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SC Rejects Greedy decision by Govt & Private Medical College-Fee Hike


 

    The Supreme Court set aside an Andhra Pradesh government order of 2017 prescribing a seven-fold increase in MBBS fees that made it ₹24 lakh per annum.

The Supreme Court in a judgment on Monday held that education is not a business to earn profit as it set aside an Andhra Pradesh government order of 2017 prescribing a seven-fold increase in MBBS fees that made it ₹24 lakh per annum.

Directing the private colleges to refund the amount collected in excess of the fees last fixed by the state government in 2011, a bench of justices MR Shah and Sudhanshu Dhulia said, “Education is not the business to earn profit. The tuition fee shall always be affordable.”

The order came on a petition filed by the Narayana Medical College challenging a September 2019 decision of the Andhra Pradesh high court striking down the fee increase and ordering refund to students admitted in the college since the academic year 2017-18. The apex court dismissed the petition with cost of ₹5 lakh to be borne equally by the petitioner college and state government and deposited in court within six weeks. The amount was directed for use in legal services by the Supreme Court Mediation and Conciliation Committee and the National Legal Services Authority.

The top court agreed with the conclusion made by the high court and said, “To enhance the fee to ₹24 lakh per annum, I.e., seven times more than the fee fixed earlier was not justifiable at all.” The aggrieved medical students who had to pay through their nose had said that the government order raising the fees issued on September 6, 2017 was done without awaiting the recommendation of the Admission and Fee Regulatory Committee (AFRC).

The bench held the order passed by the state government to be “wholly impermissible and most arbitrary”. The court even went to the extent of saying that the hike was done “only with a view to favour or oblige the private medical colleges.”

“Any enhancement of the tuition fee without the recommendation of the AFRC shall be contrary to the decision of this court in case of P.A Inamdar in 2005 and the relevant provisions of the 2006 AFRC Rules (prevailing in the state). The high court has rightly quashed and set aside the GO dated September 6, 2017.”

The students pointed out that in 2011, the tuition fee hike was introduced by the state after consulting AFRC. However, in 2019, the state acted solely on representations received from private medical colleges. Rule 4 of the Admission and Fee Regulatory Committee (for Professional Courses offered in Private, Unaided Professional Institutions) Rules, 2006 mandated the state to seek a prior report from AFRC before altering the fee.

This rule required AFRC to factor in the location of the institution, nature of professional course, cost of available infrastructure, expenditure on administration and maintenance, reasonable surplus required for growth and development of the institution, revenue foregone on account of waiver of fee in respect of students from reserved category or economically weaker sections (EWS) of the society.

The top court said, “Determination of fee/review of fee shall be within the parameters of the fixation rules and shall have the direct nexus on the factors mentioned in Rule 4 of the 2006 Rules…the state government enhanced the tuition fee at an exorbitant rate of ₹24 lakh per annum, almost seven times the tuition fee notified for the previous block period.”

The next question arose regarding refund as ordered by the high court in its order of September 24, 2019. The high court said that the colleges cannot take benefit of the unjust enrichment in fees that was wrongly increased. Accordingly, it asked the colleges to refund the students after adjusting the amounts payable under the earlier fee structure recommended by AFRC and issued in June 2011.

The bench upheld this part of the high court order and said, “The medical colleges are the beneficiaries of the illegal GO which is rightly set aside by the high court.” The bench was conscious of the hardships faced by students who arranged to pay the amount by obtaining loan from banks and financial institutions at high rate of interest. “The management cannot be permitted to retain the amount recovered or collected pursuant to the illegal GO,” it held.

The college told the Supreme Court that between 2011 and 2017, they incurred added expenses due to the requirement introduced in 2016 to pay stipend to students even as the fee remained unchanged since 2011. The bench told the college that this component would be compensated as and when the higher tuition fee is fixed by AFRC. However, the court did not permit the college to retain the illegally collected amount.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

India-UK FTA may tighten screws on Generic drugs. Britain doing Big Pharma Bidding?


