Black coat vs white coat. What if money part is taken out of medico legal cases?


What if  financial part  is taken out of medico-legal issues, like compensation and lawyers fee?  The cases will drop down drastically?  If money part is zero, only errors will be identified and punished. Few  will remain only for idea of revenge.  In an era where people cheat their brothers, sisters and spouses for money, it will be naïve to think that idea of money extracting from doctors does not exist.

Financial  zeroing  can be done  in larger public interest to  keep down the cost of medical expenses.  It is  because of career building of few professions, that medico-legal cases are being fueled. Medical errors and complications are integral part of the treatment . Even simplest of diseases carry some amount of risk.  These  will still remain, even if doctors are hanged to death. Natural complications, poor prognosis can be attributed to errors by clever lawyering and because of benefit derived by other professions.

     Many careers  are  shining in name of preventable deaths  and medical errors at the cost of medical profession.  The managers, right activists, media   and lawyers  have made their career and wealth out of it. Ask any doctor really, are these issues really preventable after a point.  The  line separating errors or natural complications is really blurred and arbitrary. People who work in life and death situation know it well that  even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.

     Lawyers  and courts  should also be given those fraction of moments to decide same as is available to doctors. Otherwise it becomes a unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.

Illegal Organ (Kidney)transplant trade : Defined as crime, but saves life


A paradox, where a defined crime saves a life and following law and regulation correctly will result in end of life. If some one is asked to choose between a certain death or follow regulations, the choice will be very predictable. A patient , who has an irreversible organ failure, will try to defy death at all cost. People who can afford, can not see their children or loved ones to die, just for the sake of following law and regulations. Genuine concern here will be that If a patient can be cured of disease, why he should be left to die for just regulations. The wish to live is the basic reason, why the procedures, which are termed illegal, will flourish. They will thrive underground or in countries, where laws are lax. Touts, agents and liaison managers are people, who will be beneficiary and mint money by organization of the procedure. The people who can afford, get gift of life, in the bargain.

Organ transplant may be termed illegal, in certain circumstances as defined by Law. But legal or illegal, it gives life . It gives another chance to people to live or have their kith and kin, children , spouses and parent to live another life. Because of gap in demand and supply, when legal means do not help, adoption of illegal means becomes a compulsion. If following law and rules means death, they are unlikely to be complied with.

The gap in demand and supply of organs is the reason behind these activities. Nearly four lakh people suffering from end stage kidney failure need transplant and only 8000 get it. (Times of India). The recipient has two choices for Kidneys. It can be living donor and deceased donor or cadaveric in cases of brain death. 90% come from relatives, rest are cadaveric. The rest has to undergo repeated dialysis to survive.

After the enactment of The Human Organ Transplantation Act of 1994, transplants became less in India. But it was followed by booming market of donors In other countries like Pakistan, Philippines .

But given the circumstances of life and death, the underground market may still be existent.

The ACT also allows unrelated donors to give one of the kidneys if there is sufficient evidence to show that they know the recipient for a long time and are donating organs out of affection. The loophole has potential to be exploited. The affection or the papers for affection can be easily generated in today’s era in lieu of money or other favors in case of high profile cases. Therefore, the mediator’s work becomes easier to generate the papers projecting affection and tutoring and training of donors and recipient.

Alternatively, the procedure can be done in nearby countries. Therefore the role of doctor or surgeon doing a transplant (although the key point) is much smaller than the agent organizing the whole process. Thereby the agents , who can manage and organize the show, are thriving. The wish to defy a certain death is stronger than following the regulation. That will remain so till demand supply gap reduced , better awareness for brain death, medical infrastructure, organ retrieval and transport and supporting facilities are uplifted. Till it happens, even if it is defined as crime, the fruits will outweigh the risks, because of shear margin of money temptations and wish to live.

