Work-life imbalance for doctors/nurses & consequences

For doctor and nurses, time of work and action is determined by need of the patient. Whereas in most of other professions, time of work can be carried out at any convenient time. As a routine, most of the human being work during day time, by convention that is 9 AM to 5 PM . whereas, It is not uncommon for medical and nursing professionals to have more heavier and challenging night shifts. Most of clinical branches, doctor and nurses remain busy through out night.

Across the globe, in the medical systems, specially not so well organized, it is a common routine for the doctor to get night calls everyday and lots of them rarely gets undisturbed normal sleep.

Needless to say that doctors and nurses do a herculean task to stream line their family and professional life. Kudos to those, who can nurture their hobbies, along with difficult clinical branches. Maintaining a work-life balance remains a distant dream for most of successful clinicians. This balance can be defined as a satisfaction gained by spending time on activities according to one’s wishes, which are besides their clinical work.

Areas of life other than work–life may include personal interests, family, social or leisure activities or hobbies.

Work–life imbalance is the lack of proper alignment between work and other important life roles. It is a kind of balanced state of time, achieved by spending time on demands of personal life, professional life and family life, that is satisfying. Work-life balance is not limited to flexible work arrangements to carry out other life programs and practices. Work-life balance is a term commonly used to describe the balance that a working individual needs between time allocated for work and other aspects of satisfying life.

The thing that strikes as a surprise to most of doctors of starting a family is simply how difficult it is. The learning curve of taking care of family along with professional responsibilities is so steep, While working as doctor in learning or training phase, parenting requires an abundance of energy, time, and grit

And when the responsibilities of being a parent are compounded with the realities of being a trainee doctor, it starts to be too much. It never feels like enough time for anything and it really becomes utterly exhausting. There is always a struggle constantly with the balance of spending quality time with family, trying to study and perform well. There is little time for hobbies or doing things to maintain sanity of mind.

The environment of work today for doctors has become more intense with legal issues, burdening much more than it was few decades ago. Burdens beyond clinical work and associated stress have created the need for a better balance between work and life. Doctors have started thinking to devise or alter the working in an effort to have a better balance. Experience of being over-worked, long working hours and an extreme work environment has proven to affect the overall physical and psychological health of doctors and deteriorate family-life.

Although there are no structured studies on the issue, but doctors have started feeling difficulty balancing work and family. But the effects are already evident like alcohol and drug abuse, increased rates of divorce and suicides. Increased feeling of stress and early burnout is an natural outcome. Doctors, who have attained stage of financial security tend to have an early retirement, or reduce working hours.

Consequences of work–life imbalance

Problems caused by imbalance and consequent stress has become a source of major concern for doctors and nurses. Symptoms of stress can result in both physiologically and psychologically changes. Profession suffers as the workplace becomes the greatest source of stress.

Persistent stress can result in cardiovascular disease, sexual health problems, a weaker immune system and frequent headaches. It can also result in poor coping skills, irritability, jumpiness, insecurity, exhaustion, and difficulty concentrating. Stress may also perpetuate or lead to binge eating, smoking, and alcohol consumption.

In medical profession, simply working hard is not enough anymore. To get ahead, a rigorous trainings, prolonged working hours are new standards. There is very little time left to be divided among relationships, kids, and sleep.

This ordeal is prolonged over years results in less time spent with family, friends, and community as well as pursuing activities that one enjoys and taking the time to grow personally. Even close friends and relatives slowly start becoming distant.

Extending family and becoming new parents causes extreme stress in doctor’s life. It can have negative effects. Between trying to balance a new schedule, managing additional responsibilities, and lacking flexibility and support, they can only increase stress.

Consequently, the evolving system of health care have made doctors more prone to burnouts. Their quest to be the ideal, hard-working, perfectionist ultimately turns them loner, the grim and stressed individuals.

May 11, 2019 2

Advantages & disadvantages: pros & cons of medical consumer Protection Act

#Medical-Consumer-Protection-Act: Pros & Cons: Advantages & disadvantages, medico legal, medical negligence

As in last few decades, patients are defined as consumers and Medical Consumer Protection Act takes roots, the whole system of medicine and healthcare has changed. All the new changes in regulation, insurance and legal system have resulted in facilitating and exercising an easy control of medical industry over health care, each revision has affected doctors adversely. They have been reduced to just only one small component of the industry, who deliver care and remain at receiving end for poor outcomes. Other important stake holders are patients. How this change has been beneficial for patients?

Suppressed professionals can be used to work more, get less paid and can be dragged to courts easily. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario, act smart and are able to entrench themselves in changed business and legal milieu.