Several international organisations working to improve people’s access to medicines have written to the UK government protesting against provisions in a proposed India-UK FTA after the chapter on intellectual property was leaked. The provisions related to pharmaceutical IP could prevent India from making affordable generics on which the National Health Service (NHS) of the UK and several other countries depend.  India’s ability to produce generics is crucial not only to the Global South but to the UK too.

Four out of five drugs used in the NHS are generics and a third of these are produced in India. So about 25% of the drugs in the NHS come from India. Between 2011 and 2016, the NHS started to experience a crisis in the amount of money it was spending on new, very expensive drugs. The amount the NHS spent rose in those years by £3.8 billion. That is more than twice the total NHS deficit at that time – £1.85 billion. The crisis was so severe that the NHS began to look for ways to save money, including importing more generics. It worked.

International non-profit calls upon calls upon India to stay vigilant and asks the U.K. to withdraw intellectual property proposals.

The proposals on intellectual property (IP) rights in the draft India-United Kingdom Free Trade Agreement (FTA) will hurt the global supply of generic medicines, Doctors Without Borders (Médecins Sans Frontières or MSF) warned on Wednesday. In a press note, the international organisation said low medicine prices help save lives in vulnerable communities across the world but the intellectual property chapter of the India-U.K. FTA contains “harmful IP provisions”. The IP-related chapter, leaked on October 31, showed that the controversial provisions tabled by the U.K. to “tighten the screws on producing, supplying and exporting affordable generic medicines from India”.

“Given the disastrous consequences, this leaked IP chapter could have on the global supply of generic medicines, the U.K. government should withdraw it completely. India should stay vigilant and not allow barriers to affordable medicines to be written into FTA negotiations,” Leena Menghaney, South Asia head of MSF’s Access Campaign, said. 

U.K.-India trade talks continuing

In a “Fact Sheet”, MSF has argued that the demand for “harmonisation” of Indian patent law with the U.K.’s laws will lead to dilution of important provisions in the Indian patent system that are necessary for manufacturing generic medicines and vaccines.

“Article E.10 of the leaked IP chapter stipulates that both parties “shall not” make patent opposition proceedings available BEFORE the grant of a patent. In effect, this provision applies only to India as the U.K. does not have a pre-grant opposition system – this goes directly against the current Indian patent law, which allows patent opposition proceedings both before and after the grant of a patent,” the MSF said in its observations on the IP provisions.

MSF pointed out that under the proposals from the U.K., even treatment providers could be subjected to legal actions for prescribing generic medicines for which India is one of the largest manufacturing hubs. MSF said that the IP provisions brought up by the U.K. opened up possibilities for “excessive enforcement” that are likely to create difficulties for both Indian pharmaceutical companies as well as the legal set-up. 

MSF highlighted that another problematic provision is Article J.11 of the leaked IP chapter. Under this provision, Customs officials could block legitimate medicines from leaving India for other developing countries if a multinational pharmaceutical corporation was to claim that their patents were being infringed upon by the Indian product. “Furthermore, Article J.5 and J.7 prescribe how courts should adjudicate IP disputes, which could impact [Indian] judicial discretion,” MSF said.

A British government spokesperson said they would not comment on the “alleged leaks” and will only sign “a deal that is fair, reciprocal, and ultimately in the best interests of the British people and the economy”.

“The U.K. and India are negotiating an ambitious Free Trade Agreement that will boost our current trading relationship, already worth more than ₤24 billion last year,” the spokesperson told The Hindu.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

How to Reduce Social Media Addiction-Digital Minimalism


         The Demons of social media and online gaming  has rewired the people’s mind to live life and  remain in virtual world. The chaos and turmoil in the society can be linked to social media that exploits the deep wired craving of masses to know more about the “realities”. Once a curiosity  is fired, each one at social media starts feeding something or other.   In the mad game of TRP’s, clouts and engagements, these players cross ethical lines and create rifts. They literally hunt and scavenge news items that suit their narrative. They embellish it with more provocative words and share it with their name hoping to drive more engagement Conspiratorial and alarmist thinking is likely to keep people glued to social media.

