A doctor has been arrested in Madhya Pradesh’s Chhindwara after a toxic batch of Coldrif cough syrup allegedly caused the deaths of 18 children across two states, exposing alarming lapses in drug quality control.
Strangely enough, when the drug manufacturer and the drug controller are responsible for the quality of drug, the doctors are the one who is arrested. Does that imply that doctors should now stop expecting justice from courts and Government?
The whole process appeared flawed from the root. Blame for the poor quality of drugs manufactured is passed on the prescribing doctor.
Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors due to application of average wisdom.
This strange kind of justice delivery has unmasked the everyday struggle of the doctors in the present era. The unjustified arrest just for prescribing a medicine has depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. This incident has unveiled the despondency, moral burden, and injustice that doctors work with.
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 even though 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 of injustice to doctors and impact of present legal complexities is already at par with that of Hammurabi’s era.
Saif-Ali- Khan transported in auto- Primitive Ambulance retrieval system
An index case can be made, and important conclusions can be drawn of the analysis regarding Mr Saif Ali Khan case- A celebrity icon– resident of big city Mumbai- got near fatal trauma. Important point to ponder is that How he was transported to hospital? A servant went and arranged for an auto-rickshaw. He was lucky enough as he did not required oxygen or his vitals were stable. If a person like Mr Saif could not arrange or did not opt for life saving Ambulance, what can a common person expect- to be transported especially in smaller cities or remote areas. Night emergencies like heart attack, stroke, pneumonias or even severe trauma permit few minutes and need interventions at the earliest. Such situations are life-threatening and unforgiving. Not all problems of the health care can be neglected by just passing the buck to doctors. Health care delivery requires much more efficient systems, that common man can trust in time of need. Even if the retrieval system exists in Mumbai, why family of Mr saif could not depend upon that?
Whatever the situation, calling an Ambulance was not considered as first responder in this case. Ambulances are not merely transport vehicles. They are equipped with oxygen, ventilators or lifesaving drugs and more importantly with a doctor or paramedic who can actually save life in those critical moments.
As systems in our country come out of slumber only after a celebrity or VIP is involved, it is an opportunity to look at the retrieval aspect and improve upon availability of the timely safe transport of critically unwell patients. A lot of improvement can be made by making Mr Saif’s as an index case.
The issue of patient safety has been gaining increased traction year on year and the issue is in right direction. Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety. Patient safety is of paramount importance; therefore, it is a serious issue. It should be achieved by good groundwork and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.
There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel. There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies, have insight looking at life and death situations directly, know that comparing both would be just an oversimplification of the real basic issues.
At most of the points, the comparison is a complete fallacy; and like comparing apples to muskmelons.
It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does. But, the kind of comparison that some health care safety leaders make in which they compare the mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front-line health worker at any point of time, but still pretend to pioneer the quality in health industry. For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be effective.
Aircrafts are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients are in the worst shape when they enter the emergency of the hospital.
Medicine is by nature, a much more risky work than flying along with vulnerability to death always.
The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.
But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part. For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.
In other words, doctors have to fly crashed planes always on every day basis, something that never happens even once in aviation industry.
Has any Pilot ever tried to fly a plane in which engine power is only 25 percent of normal with other systems are functioning sub-optimally and the fuel tank is leaking? What will be standard procedure (SOP) for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional. Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air. Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.
Obviously the comparison is a bit overzealous.
What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.
By a simple common sense, are two situations comparable?
Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.
Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.
Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.
A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients, should be always be the first pillar of promoting a culture of safety.
Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities. Patients are not aeroplanes, and hospitals are not production lines.
Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.
Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.
In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons. Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.
Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation, still it will be required to be carried out in a diligent manner, a task which is different from mechanical task of mere check list of other industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.
Merely completing protocols mechanically and excessive documentation will result in decline in quality actually. Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely reduced to a number to the satisfaction of so called ‘pioneers’ of quality.
#Kolkata-R-G-Kar-murder case has not only exposed the cruel injustice doctors work with, but also the inability of system to provide them justice. It also exposes the law-and-order issues and poor capability of enforcing agencies to provide justice to common man.