Disadvantages of medical consumer Protection Act (Negatives, cons)

1 .Promotes Defensive medicine: Every patient with any illness has a potential for complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non-availability of doctors.

Erosion of doctor-patient relationship: Stray and occasional Incidents about negligence, the cases in courts or their outcome attract wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves being in the chaos or scenario projected. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends into and involves their own imagination and circumstances. This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant event. Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.

Increased cost of care: With the increasing need for defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to increased medical costs. Insurance companies, medical industry and lawyers have positioned themselves in between doctor and patients. They charge everyone on both sides, heavily for allaying the fears, both patients (medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.

25 factors for rising cost and expensive medical care.

Enhanced insecurity in medical profession: Needless to say, consumer protection act has increased the anxiety and insecurity of the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career, will result in professional hanging or a media trial. There is a real probability of being entangled in these problems in present era in day to day practice.

Disadvantages of being a doctor, health worker

Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons, for example the sense of revenge or to extract money or simply for avoiding to pay for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These ideas are further stoked by the incidents of previous high compensations granted by courts .

Black coat versus white coat

Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a day more worried about completing paper work as well. Initially it was a symbolic documentation, but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.

Doctors used as scape-goats for revenge: Any unsatisfied patient can vent his anger by putting complaint or case against the doctor. This is done to some extent for revenge or just finding a human factor which can be punished. Not uncommonly doctors are used as scape- goats to have a concession on the patient treatment by administrators. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.

Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight. Complex medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intentions ‘the treatment.

Early retirement or burn out: Becoming a doctor and practising has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the doctor’s whole life.

Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career to risk, why should anyone put himself in that difficult position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.

11 .Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight. All patients, who are unsatisfied or with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.

Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking for, whom to blame among themselves. All of them will try to pinpoint each other’s mistake. Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately a mutual understanding and team work takes a hit.

Doctors converted to cheap labour: Hugely benefitted are medical industry, law industry and administrators; The ease with which doctors can be harassed has lead to rampant misuse of consumer protection ac and t has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip against the doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain the maximum out of doctors hard work. Benefits to law industry and lawyers are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.

Confusion while treating; Right decisions ? A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering. What was medically right and judicious decision at that real time situation may be looked as wrong later, especially when retrospective analysis is done over years with fault finding approach. So taking medical decisions is becoming more difficult amid future uncertainty of disease.

Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem, but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed. Delay in surgeries or therapies are a common outcome.

Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate 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 instigation of lawsuit against doctors is a major setback for medical profession.

Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves starting the work in a hostile environment. They find it strange to find themselves at the receiving end of public wrath, law and media for reasons, they can’t fathom. They work with continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

Doctors have become ‘Sitting ducks’ for continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes. Mistakes are always easy to be pinpointed with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
Demoralization of medical professionals – as selectively applied: strangely it applies only to doctors. All of other professions are out of it. Selective application is what demoralizes doctors. Considering the uncertainty and kind of work of medical profession, actually it should be other way around.

The consequences are like victimization.

Advantages of Medical Consumer Protection Act: (Positives, Pros)

1. Redressal of grievances: patient will get satisfaction, if there is a genuine negligence case.

Better quality of care; medical systems will improve as they will need to lessens the errors and court cases. Better systems from abroad are also copied to improve the efficiency.

Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.

Training of medical professionals: it will be difficult to put errors under carpet. Doctor will like to get trained better as no one want to be in soup.

Future learning from court cases: each and every court decisions is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.

Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.

Better documentation and communication: for doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting much. But now there is lot of stress on documentation.

Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and achieve better results. The real problem lies in the fact that in this age, anxiety prevailing more for care givers, a sense of injustice prevails . stress generated can alter the ways, the patients get treated. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.

21 occupational risks to doctors and nurses

Reel Heroes vs Real Heroes

25 factors- why health care is expensive

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Expensive Medical College seat- Is it worth it?

May 7, 2019 140

How to choose medical specialty? Variation of doctor salary, earning & important factors

Choosing a medical specialty is possibly one of the most important variable factor in doctor’s life. This one factor will decide the rest of the life of the doctor. General rough guide to the factors involved, which persist forever and throughout the life, after a doctor chooses a specialty is given below. There can be individual variation depending upon the individual attitudes, compromises and way to do practice. Therefore there will be some variation in all the fields for individuals, places, systems and countries.

There can be extremes and variations on either side of spectrum, but are exceptions. Following article does not include satisfaction and earning gained from other businesses done by doctors, running nursing home or hospitals, commercial gains from pharmaceuticals etc. this is on basis of income purely from professional work of treating patients.