     Covid-19 pandemic worsened addiction to the internet among children. The footfall at psychiatric out-patient departments in hospitals, especially those offering help to kids hooked to the net, be it for online gaming, chatting with friends or sharing videos, offers a glimpse of the problem.

Digital Minimalism- break free from “internet compulsions”

                                       
     Freedom, Cold Turkey, RescueTime, Toggl, StayFocusd, FocusMe, SelfControl, AntiSocial… They are not random words pulsed together in a blender, but names of some of the top apps that, ironically, help you stay away from your digital addictions. As Thakur said in Sholay, “loha lohe ko kaat-ta hai”, so now we need apps to stay away from apps. This farcical situation hides a deeper reality – too many of us are spending too much time online. So, amid the launch of 5G and other high-speed tech, a growing army of people doesn’t want to be addicted to social media and googling. They aspire to live frugal, almost ascetic, digital lives without completely switching off from the internet. It’s a trend called ‘digital minimalism’, and it is different from a ‘digital detox’ where you unplug completely. To illustrate, detox is what Mohityanche Vadgaon village in Maharashtra’s Sangli district does. A siren goes off at 7pm, and residents put their electronic devices away for 90 minutes. Children are encouraged to read while the older people meet and chat.

Digital minimalism, however, does not require complete withdrawal. Coined by author Cal Newport, it is a way of using technology in which you focus your online time on a few carefully selected tasks that strongly support the things you value. It advises against excessive use of gadgets.

Digital Minimalism- break free from “internet compulsions”

       Digital minimalism is based on three tenets: clutter is expensive, optimization is critical, and intention is satisfying. The objective is that the usage should be intentional and controlled for a limited period of time. And the apps mentioned above are meant to stop you from jumping from one attention-diverting push notification to another. They can block other apps from operating, create blocklists, schedule apps to run only during a specific time of the day, and alert you about the excessive time spent online.

       This philosophy is being discussed now, especially after the pandemic when people began spending more time online, adding that children aged 13-18 years have become more prone to digital addiction since the pandemic. The parents are taking their children to counsellors as they have become addicted to screens and feel isolated and tense when they have to interact with people in the real world. For them, online networking is secure and simple.” He advised gradually introducing such children to digital minimalism, to reduce their reliance and time spent on digital platforms. He also said it is critical for parents and adults to see if those who are addicted to digital devices have any anxiety issues. Because digital addiction has been observed in people who already have anxiety issues, these issues must be addressed first.  WHO has classified excessive use of the internet and mobile phones as screen addiction, and provided a set of guidelines. There is certainly a 50% increase in screen time addiction cases post-pandemic, we should be more concerned about the changes that will occur with advancements, like the metaverse.  Need to first introduce minimalistic practices, and then, in some cases, recommend mild medication to help people break free from their “internet compulsions”.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

A Child is Born Free till he chooses to be Doctor # Rohtak-Medicos-fight-Unjust-Bonds


Choosing medical career or being a doctor  has become a struggle in present era. Aspiring doctors need to first think- why they want to be a doctor in such circumstances-enduring all kind of exploitation- from all corners of society?

    Unable to give doctors their rightful, there has been an administrators’ wish to enslave medical profession.  Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.” In a new era of  consumerism, when patient is defined as consumer and medical industry controls medical profession and the financial boundaries. All components of medical industry want their pound of flesh from hard work of doctors and nurses.  Every day routine issues turning into medico-legal hassles have put doctors in the corner, resulting in severe distraction from real point of intention-treatment of patients.

      Struggling to get admission in medical college, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.   

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

Educating a doctor cost less what   medical colleges  claim- a global phenomenon.