In real terms, it is not a problem for only doctors, but such poor law and order is a problem of masses and affects all common people.
Doctors working with routine injustice whole those years looks trivial as compared to cruelty inflicted on lady doctor during this incident. But strangely, still the doctors of R G Kar hospital are facing a kind of oppression and moral blackmail. They have become more insecure and unsure about whether they will get fair justice. To continue the protest for their genuine demands is getting difficult. Even when justice is still far and distant as it can be, they may face punitive action of worst kind. There is only a faint hope of real justice left although ‘token justice’ of temporary nature may be a possibility at the best.
Overall, a complex scenario for doctors. There is increasing discontentment amongst doctors because of complex and punishing system. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally, there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.
They are regulated in a way- no one else is. Judiciary, police, government agencies and every one else are not accountable for most of their blunders, but doctors are. But still- in such cases, everyone is looking at Supreme court and Government agencies, about whether they can deliver justice in such high-profile cases, when very powerful people are involved. Will supreme sacrifice of a young lady doctor be enough to shake up the system? Was it enough for the courts and powerful agencies to show and utilize their power in best manner? Was the animal behaviour of the accused has made courts and powerful enforcement agencies to get up and go beyond the “CULTURE OF TOKEN JUSTICE” and not merely catching scapegoats?
Common masses are curious about performance of Supreme court and Government agencies and expect to deliver real justice.
The painful incident of Kolkata Doctor rape and murder had unmasked the everyday struggle of the doctors in the present era. Her supreme sacrifice depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. Her murder has unveiled the despondency, moral burden and injustice that doctors work with.
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.
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 even though 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
Mpox (monkeypox) is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. Two different clades exist: clade I and clade II
Common symptoms of mpox are a skin rash or mucosal lesions which can last 2–4 weeks accompanied by fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
Mpox can be transmitted to humans through physical contact with someone who is infectious, with contaminated materials, or with infected animals.
Laboratory confirmation of mpox is done by testing skin lesion material by PCR.
Mpox is treated with supportive care. Vaccines and therapeutics developed for smallpox and approved for use in some countries can be used for mpox in some circumstances.
In 2022–2023 a global outbreak of mpox was caused by a strain known as clade IIb.
Mpox can be prevented by avoiding physical contact with someone who has mpox. Vaccination can help prevent infection for people at risk.
Overview
Mpox (monkeypox) is an infectious disease caused by the monkeypox virus. It can cause a painful rash, enlarged lymph nodes and fever. Most people fully recover, but some get very sick.
Anyone can get mpox. It spreads from contact with infected:
persons, through touch, kissing, or sex
animals, when hunting, skinning, or cooking them
materials, such as contaminated sheets, clothes or needles
pregnant persons, who may pass the virus on to their unborn baby.
If you have mpox:
Tell anyone you have been close to recently
Stay at home until all scabs fall off and a new layer of skin forms
Cover lesions and wear a well-fitting mask when around other people
Avoid physical contact.
The disease mpox (formerly monkeypox) is caused by the monkeypox virus (commonly abbreviated as MPXV), an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family, which includes variola, cowpox, vaccinia and other viruses. The two genetic clades of the virus are clades I and II.
The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research and the first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (DRC, 1970). Mpox can spread from person to person or occasionally from animals to people. Following eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. A global outbreak occurred in 2022–2023. The natural reservoir of the virus is unknown – various small mammals such as squirrels and monkeys are susceptible.
Transmission
Person-to-person transmission of mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is
face-to-face (talking or breathing)
skin-to-skin (touching or vaginal/anal sex)
mouth-to-mouth (kissing)
mouth-to-skin contact (oral sex or kissing the skin)
respiratory droplets or short-range aerosols from prolonged close contact
The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other members of the household and to sex partners. People with multiple sexual partners are at higher risk.
Animal to human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals. The extent of viral circulation in animal populations is not entirely known and further studies are underway.
People can contract mpox from contaminated objects such as clothing or linens, through sharps injuries in health care, or in community setting such as tattoo parlours.