Factors—

Earning
Prolonged tough training
Satisfaction of treating patients
Satisfaction of making diagnosis
Emergency & odd hour duty
Stress of life and death
Legal complexity and stress

The Unit—-Single * or (I) is one unit. With experience and years of work , this unit (for same doctor) will also multiply with age.

UNIT

India ( * or 1) is 1 million rupees/annum

Advanced countries- (* or 1)== one lac or 100,000 dollars/ annum

General practice
1. Earning	to * 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	**
Internal medicine
1. Earning	to** 2-4
2.. Prolonged tough training	to*
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	***

cardiology
1. Earning	to***** 2-7
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	****

gastroenterology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	**

Neurology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Nephrology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Pulmonary medicine
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Emergency Medicine
1. Earning	to** 2-4
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Anaesthesia
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	**
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4
Endocrinology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2
Psychiatry
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

paediatrics
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	***
7. Legal complexity and stress	**** 4

Critical care
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Paediatric critical care
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

General Surgery
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Minimal access surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Cardiac surgery- CTVS
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Urology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Gastro-surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Neurosurgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Head and Neck surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Orthopaedics
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Ophthalmology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Radiology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	*
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2
ENT
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Dermatology
1. Earning	to*** 2-5
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	*
6. Stress of life and death	*
7. Legal complexity and stress	* 1

Gynaecology/obstetrics
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	****

Plastic Surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	*
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Oncology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2

Onco-surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2

Anatomy
1. Earning	to* 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Physiology
1. Earning	to*
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Biochemistry
1. Earning	to* 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Microbiology
1. Earning	to** 2-4
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	0 to*
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

Pathology
1. Earning	to ** 2-4
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	NIl
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

Medical administrator/Manager
1. Earning	to****** 2-8 sometimes multiple
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

. There can be extremes and variations on either side of spectrum, but are exceptions.

If the reader have some different view, or want to add something, they are welcome to write in comments. This table just highlights a trend of factors and may not be perfect. But it gives the factors which need to be taken into account, before choosing specialty.

March 22, 2019 1

West Nile virus : first reported death in India ( Kerala): How to prevent?

A seven-year-old in Kerala, who had tested positive for West Nile Virus (WNV), died in Kozhikode on Monday. It is first reported death in India due to the WNV. West Nile Virus is a disease which spreads from birds to humans with the bite of an infected Culex mosquito. The symptoms include cold, fever, bodyache, fatigue and nausea, with complications leading to meningitis and death. Birds are natural hosts of the virus.

West Nile virus (WNV) is the leading cause of mosquito-borne disease in the continental United States. It is most commonly spread to people by the bite of an infected mosquito. Cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV in people. Fortunately, most people infected with WNV do not feel sick. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. You can reduce your risk of WNV by using insect repellent and wearing long-sleeved shirts and long pants to prevent mosquito bites.

The WNV can cause neurological disease and death in people and is common in Africa, Europe, the Middle East, North America and West Asia.

Here is all about the virus:

What is West Nile virus? West Nile virus (WNV) is an infectious disease spread by infected mosquitoes. It spreads from birds to humans with the bite of an infected Culex mosquito.

What are the symptoms on WNV?

People who get WNV usually have no symptoms or mild symptoms. The symptoms include a fever, headache, body aches, skin rash, and swollen lymph glands. They can last a few days to several weeks, and usually go away on their own.

When is it dangerous?

If West Nile virus enters the brain, it can be life-threatening. It may cause inflammation of the brain, called encephalitis, or inflammation of the tissue that surrounds the brain and spinal cord, called meningitis.

How is WNV diagnosed

A physical exam, medical history, and laboratory tests can diagnose it.

Who are at risk?

Older people, children and those with weakened immune systems are most at risk.

What is the cure?

There are no specific vaccines or treatments for human WNV disease. The best way to avoid WNV is to prevent mosquito bites. Treatment is supportive for patients with neuro-invasive West Nile virus, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections.

Have there been any outbreaks?

The largest outbreaks occurred in Greece, Israel, Romania, Russia and USA. Outbreak sites are on major birds migratory routes. In its original range, WNV was prevalent throughout Africa, parts of Europe,

Middle East, West Asia, and Australia. Since its introduction in 1999 into USA, the virus has spread and is now widely established from Canada to Venezuela.

In India : Since 2016, 124 cases of the disease have been reported from across the country, but no deaths.

Experts in virology say there is usually no single reason that leads to death in cases of WNV disease.

According to previous research, WNV is not a new disease to India.