   Instead of   often  repeated statements  about high expense on running medical college and  projecting it   as a  hard  fact, the amount spent  on  medical students by all medical colleges should be made transparent by all institutions. The  frequent  statement  is made that  cost of  making a doctor is very high and  gleefully  propagated  by  the  private medical colleges to extract millions out of  young  medical students . 

Such statements without any actual public data  is repeated  to the   extent  that  it  is  firmly  entrenched  in  public  mind without any real evidence.

      Projection of  high cost  of making a doctor  is  the  reason    with an intention  to  exploit the young doctors in various ways to get cheap labour and extract  millions from aspiring doctors  by  medical colleges.

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

MBBS  medical  students protest against Haryana Govt bond policy detained

In a crackdown on MBBS students protesting against Haryana government’s bond policy for government medical colleges, the Rohtak Police detained around 300 students in the early hours of Saturday and registered a First Information Report in this connection.

The police action came ahead of the visit of Governor, Chief Minister and Home Minister to PGI campus for the convocation of Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak.

He added that the students were now co-operating with the administration and a meeting was being facilitated between them and the Chief Minister soon after the convocation.

The Haryana government had come out with a policy to incentivise doctors to opt for government service in the State on November 6, 2020, saying that the candidates selected for MBBS degree course in government medical colleges need to execute an annual bond for ₹10 lakh minus the fee at the start of every academic year. The candidate can pay the entire bond amount without recourse to the loan or the State government will facilitate them for availing an education loan for this bond amount. As per the policy, the government will repay the annual instalments of the loan if the candidate obtains employment with the State government.

However, in view of the protests, the CM had three days ago announced that students need not pay the ₹10 lakh bond amount at the time of admission, but instead have to sign a bond-cum-loan agreement of the amount with the college and the bank.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Blowin’ In The Wind-Delhi Air Pollution: Colossal Administrative failure


Blowin’ In The Wind Yes, and how many times can a man turn his head

And pretend that he just doesn’t see?

 

The answer, my friend, is blowin’ in the wind

The answer is blowin’ in the wind

 

Yes, and how many times must a man look up

Before he can see the sky?

And how many ears must one man have

Before he can hear people cry?

Yes, and how many deaths will it take ’til he knows

That too many people have died?

 

The answer, my friend, is blowin’ in the wind

The answer is blowin’ in the wind

 

 

An eight year old child –scared, sitting terrified in mother’s lap, feeling breathless and  feeling a bit dizzy.  News about rising levels of smog and pollution send shivers down her spine every year. Her mother closing all the doors of house and trying to avoid the fumes  entering the room like ghosts from every small crevices, peepholes and slits. The mother prays for the smooth sail through these days as she knows very well that the season has come when the environment will be full of pollutants. The child will writhe with suffocation due to  air pollution in the same proportion. The reasons for  dangerous  levels of air pollution  can be multiple like vehicles, crackers or farm waste burning, but accumulate near the some cities due to geographical distribution and environmental factors.

 

Irony is that it is someone else’s  problem  like farm waste burning  and  ball  of a time with polluting  crackers adds to child’s suffering. Here the sufferer is not the real cause pollution. Unlike if someone smokes or drinks alcohol, it is the doer who is sufferer. But here the root cause of her trouble emanates from poor governance and administrative failure to control the irresponsible behaviour of few.

 

Every year, many factors collectively add to enormous pollution and air becomes thick with smog and suspended particulate matter at a predictable time.  It is a cause of breathlessness in children and adults and vulnerable to asthmatic attacks.

 

Like this one child, there are thousands of them and people from all ages suffer during this season because of mistakes and   thrill of others. These sufferers, who are frustrated due to their plight, with no fault of theirs, have to undergo treatment and  visit emergencies of the hospitals. This irresponsible behaviour of people puts burden on the medical services and the doctors, who are already overstretched due to workload. But it is only the doctors and nurses, who are  visible round the clock, whereas people who have polluted the air and the administrators  remain invisible.  For many, it is very hard to understand the complexity of the situation.  Patients many a times will rather tend to blame the doctors for their sufferings, poor treatment and difficulty in treatment, without realizing that constant pollution is the reason for poor response to treatment.

