Author: Dr Pankaj Kumar

I’m Dr Pankaj kumar, I entered medical school in 1984. postgraduate Int med 1994 and diploma Heath Management. presently a critical care specialist

Health policies to cover mental illness: Insurance regulator IRDAI issued a circular directing insurers


Insurance regulator IRDAI on Thursday issued a circular directing insurers to cover mental illness, which has reached serious proportions in the country. The Mental Healthcare Act, 2017 — which came into force from May 29 — has made it mandatory to provide “for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”. But to date, none of India’s 33 insurers has introduced a product that covers ailments such as depression, schizophrenia, and bipolar disorder, even though such covers are commonplace in many countries. The IRDAI order says, “All insurance companies are hereby directed to comply with the…provisions of the Mental Healthcare Act, 2017 with immediate effect.”

“This will ensure a life of dignity to those who have mental health issues. We believe it will create awareness, acceptance, and inclusion of mental illness as any other physical ailment. It will ‘normalise’ diagnoses, by reducing associated myths and stigma. Today, no one can say we won’t cover cancer, tuberculosis or heart attack. So why do we have this block towards covering mental health issues? They are just as debilitating and corrosive to a person’s well-being as physical ailments.”

Mental health conditions have always been in the list of exclusions of health insurance policies. The only exceptions to this have been the coverage of development conditions such as autism and Down’s syndrome by the National Health Insurance Scheme, and a few private schemes like Star Health Insurance’s cover for autistic children. Companies wishing to include mental health coverage will have to file a fresh product with the IRDAI, or add this to an existing product and file again. “They have to revise the rates, look at the actuarial risk, increase premium if need be. So far, no insurance company has filed for such a change with the regulator,” said a government official .

“At the lower end you have anxiety and depression. At the upper end there’s obsessive compulsive disorder, bipolar, borderline narcissistic personality disorder. We should first cover the lower end. It does seem harsh to tell a person we can’t cover you, when they are already depressed,”

It is uncharted territory. There are two coverages needed: First, OPD cover for therapy, consultation and drugs. Second, hospitalisation or rehab, which would be long-term and expensive. In western countries, both are covered. But in India, it is untested ground.

Source. Times of India

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Report finds hazardous chemicals in crayons: may cause breathing difficulties and cancer in kids


The innocuous looking items of daily use may contain hazardous chemicals. Unless these items are honestly checked and contents known, any of these can be dangerous. Users are usually unaware of the complex risks associated with simple items. Here are examples of crayon and water bottles containing dangerous chemicals.

  • The US Public Interest Research Group has just released its annual back-to-school report 
  • It found trace amounts of asbestos in Dollar Tree’s Playskool crayons
  • Asbestos has been linked to mesothelioma, a potentially deadly cancer of the lungs’ lining
  • Scientists are unsure if the chemical is in the crayons’ wax or paper wrappers
  • Carcinogenic chemicals were also found in one brand of binder and two kinds of dry erase markers 
  • Lead was once again found in two previously recalled water bottles  

 

Researchers found trace amounts of the toxic mineral in Dollar Tree’s Playskool crayons, and toxins in at least three other products.

Asbestos is a well-known carcinogen that has been blamed for thousands of cases of mesothelioma.

Just three years ago, low levels of the harmful substance were found on not one but several major brands of crayons – including Crayola and Rose Art – but one brand still could pose a risk to young children.

The US Public Interest Research Group (PIRG), which just released its report of toys and school supplies, says that finding asbestos in only one crayon brand is progress – but several other back-to-school basics may still be unsafe.

Playschool crayons, were found to contain trace amounts of asbestos, a chemical known to cause mesothelioma, a cancer of the lining of the lungs

Mass production and plastic help to keep back-to-school expenses to a minimum, but parents still need to be cautious of what products end up in their children’s backpacks.

Without fail, a number of products make it onto the PIRG’s naughty list each year.

Crayons are chief among these.

