Pros-Cons of Covid testing at admission in hospitals


 

Try not to find a hidden explosive can be a disaster. Testing after it has exploded, is of limited benefit.

Going by practical thought, testing for COVID-19 should be a non-issue, as  Up to 44% of the infection may be transmitted by pre-symptomatic patients or asymptomatic patients.

Advantages of   Covid testing at admission in hospitals   

  1. Source to other patients; Any patient  admitted with medical diseases or requiring surgery, if  Covid status  is not tested, the patient  will be mixed with others. Any one patient having Covid infection will act as a source for other patients and health workers.
  2. Further progress of Covid-19 will be influenced by the incidence of infection in the population. The true numbers of spread will be the  key to informed decision making therefore will influence the  trends. Any  orders or intention to restrict testing  defies logic. Inconsistent strategies will result in projecting an incomplete  picture of the transmission.
  3. Difficult to decide on history; It is impossible  to identify all COVID-19 patients based on history alone. One such patient could infect several healthcare workers and can significantly impact hospital services. Thus, the implications of missing a single COVID-19 patient can be enormous, in a hospital.
  4. Clear history not available; Sometimes patients are not always clear  about their history of contact or symptoms because of  many reasons. Doctors also sometimes may not be able to elicit the correct history.
  5. Generation of Data;Testing  at the hospital admission  increases   overall testing figures. It screens a population at risk of infection and source. Undertaking contact tracing and breaking the chain of transmission is helpful.  For same reasons, doctors routinely carry out testing for HIV, hepatitis B and hepatitis C preoperatively for all patients.  It is just another viral test.
  6. Hospitals turning into hotspots and risk to health workers; Hospitals are the only place, holding too many sick people. Chances of harbouring Covid, or catching infections are very high in hospitals. They can actually turn into hotspots, if testing is restricted in the hospitals. Liberal testing is one of the methods to contain infection in hospitals, so doctors can detect and segregate the source.

Disadvantages 0f Covid  testing at admission

There are some equally reasonable concerns about mandatory testing of COVID-19.

  1. First is the cost and the delay in patient management.

 

  1.    Stigmatisation if one tests positive and being refused treatment is a major fear for the patient.
  2. Universal safety precautions are always followed across all hospital surgeries, irrespective of the test result.

There are many reasons for and some against COVID-19 testing of all admitted patients. Doctors will strive to strike the balance between protecting patients and protecting  the healthcare system and workers. While treating any  patient without  delay, a more rational and practical set of comprehensive guideline is needed  for non-urgent or elective admissions from  our national and international organizations to enable health care systems  to practice medicine safely.

Otherwise every one may be at risk including  patients, health care  workers and doctors.

Inconsistent strategies of testing Covid will undermine decision making  (Times of India)

Moral burden of poor quality PPE’s on doctor and nurses#Covid time


Medical industry has found an opportunity to do a brisk business. The norms of PPE are not well defined, from the end user’s comfort,  that is doctor and nurses. Any material is that is converted into PPE and dumped on health workers, adding enormously on their plight.  A moral burden to do their  work in every situation, is becoming difficult to carry on, while the opportunist in medical industry make merry. A sin, which  may look nonpunishable in current era, but should not be forgiven in a civilized society.

Possibly working as a doctor and nurse is going to be most difficult  profession. Working in life and death situations, excessive  documentation, unrealistic expectations from patients and administrators alike, working  under legal compulsions, prone to punishments and complaints on simple human errors,  poorly paid  and facing verbal and physical assaults. Above all despite doing all this, respect and gratitude is scant for the life savers in present era. Adding to all above issues, another problem has been added, the poor quality of PPE, which makes life of saviours a hell.

Times of India  publishes a report on the same, that brings out the plight of doctor and nurses.

‘Some PPEs feel like we’re wearing plastic rice bags  from. Trussed up inside a plastic bag in the summer heat with sweat pouring down the body but afraid to drink water as it is impossible to take a loo break. This is how a nurse described the experience of wearing a personal protective equipment (PPE) suit.

