhere between five and seven years, with a fine of ` 5 lakh upwards.
Mhaiskar added that an amendment has been made to give impetus to relatives of ‘brain dead’ patients for encouraging them to consider organ donation. The current procedure is tedious and time-consuming with the law requiring a certificate from a neurosurgeon certifying the organs.
The proposed amendment says any surgeon can certify it, which makes the procedure simpler.

could'nt it be better saying any 2 competent doctors well versed in it diagnose brain dead.

krisna · Post by **krisna** » 10 Sep 2010 01:42

Reverse shoulder surgery performed at Lakeshore

South India’s first reverse shoulder surgery was performed on a patient with a crippled hand, enabling him to live normally, six weeks after the surgery was conducted.

Lakeshore orthopaedic surgeon Dr Jacob Varghese and his team of surgeons successfully corrected a shoulder that suffered irreparable rotator cuff tear and which was previously operated with a failed surface surgery. This was done by replacing the joint with the help of Delta reverse shoulder for the 72-year-old patient.

The reverse shoulder surgery provides improved function and pain relief by replacing the worn-out joint surfaces with an artificial joint made of metal and plastic.

joshvajohn · Post by **joshvajohn** » 11 Sep 2010 00:15

Global Fund seeks India's support for health spending
http://www.thehindu.com/news/national/article623684.ece

Shankar Acharya: India's health
http://www.business-standard.com/india/ ... th/407395/

joshvajohn · Post by **joshvajohn** » 13 Sep 2010 14:02

Right to health, medicine to be protected at all cost: Scindia
http://economictimes.indiatimes.com/new ... 334100.cms

Right to health
http://www.ohchr.org/Documents/Publicat ... heet31.pdf

In a first, Assam to guarantee right to health
http://timesofindia.indiatimes.com/indi ... z0zOkEerWH

Get the basics right
http://www.deccanchronicle.com/dc-comme ... -right-257

It is essential for India to think about right to health for all. It does not cost as right to food. Rather it gives some basic protection for everyone the right to treatment and so on. In India already the government medical hospital services are free. But this amendment may help in order to keep some medicine companies under control.

joshvajohn · Post by **joshvajohn** » 15 Sep 2010 00:24

An Indian health-care model
http://sify.com/finance/an-indian-healt ... cijbi.html

I wonder whether private agencies can be allowed to develop this rural medical services. On the one hand private companies and agencies can be allowed for training in nursing which is already happening in many parts of India. If we are increasing the number then quality control of training should be in place. Besides nursing and dental training the private medical colleges offering medical degrees such as MBBS should be allowed if the standards are good and high. Such investment certainly would lead to a large number of doctors being produces. This might enable many to go to rural areas as the competition in urban areas will be very high. Also medical doctors would have to compete for good service and name and thus good practitioners would suvive and all the illegal ones would slowly disappear.

krisna · Post by **krisna** » 15 Sep 2010 01:22

Number of abortions dropping in India

- in 2008, India saw 6.41 lakh abortions across 12,510 institutions, approved to carry out MTP.

India recorded 7.25 lakh MTPs in 2005, 7.21 lakh in 2006 and 6.82 lakh induced abortions in 2007

Union health secretary K Sujatha Rao told TOI, "We have been working with doctors to better train them in techniques of abortion so that MTPs can be made safer. At present 8% of maternal mortality in India is due to unsafe abortions. So reduction in abortion numbers as a whole will automaticaly decrease mortality figures also."

declining trend, good work but still a lot to be done.

praksam · Post by **praksam** » 19 Sep 2010 05:13

After all seems like it was plain propaganda.

SUPERBUG: NEITHER SUPER NOR A BUG

http://news.discovery.com/human/superbu ... hreat.html

"Calling it a superbug doesn't quite make sense," said Stephen Calderwood, chief of the infectious disease division at Massachusetts General Hospital in Boston, who recently treated someone with the infection. "It is highly resistant, but it doesn't make someone more sick. And as far as we know, it doesn't more easily go from one person to another."

Ameet · Post by **Ameet** » 20 Sep 2010 21:16

To India, for a new heart

http://www.startribune.com/lifestyle/he ... nchO7DiUss

Lemmer, of Prior Lake, walked alone through a gentle rain to a private hospital and became what is thought to be the first American recipient of a heart transplant in India.

In Minnesota, Lemmer lives within a 90-minute drive of three world-class transplant centers. But this year he defied his hometown doctors to join the growing ranks of "medical tourists" seeking donor organs in the world's poorest countries.

