FROM THE PRESS
No safety in nuclear medicine
The Atomic Energy Regulatory Board inspected 28 of
the 117 nuclear medicine units in India -- and has noted safety violations in
each of them. Chairperson Dr K S Parthasarthy said the violations caused
concern.
Some transgressions observed: workers did not use
personal dose meters; they worked without gloves, thus contaminating their
hands; they smoked and ate within the facilities; waste was disposed of in a
cardboard box instead of the recommended foot-operated waste bin;
radiation-measuring equipment was faulty, as was the process of isolating
patients after treatment. The clear lack of a safety culture and tendency to
ignore precautions could lead to more serious violations.
The application of
nuclear medicine in India is modest (160 nuclear medicine physicians and 220
technologists) compared to the US (over 2,700 physicians and 14,000
technologists). But safety is should still be a high priority, particularly with
the doubling of units in the last two decades.
Times News Network. N-medicine units are
violating safety norms. The Times of India, April 25, 2002.
Delayed emergency care
Twenty-nine-year-old Kaberi Roy died 24 hours after
a 'successful' appendicitis operation. Her parents have filed a criminal case
blaming Dr B L Chitlangia and his associates at Bombay Hospital for medical
negligence. They hold that had their daughter would have survived if she had
been operated upon promptly. She was operated upon 15 hours after her emergency
admission.
Dr Chitlangia admits that the cause of death is not
known but holds that the surgery was done properly. He denies a delay in
surgery, saying the wait was for appropriate medical reasons.
Manju Mehta. Family blames Bombay Hospital for
death of daughter after surgery. The Times of India, July 12,
2002.
The doctors of tomorrow
A first-year MBBS student at Jawahar Lal Nehru
Medical College in Raipur was stripped and made to run naked through the college
complex for wearing coloured trousers, a violation of the dress code for junior
students. Following a complaint by the student's father, Raipur police arrested
two of the accused students. A third is absconding. All three have been expelled
from the college hostel (but not, apparently, the college). The director of
medical education, Dr R C Bhola, says, "I have asked the dean of the medical
college to submit a detailed report. We will take appropriate action."
Express News Service.MBBS student stripped, made to run naked. Indian Express, July 25,
2002.
Regulating medical devices
A special body is needed to regulate the use of
medical devices such as those for laser surgery, said Dr RB Vajpayee, professor
of ophthalmology at AIIMS. In the absence of such a system, such devices may be
misused. Dr Vajpayee conducted a study which concluded that the use of the lasik
laser for correcting eye defects, may be inappropriate for many Indians because
they have smaller corneas on an average. This can result in complications if
adequate screening precautions are not taken.
Times News Network. 'Body needed to regulate
use of medical devices needed'. The Times of India, August 7, 2002.
Regulating infertility treatment
The Indian Council of Medical Research has unveiled
draft guidelines to regulate infertility treatment in India, prompted by
concerns about unethical practices in infertility clinics.
The guidelines specify infrastructure requirements
and a code of practice for infertility clinics, as well as additional training
for gynaecologists who specialise in the treatment of infertility through
assisted reproductive technology. The council has also proposed the creation of
a government agency to license infertility clinics and ensure that they adhere
to standards. The agency would also have the power to fix the upper limit of
charges for gamete donation and surrogacy.
The council's draft guidelines will be debated over
the next three months, after which a final version will be sent to the
government for legislation.
Ganapati Mudur. India considers government
agency to license infertility clinics. BMJ, September 14, 2002.
Privileged postings
An enquiry by the Mumbai Municipal Corporation has
found that an estimated 1,200 civic medical practitioners in the city manage to
retain their posting beyond the stipulated three years. A massive transfer drive
is planned to rectify the situation.
Abhishek Sharan. Civic body raps errant doctors
for overstaying. Indian Express. October 7, 2002.
What ban?
The Supreme Court directed all states and union
territories to take action against clinics advertising sex determination tests
in violation of the law. Meanwhile, in Dharwar, Karnataka, the state health
department seized two mobile diagnostic machines. These were being used to
conduct sex determination tests for between Rs 100 and Rs 1,000, followed by an
abortion if the foetus was female. PTI. SC calls for immediate action against
sex-test ads.
Indian Express, October 8, 2002. Seethalakshmi
S. Female foeticide as 'killers' change base. The Times of India, November 7,
2002.
Boys will be boys
Over 100 students from the B Block hostel of BJ
Medical college in Ahmedabad representing the North Gujarat lobby and
traditional fiefdom of former MCI president Ketan Desai broke into the rival A
block armed with steel pipes, tubelights and other weapons. They were
celebrating reports that Dr Desai was to be exonerated of corruption charges.
They injured at least 10 students in the attack, two critically.
The injured doctors chose to be treated in a
private hospital rather than the Civil hospital where they did not feel safe.
Eye witnesses said the perpetrators included Deepak Limbachiya, now an assistant
professor.
Times News Network. Ex-MCI chief's backers
split heads in Gujarat hospital. The Times of India, October 26,
2002.
