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Outbreak of Zika Virus: How to prevent?


Current outbreak of  Zika  in Rajasthan is a warning for another potential disaster. The Prime Minister’s Office (PMO) has asked the Union health ministry for a report on the localised outbreak of Zika after 22 people tested positive for the mosquito-borne virus, which can cause birth defects in unborn babies, in Rajasthan’s capital Jaipur.

The Union health ministry, in a statement on Monday, confirmed the Zika cases in Jaipur so far through the Indian Council of Medical Research (ICMR) surveillance system.

About Zika Virus- summary

  • Zika virus disease is caused by a virus transmitted by Aedes mosquitoes.
  • People with Zika virus disease usually have a mild fever, skin rash (exanthema) and conjunctivitis. These symptoms normally last for 2-7 days.
  • There is no specific treatment or vaccine currently available.
  • The best form of prevention is protection against mosquito bites.
  • The virus is known to circulate in Africa, Americas, Asia and the Pacific

India needs to be particularly conscious about the spread of the disease since the mosquito that carries the virus actually thrives in the country. The Aedes Aegypti mosquito whose bite transmits the disease is the same as the one that transmits dengue and chikungunya, which is widely prevalent in India. With the temperature rising across India, it becomes more important to take precautions and not let the Aedes Aegypti mosquito breed.

What is Zika?

The virus is transmitted by Aedes aegypti mosquito, the same mosquito that transmits dengue and chikungunya. Its name comes from the Zika Forest of Uganda, where the virus was first isolated in 1947.

In pregnant women, Zika can cause birth defects such as microcephaly – unusually small heads – and other brain abnormalities in babies in the womb. The infection can also cause Guillain-Barre syndrome, a rare neurological disorder that causes paralysis.

There is no treatment or vaccine for the Zika infection.

Symptoms

The virus can show symptoms such as mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or a headache and body ache. But only about 20% of patients show symptoms that usually last up to a week.

Why should  one fear Zika?

It is strongly suspected to cause birth defects and neurological problems in newborns and as birth rate is high in the country special care needs to be taken. Since India provides fertile climate for the aedes egypti mosquito to grow and multiply, there is the potential of an outbreak situation in the country.

How can you avoid the virus?

Check mosquito breeding in and around your house. The mosquito that carries Zika virus – Aedes aegypti – breeds in fresh water so don’t let water collect in birdbaths, planters, non-used bottles, containers, discarded waste, tyres etc.

Use mosquito repellants such as creams, gels, electronic mosquito repellents, patches, incense sticks and bed nets. Grow plants that are known to repel mosquitoes such as citronella, basil, lemon grass, lavender, mint, rosemary etc.

Take special precautions during the day as Aedes aegypti is a day-biting mosquito and dress appropriately that covers most of the body parts.

WHO risk assessment

There has been  evidence on the circulation of the virus in India. Low level transmission of Zika virus and new cases may occur in the future. Efforts to strengthen surveillance should be maintained in order to better characterize the intensity of the viral circulation and geographical spread, and monitor Zika virus related complications. Zika virus is known to be circulating in South East Asia Region. WHO encourages Member states to report similar findings to better understand the global epidemiology of Zika virus.

The risk of further spread of Zika virus to areas where the competent vectors, the Aedes mosquitoes, are present is significant given the wide geographical distribution of these mosquitoes in various regions of the world. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

WHO advice

Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.

 

History of Diphtheria


In 1613, Spain experienced an epidemic of diphtheria. The year is known as El Año de los Garrotillos (The Year of Strangulations) in the history of Spain.

In 1735, a diphtheria epidemic swept through New England.

Before 1826, diphtheria was known by different names across the world. In England, it was known as Boulogne sore throat, as it spread from France. In 1826, Pierre Bretonneau gave the disease the name diphthérite (from Greek diphthera “leather”) describing the appearance of pseudomembrane in the throat.

In 1856, Victor Fourgeaud described an epidemic of diphtheria in California.

In 1878, Queen Victoria’s daughter Princess Alice and her family became infected with diphtheria, causing two deaths, Princess Marie of Hesse and by Rhine and Princess Alice herself.

