Tag: doctors

History of Diphtheria


In 1613, Spain experienced an epidemic of diphtheria. The year is known as El Año de los Garrotillos (The Year of Strangulations) in the history of Spain.

In 1735, a diphtheria epidemic swept through New England.

Before 1826, diphtheria was known by different names across the world. In England, it was known as Boulogne sore throat, as it spread from France. In 1826, Pierre Bretonneau gave the disease the name diphthérite (from Greek diphthera “leather”) describing the appearance of pseudomembrane in the throat.

In 1856, Victor Fourgeaud described an epidemic of diphtheria in California.

In 1878, Queen Victoria’s daughter Princess Alice and her family became infected with diphtheria, causing two deaths, Princess Marie of Hesse and by Rhine and Princess Alice herself.

In 1883, Edwin Klebs identified the bacterium causing diphtheria  and named it Klebs-Loeffler bacterium. The club shape of this bacterium helped Edwin to differentiate it from other bacteria. Over the period of time, it was called Microsporon diphtheriticum, Bacillus diphtheriae, and Mycobacterium diphtheriae. Current nomenclature is Corynebacterium diphtheriae. Friedrich Loeffler was the first person to cultivate C. diphtheriae in 1884. He used Koch’s postulates to prove association between C. diphtheriae and diphtheria. He also showed that the bacillus produces an exotoxin. Joseph P. O’Dwyer introduced the O’Dwyer tube for laryngeal intubation in patients with an obstructed larynx in 1885. It soon replaced tracheostomy as the emergency diphtheric intubation method.

In 1888, Emile Roux and Alexandre Yersin showed that a substance produced by C. diphtheriae caused symptoms of   diphtheria in animals. In 1890, Shibasaburo Kitasato and Emil von Behring immunized guinea pigs with heat-treated diphtheria toxin. They also immunized goats and horses in the same way and showed that an “antitoxin” made from serum of immunized animals could cure the disease in non-immunized animals.

 

Behring used this antitoxin (now known to consist of antibodies that neutralize the toxin produced by C. diphtheriae) for human trials in 1891, but they were unsuccessful. Successful treatment of human patients with horse-derived antitoxin began in 1894, after production and quantification of antitoxin had been optimized.

 Von Behring won the first Nobel Prize in medicine in 1901 for his work on diphtheria.

 

In 1895, H. K. Mulford Company of Philadelphia started production and testing of diphtheria antitoxin in the United States. Park and Biggs described the method for producing serum from horses for use in diphtheria treatment.

In 1897, Paul Ehrlich developed a standardized unit of measure for diphtheria antitoxin. This was the first ever standardization of a biological product, and played an important role in future developmental work on sera and vaccines.

In 1901, 10 of 11 inoculated St. Louis children died from contaminated diphtheria antitoxin. The horse from which the antitoxin was derived died of tetanus. This incident, coupled with a tetanus outbreak in Camden, New Jersey, played an important part in initiating federal regulation of biologic products.

On 7 January 1904, Ruth Cleveland died of diphtheria at the age of 12 years in Princeton, New Jersey. Ruth was the eldest daughter of former President Grover Cleveland and the former first lady Frances Folsom.

In 1905, Franklin Royer, from Philadelphia’s Municipal Hospital, published a paper urging timely treatment for diphtheria and adequate doses of antitoxin.

In 1906, Clemens Pirquet and Béla Schick described serum sickness in children receiving large

quantities of horse-derived antitoxin.

Between 1910 and 1911, Béla Schick developed the Schick test to detect pre-existing immunity to diphtheria in an exposed person.

Only those who were not exposed to diphtheria were preferably vaccinated. A massive, five-year campaign was coordinated by Dr. Schick. As a part of the campaign, 85 million pieces of literature were distributed by the Metropolitan Life Insurance Company with an appeal to parents to “Save your child from diphtheria.” A vaccine was developed in the next decade, and deaths began declining significantly in 1924.

In 1919, in Dallas, Texas, 10 children were killed and 60 others made seriously ill by toxic antitoxin which had passed the tests of the New York State Health Department. Mulford Company of Philadelphia (manufacturers) paid damages in every case.