Free samples
A British and German genetic study that analysed
material from people in Kerala has renewed a debate on the need to regulate the
flow of human biological material from India. The study analysed DNA from
saliva of 988 healthy people from a coastal region in Kerala with the world's
highest levels of natural radiation. Indian scientists ask how the researchers
took samples out of the country without approval, reiterating concerns that
India's diverse population might serve as a source of valuable genetic
information with potential commercial value. Guidelines introduced in the late
1990s permit export of biological material for research only with approval from
the health ministry.
The UK researcher, Dr Peter Forster, said informed
consent was obtained from the volunteers and the university's ethics committee
had approved the study. He added that the study had no commercial application.
Ganapati Mudur, Indian scientists object to
export of human biological material for research. BMJ, November 2, 2002
Trial subjects or guinea pigs?
As foreign pharmaceutical companies target India
for 'cheaper and faster' clinical trials, how are research subjects protected
from harm during such trials? There are many mechanisms - but most of them don't
do what they are supposed to do.
The Indian Council of Medical Research guidelines
are not necessarily enforced. Once a research project gets ethical approval,
there is no authority to monitor the research to ensure that it is carried out
ethically.
EC members are often handpicked by those who have
an interest in the trial, says Dr Sanjay Nagral, member of the Forum for Medical
Ethics Society in Mumbai.
Companies pay volunteers; a drug company recently
paid Rs 2,000 to volunteers for an anti-rabies vaccine trial at the Haffkine
institute, notes Dr SM Sapatnekar, director of the Haffkine Insitute. Such
amounts will surely influence the 'informed consent' of poor and amount to
inducement.
Drug companies also 'donate' research equipment to
institutions conducting trials - which is bound to colour the result of
research.
Deepa A. 'Give medical councils more powers to
regulate clinical trials'. The Times of India, November 7, 2002.
Premarital HIV mandatory
Even as the Maharashtra government ruled out
mandatory HIV tests before marriage, village elders of Hivare Bazar near
Ahmednagar, Maharashtra, have decreed that any outsider planning to marry
someone from their village will have to be tested for HIV beforehand. If the
gram sabha approves this proposal, it will be enforced from next
April.
State health minister Digvijay Khanwilkar recently
stated that mandatory tests would add to the social and ethical problems
associated with the disease, and a law to this effect would be in violation of
NACO guidelines.
Siddhartha D Kashyap. Village all set to make
HIV test mandatory. The Times of India, November 3, 2002.
Public gives up on the medical council
The Maharashtra Medical Council has never been more
efficient than over the last three years after it was taken over by a court
administrator following allegations of bogus voting. The backlog of csses is
being tackled, hearings are held and judgements handed out. But the number of
complaints has dropped sharply, says Dr S M Sapatnekar, the court-appointed
administrator. The widespread perception that the medical profession is
unethical should have led to an increase in complaints, but the MMC's reputation
is such that the public no longer considers it the appropriate forum for
redressing grievances against doctors.
Rekha Dixit. Medical council battles to salvage
its pride. The Times of India, November 11, 2002.
Professional colleges must charge fees to
all
An eleven member Constitutional bench of the
Supreme Court ruled that there will be no more 'free' or 'payment' seats in
medical, engineering and other professional colleges in the country. Fees will
be uniform for all students in any particular college, though they may differ
from area to area depending on the costs incurred by the college.
The bench held as unconstitutional the scheme
framed by a two-judge bench in 1992 fixing 'free', 'payment' and 'management
quota' seats while admitting students in professional educational institutions.
That scheme was framed to check capitation fees. The bench held to "the
principle that there should not be capitation fees".
Manu Desai. No more 'free' and 'payment' seats
in professional colleges? Bombay Times. The Times of India, November 13,
2002.
Medical tourism, brain drain
With an estimated shortfall of 20,000 nurses in the
UK and US, Indian health care majors have jumped into the fray with services to
train and place Indian nurses in hospitals abroad. Already, reputed hospitals
lose 20-25 per cent of their nurses to hospitals abroad, usually in the Gulf.
This will soon include the UK and US, said Dr Arti Verma of Max Health Care.
At the same time, medical tourism is predicted to
double in the next few years as health services in India are a fraction of what
they cost in the West. Apollo hospital gets 10-11 foreign patients every month.
Five to seven per cent of Escorts' patients are from abroad. Though most of the
traffic is from West Asia, south-east Asia and Africa, "We are talking to
international health insurance companies so our hospitals are recognised and Non
Resident Indians can combine their treatment here with family visits," says Dr
Yogi Mehrotra of Indraprastha Apollo hospital.
Sujata Dutta Sachdeva. Wanted abroad: Florence
Nightingales. The Times of India, November 17, 2002.
Will a code result in responsible
advertising?
The Organisation of Pharmaceutical Producers of
India has unveiled the code of ethics for advertisement of drugs. The object of
the code is to ensure responsible advertising in promoting medicines which may
be purchased by the public without any prescription and for which therapeutic
claims are made.