In 1883, Edwin Klebs identified the bacterium causing diphtheria  and named it Klebs-Loeffler bacterium. The club shape of this bacterium helped Edwin to differentiate it from other bacteria. Over the period of time, it was called Microsporon diphtheriticum, Bacillus diphtheriae, and Mycobacterium diphtheriae. Current nomenclature is Corynebacterium diphtheriae. Friedrich Loeffler was the first person to cultivate C. diphtheriae in 1884. He used Koch’s postulates to prove association between C. diphtheriae and diphtheria. He also showed that the bacillus produces an exotoxin. Joseph P. O’Dwyer introduced the O’Dwyer tube for laryngeal intubation in patients with an obstructed larynx in 1885. It soon replaced tracheostomy as the emergency diphtheric intubation method.

In 1888, Emile Roux and Alexandre Yersin showed that a substance produced by C. diphtheriae caused symptoms of   diphtheria in animals. In 1890, Shibasaburo Kitasato and Emil von Behring immunized guinea pigs with heat-treated diphtheria toxin. They also immunized goats and horses in the same way and showed that an “antitoxin” made from serum of immunized animals could cure the disease in non-immunized animals.

 

Behring used this antitoxin (now known to consist of antibodies that neutralize the toxin produced by C. diphtheriae) for human trials in 1891, but they were unsuccessful. Successful treatment of human patients with horse-derived antitoxin began in 1894, after production and quantification of antitoxin had been optimized.

 Von Behring won the first Nobel Prize in medicine in 1901 for his work on diphtheria.

 

In 1895, H. K. Mulford Company of Philadelphia started production and testing of diphtheria antitoxin in the United States. Park and Biggs described the method for producing serum from horses for use in diphtheria treatment.

In 1897, Paul Ehrlich developed a standardized unit of measure for diphtheria antitoxin. This was the first ever standardization of a biological product, and played an important role in future developmental work on sera and vaccines.

In 1901, 10 of 11 inoculated St. Louis children died from contaminated diphtheria antitoxin. The horse from which the antitoxin was derived died of tetanus. This incident, coupled with a tetanus outbreak in Camden, New Jersey, played an important part in initiating federal regulation of biologic products.

On 7 January 1904, Ruth Cleveland died of diphtheria at the age of 12 years in Princeton, New Jersey. Ruth was the eldest daughter of former President Grover Cleveland and the former first lady Frances Folsom.

In 1905, Franklin Royer, from Philadelphia’s Municipal Hospital, published a paper urging timely treatment for diphtheria and adequate doses of antitoxin.

In 1906, Clemens Pirquet and Béla Schick described serum sickness in children receiving large

quantities of horse-derived antitoxin.

Between 1910 and 1911, Béla Schick developed the Schick test to detect pre-existing immunity to diphtheria in an exposed person.

Only those who were not exposed to diphtheria were preferably vaccinated. A massive, five-year campaign was coordinated by Dr. Schick. As a part of the campaign, 85 million pieces of literature were distributed by the Metropolitan Life Insurance Company with an appeal to parents to “Save your child from diphtheria.” A vaccine was developed in the next decade, and deaths began declining significantly in 1924.

In 1919, in Dallas, Texas, 10 children were killed and 60 others made seriously ill by toxic antitoxin which had passed the tests of the New York State Health Department. Mulford Company of Philadelphia (manufacturers) paid damages in every case.

In the 1920s, an estimated 100,000 to 200,000 cases of diphtheria occurred per year in the

United States, causing 13,000 to 15,000 deaths per year.  Children represented a largemajority of these cases and fatalities. One of the most infamous outbreaks of diphtheria was in Nome, Alaska; the “Great Race of Mercy” to deliver diphtheria antitoxin is now celebrated by the Iditarod Trail Sled Dog Race.

In 1926, Alexander Thomas Glenny increased the effectiveness of diphtheria toxoid (a modified version of the toxin used for vaccination) by treating it with aluminum salts. Vaccination with toxoid was not widely used untli the early 1930s.

In 1943, diphtheria outbreaks accompanied war and disruption in Europe. The 1 million cases in Europe resulted in 50,000 deaths. In 1949, 68 of 606 children died after diphtheria immunization due to improper manufacture of aluminum phosphate toxoid.

In 1974, the World Health Organization included DPT vaccine in their Expanded Programme on Immunization for developing countries.

In 1975, an outbreak of cutaneous diphtheria in Seattle, Washington, was reported.

In 1994, the Russian Federation had 39,703 diphtheria cases. By contrast, in 1990, only 1,211 cases were reported.

Between 1990 and 1998, diphtheria caused 5000 deaths in the countries of the former Soviet Union

In early May 2010, a case of diphtheria was diagnosed in Port-au-Prince, Haiti, after the devastating 2010 Haiti earthquake. The 15- year-old male patient died while workers searched for antitoxin.