Why all of us cannot keep in mind the plight of such patients? Why the administrators wake up and come out of their slumber every year when AQI is more than 500 already?

There are no punishments for repeated administrative failures.

 

But inconsequential pleasure and poor governance should not be allowed to inflict health and  life of others.

Delhi Air Pollution:  AQI more than 500. Apart from climate change, air pollution is just another biggest environmental threat to human health at present. And with pollution levels worsening in the national capital and neighbouring regions, residents of Delhi have started complaining of several health problems like difficulty in breathing, tightness of chest, asthmatic symptoms, runny nose, sore throat, itchy and watery eyes. As the city has been waking up to a thick blanket of hazardous smog every morning since Diwali, Delhi hospitals are also witnessing a surge in the number of patients coming to OPDs with health issues. And it’s the elders and children, who have lower immunity levels, complained of breathing issues. The hazardous level of air pollution towards the end of October triggered a series of official measures such as shutting down construction work across Delhi and smoke-emitting factories.

It requires sincere administrative will and not merely tokenism to control such hazardous pollution.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

 

Compare Reaction to  Death of “Hundreds of healthy people” to  single “perceived negligence” in Hospital  #Morbi-Gujarat


Reaction to ‘Death’ in this  new era  of consumerism has become a story of paradox. Massive civil negligence  and 141 deaths but there are no punching bags  as are  doctors  for revenge in case of a hospitalized death.     Just Compare the media  projection, burden of negligence and accountability of  hundreds of healthy deaths by civic negligence   to the  one hospital death by disease. 

     Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. 

Multiple Deaths in healthy people by civic negligence:

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. The number of   people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of   negligence here is massive and these deaths are unpardonable.  Timely action could have prevented these normal people from death. 

Collapse of a pedestrian bridge that killed at least 141 people. #Morbi-Gujarat.

Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.

Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.

Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.

The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.

Single  Death in Hospital due to disease:

      Reaction to single “in Hospital” medicalized death  is a paradox.   The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient.  However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault. 

     In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital  death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

Point to ponder-Misplaced priorities:

Who is to be blamed for the deaths of healthy people which occur because of civic negligence?  Here relatives are actually  helpless and the vital questions may go unanswered .  There are no punching bags  as are  doctors  for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media  forgetting the fact that thousands of patients are saved everyday by  Doctors.   

      It is time to check the  emotional reactions to single hospital death due to a disease as compared to hundreds of death  of healthy people due to civil negligence.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

Projection of  Inflated Cost of Medical Education- Global Exploitation of Young Doctors


The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Educating a doctor cost less what   medical colleges  claim- a global phenomenon.

   Instead of   often  repeated statements  about high expense on running medical college and  projecting it   as a  hard  fact, the amount spent  on  medical students by all medical colleges should be made transparent by all institutions. The  frequent  statement  is made that  cost of  making a doctor is very high and  gleefully  propagated  by  the  private medical colleges to extract millions out of  young  medical students . 

Such statements without any actual public data  is repeated  to the   extent  that  it  is  firmly  entrenched  in  public  mind without any real evidence.

     High cost  is  the  reason    with an intention  to  exploit the young doctors in various ways to get cheap labour and extract  millions from aspiring doctors  by private medical colleges.

      The  basis  of  such calculation should be transparent for every medical college and all institutions. 

       In any medical college,  only the   Departments  of  Anatomy and Physiology  are purely for medical students. The  remaining  subjects  taught  in  medical  colleges  across  the  country  are  related  to  patient 

care  and  medical  education  is only  a  by-product.  All the medical teachers are actually doctors involved in treatment of patients, running  the hospital  and students observe the treatment and learn medicine. The interns and  postgraduate  students  provide the cheap and labour and actually save the costs of running the hospital.

