Overuse of Antibiotics: Wrong analysis # Rebuttal Times of India


     The Times of India today   carries an editorial by Mr Sandeep Bansal on over prescription of antibiotics. Although there are few points which may be correct, but the article fails to highlight the basic reasons for the problem, which it was supposed to address.

    The reason for failure to find the correct reasons can be the distant analysis. Someone working in London and trying to analyse the grass root problem of India may not be a perfect idea. People need to work at ground level to identify the real issues. Otherwise the analysis remains half-baked and gives a glimpse  of the bias, which celebrities use commonly for gaining popularity by finding faults of doctors.

 

     The overall picture has to be understood to identify real reasons and hence the proper solution to the problem. The correct steps taken would settle the issue; otherwise the analytical article would   just remain a piece of paper and an matter of discussions for Arm chair preachers.

over prescription of antibiotics

   The author failed to highlight the factors like easy availability of antibiotics. People can directly approach pharmacist and get whatever antibiotic they want.  Pharmacist can sell whatever brand, doses and kind of antibiotic. The uncountable quacks, doctors of alternate medicines use all kind of antibiotics with impunity. Tons of antibiotics are consumed without any proper medical advice. Self-medication by people themselves, as it is easily available can’t be ignored as an important cause.  

       The reasons written by the author in TOI, actually constitute a minuscule fraction (5-10%), as far as use of antibiotics is concerned. By writing imperfect article, without knowing actual problems by a distant analysis, such article provides real misguidance rather than actual solutions to the problems.

         Someone to do justice to such complex and important issues, one has to work at the place and be aware about real issues and ground problems. Otherwise it just remains a method to gain cheap popularity.

   Sadly, in present era, people who do not treat patients,  are away from  truth, but they can influence the treatment of thousands of patients  just by doing an ‘On Table’ analysis.

        Wrong analysis, hence incorrect conclusions can lead to wrong decisions.

     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

Expensive Medical College Seat; A Bad Choice


In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some are naive enough to spend millions on securing an expensive medical college seat.  Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession. Following are the reasons, why spending a fortune on the medical college seat may be a bad idea, at least for the students from moderate family backgrounds.

1. Medical courses are comparatively lengthy and expensive courses and difficult training with slave like duties. “enslavement of doctors”.

2. Uncertain future for aspiring doctors at time of training:  Nowadays, doing just MBBS is not enough and it is important to specialise. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

4. Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.

5. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.

 6. Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for  inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.

7. Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.

8. Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.

9. Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.

10. Retrospective analysis of doctor’s every action continues all the life. It could be by  patients and relatives  every day  in the form of  “ Why this was not done before?” Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving, or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

 The decision taken in emergency will be questioned  and  in retrospect they may not turn out to be the best one. But later with retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

11. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent  people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.

12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.

13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.

14. Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. 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.

Advantages-Disadvantage of being a doctor

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     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Doctor’s assault a medical emergency: Silence of authorities appalling


    Attacks and assaults on doctors is an indicator of a lawless, uncivilized society, poor governance and broken health system. Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide  health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

      Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations, human right organizations, parent hospitals and institutes.

       Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They projected single stray incident   as an example and portrayed as generalization just to earn money and fame for themselves.

    Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful media machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.  

           Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession.  Role of doctor associations, parent institutes have been spineless and not encouraging.

         Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so uncivilized that an incident such as this just remains as a small news item in a local paper? 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.

  Doctors in remote area, where there are minimal medical facilities, doctors are at more risk than ever; they are at mercy of local goons with no protection.

        Silence of lords is a death sentence to the medical  profession as a whole.

    Doctor assault is definitely a poor advertisement for the medical students, who want to be doctors or others who want to buy a private medical college seat by paying millions. Why should one become doctor or  pay millions and bear risk of being beaten or killed, while doing such a stressful duty. People will be fearful to be doctors on a free seat, leave alone on the paid seat.

 The People who rue the scarcity of good doctors, should now introspect, “do they deserve to have good doctors?”