Trace amounts of asbestos fibers frequently find their way into the coloring tools, which are marketed as being made for small children.

Waxy crayons are not sharp and break easily, so they pose a somewhat lesser risk of stabbing, scratching and choking incidents when in the hands of tots.

But somehow, asbestos commonly finds its way into the products, though the US Consumer Product Safety Commission (USPSC) has yet to work out whether that danger comes from the wax itself or crayons’ paper wrappers.

Tiny, fine asbestos fibers can get lodged in the lining of the lungs, where they corrupt cells and can lead to breathing problems and cause a high-fatality cancer, mesothelioma.

The naturally occurring mineral is fire resistant and impervious to damage from many chemicals.

This discovery led to its inclusion in household insulation and many products beginning in the 1850s. But as early as the 1920s, scientists noticed a trend in early cancer deaths among those who were frequently exposed to the material.

By the 1980s and 1990s it was solidly linked to mesothelioma and banned in many countries, including the UK.

The US stopped short of outlawing asbestos, however, and trace amounts of the tightly controlled chemical still appear periodically in certain products and places, though it is now disallowed from school buildings.

But the new report suggest that while the school structures may be certifiably safe, asbestos could be sneaking in with school supplies.

Crayons are in many ways ideal implements for young children because children under-fives who tend to use their entire arm when they color.

Public Interest Research Group also found phthalates – chemicals linked to asthma, obesity and reproduction issues – in Jot Binders and carcinogens in Expo white board markers

And, worst comes to worst, if a child does decide to turn his artistic instrument into a snack, crayons are fairly non-toxic.

That is, when they don’t contain asbestos.

Dollar Tree spokesperson Randy Guiler told Daily Mail Online that the company was ‘aware of the report,’ and has since’re-verified that each of the listed products successfully passed inspection and testing.’

The product safety group also found worrisome chemicals in three ring binders, dry erase markers and two water bottles that had previously been recalled by the USCPS.

Phthalates were found in Jot binders, also sold at Dollar Tree. This set of chemicals helps to give plastic products their flexibility.

There is still some uncertainty surrounding the health effects of phthalates, but scientists have found possible links between the chemicals and everything from asthma to obesity, low IQ to reproduction issues.

Both the LL Bean GSI Outdoors Children’s Water Bottle and the Reduce Hydro Pro Furry Friends bottles, had previously recalled for their high lead contents. The PIRG’s report warned that they still do, and can still be purchased.

The health effects of phthalates are still not entirely clear, and exposure happens when people drink or eat something out of a plastic container that contains the chemicals, so as long as children are not licking their binders, the risk is probably low.

In addition to these products, Expo’s dry erase markers, as well as those made by The Board Dudes were found to contain several carcinogenic chemicals, including benzene, xylene and toluene. 

Two children’s water bottles were found to still be on the market and still contain dangerously lead, even after the USCPS recalled the two products.

Though the notion of toxins in products made specifically to be safe for children is unsettling, this year’s list of dangerous back-to-school products is encouragingly short.

Source

 

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Real failures of Dr Hazida Bawa case: Five issues to ponder-why doctors suffer?


 The case of  Dr Hazida Bawa  is of importance worldwide in many ways, an opportunity  for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in medical treatment, especially in difficult situations. Every one has sympathy for the deceased, but  to blame a human factor, doctors should not be presented as sacrificial lambs.

       The current verdict is nearer to reality and away from a feeling of revenge and harsher penalties. It  gives a hope  that now there will be  acknowledgement of the difficult circumstances and limitations of medical system in health care environment.  To make doctor scapegoat for the  system limitations, poor prognosis or severe disease may be satisfying for some but not sensible. In this case doctors lodged their protest, collected money for lawsuit and the decision was re-looked legally. But every  doctor may not be  lucky enough and may have to suffer  in silence.