While there is no dearth of PPE any more, doctors and nurses say the quality is such that it’s like wearing a plastic bag. Doctors say hospitals are besieged by companies offering PPE kits. “The quality of most of what is offered is horrible. The fabric of many is like chawal ka thaila (RICE BAG). There is zero breathability and so health workers find it impossible to wear it for long. That reluctance could endanger them,” said a senior doctor. The WHO guidelines on PPE strike a balance between protection against infection and allowing health workers “ease, dexterity, comfort and minimal heat-associated stress”. However, the guidelines framed by the ministries of health and textiles only focus on the need to prevent blood or fluid penetration but have nothing about breathability. So, manufacturers focus on thickness of the plastic rather than the wearer’s comfort. “In the initial rush to overcome the shortage of PPE, it is understandable that the ministry did not think of all aspects. But it is unacceptable to allow people to use this opportunity to make money by supplying abysmal quality PPE and endangering the  lives of health workers.

The government should immediately issue clear-cut guidelines on quality of fabric and stitching and weed out the fake manufacturers cashing in on the sudden demand for PPE,” said a doctor in a Covid hospital. According to a manufacturer of protective wear, cheap plastic laminated fabric costs just Rs 150-200 per kilo. “So even with the cost of stitching, a poor quality PPE suit would cost only Rs 100- 200 to make but is sold for Rs 500-800. With such huge margins, getting even one small order for 10,000 PPE suits would mean a profit of at least Rs 30 lakh. This is why there is a such a huge rush of people getting into PPE making,” he explained Eight labs identified by the textile ministry to do quality checks on PPE have so far issued over 900 Unique Certification Codes (UCC), mandatory for PPE sellers, especially to land government contracts.

The government says there are 600 companies manufacturing 4.5 lakh PPE suits per day. Many with the UCC have little or no experience in making protective wear. They include chemists, lingerie and footwear manufacturers, tent or tarpaulin makers, wholesale traders of drugs, small-time pharma companies, and even a food company. “Anyone who has a garage to store the stuff can buy some fabric and organize some tailors to copy a PPE suit,” said an industry insider. “One PPE lot supplied to us had electrical insulation tapes used to seal the seams. Obviously, they started coming off when we moved around,” said a doctor in a private hospital. Another doctor in a government Covid hospital pointed out that the government only tested the coverall, but other components like face shields or goggles that came with it were substandard. Almost all hospitals seem to have PPE horror stories to narrate. The government is at pains to reiterate that its certification is only for the coverall and that only a Synthetic Blood Penetration Test (SBPT) has been conducted.

Every UCC states that the certificate is based solely on the sample submitted by the applicant. It goes on to state: “The procurement agency is advised to conduct prior due diligence before placement of supply agreement…including periodical sample tests.

 

25 factors for expensive medical treatment

Altruistic professions are not cherished in present era

21 occupational risk to doctor and nurses

Being doctor or nurse- a disadvantage in present era

plight of nurse who died reusing PPE’s

 

Balancing Immunity in Corona Times


Any substance is considered effective only after rigorous testing through randomised clinical trials with Covid-19 patients, and additional laboratory analyses.  The substances that are merely propagated on social media or claims of company or advised by quacks will not help and merely remain as part of immunity business. They provide a false hope and thereby earn money  because of fear in the minds of masses.

  As there is no definite treatment or prevention against Covid-19, people need to depend upon their own body resistance and preventive strategies. There are advisory in respected papers about the same in The Hindustan times and The Wall Street Journal, that may be helpful.

 

 

Scientists bust myths about ‘immunity-boosting’ substances in fighting Covid-19

Indian scientists on Thursday released a statement against the promotion of “immunity-boosting substances” to protect oneself from being infected with the novel coronavirus. Citing lack of scientific evidence, scientists said consuming mustard oil or tea, homaeopathic solutions or ayurvedic preparations, or modern medicines like hydroxychloroquine that are claimed to provide either immunity or cure “do not provide any known and/or validated protection against Covid-19”.

Additionally, drinking cow urine, wearing talismans, exposure to ultraviolet light or injecting disinfectants are harmful to the human body, while excess consumption of supplements such as zinc or datura seeds can prove to be fatal.

Aniket Sule, astrophysicist at Homi Bhabha Centre for Science Education and one of the signatories, said, “Since the beginning of Covid-19 epidemic, several statements have propagated ‘immunity-boosting’ substances. Some assertions were also supported by a few government functionaries at the Centre and in various states; and we, therefore, wanted to place scientific facts in the public domain.”