In 2013, three children died of diphtheria in Hyderabad, India.]

In early June 2015, a case of diphtheria was diagnosed aVt all d’Hebron University Hospita lin Barcelona, Spain. The 6-year-old child who died of the illness had not been previously vaccinated due to parental opposition to vaccination. It was the first case of diphtheria in the country since 1986 as reported by” El Mundo” or from 1998, as reported by WHO.

In March 2016, a 3-year-old girl died of diphtheria in the University Hospital of Antwerp, Belgium.

In June 2016, a 3-year-old, 5-year-old, and 7-year-old girl died of diphtheria in Kedah and Malacca, Sabah Malaysia.

In January 2017, more than 300 cases were recorded in Venezuela.

In November and December 2017, an outbreak of diphtheria occurred in Indonesia with more than 600 cases found and 38 fatalities.

source

 

Loss of cabin pressure caused hypoxia, bleeds in Mumbai: Major tragedy in Greece@ air travel


More than 13 years ago, a Boeing aircraft crashed in a hilly terrain in Greece snuffing out 121 lives. A year later, investigators concluded that omissions in controlling cabin pressure was a key reason for the crash. Extreme case in 2005, a Helios Airline flight crashed into a mountain after the pilots lost consciousness from hypoxia.

One of the pilots said that generally, an aircraft is pressurized to 8,000 feet so that the pressure is adequate for the human body. Normally, a plane flies at an altitude of around 35,000 feet.

De-pressurization could even result in hypoxia for the people on board. Hypoxia or lack of adequate oxygen supply for the human tissues, can cause various problems, including deterioration in a cognitive abilities.

Loss of cabin pressure could result in hypoxia or the deprivation of oxygen. Oxygen deprivation is also the cause of headaches, nausea, and nosebleeds. A sudden drop in air pressure can be fatal for people with pre-existing conditions such as hypertension and cardiac anomalies .  There is a cavity in our oral and nasal passages and sudden change in air pressure of the surroundings negatively impairs the internal air pressure maintained in these cavities, thus causing bleeding through nose, ears or mouth. At the same time, the sudden drop in the pressure and lack of oxygen supply to the brain can also cause strokes, paralysis or convulsions in some people.

Drop in air-pressure in the surrounding affects people differently. While it usually causes heaviness in the head, dizziness and drowsiness in some, it can also be fatal for people with high blood pressure and a history of heart attacks. The five passengers suffered “barotrauma” of ear, which is caused due to a change in air pressure.

Several passengers on a Jet Airways Mumbai-Jaipur flight suffered nose and ear bleeding on Thursday morning as the pilots forgot to switch on the system to maintain cabin pressure, the DGCA said. “The 9W 697 Mumbai-Jaipur flight was turned back to Mumbai after take off as, during the climb, crew forgot to select switch to maintain cabin pressure. This resulted in the oxygen masks dropping. Thirty out of 166 passengers experienced nose and ear bleeding, some also complained of headache,”   deputy director general, Directorate General of Civil Aviation (DGCA), said. The crew has been taken off duty and Aircraft Accident Investigation Bureau (AAIB) has started an investigation, DGCA added. Ministry of Civil Aviation has requested DGCA to file its report immediately on the issue. The passengers are being treated at Mumbai airport. In a statement, Jet Airways said the B737 aircraft landed normally in Mumbai. “All guests were deplaned safely and taken to the terminal. First aid was administered to few guests who complained of ear pain, bleeding nose etc. The flight’s cockpit crew has been taken off scheduled duties pending investigation. The airline is making alternative flight arrangements for guests on this flight. Jet Airways regrets the inconvenience caused to its guests.” Several passengers posted images from inside the plane,  that showed that oxygen masks had been deployed due to the low cabin pressure

Invisible medical harms of carpet-bomb treatments with FDC (fixed dose combination): @ Government prohibits 328 fixed dose combinations


Drug Technical Advisory Board said there is no therapeutic justification for the ingredients contained in the 328 fixed-dose combination or FDC drugs.

A fixed-dose combination or FDC drug contains two or more active ingredients in a fixed dosage ratio. It means it’s not the single drug but a combination of the two or more,  which may be   unnecessary for consumption.

  1. Antibiotic  resistance: Most harmful impact can be because of antibiotics in FDC.

– Logic is simple. If  some one  is  not able to recognize, whether it is a rat, cat, dog or tiger causing trouble, carpet bomb with combination of three or four   bombs.  Is it overuse of  weapons? Yes, it is. Similarly, abuse of multiple antibiotics has potential to cause massive antibiotic resistance, can have global harmful effect.