     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

Allopathy-Ayurveda debate: Media’s Misplaced priorities


The doctors, nurses and healthcare system have been relentlessly hauled over the coals for last one year and further battered emotionally by the cruel adverse media insinuations and taunts. At the peak of pandemic, when the powerful media should be discussing the core issues to control pandemic; issues like oxygen supply, vaccination and improving the health infrastructure, it has found more interest in a futile Allopathic-Ayurveda debate. Even if someone wants to start this kind of discussion, media should have shown more wisdom not to make it a dominant issue. There are more important, urgent and pressing issues where media can play a vital role.

By many media narratives, an impression is being fostered that doctors have made a mess and forfeited their moral right to treat. Suggestions of ineptitude were gleefully aired, causing demoralization of the warriors, who were immersed in the pool of Covid patients, trying to save them.


         Their role should be as facilitators to help doctors to save more lives. One hospital death of out of millions saved, is projected as failure of doctors. They are so distant from the ground reality.  To control the health system, media has a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.

 Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful media machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.

      Media people, who have never treated a patient in their lifetime, sway opinion and treatments of the millions just by game of projection and perception. The news items and the content are guided by idea of creating sensation in a quest to sell news, be it a selective negativity. Such  negative and selective projections are causing discouragement and demonization of the medical profession. It is the biggest  tragedy to the medical profession in present era.

      Normal treatment of the sick patients is being projected as gruesome atrocity, inflicted by doctors. Media could have done better in helping to take off spectacles fogged with bias against doctors and recognizing them as real saviours, just as deserving of justice.

       National Media could have helped, had they fueled the right and constructive discussions. The TV channels  could have countered the pandemic with better imagination, sobriety, and exemplary performance rather than creating sensation by cynical and futile debates, which are absolutely inappropriate at this time.  

     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

Facilitators turn administrators: Biggest tragedy to medical profession in present era


14 Doctors in rural Unnao resign alleging mental harassment and misbehaviour by administrative officers over COVID-19 work.

       Administrators, who have never treated  a patient in their lifetimes, but control treatment of thousands of patients. The  biggest tragedy to the medical profession in present era, causing discouragement and demoralization of medical profession.
         Their role should not have been more than facilitators, but they have become medical  administrators. They are so distant from the ground reality.  To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
The vulnerability that is  intrinsic to the  doctors’ working makes them sitting ducks, an easy target for harassment and punishments and  is exploited by everyone to  their advantage. Administrators use this vulnerability to  suppress them. It is used by  media and   celebrities who projected  themselves as Messiah for the cause of patients, and  sell their news and shows by labeling the whole community of doctors as dystopian community based on just one stray incident.

     The blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful administrative machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry  and administrators is  not given, in order to maintain the prejudice  with its dangerous bias towards doctors, who are in forefront and are visible to public. Clearly separating the role of health workers and the hidden administrators would not only settle the matter, but is actually essential to project the reality. The correct perception of two fundamentally different components would reveal a real gulf and would help to address the core issues.

    A wish to govern, regulate and punish the medical professional by administrators is not new. Hammurabi 4000 years back had initiated to write the cruel rules of the game, which possibly initiated a change in the global perception and regulatory system and formed the basis for cruel regulation in radical and unprecedented ways.

      In  a quest to control  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 and  the  amalgamation of intricacies of science with legal complexity, doctors are burdened with over-regulation and administrative pressures.

               Consequently the  doctors are the sufferers, as they feel enslaved and suffocated. But ultimately who would be the sufferer, does not need an Einstein brain to guess.

14 doctors resigned, alleging harassment and misbehaviour by administrative officials.

More than a dozen doctors posted in rural hospitals in Unnao district of Uttar Pradesh collectively resigned, alleging harassment and misbehaviour by administrative officials.