 Therefore   if  some college   is  actually  spending  millions   to  produce  one  MBBS  doctor ,  it  is  a  either an   inefficient  model   or costs are inflated and exaggerated to exploit the young doctors.

Educating a doctor cost less what   medical colleges claim

The average cost of producing a doctor or nurse went down across most parts of the world between 2008 and 2018, but almost tripled in China and doubled in India, a Lancet study shows. Despite this, the estimated expenditure per medical graduate in China at $41,000 is higher only than in sub-Saharan Africa and about 42% lower than in India ($70,000) against a global average of $114,000. The pattern was the same for nurses with the estimated expenditure per nursing graduate dropping across the world while it went up by 167% in China and doubled in India. The only other region where the per graduate cost went up was in North Africa, where cost per doctor went up by 47% and by 25% for nurses. Approximately $110 billion was invested globally by governments and students’ families in medical and nursing education in 2018. Of this, $60.9 billion was invested in doctors and $48.8 billion was invested in nurses and midwives, the study estimated.

The paper looks at important developments in medical education to assess potential progress and issues with education of health professionals after the Covid-19 pandemic. Mean costs in 2018 were $114,000 per doctor and $32,000 per nurse. In 2008, China had the lowest estimated expenditure per medical graduate at just $14,000 (Rs 6 lakh) followed by India, where it was just $35,000 (Rs 15 lakh at the 2008 exchange rate of Rs 43 to a dollar). This is much lower than the estimate of Rs 1 crore or more that Indian colleges widely claim as expenditure per medical graduate.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Deaths due to Low Quality Medicine- Pharma Industry Needs Strict Regulation


It is  time to treat Pharmaceutical malaise.

    Take example for cough syrup related  66 deaths at Gambia or  Injection Propofol related deaths at PGI Chandigarh. If deep investigations are not done, poor quality medicines will continue to be marketed and doctors would be held responsible for the adverse reactions and deaths. Strict regulations for quality of pharmaceutical agents is need of the hour.

    Usually every problem related to health is called medical malaise, but that is a misnomer.  In fact health care comprises tens of different industries.  Complex interplay of various industries  like pharmaceutical, consumable industry and other businesses associated with  health care  remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain largely unregulated. Collective malaise of all these is conveniently projected as medical problems  as blame is conveniently passed on to doctors, as they are only visible component of mammoth health business.  Rest all remain invisible, earn money and  doctors are blamed for the poor outcome of the patient, as doctor is the only universal link that is visible with patient. By an average application of wisdom, it is easier to blame doctors for everything that goes wrong with patient.

      Cough syrup related deaths at Gambia or  Injection Propofol related deaths at PGI Chandigarh – two examples are only a tip of the iceberg.  In routine, if patient gets fake or low quality medicines and does not get well, gets side effects, doctor will face harassment. Whereas people involved and industry will be sitting pretty and  make money.

Therefore strict administration and quality check  is required   to correct Pharma malaise. It may be a complex issue because of complexity involved in implementation and execution of policies. But recognition and beginning to think of the problem is also an important step.

Red alert over deaths after Propofol injection- PGI CHANDIGARH

WHO warns over deaths of 66 children in The Gambia (Indian Pharmaceutical Cough syrup).

WHO warns over deaths of 66 children in The Gambia (Indian Pharmaceutical Cough syrup)

The WHO has issued an alert over four cough and cold syrups made by Maiden Pharmaceuticals in India, warning they could be linked to the deaths of 66 children in The Gambia

The World Health Organization (WHO) on Wednesday issued a warning over four cough and cold syrups made by an Indian company, saying that they could be linked to the deaths of 66 children in The Gambia. The WHO said that the cough and cold syrups, made by Maiden Pharmaceuticals in Haryana, could be the reason for serious kidney injuries. “Please do not use them,” the WHO said in its advisory.

The four cough and cold syrups that have been linked to the deaths of 66 children in The Gambia are Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup. In a release, the WHO has said that the Indian company has not yet provided guarantees on the safety and quality of these products.

“Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” the WHO said in a medical product alert. The WHO also warned that while the products had so far been found in The Gambia, they could have been distributed to other countries.

According to the WHO, diethylene glycol and ethylene glycol are toxic to humans when consumed and can prove fatal. Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death, the WHO said.

New Delhi-based Maiden Pharmaceuticals declined to comment on the matter.

The World Health Organization also said that it was conducting further investigation with the company and regulatory authorities in India regarding the cough syrup linked to deaths of 66 children.

Last month, Gambia’s government said that it has also been investigating the deaths. The government statement came as a spike in cases of acute kidney injury among children under the age of five was detected in late July.

“While the contaminated products have so far only been detected in the Gambia they may have been distributed to other countries,” WHO Director General Tedros Adhanom Ghebreyesus said at a press conference on Wednesday.

The WHO Director General added that WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients.

Meanwhile, the DSCO has already taken up an urgent investigation into the matter with the regulatory authorities in Haryana.

Red alert  over  deaths after Propofol injection- PGI  CHANDIGARH

CHANDIGARH: Five patients had died after they were sedated before surgeries on a single day last week at PGI, prompting doctors to sound a red alert to Central Drugs Standard Control Organisation (CDSCO)on Propofol injection – an anesthetic given before any major surgery. In this case, the drug was taken from the chemist shop in the hospital emergency. “Following a complaint from PGI doctors, we came with a CDSCO team to collect samples. The samples have been sent to Central Drugs Laboratory, Kolkata,” said Sunil Chaudhary, senior drug control officer, UT. He said, “The suspected batch of drugs has been stopped for supply till reports are received.” Sources said test analysis will take around two-three weeks and final report will be submitted by the CDSCO team. The five patients had to undergo orthopaedic and neurosurgeries. On deliberating the cause of deaths, doctors found Propofol injection as the common thread.

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Transition from   ‘Natural death’ to Medicalized Death- Paradox  of dying process


Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   It’s an age-old idea that a good life and a good death go together. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries; there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions.

      The story of dying in the 21st century is a story of paradox. While many people are over-treated in hospitals, with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. In this present era, process of dying represents unbalanced and contradictory picture of death.  

Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying. For example, how long should advanced medical technology be used to keep comatose people alive? How should the elderly or incapacitated be cared for? Is it reasonable for people to stop medical treatment, or even actively end their life, if that is what they wish?

          Before the 12th century he describes a period of “Tamed death,”  where death was familiar, and people knew how to die. The dying and their families accepted death calmly; they knew when death was coming and what to do; dying was a public event attended by children.

    Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. The great success with antibiotics vaccines has perhaps further fuelled the fantasy that science can defeat death. But this temporary success as only has been the result of discovery of germ theory and antibiotics.

     In true sense, Death still remains invincible.

   The fear of death also involves the fear of separation.

     As families and communities want more and more hospital care, when critically sick, health systems have occupied the centre stage in the process of dying.  Dying people are whisked away to hospitals or hospices, and whereas two generations ago most children would have seen a dead body, people may now be in their 40s or 50s without ever seeing a dead person. The language, knowledge, and confidence to support and manage dying are being lost, further fuelling a dependence on health-care services.

 

   Death systems are the means by which death and dying are understood, regulated, and managed. These systems implicitly or explicitly determine where people die, how people dying and their families should behave, how bodies are disposed of, how people mourn, and what death means for that culture or community.

Death systems are unique to societies and cultures.

    The increased number of deaths in hospital means that ever fewer people have witnessed or managed a death at home. This lack of experience and confidence causes a positive feedback loop that reinforces a dependence on institutional care of the dying.

     Medical culture, fear of litigation, and financial complexities contribute to overtreatment at the end of life, further fuelling institutional deaths and the sense that professionals must manage death. Social customs influence the conversations in clinics and in intensive care units, often maintaining the tradition of not discussing death openly. More undiscussed deaths in institutions behind closed doors further reduce social familiarity with and understanding of death and dying.