In the 1920s, an estimated 100,000 to 200,000 cases of diphtheria occurred per year in the

United States, causing 13,000 to 15,000 deaths per year.  Children represented a largemajority of these cases and fatalities. One of the most infamous outbreaks of diphtheria was in Nome, Alaska; the “Great Race of Mercy” to deliver diphtheria antitoxin is now celebrated by the Iditarod Trail Sled Dog Race.

In 1926, Alexander Thomas Glenny increased the effectiveness of diphtheria toxoid (a modified version of the toxin used for vaccination) by treating it with aluminum salts. Vaccination with toxoid was not widely used untli the early 1930s.

In 1943, diphtheria outbreaks accompanied war and disruption in Europe. The 1 million cases in Europe resulted in 50,000 deaths. In 1949, 68 of 606 children died after diphtheria immunization due to improper manufacture of aluminum phosphate toxoid.

In 1974, the World Health Organization included DPT vaccine in their Expanded Programme on Immunization for developing countries.

In 1975, an outbreak of cutaneous diphtheria in Seattle, Washington, was reported.

In 1994, the Russian Federation had 39,703 diphtheria cases. By contrast, in 1990, only 1,211 cases were reported.

Between 1990 and 1998, diphtheria caused 5000 deaths in the countries of the former Soviet Union

In early May 2010, a case of diphtheria was diagnosed in Port-au-Prince, Haiti, after the devastating 2010 Haiti earthquake. The 15- year-old male patient died while workers searched for antitoxin.

In 2013, three children died of diphtheria in Hyderabad, India.]

In early June 2015, a case of diphtheria was diagnosed aVt all d’Hebron University Hospita lin Barcelona, Spain. The 6-year-old child who died of the illness had not been previously vaccinated due to parental opposition to vaccination. It was the first case of diphtheria in the country since 1986 as reported by” El Mundo” or from 1998, as reported by WHO.

In March 2016, a 3-year-old girl died of diphtheria in the University Hospital of Antwerp, Belgium.

In June 2016, a 3-year-old, 5-year-old, and 7-year-old girl died of diphtheria in Kedah and Malacca, Sabah Malaysia.

In January 2017, more than 300 cases were recorded in Venezuela.

In November and December 2017, an outbreak of diphtheria occurred in Indonesia with more than 600 cases found and 38 fatalities.

source

 

0

Invisible medical harms of carpet-bomb treatments with FDC (fixed dose combination): @ Government prohibits 328 fixed dose combinations


Drug Technical Advisory Board said there is no therapeutic justification for the ingredients contained in the 328 fixed-dose combination or FDC drugs.

A fixed-dose combination or FDC drug contains two or more active ingredients in a fixed dosage ratio. It means it’s not the single drug but a combination of the two or more,  which may be   unnecessary for consumption.

  1. Antibiotic  resistance: Most harmful impact can be because of antibiotics in FDC.

– Logic is simple. If  some one  is  not able to recognize, whether it is a rat, cat, dog or tiger causing trouble, carpet bomb with combination of three or four   bombs.  Is it overuse of  weapons? Yes, it is. Similarly, abuse of multiple antibiotics has potential to cause massive antibiotic resistance, can have global harmful effect.

–Quacks or by self medication,  antibiotics may be overused  and abused . Quacks  or alternative medicine doctors often prescribe FDCs as they are unable to pinpoint the exact cause of an illness and carpet-bomb patients with combination doses, in the hope that one of the drugs would work.

  1. Overuse of drugs: where one drug for example a paracetamol is required, patient will take three medicines.
  2. Increase in side effects: instead of one medication, patient will have side effects of all other medicines also.
  3. inadequate doses: If many drugs are combined in one, doses may be inadequate or less. So patient takes more drugs , but in adequate doses.
  4. Increase in cost: instead of one , the patient pays for three drugs, thereby increase in cost.

Government prohibits 328 fixed dose combinations 

     Painkiller Saridon and skin cream Panderm are among 328 fixed-dose combination or FDC drugs banned by the government to stop their “irrational use”. The health ministry says the ingredients in these medicines do not markedly add to the benefits that people can get from taking them. The order immediately bans the manufacture, marketing and sale of several common cough syrups, painkillers, and cold and flu drugs. The country’s drug advisory body, the Drug Technical Advisory Board or DTAB, has said there is no therapeutic justification for the ingredients in these drugs and they must be banned in public interest.