 Real failure in this case will be ignoring the factors that actually cause huge suffering for doctors-

  1. Presumptive failure by retrospective analysis: Retrospective analysis of any treatment will always show few things at hindsight that could have been done and would have proved life saving.  One may presume that omission or commission  of certain actions during treatment would have saved the  life,   but one can’t be sure whether these additional presumed treatment would really have benefited the patient.  Therefore a  perception-reality gap is created and with  negative perception towards doctors, it is interpreted as a  failure of doctor merely on presumptive basis and hence declared as negligence.  The doctors who deal with life and death know that it is not correct interpretation, and no one can ever be sure of what the real outcome would be. They just do what they think will be most effective for the patient, and it may not eventually turn out to be the best ever.
  2. Variable interpretation: Same evidence, incidence and circumstances are interpreted and  judged differently by people and  even courts. Some will say it is negligence and other will say it is not. Some will bay for doctor’s blood and other will not. This variation in perception is not only in minds of lay men but also in the learned courts, who  decide  differently.  At the time of death of patient, a constant and  universal last link is only the doctor, that is visible. He is an unfortunate victim, a human factor   and blamed for  the harm done because of variable thought process.

 

  1. Medical knowledge vs wisdom: People who do not treat patients, may be very wise and may acquire medical knowledge by various sources. But medical wisdom comes  only after years of medical practice,  by observing varied situations and spectrum of diseases. An understanding of what can happen in given circumstances comes only by treating such   emergencies.         For non doctors, it is very difficult to  comprehend the medical complexities and real time scenarios. Even doctors, who do not treat regularly emergency patients, can attribute the harm as doctor’s  mistake.

 

  1. Feeling of revenge:  in case of an  adverse event, negative thoughts prevail all over. In present scenario with legal powers with the sufferer and common sentiments against doctors, it is easier to identify and blame some human factors.   Adverse outcome is frequently covered by media to create a sensation among masses.  Real circumstances can only be felt by doctors  but that remains unheard. Harm to patient, media cry and negative sentiments against the service providers creates a sense of revenge in mind of people.

 

  1. Doctor’s negligence vs system inadequacy; This visibility of doctor at the time of  declaration of death  or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom, all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, inadequate equipment and  other innumerable shortcomings of the whole system may not be visible or not given consideration in the  haze, as compared to  publicity and attention  given to only doctor’s faults.

 

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Doctors need genuine Leave – painful barb for others @ Tokyo medical school


Japan medical school admits to altering scores to keep out female applicants

  Usually the kind of work of doctors keep them on toes and it is difficult to have leaves. This may be a global  phenomenon.  Medical systems also are not very comfortable with doctor’s leaves. Scarcity of doctors and difficult replacements makes life of doctors busy and unsocial.  Systematic  denial of genuine leave has been proved by  investigations  at   Tokyo medical school.

 

A Tokyo medical school has confirmed after an internal investigation that it systematically altered entrance exam scores for years to keep out female applicants and ensure more men became doctors. The school wanted fewer female doctors because it anticipated they would become mothers and would shorten or halt their careers. It is extremely important to improve the working environment so that women can pursue their medical professions. School’s purpose in denying women entry was because female doctors often quit working after starting families. Women tend to avoid tough jobs like surgery or work in remote areas. They need to take a break from their careers because of pregnancy and childbirth.

 Tokyo Medical University manipulated all entrance tests results since 2000 or even earlier. The findings released Tuesday by lawyers involved in the internal investigation confirm recent reports in Japanese media.

The manipulation surfaced during an investigation of an alleged wrongful admission of a bureaucrat’s son.

The internal investigation found the school first reduced all applicants’ first-stage scores to 80 percent then added up to 20 points only to male applicants with three or fewer application tries.

The school wanted fewer female doctors because it anticipated they would become mothers and would shorten or halt their careers.

Japan’s government urged a medical university to promptly disclose the results of an investigation into its admissions process Friday after reports alleged it had altered the test scores of female applicants for years to deny them entry and ensure fewer women became doctors.