Quacks or by self medication,  antibiotics may be overused  and abused . Quacks  or alternative medicine doctors often prescribe FDCs as they are unable to pinpoint the exact cause of an illness and carpet-bomb patients with combination doses, in the hope that one of the drugs would work.

  1. Overuse of drugs: where one drug for example a paracetamol is required, patient will take three medicines.
  2. Increase in side effects: instead of one medication, patient will have side effects of all other medicines also.
  3. inadequate doses: If many drugs are combined in one, doses may be inadequate or less. So patient takes more drugs , but in adequate doses.
  4. Increase in cost: instead of one , the patient pays for three drugs, thereby increase in cost.

Government prohibits 328 fixed dose combinations 

     Painkiller Saridon and skin cream Panderm are among 328 fixed-dose combination or FDC drugs banned by the government to stop their “irrational use”. The health ministry says the ingredients in these medicines do not markedly add to the benefits that people can get from taking them. The order immediately bans the manufacture, marketing and sale of several common cough syrups, painkillers, and cold and flu drugs. The country’s drug advisory body, the Drug Technical Advisory Board or DTAB, has said there is no therapeutic justification for the ingredients in these drugs and they must be banned in public interest.

-The government has added restrictions to dosage and use of six more FDCs,  not among the 328 banned ones,  over their ingredients having no therapeutic value and posing a risk to consumers.

-The health ministry took the decision after the country’s top drug advisory body, the Drug Technical Advisory Board or DTAB, in a report said taking the 328 FDCs would be a health risk. India has some 2,000 FDCs as against a little over 500 in USA.

-It is a good move for public health. Individual drugs are approved by the centre, but some manufacturers make combinations of two drugs and get state licences.

-Mixing two drugs create a new medicine. For new medicine , pharma companies should approach the Drugs Controller General of India and apply for a fresh licence, conduct trials and  prove safety.

-In March 2010, the government restricted sales of 344 FDCs, a move that was challenged by pharma firms in court. The Supreme Court last December told the DTAB to ascertain whether FDCs should be banned from the market.

Every one is  calculative about  the loss of millions.  The invisible losses to human kind are still to be calculated.

 

Air pollution, Ultra fine dust causing millions premature deaths by heart attacks, strokes


Globally, 58% of outdoor air pollution-related premature deaths are due to heart disease and strokes, 18% due to chronic obstructive pulmonary disease, 18% from lung infections, and 6% because of lung cancer, said the World Health Organisation’s 2016 estimates.

Outdoor air pollution leads to 4.2 million premature deaths worldwide each year, with close to 60% of the deaths from heart attacks and strokes, according to the World Health Organisation. Finally, scientists appear to have figured out just how fine dust attacks the cardiovascular system.

An analysis of the effect of the different components of polluted air, including ozone, nitrogen dioxide, carbon monoxide and sulfur dioxide, showed that small particulate matter is the most damaging to the body’s vascular system, reported a team of researchers from Germany, England and the US.

Ultrafine dust (particulate matter 2.5 microns or less in diameter, or PM2.5) is the size of a virus and can penetrate the lung barrier to enter the blood system, leading to local inflammation in the blood vessels, the researchers found. This leads to atherosclerosis (plaque or fatty deposits in the side wall of the arteries), which stops blood flow to cause heart attacks, heart failure and irregular heartbeat (arrhythmias), they said.

It was PM2.5 and not nitrogen dioxide (NO2) — both of which are found in diesel exhaust emissions — which affected vascular function and posed a bigger risk to cardiovascular health, found the study published in the European Heart Journal on Thursday.

Heart disease is the leading cause of death in India, which has 14 of the world’s most polluted cities by small particulate matter concentration (see box). According to the Global Burden of Disease report, an estimated 1.1 million deaths in India were linked to PM2.5 air pollution in 2015.

PM2.5 inhalation causes hypertension, insulin resistance, and endothelial dysfunction with impaired vasodilation (stiffening of the arteries), inflammation and clot formation, which can trigger heart attack and stroke. “The fine dust particles are chemically formed mainly in the atmosphere from emissions from traffic, industry, and agriculture. In order to achieve low, harmless concentrations, emissions from all these sources need to be reduced,” said lead author Thomas Münzel, director of cardiology at the Medical Center of Johannes Gutenberg University Mainz, Germany.