The doctors, numbering 14, posted at community health centres and primary health centres submitted their resignation letters to the chief medical officer (CMO) of the district on Wednesday. Speaking to the media, one them said that while their teams would work on the field from noon to 4-5 p.m., isolating COVID-19 positive cases in their home, distributing medicine and carrying out sampling, the local SDM would summon them after that seeking a report of their work. The doctors would have to drive back several km to the tehsil from their place of work just to “prove that they are working,” said the doctor. “Despite continuously working, it has been made to appear like we are not working and that due to this, the COVID-19 situation is going out of control,” he said. The doctors also alleged that they were not provided sufficient drug supply from the government and often faced verbal harassment at the hands of the CMO and the CMS. If the field teams were unable to trace down patients because of submission of wrong phone numbers and addresses, they should not be held responsible for it, said the doctors.

     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

Financial complexity of MIDDLE-MAN in Medical Industry # Insurance pays 45 -80 % of Covid bills


     

 Medical care  intertwined with health business, further braided with changes in medical law presents a more complex problem rather than   just treating a patient well. In present era, many kinds of organizations have positioned themselves between doctor and the patient.

      This era  belongs to a transitional phase, when  gradual  conversion of doctor-patient interaction to a business transaction  is being controlled by industry’s middlemen .  One such middle industry is Insurance industry. The medical industry, insurance, law industry and administrative machinery remain hidden in the background and enormously benefitted at the cost of doctors and nurses, who suffered at the front, as face of the veiled colossal medical business and remain the only visible components.  Insurance industry is in a position to extract business from doctor as well as patients.  One such example is published in Times of India, where insurance company  has paid bills between 45-80%.  Each one of the medical industrial component trying to have their pound of flesh, will not only push  the cost of health care upwards, but would leave  both the main stakeholders, doctors and patients feel dissatisfied.

Policy holders get only  45 -80 % of Covid bills TIMES OF INDIA

As the number of people hospitalised due to Covid rise, many find that they have to settle a big chunk of the bill out of their own pockets despite having health insurance. Policyholders are again caught in the crossfire between hospitals and insurers over the treatment of consumables like personal protection equipment (PPE) kits resulting in only 45% to 80% of hospital bills being recoverable by customers. For 81-year-old diabetic and hip fracture patient K Saraswathi, who was treated for Covid-19 for eight days got only Rs 56,500 reimbursed of the total Rs 1.18 lakh bill from third-party administrator Raksha. Among other things that were disallowed included Rs 17,600 for PPE claims. While insurers cite General Insurance Council (GIC) norms their argument may not hold water as IRDA has not approved any norms. “How can a hospital treat a patient without PPEs?” asked an official at the Insurance Ombudsman office which is snowed under with complaints for short-settlement. “We used to get a few cases last year, now we have 88 pending cases, 70% to 80% of which are short settlements,” the official said.


For some insurers, the exclusions amount to a third of hospital bills. Liberty General officials said around 35% of the bill does not fall under the ambit of insurance coverage. Its VP and national claims manager for accident & health, Amol Sawai said, “On the industry level, the average Covid claim severity is Rs 1,40,000, the settlement severity is about Rs 95,000 of the claimed amount. We have seen almost 20% of the total bill is attributed to PPE costs.” India’s largest health insurer Star Health settles nearly 80% to 90% of claims under cashless settlement within two hours of receiving claims. S Prakash, MD of Star Health said, “One doctor who takes a round in the same PPE kit, cannot charge for each of ten patients he visits. The controversy is not in the reimbursement for PPEs, but in the number of PPEs covered. One cannot claim for ten PPEs per day. For ICUs, we allow a higher number of PPE kits compared to the ward,” he said.


According to the GIC officials, the referral rate for PPE kits is Rs 1,200 per day for moderate sickness and Rs 2,000 per day for severe sickness.


“We also see a spike in claims made for CT scans per person. We allow maximum two CT scans per patient,” he added. Officials at the GI Council blamed the hospitals for this situation. “Why are no directions given to hospitals on billing?” asks a council official. He points out an instance where a Tamil Nadu hospital charged Rs 14,000 for medicines, Rs 55,000 for diagnostics and Rs 50,000 for PPE besides room rent. When the insurer raised a red flag, the bill was halved to Rs 1.5 lakh.