The school’s public affairs department said it had no knowledge of the reported manipulation but is investigating. The school is already facing a separate scandal involving the inappropriate admission of a top education bureaucrat’s son and was ordered by the education ministry to investigate its admissions records for the past six years. On Thursday, the school said it will combine the examination of the score manipulation allegation with that probe.

The share of female doctors who have passed the national medical exam has stayed at around 30 percent for more than 20 years, prompting speculation that interference in admissions is widespread at Japanese medical schools.

The Japanese medical university’s alleged systematic deduction of entrance exam scores only from female applicants has sparked outrage across Japan. It was reported Thursday that Tokyo Medical University has been slashing female applicants’ entrance exam scores for years to keep female student population low, on grounds they tend to quit as doctors after starting families, causing staffing shortages

Admissions records released to The Associated Press by the school show the percentage of women who passed the entrance exam rose from 24 percent in 2009 to 38 percent in 2010. The figure has since stayed below that level until decreasing to 18 percent this year, when a total of 171 students passed the exam. The ratio of female applicants who were accepted this year was 2.9 percent, compared to 8.8 percent for men.

 

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Medical lawsuits, revenge & punishments to doctors : reminiscent of realms of ancient Hammurabi medical regulation


With the evolution of medical science and medical care intertwined with  medical business, braided changes in  medical  regulation is not an far off expectation. But reticulation of evolution to modern medicine  and health care has not happened  in  isolation. Simultaneously there has been  progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care  has also ushered.  Every one now wishes  to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and investors putting money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care allowed health care to be controlled  in some way by administrators and investors. Away from the health providers, who actually treated the patients.

As it is no more simply treating a disease and involves many more issues.  New model of  medical regulation and business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   No one really knows how to regulate this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is  amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the medical profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi  had initiated to  write the rules of the game. This single professional species was managed with cruel regulation around 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naive or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity.

  Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors due to application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished.

Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such harsh  regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously,  harsher  penalties will discourage a physician surplus.

Today the global  system of medical regulation, is becoming somewhat  similar, to those ancient regulations in  terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is despite the fact that now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era

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“Doctor, why to risk yourself for petty gains?” Telephonic treatment is negligence: Bombay High Court


“Doctor, save the patient, but save yourself also”.

In medicine, any small or big disease or  procedure can have complications.  Frequently, dangerous complications have a subtle and insidious onset with very little symptoms. DVT and pulmonary thrombo- embolism is a known and life threatening complication associated with pregnancy.  This complication and the unfortunate  scenario that  happened  is not unknown and has a potential to recur. So doctors need to learn from such incidences to save themselves.

Since the overall scenario of medical complication and consumerism have undergone a sea change, doctors need to  be careful and change their approach to save from legal issues arising from these. They have to make sure that each small problem  has to be seen carefully in person, as it may harbour a serious threat.

Observing that prescribing medicines to patients without diagnosis amounted to culpable negligence, the Bombay High Court has turned down the anticipatory bail pleas of a doctor couple booked for the death of a woman patient. The doctors have been booked by the Ratnagiri Police under section 304 of Indian Penal Code (culpable homicide not amounting to murder) after the patient died earlier this year. According to the police, the woman was admitted to the accused couple’s hospital in Ratnagiri in February this year where she underwent caesarean operation and gave birth to a baby. The court order said the woman and the child were normal and were discharged two days later. The doctor spoke with the chemist who then gave some medicines to the relatives of the woman. However, even after taking the medicines, the woman did not feel better and was taken to the same hospital, it said. When the woman’s condition deteriorated the next day, the doctors at the hospital shifted her to another hospital, where she died, it said.