The most severe cases of Covid-19 are made worse by an overreaction of the immune system. So trying to boost general immunity using untested methods may be risky.”

Facts (and Myths) About Boosting Your Immune System

It’s crucial to stay healthy as the threat of coronavirus spreads. Here are the best strategies.

As the new coronavirus continues to spread across the country, having an optimally functioning immune system is more important than ever.

Medical professionals say it is important not to rush to buy supplements and vitamins that promise to enhance your immune system; there isn’t much evidence that such products do any good. Instead, they say, stick with the more mundane, but proven, approaches:

  • Keep your stress levels down.It’s a bit of a vicious cycle, of course: The more you stress about the virus, the more likely you are to suffer from it. “Stress can certainly hurt your immune system,” says Morgan Katz, an assistant professor of infectious diseases at Johns Hopkins University. “Do not panic, try to minimize stress.”

Andrew Diamond, chief medical officer of One Medical, a nationwide network of primary-care providers, says the stress hormone cortisol turns off cells in your immune system. He recommends engaging in activities that people find relaxing, such as meditation.

  • Exercise.Low- and moderate-intensity exercise naturally lowers cortisol levels and helps with immune-system function, says Dr. Diamond. One Medical recommends 30 to 60 minutes of exercise a day. If you’re apprehensive about germs in the gym, walk or run outside.

But it is important not to go overboard. A recent study found high-performance athletes have an increased risk of infection, says Elizabeth Bradley, medical director of the Cleveland Clinic’s Center for Functional Medicine. “Exercise helps boost the immune system, but we have to be careful not to overexercise because it can weaken your immune system,” she says.

  • Get adequate sleep.For adults, that means getting seven to eight hours of sleep a night. Children should get more, depending on their age.
  • Make sure your vaccines are up-to-date, especially the flu vaccine.
  • Eat plenty of plain yogurt every day.“It’s really an easy way to boost your probiotics and help support your microbiome,” Dr. Katz says. “It helps to support the good bacteria that live in your body, which help to fight bad bacteria or viruses.”

Dr. Katz also suggests avoiding antibiotics unless you must take them because they deplete the good bacteria in the system, leaving you more vulnerable to other infections.

Other foods that can help support the microbiome include garlic, onion, ginger, sauerkraut and fermented foods, says Dr. Bradley.

 Watch your diet. Stick to a healthful, balanced diet filled with lots of colorful fruits and vegetables to ensure you’re getting enough zinc and vitamin D and other important vitamins and minerals. Most experts say you should be able to get enough of these vitamins and minerals through your diet, and extra supplementation isn’t necessary. But because vitamin D deficiency is relatively common, experts do recommend supplementation if levels are low.

Dr. Bradley recommends eating lots of dark green, leafy vegetables and berries, as well as nuts and seeds, and to minimize foods with sugar and trans fats, which aren’t as nutrient-dense.

Your immune system needs fuel, so avoid ultralow-carbohydrate diets, experts say. In addition, drink lots of water and reduce alcohol consumption, which can disrupt your sleep.

  • Stop smoking or vaping.Smokers and those with respiratory disease have a higher rate of serious illness and complications from coronavirus. “Anything that is challenging to your lungs is going to work in the wrong direction,” says Dr. Diamond.

 

 

 

Grief : Death of AIIMS Covid warrior; raises questions


What happened to my father shouldn’t happen to anyone: Son of deceased AIIMS sanitation chief

 

Two days after his father, senior sanitation supervisor at AIIMS New Delhi, died of COVID-19 at the institute’s trauma centre, his son is still in shock.

Amid conflicting versions from the family and the institute administration, it’s unclear where the truth lies. What’s clear is, COVID warriors remain vulnerable to the disease and must do all they can to protect themselves.

The complexity associated spread and treatment  with Covid-19, is beyond the present day medical science. Although global efforts are being done on war footing, but it may take few months or a year to have some reasonable control over virus.

 

“My father got the infection on May 15 and passed away on May 24, within nine days.He was still on duty when he first developed uneasiness and illness. Routine checks were done at AIIMS on the morning of May 15. COVID test was not done and the doctors on duty suggested that my father should return for a COVID test after he develops symptoms. By the time visible symptoms developed around May 19, my father was already in need of a ventilator,” says his son urging asymptomatic people to get tested as soon as possible.