“Is it okay for hospitals to loot with such high bills, whose money are we paying? It is the public’s money. If the premium doubles next year, will anyone even think of medical insurance. If we raise our hands and give up covering medical insurance, can anyone force us to provide a cover,” the official asked. The short settlement by insurance companies is resulting in a rise in complaints at the office of Insurance Ombudsman in Chennai.


“Insurers are citing some GI Council norms for claims settlement. Whatever they are saying does not hold water as IRDA has not approved any norms. How can a hospital treat a patient without PPEs?,” an official at the Insurance Ombudsman office said. Hospitals on their part blame the westernization of healthcare where insurance companies call the shots. “How can an insurance company decide on medication? A Dolo works for some while a Combiflam works for another, both these have a price differential. Now to say I will pay Dolo charges for a Combiflam or vice versa is plain stupidity. We need someone who looks at the bill and the patient and not one size fits all,” a MD and head of infectious diseases in a private hospital said. “The need is a regulator who understands medicine,” he said.

     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

New book: ‘The Real Issues’ through ‘fictional narratives’


“AT THE HORIZON OF LIFE AND DEATH”

Find it on Amazon :

Description

         This book comprises of stories that capture the pivotal moments in the treatment trajectory of the critical patients facing death.  The times that force the doctor to confront the saddest moments, while battling a terrifying, unbeatable foe, the death monster alongside families’ fears, gloom, indecisiveness, dilemmas about future and saviour’s own predicaments intertwined with medico-legal intricacies and consequent complex emotional interactions.  

        The situations depict ‘the real issues’ through ‘fictional narratives’. 

       The stories reflect life of a doctor in the present era, amidst sick patients in an imposed legal milieu, a mystic journey, an arcane odyssey punctuated with pain and pleasure in the narrow and uncertain lanes at the horizon of life and death, carrying the burden of various vicissitudes like consumerism, legalities, unpredictable course of diseases, mistrust and blame for poor outcomes.   

        The narratives try to unmask the eternal latent vulnerability that is intrinsic in doctor’s work, which is exploited by media, law industry and even celebrities to sensationalize and sell their news and shows. The vulnerability turns more evil as the delineating cleft that separates doctors from the invisible overpowering medical industry is not shown, thus ensuring to sustain the prejudice with its dangerous bias towards health care workers. 

        One negative news story through a ‘portrayal effect’ generates unbridgeable gap in doctor -patient relationship, painful burden of mistrust loaded on doctors, that would heal only if millions of unfettered, unprejudiced, unbiased facts are clearly projected. 

           The book tries to highlight a seemingly illogical and contrary nature of the conflict; the doctors are finding themselves increasingly being engaged into. The dense mazes of consumerism, extensive communication, documentation, unrealistic expectations, negative media insinuations, legal complexities are demoralizing to doctors and certainly counterproductive for patients.

         The futile discords emanate frequently, that are mundane in reality when compared to the actual disease and the real point of intention which is ‘The Treatment of the Patient’.

         But is this what the patients actually need? Does the entanglement of doctors in such a maze help the patients in real sense?

        The author felt morally compelled and attempted to find answers, embedded in a journey that was wondrous and inspirational, but with horrifying moments as well.

        Has the decision to treat human fragility become a mistake in present era?  No reward, if you win the match of life and death but sword hanging; if  one were to lose?     

       Patient will need to decide someday, whether to be a consumer or just remain a patient. 

       Being a consumer may be an overall loss-making deal for the patient.

Disclaimer

   The stories are fictional, but the depiction of the problems to the doctors, nurses and patients are real, based on day to day routine incidents. The episodes do not pertain to any single particular person, patient, doctor, nurse, hospital and organization. All the characters, names and dialogues in the book are figment of imagination of the author and similarity to any person, any situation or organization may be co-incidental.