In India, the existence of antibodies (protein produced by the human body to fight bacteria and viruses) against WNV in humans was recorded for the first time in 1952, according to a 2006 research paper titled “West Nile Virus isolates from India: evidence for a distinct genetic lineage”.

The research was conducted by experts at the National Institute of Virology in Pune, and published in the Journal of General Virology.

Since WNV is a vector-borne disease, the health ministry has been monitoring the situation closely. A team of experts from health ministry’s National Centre for Disease Control has been assisting state authorities

Prevention

The most effective way to prevent infection from West Nile virus is to prevent mosquito bites. Mosquitoes bite during the day and night. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear, and take steps to control mosquitoes indoors and outdoors.

Take steps to control mosquitoes indoors and outdoors

Use screens on windows and doors. Repair holes in screens to keep mosquitoes outdoors.
Use air conditioning, if available.
Stop mosquitoes from laying eggs in or near water.
- Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers.
- Check indoors and outdoors.

Treatment

There is no specific treatment for WNV disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting. Patients with encephalitis require close monitoring for the development of elevated intracranial pressure and seizures. Patients with encephalitis or poliomyelitis should be monitored for inability to protect their airway. Acute neuromuscular respiratory failure may develop rapidly and prolonged ventilatory support may be required.

WNV Antibody Testing

Laboratory diagnosis is generally accomplished by testing of serum or cerebrospinal fluid (CSF) to detect WNV-specific IgM antibodies. Immunoassays for WNV-specific IgM are available commercially and through state public health laboratories.

WNV-specific IgM antibodies are usually detectable 3 to 8 days after onset of illness and persist for 30 to 90 days, but longer persistence has been documented. Therefore, positive IgM antibodies occasionally may reflect a past infection. If serum is collected within 8 days of illness onset, the absence of detectable virus-specific IgM does not rule out the diagnosis of WNV infection, and the test may need to be repeated on a later sample.

The presence of WNV-specific IgM in blood or CSF provides good evidence of recent infection but may also result from cross-reactive antibodies after infection with other flaviviruses or from non-specific reactivity. According to product inserts for commercially available WNV IgM assays, all positive results obtained with these assays should be confirmed by neutralizing antibody testing of acute- and convalescent-phase serum specimens at a state public health laboratory or CDC.

WNV IgG antibodies generally are detected shortly after IgM antibodies and persist for many years following a symptomatic or asymptomatic infection. Therefore, the presence of IgG antibodies alone is only evidence of previous infection and clinically compatible cases with the presence of IgG, but not IgM, should be evaluated for other etiologic agents.

Plaque-reduction neutralization tests (PRNTs) performed in reference laboratories, including some state public health laboratories and CDC, can help determine the specific infecting flavivirus. PRNTs can also confirm acute infection by demonstrating a fourfold or greater change in WNV-specific neutralizing antibody titer between acute- and convalescent-phase serum samples collected 2 to 3 weeks apart.

Other testing for WNV disease

Viral cultures and tests to detect viral RNA (e.g., reverse transcriptase-polymerase chain reaction [RT-PCR]) can be performed on serum, CSF, and tissue specimens that are collected early in the course of illness and, if results are positive, can confirm an infection. Immunohistochemistry (IHC) can detect WNV antigen in formalin-fixed tissue. Negative results of these tests do not rule out WNV infection. Viral culture, RT-PCR, and IHC can be requested through state public health laboratories or CDC.

March 19, 2019 0

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.

March 14, 2019 2

Doctor need to train themselves for “ Cool” communication with patients to save themselves.@ Supreme court on insensitive comments by Shimla Doc

Doctors are sitting ducks for revenge, which can be in many forms. It is necessary not to make unnecessary comments during discussions with patients and relatives. A sweet talk or even stoic silence is still better than making irrelevant and insensitive comments. Sometimes, in emergencies doctors are too busy, feeling harassed, and in heat of moment , they utter some words. But later, no one will take into account the amount of distress in emergency situations. Irrespective of the number of patients, try to refrain from uttering the words, which are non- professional. But few words said in disgust will be remembered by patient and interpreted by courts in retrospective analysis can be held against the doctors..

Supreme court granted an additional Rs 10 lakh in compensation to a woman from hills in medical negligence case on finding about the insensitive comment made by doctor at hospital in Shimla

Few points, which should be followed are as under to save themselves from future harassment. There can be many more.

Do not have a word match with patient or attendants.
If attendant are shouting or angry, restrain your mind and do not answer to give back in same words. Better to be silent.
Try to avoid being in that situation, specially if you are being irritated and some thing goes out of your mouth.
If the situation is arising because diagnosis is not clear or not able to treat, try to refer the patient, without making comments.
Try to have cool and calm communication and make a record of it.
Communication should be regarding only professional matters. Rest all irrelevant communication to be avoided.
Unreasonable and unrealistic demands are not uncommon . Just tell calmly about the same. Do not make angry or sarcastic comments.