The surgeons, who had trained in England, said he might get a new heart in as little as two weeks, he said. It would cost $65,000 in cash (about a tenth of the cost in the United States) plus living expenses.

They learned that Indian nationals get priority over foreigners for donor hearts. But as a practical matter, poverty limits demand -- Indians, too, must pay cash, and most can't afford transplants.

Before he left, Lemmer paid a visit to an ashram, or Hindu temple, in the donor's home town. "He told me," said Shelly, "that he wanted to bring that young man's heart home one last time."

vish_mulay · Post by **vish_mulay** » 21 Sep 2010 07:28

http://sify.com/news/india-doing-well-i ... cdjff.html

India doing well in reducing maternal mortality: UNICEF
'India ranks 25th among the countries in terms of percentage decline in maternal mortality rates, reducing it by 59 percent since 1990. There is no dispute that India has done well in reducing maternal mortality,' Unicef Chief of Communication in India Angela Walker told IANS.

Update
http://www.google.com/hostednews/afp/ar ... UqaFfXmKxw

Rights group accuses India over maternal health

MUMBAI — A leading rights group has accused India of hoodwinking the public over its claims of improving maternal health, as renewed efforts began at the United Nations to cut global poverty.

Human Rights Watch said the government in New Delhi was wrong to focus on the number of women who give birth in health facilities as a measure of progress rather than how many survive the delivery and post-delivery period.

The group's Asia women's rights researcher, Aruna Kashyap, said in a statement Monday that the authorities were "playing number games with women's lives" and "dangerously misleading the public".

Reducing maternal mortality is the fifth of the eight Millennium Development Goals adopted by world leaders in 2000 and set to be achieved by 2015

SSridhar · Post by **SSridhar** » 22 Sep 2010 08:57

Ameet wrote:To India, for a new heart

http://www.startribune.com/lifestyle/he ... nchO7DiUss

That article brings out all the stereotypical and condescending mindset that we have to frequently tackle.

"There's a reason that everyone in the world wants to come to the U.S. for their medical care, and not the other way around," said Dr. Nader Moazami, director of Abbott's heart transplant program.

There are few operations more complex than this one, he said in an interview, and success depends on a lot more than the quality of the surgeons. In this country, he said, an elaborate system makes sure the donor's family gives consent; that the organs are tested for infections and disease; that they're safely transported, and that the recipient is properly prepared, cared for and closely monitored.

"This whole process requires a village," Moazami said.

This was the Abbot's Heart Transplant Group's director's opinion before the patient went to India for surgery. After he returned from a successful surgery in India, the same Dirctor said

"I hope people don't get the impression that they performed a miracle in India," said Moazami.

sivabala · Post by **sivabala** » 22 Sep 2010 09:07

^
Happy to know that such surgeries are becoming routine affairs.
Another thing to note is the heart donor is 36 yrs old but the receiver is 65 yrs old. So, is the transfer ethical? Did the doctors even try to find an younger patient to receive the heart? Or the pvt. hospital let the foreigner get a heart because he could pay? There may be valid reasons for the transfer happened, which was not listed in the article. Anyway that's something that needs to be verified.

SSridhar · Post by **SSridhar** » 22 Sep 2010 09:51

The TN Government has issued G.O.s on the procedure to be followed and there is also an organ transplant registry maintained at the Government General Hospital whose coordinators coordinate all activities.

The part of the G.O. for Heart Transplantation is as follows

IV. PROCEDURE TO BE ADOPTED FOR CADAVER TRANSPLANT BY THE GOVERNMENTAND PRIVATE HOSPITALS APPROVED FOR ORGAN TRANSPLANT BY THE APPROPRIATEAUTHORITY