   Question arises, why  doctors commonly   need to prescribe by telephonic advice,  specially as in this case, if the doctor themselves were not available.  what made them  to enter into such a dangerous situation? Do  really there are substantial gains to risk so much and everything in life? The reasons:

  1. Most of the time, to retain the patient. As they already treated the patient, It is a natural tendency to  continue the treatment. Factors here are loyalty issues and loosing patient to other physicians.
  2. Sometimes patient request, to avoid coming to hospital or to avoid visiting unknown hospital or other doctors. It is not uncommon that patients request some advice on phone.
  3. Symptoms do not look dangerous or alarming. Patient interpretation is not appropriate. Even myocardial infarction ( heart attack) is taken  as due to “wind problem.”  Main problem here is that doctor is relying on patient’s interpretation, which is likely to be incorrect.
  4. Most dangerous is a friendly advice or relatives. Where it is mistake of both doctor and patient.
  5. Patient is far off and for convenience

 

So  “Gains” in such situations are nil or petty.

Rarely it is done for earning money. It is just done for the sake of convenience. But doctors should  wake up in  the era of consumerism, where no one is going to pardon them for  mistakes.  Retrospective analysis gained with wisdom of hindsight makes them repent many times more than petty gains.

Doctor need to forgo petty gains in order to save themselves. Do not take chances. No one will realize later, what were the causes and intentions behind the mistake.

“Doctor, save the patient, but save yourself also”.

 

 

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Ban imposed on import of Rabies vaccine from tainted Chinese company


The drug controller general of India on Tuesday banned the import of the rabies vaccine from Chinese vaccine manufacturer Changchun Changsheng Life Sciences, which was found to have faked records and ordered to stop production earlier this month by China’s drug controller.

Rabies kills an estimated 20,000 people in India each year, according to the National Rabies Control Programme.
The drug controller general of India on Tuesday banned the import of the rabies vaccine from Chinese vaccine manufacturer Changchun Changsheng Life Sciences, which was found to have faked records and ordered to stop production earlier this month by China’s drug controller.
Officials familiar with the matter said the vaccine is imported by India and procured by both private and government centres that administer it for protection from rabies, which is 100% fatal but can be prevented by vaccination. Rabies kills an estimated 20,000 people in the country each year, according to the National Rabies Control Programme.
“We’re in the process of issuing a show cause notice to the procurer who gets the vaccine for the government .

“The vaccine is being used in India, but we don’t have the exact details of the total number of units imported or where they have been distributed. I have asked my staff to prepare a detailed information report on its import and distribution,” Reddy added. “Once we get the information, we will ask for a recall of the vaccine from market. But till then, there is a blanket ban on its import.”
Rabies is endemic throughout the country, with the exception of Andaman & Nicobar and Lakshadweep. Dogs are responsible for about 97% of human rabies, followed by cats (2%) and monkeys, mongoose and others (1%). According to the city’s civic agencies, each week about 8,000 shots are given to prevent rabies in all government hospitals.
“We get 500 to 700 cases each day, which also includes people there for booster doses. Dog and rat bites are very common. A combination of anti-rabies vaccine, serum and tetanus is injected, depending on the severity of the bite,” said a staff member at Safdarjung Hospital who asked not to be named.
“We usually get products from procurers, who get it from importers. Both Indian- and foreign-made drugs and vaccines, including those from China, are used in the public sector.
On July 24, Chinese president Xi Jinping has ordered a “thorough investigation” into widespread concerns that hundreds of thousands of infants might have been administered fake vaccines produced by one of the country’s largest pharmaceutical firms.
According to official news agency Xinhua, Xi had termed “the illegal production of vaccines by Changchun Changsheng Life Sciences Limited as hideous and appalling”. Reports suggested the company may have supplied ineffective DPT (diphtheria, whooping cough and tetanus) vaccines that were given to babies as young as three months old, and forging data for anti-rabies vaccines.
As outrage among people in China grew over the past week, the company’s leaders apologised in a statement on Sunday, saying they felt “deeply ashamed”, according to the New York Times.