But sometimes when during ongoing medico legal lawsuits, a feeling of revenge prevails or as guided by lawyers, such uttered words may cause unnecessary problems.

“Documenting the communication”

examine, investigate, diagnosis , treat correctly and communicate
Make a note of plan of treatment and prognosis, and communicate to patient or attendants.
Sign yourself and ask the patient or nearest relative to sign.
It is not uncommon that relative will refuse to sign. In that case just write a note and mention that attendant refuses to sign.
It is also a common issue that after listening to everything, relative will say that he does not understand or will ask his uncle or aunt. These are difficult moments and commonly happen. Just make a note of everything. Besides it wastes crucial time.
Can use camera for communication in difficult cases.
Never rely on verbal communication. It has little value. Commonly people refuse to admit verbal communication, and will say that they were not told anything.

As time for everything is limited in life, be it treatment, communication, consent or documentation. . “Talk less and write more”. You will be judged by documents after many years.

Doctors need to train themselves to restrain and avoid irrelevant comments, to save themselves.

March 12, 2019 0

Thousands Healthy deaths vs one hospital death. Perception of moral burden of negligence (# SUPREME COURT on pothole deaths)

The death pronouncement is one of the most sensitive and complex part of communication in

There is a infernal difference in the kind of media projection, burden of negligence and accountability of preventable multiple healthy deaths by civic negligence as compared to one hospital death occurring due to severe disease. In fact the burden of negligence here in healthy deaths is massive and these deaths are unpardonable. But reality is opposite. Strangely “alleged and perceived negligence” ( with no proof and no investigation ) in death of someone already having disease and death in hospital during treatment attracts more scrutiny and stringent punishment as compared to a naked “negligence in deaths of healthy people” in such cases of civic negligence.

Massive civic negligence leading to entirely preventable loss of lives. These incidents bring fore the misplaced priorities of media and society which too have contributed to some extent to these unabated ongoing preventable deaths of thousands of healthy people.

Deaths due to potholes ‘unacceptable’, Supreme court

The bench, said the number of deaths from 2013 to 2017 in accidents due to potholes indicated that the authorities concerned were not maintaining the roads. The Supreme Court Thursday expressed concern over 14,926 people being killed in road accidents due to potholes in last five years and termed it “unacceptable”. A bench said the large number of deaths caused due to potholes across the country was “probably more than those killed on border or by the terrorists”. Terming the situation as frightening, the top court had asked the Supreme Court Committee on Road Safety to look into the matter. The bench had also said that people who have lost their lives as a result of accidents due to potholes should be entitled to compensation.

Multiple Deaths in healthy people by civic negligence :

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

Single Death in Hospital due to disease:

The media has always, instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault. Media has been responsible for creating a misunderstanding about the whole process of treatment and creating something sensational out of nothing.

Point to ponder-Misplaced priorities:

Who is to be blamed for the deaths of healthy people which occur because of civic negligence? Here relatives may be helpless and the vital questions may go unanswered or taken as a routine. There are no punching bags like doctor for revenge. But on the contrary, any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by doctors. But media instead chose to defame medical profession by igniting the emotions of people by sensationalizing death of diseased and ill, who probably were already at risk of death and did not give due importance to highlighting prevention of healthy and absolutely 100% preventable deaths.

Right issues raised at right time will save thousands of healthy preventable deaths. Multiple healthy deaths should carry more burden of negligence than one death due to disease.

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December 9, 2018 1

Global corrupt medical (#implant) market & unholy nexus: tip of iceberg revealed

With aberrant evolution of modern medicine and advancement of medical procedures, everything appears to be controlled by medical industry. The investors have gained control of the financial game. How large companies create a web of corrupt practices, and earn huge profits, is a common prevalent sentiment. Tip of the Iceberg has been revealed indicating inducements to some doctors and dubious deals with hospitals. If these are the hallmarks of the big unregulated medical bazaar in India and some others, a rare case involving a global major has put a figure to it.

In a filing two months ago, the top financial regulator in the USA, the Securities and Exchange Commission (SEC), ordered the world’s leading manufacturer of orthopaedic implant devices, Stryker, to pay $7.8 million (over Rs 55 crore) in settlement for violating its corruption norms in India, China and Kuwait, documents accessed by The Indian Express reveal.