Administrative and infrastructure deficiencies in health care: fail and blame for doctors


Adverse outcome in patients  can be  because of  many factors. Most of the time it is  serious illness, natural poor prognosis of disease, genuine complications or infections. Sometimes, It can be deficiency of equipment, malfunction, lack of infrastructure or facilities. There can be poor training or lack of  proper human resource and many others. There may be unintentional or human errors  by doctors or staff.  Root cause for most of the problems  can be traced to  administrative and system deficiencies rather than mistake of doctor. But since doctor is universal final link, when a patient dies, who  is visible on the bedside. So by application of an average wisdom, it is the doctor who will be held responsible for any problem or adverse outcome. Administration and people who are responsible for building infrastructure, procurement of  equipment and allocating finances or manpower  are not visible in forefront. It is very common for the doctors  to find themselves in a helpless situation, specially  in presence of  deluge of patients, difficult circumstances, scarce resources  and other  administrative issues.  In cases of adverse outcomes,  administration can   pretend to hide behind the common escape route by punishing doctors and hold them  guilty for the adverse events, as no other cause or person   is visible. By retrospective analysis  and  wisdom of hindsight along with luxury of time , it is a cake walk to give  verdict of one’s choice later, by fault finding analysis.

Non availability of ventilators or  malfunctioning  is not an issue, for which doctors are responsible. Procurement and allocation of funds is an  administrator’s domain.  But it is common that  doctors can be accused for not saving a life. They can be punished, dragged to court and even assaulted physically by crowds.  Dismal percentage of availability  of ventilators in Delhi Hospitals is a tip of the iceberg. This can be even  worse in other parts of the country. Ironically crowds visiting the hospitals only see and blame  the doctor, who is present on bedside and trying to save the patient. Patients hold them responsible for  malaise of the system  and fail to see the presence of  large  administration and industry,   that is behind  the scene. An unfortunate era,  when  the  doctors are blamed on  individual basis for system failure. In present circumstances, Lack of medical wisdom among masses is a cause of  huge discouragement for doctors.

With  High court being proactive in asking about the number of ventilators, the administration can not pretend to hide behind any more, but masses need to know the real truth.

Only 3.4% beds on Delhi Govt Hospitals have ventilator facility against the minimum requirement of 10% in every state run medical center. For  over 10,000 beds,  only 348 ventilators are there. That is an extremely low number.

52 of 400 ventilators in Delhi hospitals non-functional, state tells HC.

After 3-year-old Farhan died in the national Capital for an alleged want of proper ventilator care earlier this month, the state government of Delhi has told the High Court that a substantial number of ventilators in its government hospitals are not working. The state also told the HC on Tuesday that they were aiming to have a web portal up and running within two months, which would provide an online daily update on ventilator and bed availability across Delhi’s government hospitals.

After directions were issued by the HC, the state asked all its hospitals to provide a status update on ventilators and according to the information received from the government hospitals, up to 52 ventilators (13 per cent) of the total of 400 ventilator beds (including 300 ICU and 100 non-ICU) available in the hospitals are non-functional. “Fifty-two ventilators are non-functional and efforts are being made to get them repaired. The procurement of 18 ventilators is under process,” said the reply filed by the state government in the High Court on February 12.

The state government also stated in its reply that as far as maintaining real-time information on the availability of vacant beds in Delhi government hospitals goes, it may not be feasible to implement real-time availability information in the initial phase and the Delhi State Health Mission should be advised to start uploading information on bed availability in all the hospitals once a day in the morning.

The state government also said the State Programme Officer (MIS) of the Delhi State Health Mission has been requested, in

a letter dated January 31, to prepare a web portal for online bed/ ventilator availability and that such a Web portal should be made functional within two months.

The state government through an email sent on February 7 has also requested all the hospitals to complete repair, condemnation and procurement of ventilators at the earliest, according to Nutan Mundeja, Director General of Health Services.

After the matter of alleged unavailability of healthcare to Farhan came to light, the High Court moved a motion against the Union of India and sought a reply.