G.O.No.287 dated 05.09.2008

1. Hospitals to upload waiting list of prospective cadaver organ recipients through an online form to a computer database
2. Maintained by the Transplant Coordinator of the Government General Hospital,
Chennai. (Convenor, Cadaver Transplant Program, Tamil Nadu)
3. NGOs to assist in maintaining database
4. Database will maintain prioritization lists for
1. each hospital
2. for all Government hospitals combined
3. for all private hospitals combined and
4. for Government plus private hospitals combined
Each hospital will have its own waiting list for each organ, which will include the date of registration.
5. An individual can be registered through only one hospital at a giventime. Original date of registration will continue to apply even withhospital change Organs will be shared in the following manner:
1. A multi organ recipient takes precedence over all others on the regular waiting list.
2. Potential liver recipients
1. URGENT
- Hepatic Artery Thrombosis following a liver transplant.
- Primary Non function of a graft
- Fulminant hepatic failure.
These conditions do not require a waiting time on the list.
2. STANDARD
- Patients on the standard list have to be registered for more than 24
hours to be listed in this category.
The Liver is to be allotted to participating hospitals in turn.
Note: Patients on the urgent list supersede the standard list
and the hospital misses its regular turn on the rota. Potential heart recipients
3.
1. URGENT:
1. Patients with Left Ventricular Assist Device (LVAD).
2. Followed by patients with Intraaortic Balloon Pump
(IABP)
2. STANDARD: Sick, but stable patients waiting at home for a
heart transplant.
A Heart is to be allotted to participating hospitals in turn.
4. Likewise for lungs, prioritization would be made according to the
urgency of transplant and allotted to participating hospitals in turn.
5. For kidneys no out of turn allocation would be permitted and the
sharing criteria in the following para shall be followed.
6. Sharing of Organs for waitlisted recipients, retrieved from cadaver
donors in Government Institutions:
1. First priority to the list of the Government Hospital where the
deceased donor is located, for liver, heart and one kidney. The other kidney
2. would be allocated to the general pool in the priority sequence as listed below. Combined Government Hospitals list
3. Combined Private Hospitals list
4. Government Hospitals outside the State(in order to maximize organ utilization)
5. Private Hospitals outside the State
6. Fforeign national registered in a Government or Private hospital within and then outside state.
7. Sharing of Organs for waitlisted recipients retrieved from cadaver
donors in Private Hospitals, which are transplant centers.
1. First priority to the list within the Private Hospital where the
deceased donor is located, for liver, heart and one kidney. The other kidney
would be allocated to the general pool in the priority sequence as listed below.
2. combined list of Government and Private Hospitals.
3. Government / private hospitals outside the state
4. Foreign national registered in Government or private hospital within and then outside the state
8. Whenever a deceased donor becomes available in a hospital, the
concerned hospital shall contact the Transplant Coordinator or a member of
his team at the Government General Hospital, Chennai who will then make
allocations based on the above. MOHAN Foundation and National Network for
Organ Sharing, (NNOS), NGOs promoting organ transplantation may assist
the Transplant Coordinator.
9. Advisory committee will work on
1. establishing formats and procedures for recipient listing, organ
allocation and transfer
2. coordination between hospitals where donor / recipient are
located
3. Forming a coordinating body that would be
institutionalized and fine-tuning identification criteria to
determine the beneficiaries-
4. Proposing policy initiatives from time to time.
5. Monitor working of the cadaver organ
transplantation program,
10. Advisory committee shall be headed by the Secretary, Health or
his nominee as Chairman and the committee shall consist of:
1. Secretary, Health or his nominee-Chairman
2. Convenor, Cadaver Organ Transplant Program,
Tamil Nadu (i.e Transplant Co-ordinator,
Government General Hospital, Chennai.)
3. Director of Medical Education or preventative
4. Director of Medical and Rural Health Services or representative
5. Transplant team member, Government Stanley Hospital, Chennai
6. Transplant team member, Kilpauk Medical College Hospital,
Chennai.
7. Transplant team member, Government General Hospital. Chennai.
8. One senior police officer of DIG rank or above as nominated by the
Director General of Police, Chennai.
9. Member from MOHAN Foundation, Chennai.
10. Member from National Network for Organ Sharing, (NNOS)
Chennai.
11. One transplant team member from three different hospitals that
currently have largest cadaver donation experience.

V. RESPONSIBILITIES OF TRANSPLANT CENTRE HOSPITALS
G.O.No.288 dated 05.09.2008

Transplant surgery records for a minimum period of ten years.

Availability of a counseling department with trained personnel. Assist in pre- and post-operative counseling.

Designate in-house person as Transplant coordinator.
Coordinates matters relating to organ transplant on behalf of the hospital.

Media publicity not to be sought earlier than the date of discharge of recipients.
Positive aspects of organ donation may be highlighted to promote the cause of organ donation.

Details of the recipient and ethics of the medical profession not to be compromised.

Approximate cost of a transplant surgery to be displayed on website ofhospital and the website designated for this purpose by the HealthDepartment.