-The government has added restrictions to dosage and use of six more FDCs,  not among the 328 banned ones,  over their ingredients having no therapeutic value and posing a risk to consumers.

-The health ministry took the decision after the country’s top drug advisory body, the Drug Technical Advisory Board or DTAB, in a report said taking the 328 FDCs would be a health risk. India has some 2,000 FDCs as against a little over 500 in USA.

-It is a good move for public health. Individual drugs are approved by the centre, but some manufacturers make combinations of two drugs and get state licences.

-Mixing two drugs create a new medicine. For new medicine , pharma companies should approach the Drugs Controller General of India and apply for a fresh licence, conduct trials and  prove safety.

-In March 2010, the government restricted sales of 344 FDCs, a move that was challenged by pharma firms in court. The Supreme Court last December told the DTAB to ascertain whether FDCs should be banned from the market.

Every one is  calculative about  the loss of millions.  The invisible losses to human kind are still to be calculated.

 

0

How viruses, germ cross international borders? Toilets cleaner than Airport trays


Airport security trays carry more diseases than toilets.  The plastic trays that passengers put their hand luggage in at airport security checkpoints harbour the highest levels of viruses, even more than toilets, a study warns. Researchers from the University of Nottingham in the UK swabbed a variety of surfaces at Helsinki-Vantaa airport in Finland during the winter of 2016. They set out to identify and quantify the respiratory viruses on frequently touched surfaces in airports. The team found evidence of viruses on 10 per cent of the surfaces tested and most commonly on the plastic trays that are circulated along the passenger queue at the hand luggage X-ray checkpoint. The study, published in the journal BMC Infectious Diseases, concludes that hand washing and careful coughing hygiene are crucial to the control of contagious infections in public areas with high volumes of people passing through. The findings add weight to previous studies showing that microbes are commonly found on surfaces in public transport vehicles and will strengthen public health advice in preparation for future flu pandemics, researchers said. Airport security trays carry more diseases than toilets. The highest concentration of viruses was detected on the security check plastic trays with further viruses detected on shop payment terminals, staircase rails, passport checking counters, children’s play areas and in the air. The most common virus found in the survey was rhinovirus, which causes the common cold but the swabs also picked up the influenza A virus, researchers said. Interestingly, no respiratory viruses were found on toilet surfaces, they said.

0

Story of Unlabeled drugs and Fraud In name of Ayurvedic treatment


         A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who have been given a “no hope” by scientific medicine, are an easy prey for such fraudsters.

   Another major problem is that medicines and syrups distributed in such manner are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses.  

     Ayurvedic medicines and practitioners  belong to a  stream, also based on a  science. The medicines and treatment has to be  controlled and regulated in the same way, as for allopathic  stream.  So that criminals, who are not trained in ayurvedic stream can not play with lives of gullible people, giving them false hope.  Such acts  are  real crime to society, done with an intention to cheat rather than treating them.

   Any one distributing medicines or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis.

Regulating Ayurvedic medicines and practice will help  not only the genuine  Ayurvedic  doctors but also go a long way  in benefiting the ancient system of medicine and promote research.  

  Following may be just one of the cases, millions may remain unnoticed.

False ayurveda hopes to the hopeless

Tarun Mandal has spent almost all of his savings trying to get his son, suffering from acute jaundice since his birth, treated for the past one and a half years. A desperate Mandal recently paid a youth Rs 65,000 for an ayurvedic cure. However, his wife’s suspicion about the ‘gold ash’ tasting like churan led cops to an inter-state racket cheating terminally ill patients with a promise of cure. Mandal, who sells food items on a cart at the Sarojini Nagar market, was not the only one to fall in the trap. Cops have found at least 40 people who had been duped by the gang. Most of the victims are family members of children from different states getting treated in the capital’s top government hospitals.
“I gave away all my savings to them. They even guaranteed that all my money would be returned if the medicines failed. But when I went back to the same shop, they refused to recognise me,” said Mandal, who has already spent Rs 2 lakh and needs more money for a surgery.
The gang has also duped the grandfather of a seven-year-old thalessemia patient from Uttarakhand.

other incident dangerous chemicals in alternate medicines

0

The Story of Faulty Johnson & Johnson (J&J) Hip Implant


Govt to track patients with faulty J&J hip implant to ensure compensation

Close to 4,700 people with damaged hip joints in India received the implant before 2010, when it was recalled, of which only 1,080 were tracked and compensated.