Governments need to introduce strong regulatory policies to regulate emissions and invest in clean transport, green power generation and efficient waste management.

source

 

How viruses, germ cross international borders? Toilets cleaner than Airport trays


Airport security trays carry more diseases than toilets.  The plastic trays that passengers put their hand luggage in at airport security checkpoints harbour the highest levels of viruses, even more than toilets, a study warns. Researchers from the University of Nottingham in the UK swabbed a variety of surfaces at Helsinki-Vantaa airport in Finland during the winter of 2016. They set out to identify and quantify the respiratory viruses on frequently touched surfaces in airports. The team found evidence of viruses on 10 per cent of the surfaces tested and most commonly on the plastic trays that are circulated along the passenger queue at the hand luggage X-ray checkpoint. The study, published in the journal BMC Infectious Diseases, concludes that hand washing and careful coughing hygiene are crucial to the control of contagious infections in public areas with high volumes of people passing through. The findings add weight to previous studies showing that microbes are commonly found on surfaces in public transport vehicles and will strengthen public health advice in preparation for future flu pandemics, researchers said. Airport security trays carry more diseases than toilets. The highest concentration of viruses was detected on the security check plastic trays with further viruses detected on shop payment terminals, staircase rails, passport checking counters, children’s play areas and in the air. The most common virus found in the survey was rhinovirus, which causes the common cold but the swabs also picked up the influenza A virus, researchers said. Interestingly, no respiratory viruses were found on toilet surfaces, they said.

Story of Unlabeled drugs and Fraud In name of Ayurvedic treatment


         A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who have been given a “no hope” by scientific medicine, are an easy prey for such fraudsters.

   Another major problem is that medicines and syrups distributed in such manner are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses.  

     Ayurvedic medicines and practitioners  belong to a  stream, also based on a  science. The medicines and treatment has to be  controlled and regulated in the same way, as for allopathic  stream.  So that criminals, who are not trained in ayurvedic stream can not play with lives of gullible people, giving them false hope.  Such acts  are  real crime to society, done with an intention to cheat rather than treating them.

   Any one distributing medicines or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis.

Regulating Ayurvedic medicines and practice will help  not only the genuine  Ayurvedic  doctors but also go a long way  in benefiting the ancient system of medicine and promote research.  

  Following may be just one of the cases, millions may remain unnoticed.

False ayurveda hopes to the hopeless

Tarun Mandal has spent almost all of his savings trying to get his son, suffering from acute jaundice since his birth, treated for the past one and a half years. A desperate Mandal recently paid a youth Rs 65,000 for an ayurvedic cure. However, his wife’s suspicion about the ‘gold ash’ tasting like churan led cops to an inter-state racket cheating terminally ill patients with a promise of cure. Mandal, who sells food items on a cart at the Sarojini Nagar market, was not the only one to fall in the trap. Cops have found at least 40 people who had been duped by the gang. Most of the victims are family members of children from different states getting treated in the capital’s top government hospitals.
“I gave away all my savings to them. They even guaranteed that all my money would be returned if the medicines failed. But when I went back to the same shop, they refused to recognise me,” said Mandal, who has already spent Rs 2 lakh and needs more money for a surgery.
The gang has also duped the grandfather of a seven-year-old thalessemia patient from Uttarakhand.

other incident dangerous chemicals in alternate medicines

The Story of Faulty Johnson & Johnson (J&J) Hip Implant


Govt to track patients with faulty J&J hip implant to ensure compensation

Close to 4,700 people with damaged hip joints in India received the implant before 2010, when it was recalled, of which only 1,080 were tracked and compensated.

   The Union health ministry will establish committees at the Central and state levels to track and compensate patients who received a faulty artificial hip implant that was recalled worldwide by the manufacturer Johnson & Johnson (J&J), in 2010.

Close to 4,700 people with damaged hip joints in India received the implant before 2010, when it was recalled, of which only 1,080 were tracked and compensated. Of them, 275 underwent revision surgeries.

Following complaints from patients, the health ministry set up an 11-member committee on February 7, 2017, to investigate patient complaints of adverse events against J&J’s metal-on-metal Articular Surface Replacement (ASR) hip implant devices — XL Acetabular Hip System and Hip Resurfacing System.

The committee  submitted its report on February 19, 2018. It said specialists must assess cases individually for treatment and compensation of at least Rs 20 lakh.

In November last year, the federal jury in Dallas had ordered J&J and its DePuy Orthopaedics unit to pay $247 million to six patients for not warning patients about the potential risks of the defective design of the metal-on-metal hip implants .