In his address on understanding the Indian consumer
the managing director of Morepen Ltd emphasised the role of the housewife in
household drug purchases. He described the company's concept of a housewife's
'pitara' which consists of a number of OTC drugs and also some ethical drugs
stored for self-mediation. The latter have generally been bought after the first
prescription has been made by the family physician. The executive director
(consumer pharmaceuticals) of Johnson & Johnson, USA, said the Asia-Pacific
OTC market was valued at $ 15.1 billion in 2001. The varying sizes of OTC
markets in different countries were determined by purchasing power, awareness,
definition of OTC, competition, government regulation and cultural differences.
"Self medication is accepted as part of treatment options in health care in this
part of the world."
Express News Service Economic Bureau. Code of
ethics for ads on drugs unveiled. Indian Express, November 20, 2002.
Elections IMA style?
The president elect of the Indian Medical
Association, Maharashtra, Dr Dilip Guha, has ordered an inquiry into allegations
of bogus voting during its annual conference in Sangli. Two voters, who were
registered as doctors from Mumbai, stated under interrogation that they were not
doctors but had come to vote for Dr Vasant Shenoy, general secretary of the
Mumbai suburban west branch. Dr Shenoy said he had nothing to do with the two
men. After this incident came to light Dr Guha received other similar
complaints. Sources said many doctors aspired to become office-bearers of the
IMA because of the money associated with pharmaceutical firms that sponsor
events. The IMA has a membership of 1.5 lakh doctors in India.
Times News Network. Probe ordered into IMA
polls. The Times of India, November 23, 2002.
Public services do better
A survey of patient satisfaction at the King Edward
Memorial Hospital in Mumbai, the city's largest public hospital, found that not
only were the majority of patients satisfied with its services, they also rated
the hospital better than private clinics they had attended before admission to
KEM.
Seventy per cent felt doctors gave good treatment
though they did not communicate enough and other staff were unhelpful. Many felt
post-operative care was poor. The food was okay but bed linen was inadequate and
the toilets dirty. People had to wait for tests and treatment, and were
not informed of delays. Even subsidised services were too expensive. Over 90 per
cent were unaware that a grievance cell existed in the hospital.
Dr Arun Bal of ACASH says the survey demonstrates
the need for public hospitals. Dr N Kshirsagar, dean of KEM
hospital, said the survey has led to some changes but much of the problem lies
in money shortages. The hospital needs Rs 9 crore annually but gets only Rs 3
crore.
Rekha Dixit. KEM services better than private
clinics, says survey. The Times of India, November 23, 2002.
Kerala doctors strike
On October 1, 2002, doctors all over Kerala
responded to a call by the Indian Medical Asociation, Kerala State Branch, to
strike in protest against the increasing attacks on doctors and hospitals.
At the Emergency State Working Committee meeting in Guruvayur, IMA Kerala State
president Dr PT Cheriyan announced that the strike call was binding to all IMA
members and that anyone defying the IMA's directives would be seriously dealt
with. Landmark strike by the doctors of Kerala state. IMA (Kerala state branch)
Newsletter, Number 54, October 2002.
Guidelines for the drug industry The US government
has issued a Compliance Program Guidance for Pharmaceutical Manufacturers to
control drug company handouts to the medical profession. The recommendations,
however, are voluntary. Compliance Program Guidance for Pharmaceutical
Manufacturers can be read atwww.oig.hhs.govCharles
Marwick. US tackles drug company gifts to doctors. BMJ, October 12,
2002
The IMA and the kidney trade A close look by The
Hindu at an inquiry report by the Indian Medical Association, Kerala branch,
seems to have dug up a can of worms. The reports appeared between October 25,
2002, and December 2, 2002.
The IMA inquiry into the kidney transplant racket
in the state concluded that money did change hands between kidney donor and
recipient - but that doctors and hospitals knew nothing about it. Apparently the
doctors were earnest but innocent.
The report documented irregularities in various
hospitals but pardoned them. It referred to a person who complained that he was
coerced into handing over his kidney but did not investigate it further.
Investigations revealed that the IMA's report
findings were diluted before being made public. This was done to let guilty
doctors and hospitals go scot free.
The original report included a complaint that a
kidney was extracted from a pregnant woman with a six-month-old child. She
underwent an abortion and five days later she was certified fit for surgery by a
gynaecologist, AM Indira. Her kidney was removed one month later. The original
report also noted that at some hospitals, money for the kidney sale would be
kept at the hospital cash counter for safe custody.
Senior doctors in Kerala issued a statement
condemning the IMA for its refusal to hold the medical profession accountable
for its involvement in the kidney trade. The People's Health Movement, a
people-oriented global initiative, expressed concern over the illegal trading of
kidneys in Kerala and the effort of the professional body of doctors to protect
the culprits.
HIV: blood donors to be informed
India's health ministry announced that blood donors
found to be HIV positive would be told of their infection and asked to seek
confirmatory tests and counselling. This will end the existing policy in which
blood infected with HIV is discarded without repeating the test and without
informing the donor. India's blood banks have been screening blood for HIV since
the early 1990s, but health officials say donors could not be informed because
of a lack of infrastructure for counselling.
The health ministry has announced a plan that seeks
to introduce an accreditation scheme for blood banks to achieve required quality
standards by March 2003.
Ganapati Mudur. India announces plan to
inform HIV infected blood donors. BMJ December 14, 2002.