     How people die has changed radically over recent generations. Death comes later in life for many and dying is often prolonged. Futile or potentially inappropriate treatment can continue into the last hours of life. The roles of families and communities have receded as death and dying have become unfamiliar and skills, traditions, and knowledge are lost.

    At first only the rich could expect that doctors would delay death. However, by the 20th century this expectation had come to be seen as a civic right.

         ‘Natural death’ is now the point at which the human organism refuses any further input of treatment.

       Corporatization of health care has projected medicine as a purchasable commodity and consequently resulted in an illogical distribution of health care. People, who can afford, spend millions in the last few days of their life, just to have only a few more days to live. Resources spent in such a futile quest are equivalent to thousands of times the money for food and medicines for the poor who lose lives for fraction of that expense.

     Death is not so much denied but has become invisible to people. People now have less understanding and less acceptance of death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

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CCI investigates India’s largest hospital chains’ Practices


The potential penalty by India’s fair trade regulator could be steep. The CCI  (The Competition Commission of India)  investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated free of regulation so far.

A four-year investigation by India’s fair-trade regulator has concluded that some of India’s largest hospital chains abused their dominance through exorbitant pricing of medical services and products in contravention of competition laws.

The Competition Commission of India (CCI) will soon meet to weigh in on the responses by Apollo Hospitals, Max Healthcare, Fortis Healthcare, Sir Ganga Ram Hospital, Batra Hospital & Medical Research and St. Stephen’s Hospital. It will then decide whether to impose penalties, said people familiar with the matter.

The CCI can impose a penalty of up to 10 percent of the average turnover for the past three preceding financial years of an enterprise that has violated competition laws. The penalties could be steep. Apollo Hospitals posted an average turnover of Rs 12,206 crore and Fortis Rs 4,834 crore in the past three financial years.

The CCI’s director-general found that 12 super-speciality hospitals of these chains that operate in the National Capital Region abused their positions of dominance by charging “unfair and excessive prices” for renting rooms, medicines, medical tests, medical devices, and consumables, according to a copy of the summary report that Moneycontrol reviewed.

Some hospital room rents exceeded those charged by 3-star and 4-star hotels, according to the findings by the DG, who examines anti-competitive practices.

Significance of the investigation

The CCI investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated unencumbered by regulation so far. The watchdog’s action could potentially rein in the prices of medicines and healthcare equipment, or at the very least, bring transparency in the way hospitals sell these items, according to competition lawyers.

Of the 12 hospitals that faced CCI scrutiny, six belonged to Max  and two to Fortis.

The CCI and the hospital chains had no comment for this article.

Overcharging without checks

Exorbitant pricing is a common thread running through the CCI investigation report. The hospitals were found to charge more for certain medical tests as well as for X-rays, MRI and ultrasound scans than rates offered by other diagnostic centres. For consumables such as syringes and surgical blades, hospitals charged rates that were higher than those of other consumable makers, according to the CCI report.

The only exception was medicines, which hospitals sold at the maximum retail price, although they earned significant profits by procuring them at lower prices.

The CCI selected the hospitals for investigation on the basis of the number of doctors, paramedics, beds, and turnover for the period 2015-2018. The investigation found that these hospitals do not allow the use of purchase of consumables, medical devices, medicines and medical test results from outside, adding that patients use the service of in-house pharmacy and laboratories for ease of convenience.

Investigative reports pertaining to each of the hospital chains were submitted by the DG to the CCI on December 24, 2021. The CCI forwarded a copy of these reports to the hospitals on July 12, 2022, and sought their responses, according to the people, who did not want to be identified.

The CCI has been examining the pharmaceutical sector in India for years, scrutinising the pricing of medicines by healthcare companies. On April 19, 2020, it cautioned businesses, including healthcare companies, against taking advantage of Covid-19 to contravene competition laws.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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