The settlement, recorded by the SEC on September 28, came after the Commission’s “accounting and audit enforcement” proceedings noted a number of “violations” by the company’s Indian subsidiary and its dealers. These “violations” include questionable payments to doctors for “consulting fees, travel, and other benefits” and “inflated invoices” issued to “mostly large, corporate hospitals”.

And that’s not all. In 2012, the anti-monopoly regulator, Competition Commission of India (CCI), fined an authorised distributor of Stryker India and two other firms Rs 3 crore for allegedly rigging bids, manipulating tenders and forming a cartel to sell equipment to the All India Institute of Medical Sciences (AIIMS) and Safdarjung Hospital, two of the largest government hospitals. In its scrutiny of Stryker’s India operations, including the findings of internal audits between 2010 and 2015, the US SEC concluded: “Payments intended to benefit HCPs (Health Care Providers) also lacked sufficient documentation, such as consulting fees paid to doctors without adequate explanation of the doctors’ consulting services or hours billed, and payments for HCP travel with documentation that appeared falsified…

“Additionally, the forensic review found missing or inaccurate documentation for numerous other transactions flagged as high-risk, including expenses related to consulting fees, travel, and other benefits to health-care professionals in India.”

The US regulator’s severe indictment of Stryker’s India operations is one of the most startling findings to emerge from the Implant Files investigation by The Indian Express and the International Consortium of Investigative Journalists (ICIJ) on the medical bazaar, where pharma majors hard sell their products without any regulation via a dubious nexus with hospitals and doctors.

Stryker India has four offices in the country — Delhi NCR, Mumbai, Chennai and Kolkata — and an annual turnover of Rs 300 crore in FY 2017-18, mainly from selling hip and knee implants, and medical devices for spine and neuro surgeries. The US-based parent company has a market cap of $58.87 billion with operations spread across 100 countries covering Asia, Europe, Africa and Latin America.

Dubious deals with hospitals:

Private hospitals that “requested inflated invoices from dealers profited from their purchase of Stryker orthopaedic products by passing on the higher (invoiced) prices to their patients or their patients’ insurers, even as the hospitals paid the lower prices previously negotiated with Stryker India to Stryker India’s dealers”, the US SEC found.

In doing so, the SEC said, the dealers “allowed these private hospitals to gain a windfall from passing on the higher (invoiced) prices to their patients or their insurance companies”.

Linking Stryker to these deals, the regulator said: “Stryker India authorized these dealer transactions only after Stryker India’s management negotiated and approved the price that the hospitals would pay to the dealers. Thus, in determining the price charged to dealers, Stryker India’s management and the dealers specifically negotiated the profit margin such dealers would stand to earn based on the difference between what hospitals paid the dealers and what the dealers paid Stryker India.”

SEC records do not identify the dealers involved. But documents maintained by CCI show that it had fined PES Installations, an authorised distributor, and two other firms, MDD Medical System and Medical Product Services (MPS), Rs 3 crore in April 2012 for a number of alleged irregularities in sale of equipment to AIIMS and Safdarjung Hospital, both in Delhi.

Responding to a questionnaire from The Indian Express on the SEC findings, Stryker said in a statement: “We are committed to working with our customers to make healthcare better while operating ethically and in compliance with all applicable laws and regulations.”

The US SEC, meanwhile, found a number of similar violations in Stryker’s operations in China and Kuwait, too. According to the SEC, it took into consideration “Stryker’s cooperation and remedial acts undertaken” while deciding to accept the company’s settlement offer to be paid “within 14 days”.

Unlike in India, the US has robust anti-corruption checks in place with the Foreign Corrupt Practices Act (FCPA), enacted in 1977, prohibiting the payment of bribes to foreign officials to assist in obtaining or retaining business, and mandating companies “to maintain accurate books and records”. In Stryker’s case, the SEC decided on a settlement after issuing a “cease-and-desist” offer to the company.

WHAT THE US REGULATOR FOUND

Inadequate oversight of dealers

* In 2012, in response to allegations of misconduct concerning Stryker India’s dealers, Stryker exercised its audit rights over three dealers in India. Those audits revealed insufficiencies in the financial record-keeping and internal accounting controls of all three dealers. Additionally, Stryker identified suspicious expenses by one dealer and instances of another dealer over-billing a hospital upon the hospital’s request. While Stryker took some corrective actions in response to these audits, including terminating one of the three dealers, the actions were limited to the three dealers audited.

* (The)deficiencies violated Stryker India’s agreements with its dealers. Specifically, the deficiencies in dealers’ financial record-keeping violated dealers’ obligation to “maintain complete and accurate records relating to [their] promotion, marketing, use and distribution of [Stryker] Products,” and the over-billing violated Stryker’s business conduct policy prohibiting participation in any improper payments. Despite the red flags raised during the 2012 audits, and numerous complaints reported to Stryker of dealer misconduct, Stryker did not act to determine the scope of dealer-inflated invoices until 2015.