   The Union health ministry will establish committees at the Central and state levels to track and compensate patients who received a faulty artificial hip implant that was recalled worldwide by the manufacturer Johnson & Johnson (J&J), in 2010.

Close to 4,700 people with damaged hip joints in India received the implant before 2010, when it was recalled, of which only 1,080 were tracked and compensated. Of them, 275 underwent revision surgeries.

Following complaints from patients, the health ministry set up an 11-member committee on February 7, 2017, to investigate patient complaints of adverse events against J&J’s metal-on-metal Articular Surface Replacement (ASR) hip implant devices — XL Acetabular Hip System and Hip Resurfacing System.

The committee  submitted its report on February 19, 2018. It said specialists must assess cases individually for treatment and compensation of at least Rs 20 lakh.

In November last year, the federal jury in Dallas had ordered J&J and its DePuy Orthopaedics unit to pay $247 million to six patients for not warning patients about the potential risks of the defective design of the metal-on-metal hip implants .

The committee at the state level will be tracking the affected patients. These cases are old and hospitals don’t have data available on them; close to 100 hospitals were approached but there was no data. State governments will be widely advertising the move to see that affected people approach them,” said a senior official, requesting anonymity.

Each case will be physically and clinically assessed by the state government committee to determine the degree of disability and refer to the central government committee to decide on the compensation amount.

In it response J&J said: “DePuy has fully cooperated with the expert committee in their investigation of the ASR matter. However, the Expert Committee Report has not been provided to the company for review to date, so it would be inappropriate for us to comment on it. We would like to reiterate that we have furnished full facts and data available with us to the expert committee.”

Metal on metal implants are rarely used now, say orthopaedic surgeons. “Metal-on-metal hip implants have been largely discontinued because of the associated complications. With other implants, the revision surgery rate would be around 3-5%, but with this particular brand, it was a higher 10-12 percent.

People complain of pain, which is largely due to loosening of the implant and wear and tear of the metal that would cause collection of metal in the body that it would react to. Another  available implant is ceramic cross-linked with plastic polyethylene socket, where head ball is of ceramic and socket of polyethylene.

After years of testing, ASR was imported and marketed in India and in various countries around the world, with all regulatory approval and permissions as were then applicable. After it was on the market, DePuy continued studying and closely watching how the device was performing and in August 2010.  DePuy issued a voluntary recall of the ASR Hip System after receiving new information from the UK National Joint Registry.

It immediately informed the Drugs Controller General of India (DCGI) about the voluntary recall. Since then, we have kept the DCGI informed of all key actions and worked to provide Indian patients and surgeons with the information and support they need, in line with government requirements.”

0

Health policies to cover mental illness: Insurance regulator IRDAI issued a circular directing insurers


Insurance regulator IRDAI on Thursday issued a circular directing insurers to cover mental illness, which has reached serious proportions in the country. The Mental Healthcare Act, 2017 — which came into force from May 29 — has made it mandatory to provide “for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness”. But to date, none of India’s 33 insurers has introduced a product that covers ailments such as depression, schizophrenia, and bipolar disorder, even though such covers are commonplace in many countries. The IRDAI order says, “All insurance companies are hereby directed to comply with the…provisions of the Mental Healthcare Act, 2017 with immediate effect.”

“This will ensure a life of dignity to those who have mental health issues. We believe it will create awareness, acceptance, and inclusion of mental illness as any other physical ailment. It will ‘normalise’ diagnoses, by reducing associated myths and stigma. Today, no one can say we won’t cover cancer, tuberculosis or heart attack. So why do we have this block towards covering mental health issues? They are just as debilitating and corrosive to a person’s well-being as physical ailments.”

Mental health conditions have always been in the list of exclusions of health insurance policies. The only exceptions to this have been the coverage of development conditions such as autism and Down’s syndrome by the National Health Insurance Scheme, and a few private schemes like Star Health Insurance’s cover for autistic children. Companies wishing to include mental health coverage will have to file a fresh product with the IRDAI, or add this to an existing product and file again. “They have to revise the rates, look at the actuarial risk, increase premium if need be. So far, no insurance company has filed for such a change with the regulator,” said a government official .