Every day is crucial in the fight against this disease as it doesn’t give you any time to respond, says the young man who, like his father, is a permanent staffer at AIIMS.

The son  also raises the question of quality of protective gear available to sanitation staff, cleaners, sweepers, ward boys and other workers at the institute.

While acknowledging the pressures of COVID management on AIIMS, the distraught son says that the N-95 masks provided to the sanitation workers at AIIMS were of low quality.

“We are all given four N-95 masks with four envelopes for 15 days and we a supposed to use one each day, store the others and then repeat the cycle. Since the COVID outbreak, I’ve only received eight masks till now. My father also had the same mask and its quality is very low as compared to the quality of filter N-95 masks you get in the markets. We do not get gloves. Sanitizers are also not freely available and we are mostly encouraged to use soap and water. But because the sanitation staffers’ job is prone to infection they should get the best quality masks, head caps, gloves and full disinfection kits. What happened to my father should not happen to anyone,” he  said, urging the government to increase testing of asymptomatic people.

Sudden demise of the front warrior has now brought the lens on the safety of cleaners and ward boys across top COVID hospitals.

Questions also arise on whether he had received Hydroxychloroquine preventive drug against COVID considering

ICMR recently revised its HCQ guidelines to include asymptotic COVID warriors in containment zones.

When contacted, AIIMS medical superintendent ruled out laxity on the part of AIIMS in handling the the case.

AIIMS medical superintendent also said AIIMS had issued HCQ for all its COVID warriors much in advance of ICMR’s revised guidelines covering all frontline staffers in containment areas and provided its staffers with all the necessary protection.

“Why wouldn’t we care for our own staff? We managed the case  the moment he came to us,” said  AIIMS medical superintendent

Amid conflicting versions from the family and the institute administration, it’s unclear where the truth lies.

What’s clear is, COVID warriors remain vulnerable to the disease and must do all they can to protect themselves.

21 occupational risk to doctor and nurses

covid 19 unmasks risk to health workers, administrators refrain

disbelief to grief

Antibiotic for resistant super bugs discovered by machine learning (AI) for first time


 

An important breakthrough   towards  discovering new antibiotics, that has potential to change  the ways, new molecules are discovered,  Team at MIT says HALICIN  kills some of the world’s most dangerous strains. Discovery  has been possible using artificial intelligence.  It also signifies the role of artificial intelligence in medicine, in future.

Antibiotic resistance arises when bacteria mutate and evolve to sidestep the mechanisms that antimicrobial drugs use to kill them. Without new antibiotics to tackle resistance, 10 million lives around the world could be at risk each year from infections by 2050.

To find new antibiotics, the researchers first trained a “deep learning” algorithm to identify the sorts of molecules that kill bacteria. To do this, they fed the program information on the atomic and molecular features of nearly 2,500 drugs and natural compounds, and how well or not the substance blocked the growth of the bug E coli.

A powerful antibiotic that kills some of the most dangerous drug-resistant bacteria in the world has been discovered using artificial intelligence.

The drug works in a different way to existing antibacterials and is the first of its kind to be found by setting AI loose on vast digital libraries of pharmaceutical compounds.

Tests showed that the drug wiped out a range of antibiotic-resistant strains of bacteria, including Acinetobacter baumannii and Enterobacteriaceae, two of the three high-priority pathogens that the World Health Organization ranks as “critical” for new antibiotics to target.

“In terms of antibiotic discovery, this is absolutely a first,” said Regina Barzilay, a senior researcher on the project and specialist in machine learning at Massachusetts Institute of Technology (MIT).

“I think this is one of the more powerful antibiotics that has been discovered to date,” added James Collins, a bioengineer on the team at MIT. “It has remarkable activity against a broad range of antibiotic-resistant pathogens.”

Once the algorithm had learned what molecular features made for good antibiotics, the scientists set it working on a library of more than 6,000 compounds under investigation for treating various human diseases. Rather than looking for any potential antimicrobials, the algorithm focused on compounds that looked effective but unlike existing antibiotics. This boosted

the chances that the drugs would work in radical new ways that bugs had yet to develop resistance to.