* In 2015, Stryker performed audits of other dealers in India. The audits revealed that the practice of Stryker India’s dealers inflating invoices for the sale of Stryker orthopaedic products to certain private hospitals — an improper practice identified three years earlier in connection with the 2012 audits — had become more widespread.

Lack of accurate books, records

* From 2010 through 2015, Stryker India failed to make and keep complete and accurate books and records that reflected its transactions and disposition of assets. In particular, Stryker India recorded potentially problematic payments to its dealers and to HCPs, some of which lacked any supporting documentation reflecting a clear business purpose.

* A forensic review of Stryker India’s general ledger for the period 2010 through 2015 found a complete lack of documentation for 144 out of 533 transactions selected as a sample of Stryker India’s highest-risk and most compliance-sensitive accounts.

* During the period of 2010 through 2015, Stryker was unable to provide any documentation for 27% of sampled high-risk transactions on Stryker India’s general ledger.

The SEC ordered Stryker to appoint an independent consultant, review and evaluate the company’s internal controls, record-keeping and anti-corruption policies, and procedures relating to use of dealers, agents, distributors, sub- distributors, and other such third parties that sell on behalf of the company. The SEC noted in its official filing: “Stryker fortified its existing compliance program, which is designed to prevent, detect, and remediate potential misconduct. This program develops, maintains, and implements corporate policies and standard operating procedures setting forth specific due diligence and documentation requirements for relationships with foreign officials, health care professionals, consultants, and distributors.”

The company has also retained an independent consultant to “formulate a work plan: that will be evaluated by the agency and Stryker to address the SEC’s findings”.

WHAT INDIA’S REGULATOR FOUND

Dealers rigging bids, forming cartel

* In April 2012, the CCI fined PES Installations, MDD Medical System and Medical Product Services for “bid-rigging and forming a cartel” in tenders for procurement of a Modular Operation Theatre (MOT) and other medical equipment at AIIMS and Safdarjung Hospital.

* The CCI also examined a contentious question: did the dealership agreement between Stryker India and PES violate sections of the Competition Commission Act? According to the official website of the Ministry of Corporate Affairs, the Act, enacted in 2002, aims “to

prevent practices having adverse effect on competition, to promote and sustain competition in markets, to protect the interests of consumers and to ensure freedom of trade carried on by other participants…”

* In its final order issued on April 16, 2014, based on the documents placed before it, CCI ruled that “according to the agreement struck with the dealer (PES Installations), Stryker could appoint any other firm as its dealer”. “However, according to the agreement, in this case PES Installations, the dealer could not sell products of any other company without the permission of Stryker,” the order said.

* The Director General appointed by CCI, under section 26 of the CCI Act, to conduct the investigation noted that the agreement that restricts PES to Stryker alone “impeded and restricts competition” and “constitutes violation of the law”.

* However, the CCI ruled in its final order that the agreement was “not violative of the law” on the grounds that “there are other competing products in the market” that are available to other “similarly placed” distributors.

The point to ponder here is that, with such unholy scenario and milieu developing, where business deals and investors decide the treatment with aberrant medical evolution taking place. Doctors involved with such big companies will be promoted, projected and survive. Will the honest doctors, who are not part of the game, be able to survive, sustain themselves or ultimately alienated to extinction?

source

November 28, 2018 0

Made in India coronary stents non inferior to international stents

In a major advancement, a study shows that made in India coronary stents are as good as those manufactured in other countries by multinational companies, according to a recent scientific trial.

The study’s findings were presented at the prestigious international conference on Non Surgical Cardiac interventions—TCT (Trans Catheter Interventions)—on September 22 in San Diego, USA.

The study, which involved around 1,500 patients, was conducted in various countries of Europe and monitored by an international reputed clinical research organisation (CRO), Cardialysis.

The scientific study had the acronym TALENT.

The study dispels the perception among many doctors and patients that stents made in India may not be as safe and efficacious as those manufactured in foreign countries.

The TALENT trial was conceived by Prof Upendra Kaul, a well known interventional cardiologist who is currently the chairman of Batra Heart Centre, New Delhi, and Prof Patrick Serruys, an internationally acclaimed researcher in this field from the Netherlands.

Coronary stents are devices made of metal, usually chromium cobalt and coated with polymers and drug to treat blocked coronary arteries and also with a good and safe long-term performance.