The committee at the state level will be tracking the affected patients. These cases are old and hospitals don’t have data available on them; close to 100 hospitals were approached but there was no data. State governments will be widely advertising the move to see that affected people approach them,” said a senior official, requesting anonymity.

Each case will be physically and clinically assessed by the state government committee to determine the degree of disability and refer to the central government committee to decide on the compensation amount.

In it response J&J said: “DePuy has fully cooperated with the expert committee in their investigation of the ASR matter. However, the Expert Committee Report has not been provided to the company for review to date, so it would be inappropriate for us to comment on it. We would like to reiterate that we have furnished full facts and data available with us to the expert committee.”

Metal on metal implants are rarely used now, say orthopaedic surgeons. “Metal-on-metal hip implants have been largely discontinued because of the associated complications. With other implants, the revision surgery rate would be around 3-5%, but with this particular brand, it was a higher 10-12 percent.

People complain of pain, which is largely due to loosening of the implant and wear and tear of the metal that would cause collection of metal in the body that it would react to. Another  available implant is ceramic cross-linked with plastic polyethylene socket, where head ball is of ceramic and socket of polyethylene.

After years of testing, ASR was imported and marketed in India and in various countries around the world, with all regulatory approval and permissions as were then applicable. After it was on the market, DePuy continued studying and closely watching how the device was performing and in August 2010.  DePuy issued a voluntary recall of the ASR Hip System after receiving new information from the UK National Joint Registry.

It immediately informed the Drugs Controller General of India (DCGI) about the voluntary recall. Since then, we have kept the DCGI informed of all key actions and worked to provide Indian patients and surgeons with the information and support they need, in line with government requirements.”

Expensive medical education ? Future may be “free medical education”: NYU offers free education for all its medical students


     At a time when students, parents and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with   becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat of MBBS.

Truth  cannot remain hidden for long.  It has  to be realized that getting into medical college is a minuscule component of the process of becoming a good doctor.  Once they opt for this profession, the real tough and prolonged battle begins. Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it, especially those who may have invested in heavy fees and in debt.

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

Paying the irrational fee of medical colleges may be an 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 or fail to get residency.

The New York University School of Medicine will provide free tuition for all present and future students, the university announced.

Citing the risk of “overwhelming” debt, it says every student will qualify regardless of merit or financial need.  NYU said financial worries were driving graduates to more lucrative specialities, pushing doctors away from more general positions. The scholarship covers annual tuition costs of up to $55,000 (£43,000). A study produced by the Association of American Medical Colleges estimated that in 2017 75% of medical students graduated in debt. The university has reportedly been working for more than a decade to accrue the necessary funds to pay for tuition, and hopes to raise a total of $600 million (£472m) to make the scholarships available permanently. NYU School of Medicine made the surprise announcement at its annual White Coat Ceremony on Thursday – when new students receive a white lab coat as they begin their studies. In their statement, the university said debt is “fundamentally reshaping the medical profession in ways that are adversely affecting healthcare”.Graduates move towards higher-paying areas of medicine over paediatrics, primary care or gynaecology due to their “staggering student loans”. Aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt”. Robert Grossman, dean of the medical school and chief executive officer of NYU Langone Health, said: “This decision recognises a moral imperative that must be addressed, as institutions place an increasing debt burden on young people who aspire to become physicians.”To date, only a handful of institutions have tried to make medical education tuition-free, according to Julie Fresne, senior director of student financial services of the Association of American Medical Colleges, a nonprofit organisation that represents medical schools. At UCLA’s David Geffen School of Medicine, a $100m (£79m) fund announced several years ago pays for the entire cost of medical school for all four years, including tuition, fees, books and living expenses for about 20 per cent of its students. But that program is based on merit, not need.

Meanwhile, a small medical school affiliated with Case Western Reserve University at the Cleveland Clinic covers the tuition and fees for its five-year programme focusing on research. Most of the roughly 20,000 students per year enrolled in US medical schools take out sizeable federal loans to support their studies. According to the Association of American Medical Colleges, in 2017, the median debt for graduating medical students was $192,000 (£151,000).The median cost of medical school attendance, including living expenses, was $60,945 (£47,906) a year for public medical school and $82,278 (£64,675) for private medical school.

This may be a indicator of the future days to come, the need for medical education   to be cheap or made free,  to encourage young generation to become doctors. Society has the choice to encourage and nurture good doctor for itself or discourage them by financial exploitation and subjecting them to debt trap. NYU has wisely decided on its choice.

 

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