Signs and symptoms
Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.
Common symptoms of mpox are:
rash
fever
sore throat
headache
muscle aches
back pain
low energy
swollen lymph nodes.
For some people, the first symptom of mpox is a rash, while others may have different symptoms first.
The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.
Some people may have one or a few skin lesions and others have hundreds or more. These can appear anywhere on the body such as the:
palms of hands and soles of feet
face, mouth and throat
groin and genital areas
anus.
Some people also have painful swelling of their rectum or pain and difficulty when peeing.
People with mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed.
Children, pregnant people and people with weak immune systems are at risk for complications from mpox.
Typically for mpox, fever, muscle aches and sore throat appear first. The mpox rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and evolves over 2-4 weeks in stages – macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is a classic feature of mpox. Some people can be infected without developing any symptoms.
In the context of the global outbreak of mpox which began in 2022 (caused mostly by Clade IIb virus), the illness begins differently in some people. In just over a half of cases, a rash may appear before or at the same time as other symptoms and does not always progress over the body. The first lesion can be in the groin, anus, or in or around the mouth.
People with mpox can become very sick. For example, the skin can become infected with bacteria leading to abscesses or serious skin damage. Other complications include pneumonia, corneal infection with loss of vision; pain or difficulty swallowing, vomiting and diarrhoea causing severe dehydration or malnutrition; sepsis (infection of the blood with a widespread inflammatory response in the body), inflammation of the brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis), or death. Persons with immune suppression due to medication or medical conditions are at higher risk of serious illness and death due to mpox. People living with HIV that is not well-controlled or treated more often develop severe disease.
Diagnosis
Identifying mpox can be difficult as other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also have another sexually transmissible infection such as herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread.
Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.
More information on laboratory confirmation of mpox can be found here.
Treatment and vaccination
The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.
Getting an mpox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).
It is recommended for people at high risk to get vaccinated to prevent infection with mpox, especially during an outbreak. This includes:
health workers at risk of exposure
men who have sex with men
people with multiple sex partners
sex workers.
Persons who have mpox should be cared for away from other people.
Several antivirals, such as tecovirimat, originally developed to treat smallpox have been used to treat mpox and further studies are underway. Further information is available on mpox vaccination and case management.
Self-care and prevention
Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent infecting others:
Do
stay home and in your own room if possible
wash hands often with soap and water or hand sanitizer, especially before or after touching sores
wear a mask and cover lesions when around other people until your rash heals
keep skin dry and uncovered (unless in a room with someone else)
avoid touching items in shared spaces and disinfect shared spaces frequently
use saltwater rinses for sores in the mouth
take sitz baths or warm baths with baking soda or Epsom salts for body sores
take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.
Do not
pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or
shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body).
To prevent spread of mpox to others, persons with mpox should isolate at home, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a medical mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact.
Outbreaks
After 1970, mpox occurred sporadically in Central and East Africa (clade I) and West Africa (clade II). In 2003 an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of suspected cases are reported in the DRC every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travellers to other destinations. Data on cases reported up to 2021 are available here.
In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions, with 110 countries reporting about 87 thousand cases and 112 deaths. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks. More information on the global outbreak is available here with detailed outbreak data here;
In 2022, outbreaks of mpox due to Clade I MPXV occurred in refugee camps in the Republic of the Sudan. A zoonotic origin has not been found.
In the absence of strict Government control, all kinds of dubious assertions are available about curing all types of ailments. These alleged remedies, and the belief systems, are based on the facts that can neither be proved nor disapproved. They are dangerous to life of patients, which is why it is necessary to fight them and refute them. But who should fight? Patients themselves are blinded by a projected faith and false belief about definite cure.
While pharmaceuticals and scientific drugs are regulated to some extent, but side effects and harms associated with various health products worth billions of market remain untested and unregulated.
It has become a common practice to advertise health products (especially alternate medicine) that claim to be panacea for all ailments, enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. The objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.