Jonathan Stokes, the first author of the study, said it took a matter of hours for the algorithm to assess the compounds and come up with some promising antibiotics. One, which the researchers named “halicin” after Hal, the astronaut-bothering AI in the film 2001: A Space Odyssey, looked particularly potent.

Writing in the journal Cell, the researchers describe how they treated numerous drug-resistant infections with halicin, a compound that was originally developed to treat diabetes, but which fell by the wayside before it reached the clinic.

Tests on bacteria collected from patients showed that halicin killed Mycobacterium tuberculosis, the bug that causes TB, and strains of

Enterobacteriaceae that are resistant to carbapenems, a group of antibiotics that are considered the last resort for such infections. Halicin also cleared C difficile and multidrug-resistant Acinetobacter baumannii infections in mice.

To hunt for more new drugs, the team next turned to a massive digital database of about 1.5bn compounds. They set the algorithm working on 107m of these. Three days later, the program returned a shortlist of 23 potential antibiotics, of which two appear to be particularly potent. The scientists now intend to search more of the database.

Stokes said it would have been impossible to screen all 107m compounds by the conventional route of obtaining or making the substances and then testing them in the lab. “Being able to perform these experiments in the computer dramatically reduces the time and cost to look at these compounds,” he said.

Barzilay now wants to use the algorithm to find antibiotics that are more sekills only the bugs causing an infection, and not all the healthy bacteria that live in the gut. More ambitiously, the scientists aim to use the algorithm to design potent new antibiotics from scratch.

“The work really is remarkable,” said Jacob Durrant, who works on computer-aided drug design at the University of Pittsburgh. “Their approach highlights the power of computer-aided drug discovery. It would be impossible to physically test over 100m compounds for antibiotic activity.”

“Given typical drug-development costs, in terms of both time and money, any method that can speed early-stage drug discovery has the potential to make a big impact,” he added.

Antibiotic resistance

 

 

Johnson & Johnson held guilty for profiteering by GST body


 

Just one example how  intentions of industry  have been of profiteering rather than making  reasonable  profits.

NAA directs J&J to reduce prices of its products and asked the company to deposit Rs230 crore in consumer welfare funds of the central and state governments

J&J is liable for imposition of penalty under section 171(3A) of the CGST Act

The National Anti-Profiteering Authority (NAA) said Johnson & Johnson Pvt Ltd (J&J) profiteeredfrom reduction in rates under the goods and services tax (GST), denying the benefit of lower rates to consumers. The profiteered amount stood at Rs230 crore, according to an order dated 23 December 2019.

The Director General of Anti-Profiteering had filed an application against J&J in the matter.

“It is evident from the facts that the respondent (J&J) has denied the benefit of tax reduction to the customers in contravention of the provisions of section 171(1) of the CGST (Central GST) Act, 2017, and has thus, profiteered as per the explanation attached to section 171 of the above Act,” the order said.

“Therefore, he (J&J) is liable for imposition of penalty under section 171(3A) of the CGST Act,” it added.

The authority, in its order, directed J&J to reduce prices of its products and asked the company to deposit Rs230 crore in consumer welfare funds (CWFs) of the central and state governments.

“…18% interest payable from the dates from which the above amount was realised by the respondent (J&J) from his recipients till the date of its deposits,” the authority said in its order.

J&J will have to deposit Rs230 crore to CWFs of the centre and state governments within three months from the date of passage of the order. In case the company fails to do so, commissioners under the central GST and state GST will recover the amount, said NAA, the quasi-judicial authority of the GST structure.

Himachal Pradesh, Punjab, Uttarakhand, Haryana, Delhi, Rajasthan, Uttar Pradesh, Assam, Bihar, West Bengal, Jharkhand, Odisha will receive deposits above Rs1 crore in their state CWFs.

In 2017, the government had introduced an anti-profiteering clause to ensure businesses transfer the benefit of the tax credit to consumers by making products cheaper.

Healthcare system a sinking ship: Says Niti Aayog


A chaotic and non-uniform system, after years of neglect cannot be corrected overnight or by change in piecemeal policies. It needs to be revamped from the roots. To do it from grass root  level especially with financial constraints,  it will need a  sincere will to develop  the system.