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Viagra & anaesthetic drug sold as herbal alternative medicines


This news in Times of India  is just an tip of the iceberg, the reality  of alternative medicine  industry. Toxic substances being sold at exorbitant prices  labelled as herbal substances can be unmasked only if checked  and controlled strictly.  Gullible masses consume these substances without knowing the right dose or right drugs thinking them as herbal products . Assumptions that they are free from side effects is another myth, that goes unsaid.

MUMBAI: The Aurangabad division of FDA has found sildenafil citrate, commonly known as Viagra, and a short-acting anaesthetic drug in two alternative  medicines meant to increase sexual desire and potency that were randomly tested for quality recently. The worrying finding has prompted the drug regulatory body to issue a statewide circular asking its officials to seize any available stock of these drugs- Power up capsules and Tiger king cream. The containers of both the alternative medicines didn’t mention the allopathic components sildenafil and anaesthetic drug (lignocaine hydrochloride), giving rise to fear of serious health consequences in people who might consume them unknowingly. Viagra, in particular, which is given for erectile dysfunction, is supposed to be taken only when prescribed by a specialist as it can react with other ongoing medications and give rise to life-threatening complications. In July, FDA officials raided the office of Srishti Unani Medicine Agency in Aurangabad and found stocks worth Rs 16,000 that had arrived from Saharanpur district of Uttar Pradesh. Tests revealed each Power up capsule contained 49.45mg of Viagra, while Tiger king cream had a significant amount of lignocaine hydrochloride, though only the herbal components were mentioned in the packing material.

The spurious drugs were manufactured in violation of the Drugs and Cosmetics Act. “We will lodge an FIR against Naman India, the UP-based manufacturer, that has been selling these drugs in the name of herbal medicine to gullible consumers,”, joint commissioner, FDA, Aurangabad. He said the department is yet to establish where these drugs were supposed to be distributed, but there is demand from across the state. It was during a raid in the city sometime in 2015 when the department woke up to rampant adulteration of so-called alternative  medicines with allopathic drugs. An official said it was an “industry worth millions” that clandestinely ran out of Tier-2 and 3 cities or slums in metros. “Under the Act, manufacturing of alternative  drugs needs a licence, but there are no legal provisions for distribution and supply. So monitoring becomes a challenge,” said an FDA official. Medically, doctors say, such rackets are not just about making spurious drugs and making a quick buck but messing with people’s lives. “It’s a menace that has existed for years unchecked. Alternative  practitioners charge exorbitant sums for these  medicines that illegally contain sildenafil, which otherwise costs just Rs 30-40 when sold as an allopathy drug.

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Private Medical College Seat (MBBS)(#Medical #NEET): System of Entrapment or (?)Debt Trap For Many.


MBBS debt trap for many Private Medical College Seat (MBBS)-Debt Trap For Many.

Mirroring the US situation, where medical students come out of the education system with huge loans to repay, India’s medical education is becoming a debt trap for thousands  of medical students with governments doing little to regulate medical college fees.

High fees in most medical colleges means that students who have to take loans to pay it cannot hope to service the loans from what they earn as doctors after completing MBBS. Here’s how the math works. Annual tuition fees in private medical colleges average over Rs 10 lakh. That’s half a crore rupees or more for the entire course when charges for things like hostel, mess, library, internet and examinations are included. The EMI on an education loan of Rs 50 lakh works out to at least Rs 60,000. Government salaries for an MBBS graduate range from Rs 45,000 to Rs 65,000 depending on the state and area. The private sector is even worse.