            The stories are not against any law, word of courts, profession, any government or any organizational set up or rules of any country. They depict the problems commonly faced by doctors in performing their duties hence are likely to affect the patient directly.

Challenges of Covid Vaccination-2021


If 2020 was consumed by Covid Virus ,  the next year 2021 will be  for Covid vaccination.

All over the world, billions of people are going to get vaccine.

Corona vaccination is one of the most anticipated events in every country. in coming weeks, multiple vaccines   are likely to get regulatory approval. 

    However, while making a good vaccine was the difficult part, earning  trust of public in vaccine is going to be another one. Especially the hurried development at Pandemic speed  and lack of awareness about safety issues will be areas of concern.

  The adverse events, which are unexpected medial problems that occur with drug treatments, are unavoidable part of any treatment, including vaccine science.

    The system need to be in place to identify  the causal relationship between vaccine agent and  the adverse event.  The objective criteria have to be in place to identify and treat, as the population to be vaccinated is also very large.

 The main hurdles equally challenging will be sourcing, distributing and giving the actual vaccination doses.

The preparation for mammoth exercise will also be a herculean task. It may take months to get ready to supply and build the chains and preparation for this need to begin now.

A systematic approach needs to be ready, so that the process of vaccination gets on smoothly and quickly, as soon as the doses are available. For example, the need for transport vehicles and the storage facilities for billions of doses at distant places will be one of challenges.

It will take mammoth number of healthcare workers, who will vaccinate people at different towns and cities.  

This exercise, if not done in a well-planned manner, could result in chaos.   The failure to set up a system will not only result in suboptimal vaccination but also non uniform supplies. Maintaining the cold chain will be crucial for effectiveness.

 People should get it based on needs rather than black marketing or money power.   The issues which look insignificant like the financial complexity among various stake holders or customer clearances need to be settled first, as they may become significant hurdles for smooth distribution.

    Most important would be to safeguard citizen’s faith in vaccine and clinical trials. As for the future science to develop, would   require people’s co-operation, faith and participation.

     Government regulators and Vaccine makers need to recognize the utmost importance of the communication about the true results of trials and effective communication with the public.  The misinformation and distrust should not  undermine the good work of medical science and advancements.

     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

Authorities mum on Adverse Event at Covid Vaccine Trial


Safety data of Covid Vaccine- need disclosure

   There are two important aspect of a successful vaccine,

1. Efficacy  for the prevention

2. Safety

       Given that the Covid vaccine is needed urgently and will be developed within a years’ time, some doubts about the safety aspect are natural. But safety can be assured, if the data about side effects is made public.

   All  the  companies  in a bid to rush their  vaccine into the market, are eager to  create an hype. But a caution need to be exercised against such hyping, especially when long term safety data is not available.

  Even the sparse details of the severe side effect,  that leak into the public domain, may be just tip of the iceberg, as far as long term safety data of a vaccine is concerned.

   All the side effects, mild or severe, need to be made known  and  in public domain, rather than exposed later after the use.

More than a month and a half after an adverse event occurred in a clinical trial in India of the AstraZeneca vaccine, the Central Drug Standard Control Organisation (CDSCO), the regulator for vaccine trials, has not issued any statement on the occurrence. It also did not respond to queries about whether it has completed its investigation to determine if the trial participant’s illness was related to the vaccine. Serum Institute, which is partnering the pharma MNC and Oxford University for producing the vaccine in India, has also refused to comment. This is in sharp contrast to AstraZeneca and Oxford University going public when one of the trial participants in the vaccine trial in the UK fell ill and halting the trial till an independent safety monitoring board and UK’s regulatory authority gave safety clearance. Information about the occurrence of the serious adverse event (SAE) during the vaccine trial in India came from the family of the trial participant, which has sent the company and the regulators a legal notice. Serum Institute merely stated that it would issue an official statement next week. AstraZeneca had issued a statement within days of the trial participant in UK falling ill and halted the trials across the world in the UK, Brazil and South Africa. The trial was resumed within a week after the independent safety review committee and national regulators gave clearance. The Indian Council of Medical Research is a co-sponsor of the trial along with Serum Institute.