                     India’s top think tank said Thursday that the country’s healthcare system resembled a “sinking ship”and desperately needs more private participation in smaller towns to run the government’s ambitious Ayushman Bharat program efficiently.

“We would require all hands on deck, as they say,” Niti Aayog adviser Alok Kumar said at the Healthcare Federation of India’s Sixth Annual Summit, referring to the poor state of healthcare in India. The Ayushman Bharat’s insurance program, Pradhan Mantri Jan Arogya Yojana (PMJAY), has been facing constraints in smaller cities due to a dearth of hospitals.

“We can’t have all the patients being transported to tier-1 and tier-2 cities for treatment because that is not a model which is sustainable,” Kumar said.

The Lancet, the world’s oldest and most prestigious journal, had last year ranked India’s healthcare system at a dismal 145 out of 195 countries, worse than even North Korea and Syria. The ranking was worse than its smaller Asian peer Philippines and neighbour Sri Lanka, a fact also pointed by Kumar.

Kumar said that a number of hospitals in smaller cities, including those run by public sector enterprises, are under-utilized even though there is strong demand for their services in these regions, especially because of the insurance program.

“Singrauli, for instance, the power capital of India, has hospitals of NTPC, Coal India Ltd; all of them underutilized (like) shells standing. Railway hospitals (are like) shells standing but not being utilized efficiently enough,” Kumar said.

He urged large private hospital chains to manage the hospitals run by state enterprises better by widening the scope of their services to beyond their own employees.

The PMJAY was introduced last year, and aims to provide health insurance cover of 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10 crore poor and vulnerable families, which would total around 50 crore beneficiaries.

Ayushman Bharat is the umbrella program, with PMJAY for secondary and tertiary hospitalization, and health and wellness centres for primary healthcare facilities. Under the Ayushman Bharat, the government aims to create around 1.5 lakh health and wellness centres.

While the Indian government aims to increase the share of public health spending to 2.5% of GDP by 2025 under the National Health Policy, currently it is still only around 1%.

Another major problem for the poor state of the sector is the lack of health insurance for patients, leading to an out of pocket expenditure making up for 61% of total health expenses for households, as of 2015-16, latest National Health Accounts data showed.

To reduce out of pocket expenses, the government introduced the Ayushman Bharat insurance scheme, but large private hospital chains have shown resistance to participating in it due to ‘low package rates’ for various treatment procedures. Kumar said that the government was willing to listen to hospitals and other private entities and make changes to policy if they were ready to invest in the sector.

 

Reshaping medical industry & medical profession/Doctor: #Doctor assault


 

    Routine instances of verbal abuse,  threat  and physical assaults are common incidents. Usually media justifies assaults on doctors, administration and courts are of little help. Doctors suffer for  no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real these days.  Recently, even female doctors have not been spared by mobs. Silence of prominent social people, celebrities and society icons on this issue is a pointer towards increasingly uncivilized mindset of society. But these are not without having long term effects. There will be definite effects on how medical profession and industry reshapes  in coming times.

    1.  Poor advertisement for  Private medical college seat- Doctor assault is definitely a poor advertisement  for the medical students, who want to buy a private medical college seat by paying millions. Medical colleges are owned by rich and powerful.  There is possibility of loss of business. Why should one pay millions and bear  risk of being beaten or killed, while doing such a  stressful duty. People will be fearful to be doctors on a free seat, leave alone on the paid seatIt will be a naïve idea to pay millions and be a doctor.

       So  “loss in business” is something which can force administrators and  government to make laws against doctor assault and lawlessness against doctors.  That is the only silver lining  of doctor assaults. If private medical colleges are to survive and attract rich candidates  and earn money, a law to protect doctors is a must.

 

  1. Closure-Bundling out single practitioner and doctor run small practices: small nursing homes and single or doctor couple practices depend on a good doctor patient relationship. In  an era of deep mistrust  generated by media, it is difficult for individual doctor to have community practices, which were cheap and helpful locally. Doctors can not work with fear and in an unprotected environment. Automatically these smaller units will cease to exist and practically   It is a natural consequence of such incidents. There will be scanty friendly neighborhood doctors or their quality will  suffer.