No one can deny that the knowledge circulated through various media plays an important role in reframing the narrative in patient’s or people’s mind. These can be in form of advertisements in television or articles in newspapers. The subjectivity of such advertisements creating new impressions and replacing previous ones, right or wrong cannot be denied.
A frightening scenario is emerging as there seems to be an epidemic about fake or substandard medicines, spurious drugs and heightened belief in marketed therapies by advertisements. An epidemic of ignorance that causes people to believe in pseudoscience or merely in projected promise of cure. A hope of miracle is flashed to patients, who have been given a ‘no hope’ by scientific medicine. Such patients are an easy prey for such fraudsters. It is not uncommon that lethal substances like steroids, hormones and heavy metals are given in dangerous doses.
Synopsis Cyberabad police raided a kirana store in Petbasheerabad, seizing ganja-infused chocolates marketed as ayurvedic medicine. The chocolates contained 14 grams of cannabis per 100 grams and claimed to treat indigestion. The Telangana anti-narcotics bureau has notified UP and Rajasthan police about manufacturers in these states producing similar drug-laced products. In an emerging trend, ganja-laced chocolates made in Uttar Pradesh guised as ayurvedic medicine are making becoming popular in Hyderabad. Wrapped in attractive packaging, the chocolates come with ‘Ayurvedic Aushadh’ printed on wrappers, reported ToI. On Sunday, Cyberabad police seized a substantial shipment of drug-infused chocolates from a kirana store in Petbasheerabad. The packaging of the seized chocolates indicated that each 100 grams contained 14 grams of cannabis.
Additionally, the label suggested that the chocolates could be consumed twice daily to alleviate indigestion and other stomach-related problems when mixed with water.
The chocolate cover also mentions that it can be consumed twice a day to treat indigestion and other stomach-related issues, is also used as a medication for diabetes. Meanwhile, Telangana anti-narcotics bureau has identified several private players in UP and Rajasthan manufacturing ganja-laced chocolates and has alerted the respective state police departments.
The brutal assault and murder on a woman doctor at R G Kar Medical college Kolkata has made doctors preparing for a career in the medical profession worried. This shameful act on a lady doctor reflects that doctors are serving an uncivilized society. Such news is viewed by medical community anxiously and is a poor advertisement for younger generation to take medicine as profession. Aspiring medical students need to think- whether they should enter the ring-on-fire, opt to become doctors to serve an uncivilized society.
Strangely media, courts, prominent people, celebrities, human right commission, woman right activists and women commission are little concerned about the blatant injustice done towards doctors. This again brings forth the hypocrisy of these people and organizations, who otherwise cry hoarse about woman rights and empowerment. Whenever a female is assaulted, there is an outrage, but the same support is not extended to a female if she is a doctor. Such bestiality should create havoc in minds of civilized people but this apathy to such incidents repeatedly clearly indicates otherwise. Can’t we see that such incidents are harbinger of many more in future? It is important to realize that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realize that they cannot get away with it.
Brutality against doctors reveals a deep prejudice and lawlessness. Everyday violence against doctors is common merely on the basis of perceived negligence. Government is either unwilling to act and establish a strong culture of deterrence, so justice been elusive for medical professionals.
Even murderous assaults on doctors in the past are not enough to shake administrators, courts and doctors’ organizations out of slumber. Such violence, if unabated will be poor advertisement for next generation to take medical profession as a first choice.
Media and celebrities have proudly projected in films and television that doctors can be beaten and assaulted, in case there are unexpected results or in case of dissatisfaction. The “Reel Heroes” depicting violence against the doctor is seen as a routine and looked as an easily do-able- adventure due to unwillingness of Government to take stringent action. As patients will continue to get treatment in hospitals and few cannot be saved, so every death declaration may be a harbinger to such attacks in future.
After such big hue and cry after this incidence, Courts and Government have woken up and there is a hope that real culprits and preparators will be caught. People need to know the truth and not merely hanging the scapegoats.