According to the ICMR, it is for the DCGI to take a call on whether or not to halt the trial. The DCGI heads the CDSCO.

The 40-year-old trial participant, a business consultant with an MBA from New Zealand who says he took part in the trial deeming it his duty to help such an important venture, was administered the vaccine at SRMC on October 1. Eleven days later, he woke up with a severe headache, and progressively lost his memory, showed behaviour changes, became disoriented and was unable to talk or recognise his family members, according to the legal notice. As soon as he fell ill he was admitted to the ICU in SRMC.

“Though the legal notice we have served talks of a compensation of Rs 5 crore, our focus is not on monetary compensation. It was sent just last week, more than a month after the occurrence when we saw that none of the authorities was making the adverse event public. They ought to have warned other participants so that they could watch out for similar symptoms. We want to know why the occurrence of the adverse event has been kept under wraps and why the trial was not halted like it was done in the UK. Is an Indian life of less value than that of an UK citizen?” asked a close family friend who has been helping the family cope with the illness.

WHO says more data needed on AstraZeneca dose

     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

Ayurvedic Surgery: 10 Technical Questions? About safety concerns


      If there are certain doubts about the safety of the patient, the apprehension needs to be addressed.

      The government has issued a notification which authorises post-graduate practitioners in specified streams of Ayurveda to be trained to perform surgical procedures such as excisions of benign tumours, amputation of gangrene, nasal and cataract surgeries.

    The notification by the Central Council of Indian Medicine, a statutory body under the AYUSH Ministry to regulate the Indian systems of medicine, listed 39 general surgery procedures and around 19 procedures involving the eye, ear, nose and throat by amending the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016.

     Any  Surgery, how-so-ever simple it may look to the people sitting on fence, carries some  risk and needs  some kind of precautions and regulations to make it risk free.  Therefore if there are certain doubts about the safety of the patient, the apprehension needs to be addressed. If the service of surgery by Ayurveda surgeon has to be availed by public, a certain confidence needs to be generated about the safety and quality assurance. Mere push by an enforced law will not lead to genesis of trust and confidence. So there needs to be technical analysis of some kind, whether  it is a genuine original  strategy or merely  an imposed law.

     If it was an accepted practice till now, there was no need for such notification. So apparently,  if the need was felt  to be said in a forceful manner, there has to be something unusual about the practice.

      No doubt, ancient Ayurvedic text referred to surgical practices. But  in present era of consumerism, patients need to know, how it was being practiced for last 200 to 300 years. What are the results and data about complications.

  There are two main categories for the purpose of discussion.

A. Existence of a robust system

B. Individual competencies.

    Firstly, there should be basic robust system  that will generate Ayurvedic surgeons.

To start with, the  CCIM need to  satisfy on following questions. Following are the basic requirements of surgery.

1. What  kind of Anaesthesia  will be used in surgeries by Ayurveda surgeons? Who will be the anaesthesiologist?

2. What are post op pain killers be used in surgeries by Ayurveda surgeons?

3. What antibiotics  will be  used;. Allopathic or ayurvedic?

4. What are principles of pre-op evaluation?

5. How surgical techniques are different. Are they same used in allopathic surgery or different ones described in Ayurveda?

6. How the post op complications are being managed. Is it by using allopathic medications and investigations?

7.  Data of surgeries done in last decade or two in all of  Ayurvedic medical colleges, especially those done by Ayurvedic surgeons.

8. Who is teaching Ayurveda doctors about the  surgeries? Are there ayurvedic teachers  or being taught by allopathic surgeons?

9. Will  the people in higher positions and government  officials be availing such facilities or it is only for the  poor people? 

10. Will the patients be given enough information or an informed consent about such Ayurvedic surgeons before  surgery?

         More than a law, the whole exercise   will require a trust building   in public  along with quality assurance and something unique to make such surgeries practically happen.

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