The number of ventilators as compared to bed strength in government hospitals is meager. “In private hospitals, there is one ventilator bed for every four normal beds. In government set-ups though, even as we have over 10,000 beds, we have only 348 ventilators. That is an extremely low number. Also, these ventilators may not be evenly distributed across the city,” pointed out  stated U Jhamb, Director, Professor and Head, Department of Paediatrics at the hospital.

 

#Soldier/Nurse/doctor vs Filmy superstar: Reel Heroes or Real Heroes. what does the society Need/desire/deserve?


The old adage  “All that glitters is not Gold” is particularly relevant  in current era of media domination where media  projection shapes the perception and may defy  the  reality.  Media has dominated our lives and can sway the  opinion formation of masses.  Written media, television, social media  can collectively influence the mass opinion.

Society, in general, needs to be wise  enough  to realize the importance   of  getting  rid of  these blinders in  real life . One such factor that causes an illusional mist in the  thoughts of masses is projection in films. They create a mirage of illusional glitter wherein  there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in  peoples’ imagination and are perceived as real and   becomes ingrained in mind. The naivety of masses to perceive the projected character as real one  goes beyond a reasonable thought process and imagination.

 

These roles played in films are  not  really act of   inspiration  in real life  as  the actual purpose accomplished in the end of a movie  is entertainment of society and business for themselves. A recent  candid  admission  by the actor Mr Irrfan Khan  that film stars should  not be role models  was impressive (Hindustan times) .

   At the best, a particular projected character  (and  not individual acting star) may be a  role model. An actor or super star, is simply doing his work of “acting” in  the end. This work of acting may bring an entertainment of few hours at the most.

One  cannot stray away from the wisdom to  choose between what we consume merely for our entertainment and  what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.

 

But the problem starts, when these false perceptions created merely   by a projected  glimmer    takes the shimmer  away from the real worthy. The real  professionals and people who are worthy of glory become invisible behind  the glittery mist, a haze, which is unreal and unhelpful in real life.

   A  soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a  day in emergencies as compared to work of a superstar in films.  A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the  real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and  behaves like one, is respected and paid thousand times or more than the real one. In reality, people need  more than mere entertainment and reel role models and actors in their real lives.

 

Compare the trivial  amount of  remuneration, fame  and respect the real worker  gets  as compared to the film stars, who merely imitate their actions. Reel projection for purpose  of entertainment is more easier to enact and more profitable  than actual performance  in real life.  It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity.  Some one can be a reel hero just  by  dynastic factor  easily. Hard work is definitely required but that may or may not be prerequisite.

 

Even good films  may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually  project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from  possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.

 

 

In present era, real contributions by people, who are saviours of human life and  the real heroes, remain unappreciated. People are so besotted by  fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero  just imitates  a doctor, soldier,  dacoit or a street hooligan and just pretends to be one on the screen.

 

But there are  real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy  of more respect and are real heroes.  And it is up to the society  to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate  real heroes.

Point to  ponder  is that whether society needs people  just  acting like   doctors,  soldiers  and not the  actual and real ones, who saves lives. Does Society need  only  entertainment, because respect  which is paid to someone who is  just  an   actor, is  not extended to real doctors, soldiers or other altruistic professions.

 A reel hero who acts like a soldier, is famous  and richer and than the  actual soldier, who dies unnamed and in penury.   Children of today’s times will strive  to become, who is worshiped and paid respect  by society and  therefore will prefer  to become reel heroes.

 

A  society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.

It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.

Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.                          

The perception of the projection will decide, what does the   society actually  need- or desire-or deserve , “Reel Heroes or Real Heroes”.

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

 

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


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

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

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

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

 

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

 

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

 

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

 

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


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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

 

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

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

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

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

 

 

Viagra & anaesthetic drug sold as herbal alternative medicines


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

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

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

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