In the new ‘ Right to Health- Bill- Rajasthan’, because of government inability to provide basic and essential services, private hospitals are dictated to render services. As services at Government hospitals are inadequate and have failed to provide facilities to handle the emergencies. Since the patients cannot be left without treatment, provision for emergency services should be made available to country’s population. That is the Government’s duty which the administrators have failed to fulfil. Therefore co-operation from private sector is expected, but it should be sought as help rather than an imposed dictate. This act, though may have a noble intention in mind, should be analysed by all stakeholders in an objective manners.
• Will government render some support in any manner to private health organizations, which they may need genuinely in order to do this difficult task, as the Government itself has been unable to do in so many years?
• In order to provide these essential services especially emergency and lifesaving, is government asking the private players for help for this noble cause or does this act simply dictates its wish onto the private players bulldozing their genuine concerns in doing so?
Will Government increase its’ own responsibility and accountability and shoulder more responsibility towards ‘Health to All’ or it is only for private doctors to provide?
• Will government provide physical and legal protection to doctors and health establishments on the issues arising from the act?
• Although the RTH looks like is a democratic action, but is it democratic to doctors and private health players as well? Are their genuine problems and views addressed and accommodated?
• What are government’s plans in the long term to improve such services? Does it plan to continue forcing the private setups (without ant help to them) or are there any plans to improve the government health facilities in future to a level commiserate with the need of the hour.
Imposing such dictates will definitely force the aspiring doctors to think, whether to choose medical career or not.
The Rajasthan government’s proposed right to health bill has landed in deep controversy due to objections from the private healthcare sector, which is dishonouring as a part of the protests the provision of cashless treatment under existing state-run schemes. The draft bill has been criticised as a hasty job that overlooks ground realities and suffers from lacunae that the Ashok Gehlot government is apparently resisting taking note of.
Chief minister Gehlot, on February 17, urged private hospitals to end their boycott of the Chiranjeevi scheme and the Rajasthan Government Health Scheme (RGHS), which provide mostly cashless treatment to private individuals and government employees, respectively, terming it improper on humanitarian grounds. “The private sector has a role to play in making Rajasthan a model state in healthcare, and we will clarify all doubts of private hospitals about the right to health bill,” Gehlot said. It remains to be seen if his appeal has any impact, given that private doctors’ associations have accused the government of intimidating private hospitals to end the boycott of the bill.
Social activists backing the bill have opened a separate front by criticising private hospitals for opposing the proposed legislation. The moot question is this: Does right to health only include private healthcare, which the bill aims at, or also things like potable water, clean air, unadulterated edibles and quality roads? In short, factors determining a healthy life but excluded from the ambit of the proposed law.
The bill has been in the pipeline for some months now. It was tabled in the state assembly in September 2022 but referred to a select committee subsequently because the Opposition and doctors’ fraternity wanted it be debated thoroughly. On February 15, the select committee deferred its scheduled meeting as private doctors threatened to step up their stir against the bill. Earlier, the state government had expressed its resolve to push ahead with passage of the bill.
A key contentious point in the bill is that no medical facility—whether government or private—can deny a patient ‘emergency’ care. The bill, however, falls short of defining ‘emergency condition’ and how the cost of treatment is to be reimbursed to private hospitals. Private doctors and private medical institutions feel the bill will give extraordinary powers to designated government officials to enter their premises and harass them.
Rajasthan has been witnessing a sharp rise in patient-doctor conflicts, both in government hospitals where doctors are accused of negligence as well as private medical facilities, which are accused of charging patients exorbitantly. Critics of the bill say it fails to address the concerns of doctors. Initially, private doctors had protested against the clause to compulsorily provide ‘emergency’ care to patients. They cited various aspects of their concern, such as someone with even a minor injury demanding emergency treatment at a hospital or a person suffering a heart attack approaching a hospital or nursing home that lacks facilities to deal with such a case.