 

  1. Lesser   doctors for emergency work: as working in life and death situations is attracting heavy risk to doctor’s life, there will be less enthusiasm to work in emergency situations. If the  situations continue, it will be more of a forced decision rather than  elective to work in emergencies.
  1. Corporate health care will be a way of life: when doctors owned small practices becoming extinct and  remain rudimentary or  cease to exist, the investor run big set ups  will be the only option. The big systems will be run on business model and doctors will be better protected workers in  the industry. That will become way of life as far as health care is concerned.
  2. Doctor & nurses turning into cheap labor: biggest threat of the oppressive system is the minimizing  independence of doctors as professionals.  Dependence on investor driven big health systems will increase. So abundance of skilled manpower will be available to investor led healthcare, and doctors and nurses  end up  being converted    into cheap labor for industry.
  3. Good for administrators and health managers: the dream of health industry to have cheap skilled manpower, is not that distant now. Security risk will close independent practices and they will be available for safer zones,  which for administrators and investor is a dream coming true. Less expensive abundant skilled manpower is an administrator’s delight.
  4. Demoralization of doctors and nurses: needless to say, it is one of darkest era for medical professionals. They are ebbed from all sides. Medical profession reeks of desperation and desolation, with not any one from power corridors to protect them, no courts, no human right commission for them to save the saviors from its decrepit state. Real medical profession has been devastated with little hope of regeneration.
  5. Survival of  commercially fittest doctors: doctors who survive in changing environment will be commercially fittest, able to entrench themselves in changing business environment, able to wriggle through legalities, well connected, glib talking, able to connect to industry. Doctors, who  do not possess above qualities, will not survive the health markets.
  6. Medical Community broken to single  suffering individuals: Every doctor knows that some thing is really wrong happening against the profession.  Not only every day minor irritants but there  are recurring episodes of blatant cruelty against doctors. The whole profession is being criticized openly in the garb of stray incidences or in cases of genuine poor prognosis. Each and every doctors  wants  to react.  But no one knows  really “ how to do it”. There is no unity  amid this chaotic problem. The community has been broken  and pushed to behave as single suffering   whatever way  they choose to react ,  the slightest reaction may  invite the ire of many unknown people, may be mighty and revengeful. More over, it is the individuals, not a community, that remains  non-united,  whose  career   and life is at stake.
  7. Effect on patients: at present,  leave it to wisdom of readers.

#Expensive-modern-health-care: Reminiscent of an ancient realm of medical regulation #Medical-lawsuits


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 corporate invested money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care really took away the profession from control  of doctors. As it is no more simply treating a disease and involves many more issues.  New model of 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 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 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 naïve 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 by 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  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.

In an effort to institute  a  well controlled  healthcare, our society is in a way re-entering the realm of an ancient medical regulatory  system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy  benefits of medical advancement to the fullest. Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

Re-blogged

Price fixing by broad generic drug makers in collusion : allege 45 US states


The states said the drug makers and executives divided customers for their drugs among themselves, agreeing that each company would have a certain percentage of the market.

How large  companies  create a web of  corrupt practices, and earn   huge profits, is a common prevalent sentiment.  Tip of the Iceberg has been revealed indicating  a collusion among  generic drug makers, to jack up prices.  If these allegations are proved correct, it may expose   one  reason of exorbitant prices of pharmaceutical industry.  Whereas doctors are blamed for healthcare being expensive, the real  health industry remains hidden and  earning huge profits by dubious means.

Soaring drug prices from both branded and generic drug manufacturers have sparked outrage and investigations in the United States. President Donald Trump this year accused pharmaceutical companies of “getting away with murder” with their drug pricing.

It might be the biggest price-fixing scheme in U.S. history. On Friday, Connecticut and a coalition of more than 40 states filed a 500-page lawsuit accusing the biggest generic drug makers of a massive, systematic conspiracy to bilk consumers out of billions of dollars. It’s a more sweeping version of a similar lawsuit the states filed in 2016 that’s still being litigated. The generic industry vehemently denies the allegations.

Congress established the current generic industry in 1984 to push prices down. The idea was that once patents on brand name drugs expired, generic makers would compete to make drugs more affordable. But 1,215 generics, many of them the most prescribed drugs, jumped on average more than 400 percent in a single year.