This raises a question: The government is allowing the opening of more private colleges or allowing existing ones to increase seats citing shortage of doctors, especially in rural areas and in primary health centres, but don’t high fees defeat the purpose? Can such doctors have a living wage after they pay the EMI? In most banks, education loans cannot exceed Rs 7 lakh to Rs 10 lakh without collateral, which typically would mean mortgaging a house or land. With collateral, the loan amount can be . High MBBS fees leaving many doctors in debt trap

Usually, the loan carries an interest of 10% to 12.5% and has to be repaid within 10 to 12 years. If education loans become prohibitive, it could make medical education the preserve of the rich. A TOI analysis of fees charged in 210 private medical colleges in 2017 showed that about 50 charged anything between Rs 10 lakh and Rs 15 lakh and over 30 charged even more. Several government colleges too charge high fees, especially in Gujarat and Rajasthan. After 4.5 years of MBBS, a student has to do a one-year paid internship, during which time his/her salary would be at best Rs 20,000-25,000 per month.

After MBBS, whether a student is doing three-year post-graduation or working as a resident doctor or medical officer, the salary in government service ranges from Rs 40,000 to Rs 55,000 in most states and even less in the private sector. In about three to four years, the salary rises to about Rs 70,000 at best in most places. With EMIs of Rs 45,000- 65,000 for loans ranging from Rs 30 lakh to Rs 50 lakh, doctors are left with barely enough to live on. For those who get married by this stage, the added responsibility of running a household complicates matters further. Even in states with fee regulation, the annual fees in private colleges could range from Rs 2.5 lakh to over Rs 6 lakh+ ,

For those without means, that would entail a loan of Rs 12 lakh to Rs 30 lakh and hence unaffordable EMIs.

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Zero marks & still can be doctor (#NEET). Society deserves the doctors, it chooses and nurtures.


Rot of exorbitantly expensive medical education and lowered merit  has been systematic. Aspiring doctors are now forced to pay exorbitant fee,  in millions. Many go under heavy debt to pay medical colleges fee. Children with lower ranks in merit pay millions and can  become doctors. The real problem here is that real deserving will be left out.

Medical students from the very onset are victim and witness to  these practices and   exploitation. They see their parents pay this unreasonable fee through their noses or take loans. Such blatant injustice  will have an everlasting effect on the young impressionable minds. Society gives them lessons of corruption and exploitation.

Our society fails to develops a robust system of choosing and  nurturing  good doctors and therefore  itself responsible for decline in standards of medical profession.

Some MBBS students got zero or less in NEET papers

With no cut-off for individual subjects – physics, chemistry and biology—in the NEET entrance exam, at least 400 students with single-digit marks in physics and chemistry and 110 students with zero or negative marks in them have been admitted for MBBS in 2017, mostly in private colleges. This raises a question. If getting zero in these subjects doesn’t make a person ineligible for admission, why bother to test in that subject at all? Interestingly, the original notification to adopt a common entrance examination had stipulated that students should score at least 50% in individual subjects. However, the subsequent notification, which brought in the percentile system, dropped the stipulation on marks in individual subjects. TOI analysed the subject marks of 1,990 students who got admitted to MBBS with NEET scores of less than 150 out of 720 in 2017. it was found that 530 with single-digit marks, zero or less in physics or chemistry or even both.

 

Doctors are just as offshoots of a tree called as society. They essentially are the same as rest of the society.  It is a specialized branch of tree which helps other offshoots of tree to save others.  As  part of same tree, they resemble the parent society, of which they are part.  Society needs to choose and nurture a force of doctors carefully with an aim to combat for  safety of its own people.  

       Apple tree will have apples and musk melons plant will  grow muskmelons only.  One should not expect apples to grow on muskmelon stem. If society has failed to demand for a good and robust system, failed to save them, it should not  rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety.

What is the need to dilute and shortlist around half a million for few thousand seats. Answer to that is simple.  To select and find only those students from millions, who can pay millions to become doctors.  

      Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession. By allowing a intentional dilution of quality  can be advantageous only to  few and detrimental to others. 

If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way  forward.  So children have to be careful while choosing medical careers from the beginning.

A famous axiom “as you sow so shall you reap” has an application to health system in this scenario, so people should not rue scarcity of good doctors.     Therefore the quality of doctors who survive and flourish in such system will be a natural consequence of  how society chooses and nurtures the best for themselves.

 

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