As details of the draft bill emerged, there was also apprehension in the private healthcare sector that the bill may become a tool to bring ‘inspector raj’ into the medical sector. “Once you give officials open access to enter our premises, it is bound to be misused. The bill is a ploy of bureaucrats to control the private medical sector,” alleges Dr Vijay Kapoor, secretary, Private Hospitals and Nursing Home Societies, Jaipur. Highlighting ‘discrepancies’ in the bill, Kapoor points out that while a person who wheels in an accident victim to a hospital is entitled to a reward of Rs 5,000, the bill is silent on how the hospital would be reimbursed for treating the patient. “The bill
Private hospitals have been the backbone of the Gehlot government’s flagship Chiranjeevi scheme, under which beneficiaries are entitled to free treatment worth up to Rs 25 lakh in government and affiliated private hospitals. The scheme has been hit by the alleged refusal of many private hospitals to admit patients—as a symbol of protest against the right to health bill.
The Chiranjeevi scheme allows private hospitals to bill patients for certain costs incurred so as to partially compensate for the high cost of diagnostics and treatment. Private hospitals expect a similar consideration in the right to health bill, besides widening the scope of factors determining ‘healthy life’.
Some doctors wonder if a separate bill like this was necessary at all since right to health was enshrined as a fundamental right under Article 21 of the Constitution. Moreover, private doctors say they hardly have any representation in the various committees proposed to implement the provisions of the bill, grassroots level up.
Social activists like Nikhil Dey of the Rajasthan Soochna Evam Rozgar Adhikar Abhiyan and Kavita Srivastava of the Peoples Union of Civil Liberties (PUCL) are dismissive of the opposition to the bill. “It cannot be acceptable that the life of a rich individual is saved but not of a poor for want of money,” says Dey. Srivastava adds that while some objections of doctors could be genuine, the bill cannot be rejected outright.
Private doctors claim schemes to provide healthcare through the private sector under insurance coverage by the state government have been marred by corruption. “Hefty bribes are sought for empanelment of hospitals under these schemes, reimbursement of claims and settlement of complaints if any,” alleges Kapoor.
With more and more private hospitals allegedly refusing cashless treatment to private individuals and government employees under state-run health schemes, patients are suffering. Besides, given the accusation that officials demand bribes and some government doctors patronise certain private hospitals, Gehlot’s right to health bill appears caught in rough weather, all the more since it’s perceived as been hastily drafted.
Twelve years from now, 4 billion people, or more than half the world’s population, will be overweight or obese, according to a recent report. While obesity is an issue more commonly associated with high-income countries, the World Obesity Federation (WOF) points out that lower income countries are facing rapid increases in its prevalence. The economic and environmental costs of obesity aside, there is also the impact on the climate to contend with in the battle of the bulge. A $4tn crisis
The World Obesity Atlas 2023 says the cost of obesity-related issues would be more than $4 trillion globally by 2035. Apart from health, high BMI – obesity is defined as a Body Mass Index (BMI) equal to or more than 30 – also impacts economic productivity, including through premature retirement or death. The biggest presence of obese people will continue to be in high-income countries, the report says, but it is the low and lower middle income countries that are likely to experience major increases in the prevalence of obesity by 2035. The total economic costs linked to a rise in obesity in these countries would be more than $350 billion but the burden for upper middle and high income countries would be close to $4 trillion. The share of obese people in middle-income countries could jump to 66% among men and 70% for women even as the rate of increase in obesity prevalence appears to be slowing down in some rich countries. The chief reasons for rising obesity in poorer countries include a shift towards more highly processed foods and greater levels of sedentary behaviour.
Rising temperature and rainfall due to climate change could lead to higher obesity rates by hampering physical activity, studies say. The impact of extreme weather on fruit and vegetable production could also make it harder to maintain a healthy diet owing to rising prices. Higher prices could prompt a shift towards processed foods, which are linked to obesity. A 2019 Lancet report says severe food insecurity and hunger are associated with lower obesity prevalence, but mild to moderate food insecurity is “associated with higher obesity prevalence”. Another 2019 study says obesity is linked to about “20% greater GHG emissions compared with the normal weight state”. The total impact of obesity “may be extra emissions of (about) 700 megatons per year of CO2 equivalent. about 1. 6% of worldwide GHG emissions”.
Evolution of Medical profession-Extinction of good doctors 