A large group of US states accused key players in the generic drug industry of a broad price-fixing conspiracy, moving on Tuesday to widen an earlier lawsuit to add many more drug makers and medicines in an action that sent some company shares tumbling.

The lawsuit, brought by the attorneys general of 45 states and the District of Columbia, accused 18 companies and subsidiaries and named 15 medicines. It also targeted two individual executives: Rajiv Malik, president and executive director of Mylan NV, and Satish Mehta, CEO and managing director of India’s Emcure Pharmaceuticals.

Shares of Pennsylvania-based Mylan, also named as a defendant, closed down 6.6%.

The states said the drug makers and executives divided customers for their drugs among themselves, agreeing that each company would have a certain percentage of the market. The companies sometimes agreed on price increases companies sometimes agreed on price increases in advance, the states added.

The states said Malik and Mehta spoke directly to one another to agree on their companies’ shares of the market for a delayed-release version of a common antibiotic, doxycycline hyclate.

“It is our belief that price-fixing is systematic, it is pervasive, and that a culture of collusion exists in the industry,” Connecticut Attorney General George Jepsen, who is leading the case, told a news conference in Hartford.

Mylan said in a statement it had found no evidence of price-fixing by the company or any of its employees, and vowed to defend itself vigorously. Malik, the company’s second-ranking official, has received more than $50 million in compensation over the past three years, last year making more than CEO Heather Bresch.

Emcure, also a defendant in the case, did not immediately respond to a request for comment.

Two former executives of Emcure’s subsidiary Heritage Pharmaceuticals pleaded guilty in January to federal charges of conspiring to fix prices and divide up the market for doxycycline and the diabetes drug glyburide.

The two men, former Heritage president Jason Malek and former chairman and chief executive Jeffrey Glazer, reached a deal with 41 states and territories in which they each agreed to pay $25,000 and cooperate with the state probe.

Executives like Mylan’s Bresch and former Turing Pharmaceuticals CEO Martin Shkreli

have been called in front of Congress to defend the cost of their products.

MORE COMPANIES TARGETED

The original complaint, filed in December, targeted Mylan, Heritage, Aurobindo Pharma USA Inc, Citron Pharma LLC, Mayne Pharma USA Inc and Teva Pharmaceuticals USA Inc.

The states are pressing a new complaint that would add Novartis AG’s unit Sandoz, India-based Sun Pharmaceutical Industries Ltd, Endo International PLC’s unit Par Pharmaceutical, Dr

Reddy’s Laboratories, Apotex Corp, Glenmark Generics Ltd, Lannett Company Inc, Alkem Laboratories Ltd’s unit Ascend Laboratories and Cadila Healthcare Ltd’s unit Zydus Pharmaceuticals Inc.

Jepsen said the investigation is continuing, and that claims would likely be brought against more companies, and possibly executives, in the future.

The news hurt shares of companies named in the expanded suit that are traded in the United States. In addition to Mylan’s drop, Lannett lost 13.7 percent. Shares of Endo were up 7 percent, but down from their 12 percent peak before the news of the amended lawsuit.

Teva spokeswoman Denise Bradley said the company denied the allegations. Endo spokeswoman Heather Lubeski said the company would vigorously defend itself against the claims. Other companies did not immediately respond to requests for comment

The expansion of the suit requires the court’s permission.

The original lawsuit centred on just two medicines, delayed-release doxycycline and glyburide.

The price of doxycycline rose from $20 for 500 tablets to $1,849 between October 2013 and May 2014, according to US Senator Amy Klobuchar, a Minnesota Democrat who had been pressing for action on high drug prices.

The amended complaint would expand the number of drugs to include glipizide-metformin and glyburide-metformin, which are among the most commonly used diabetes treatments.

Others include: acetazolamide, which is used to treat glaucoma and epilepsy; the antibiotic doxycycline monohydrate; the blood pressure medicine fosinopril; the anti-anxiety medicine meprobamate; and the calcium channel blocking agent nimodipine.

The US Justice Department is conducting a parallel criminal investigation. On Friday, the department asked the Pennsylvania court presiding over the lawsuit to put the lawsuit’s discovery process on hold, saying it could interfere with the criminal probe.

Connecticut Assistant Attorney General Joseph Nielsen said on Tuesday the states would likely oppose that request, which could slow the lawsuit.

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