In the recently conducted randomised trial to compare an India-made stent Supraflex with the world leader Xience stent from Abbott Vascular, the Supraflex sirolimus-eluting coronary stent manufactured by SMT in Surat emerged to be as good as the Xience stent made in Europe and the USA.

The study was sufficiently powered to give the final answer regarding non-inferiority of the Supraflex sirolimus-eluting stent versus the best-in class Xience stent from Abbott. The study was done in all comers with no exclusions, Prof Kaul said.

“The aim of the study was to test the hypothesis that both stents are equal in performance and safety. To dispel the belief that imported coronary devices are better, it needed a scientific study without any bias,” he explained.

In February, last year, when the Indian government decided to cap the prices of coronary stents, there was a dramatic reduction in prices from an average of USD 1,800 for the drug-eluting stent (DES) to USD 480 irrespective of the country they were manufactured in.

This resulted in increase in the usage of domestic stents because they offered it at lower prices, Dr Kaul said.

“However, the users still had the belief that India made stents may not be as good (as the imported ones). This required an acceptable scientific trial to draw a comparison between the two stents,” he claimed.

“The study was done in Europe to remove any bias and it was monitored by an international clinical research organisation (CRO), Cardialysis, which is world reputed,” Dr Kaul added.

The study showed that the composite end points consisting of cardiac death, target-vessel MI and clinically indicated repeat procedures at 12 months were similar for both.

Thus proving that the India made stent Supraflex was as good as the market leader Xinence, Dr Kaul claimed.

The study has important economic implications in countries where cost of the stent is an important issue. The full paper of this trial will soon be published in the Lancet, he said.

Dr Kaul further called upon other Indian manufacturers to do similar clinical trials to prove that their devices are worthy competitors to those made abroad.

source

November 15, 2018 0

Food supplement or Concealed harmful drugs? Dangling false promise of miracle

One of the paradox of the era is about dangling a false promise of miracle about health may be bought easily and used with great confidence rather than a scientifically proved truth and fact. Same is particularly truth about the health supplements and many so called “natural products” that are sold with just publicity or mere endorsement. There are no safe guards and users are completely oblivious of the harm caused by uncounted number of such health supplements or substances.

Be careful while popping a pill for weight loss, muscle building or sexual enhancement. Several dietary supplements, most of which are widely available in India, have been found adulterated with unapproved and even banned pharmaceutical ingredients in the US with potential to cause serious health risks, a latest study published in ‘JAMA Open’ revealed.

At least 776 dietary supplements sold over the counter in the US over a period of 10 years from 2007 to 2016 were found containing unapproved pharmaceutical ingredients such as sildenafil, sibutramine and synthetic steroids — which have potential to cause side-effects ranging from stroke to kidney failure and even death, say researchers, who extracted and analyzed data from the US Food and Drug Administration’s (US FDA) Center for Drug Evaluation and Research.

These products were commonly marketed for sexual enhancement, weight loss, or muscle building.

In India the problem may be bigger here as most of the dietary supplements are easily available and widely used in India without any regulation and guidelines. Even the US regulator said it has been able to test only a portion of products available on the market.

Dietary supplements in India are not tested or sampled by any authority and are easily available.

The dietary supplement segment which include nutraceuticals, foods for special dietary use and foods for special medical purpose poised to become a $10 billion industry by 2025. While rising income levels coupled with changing lifestyle have kindled demand for such products.

But lack of regulation and usage guidelines have made these products easily available over the counter and through online sales.

In the absence of wherewithal to do product sampling and testing, quality, efficacy and safety of such dietary supplements continue to be under question.

Another major grey area in this issue is the overlapping between food and drugs. While drugs or medicines are regulated by the Drugs Controller General of India (DCGI), food supplements come under the purview of FSSAI. Often to circumvent drug price regulation or stringent pharmaceutical norms, companies tweak their pharma formulations and launch their products as food supplements, bypassing regulatory approvals from the DCGI. The US FDA data shows, more than 20% of adulterated dietary supplements contained more than one unapproved pharmaceutical ingredients.

Effectiveness and safety of many ingredients in dietary supplements remains questionable.

Good nutrition and a balanced diet are extremely important for good health. However, there are many people who turn to dietary supplements for a boost to their routines.

Many don’t seem to work, and some might even be harmful.

Dietary Supplements for Weight Loss guides readers through the confusing set of options in the marketplace.

People may not know that many manufacturers of weight-loss supplements don’t conduct studies in humans to find out whether their product works and is safe.

October 27, 2018 0

Consequences of work–life imbalance

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Take steps to control mosquitoes indoors and outdoors

Treatment

WNV Antibody Testing

Other testing for WNV disease

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