“At the lower end you have anxiety and depression. At the upper end there’s obsessive compulsive disorder, bipolar, borderline narcissistic personality disorder. We should first cover the lower end. It does seem harsh to tell a person we can’t cover you, when they are already depressed,”

It is uncharted territory. There are two coverages needed: First, OPD cover for therapy, consultation and drugs. Second, hospitalisation or rehab, which would be long-term and expensive. In western countries, both are covered. But in India, it is untested ground.

Source. Times of India

0

Report finds hazardous chemicals in crayons: may cause breathing difficulties and cancer in kids


The innocuous looking items of daily use may contain hazardous chemicals. Unless these items are honestly checked and contents known, any of these can be dangerous. Users are usually unaware of the complex risks associated with simple items. Here are examples of crayon and water bottles containing dangerous chemicals.

  • The US Public Interest Research Group has just released its annual back-to-school report 
  • It found trace amounts of asbestos in Dollar Tree’s Playskool crayons
  • Asbestos has been linked to mesothelioma, a potentially deadly cancer of the lungs’ lining
  • Scientists are unsure if the chemical is in the crayons’ wax or paper wrappers
  • Carcinogenic chemicals were also found in one brand of binder and two kinds of dry erase markers 
  • Lead was once again found in two previously recalled water bottles  

 

Researchers found trace amounts of the toxic mineral in Dollar Tree’s Playskool crayons, and toxins in at least three other products.

Asbestos is a well-known carcinogen that has been blamed for thousands of cases of mesothelioma.

Just three years ago, low levels of the harmful substance were found on not one but several major brands of crayons – including Crayola and Rose Art – but one brand still could pose a risk to young children.

The US Public Interest Research Group (PIRG), which just released its report of toys and school supplies, says that finding asbestos in only one crayon brand is progress – but several other back-to-school basics may still be unsafe.

Playschool crayons, were found to contain trace amounts of asbestos, a chemical known to cause mesothelioma, a cancer of the lining of the lungs

Mass production and plastic help to keep back-to-school expenses to a minimum, but parents still need to be cautious of what products end up in their children’s backpacks.

Without fail, a number of products make it onto the PIRG’s naughty list each year.

Crayons are chief among these.

Trace amounts of asbestos fibers frequently find their way into the coloring tools, which are marketed as being made for small children.

Waxy crayons are not sharp and break easily, so they pose a somewhat lesser risk of stabbing, scratching and choking incidents when in the hands of tots.

But somehow, asbestos commonly finds its way into the products, though the US Consumer Product Safety Commission (USPSC) has yet to work out whether that danger comes from the wax itself or crayons’ paper wrappers.

Tiny, fine asbestos fibers can get lodged in the lining of the lungs, where they corrupt cells and can lead to breathing problems and cause a high-fatality cancer, mesothelioma.

The naturally occurring mineral is fire resistant and impervious to damage from many chemicals.

This discovery led to its inclusion in household insulation and many products beginning in the 1850s. But as early as the 1920s, scientists noticed a trend in early cancer deaths among those who were frequently exposed to the material.

By the 1980s and 1990s it was solidly linked to mesothelioma and banned in many countries, including the UK.

The US stopped short of outlawing asbestos, however, and trace amounts of the tightly controlled chemical still appear periodically in certain products and places, though it is now disallowed from school buildings.

But the new report suggest that while the school structures may be certifiably safe, asbestos could be sneaking in with school supplies.

Crayons are in many ways ideal implements for young children because children under-fives who tend to use their entire arm when they color.

Public Interest Research Group also found phthalates – chemicals linked to asthma, obesity and reproduction issues – in Jot Binders and carcinogens in Expo white board markers

And, worst comes to worst, if a child does decide to turn his artistic instrument into a snack, crayons are fairly non-toxic.

That is, when they don’t contain asbestos.

Dollar Tree spokesperson Randy Guiler told Daily Mail Online that the company was ‘aware of the report,’ and has since’re-verified that each of the listed products successfully passed inspection and testing.’

The product safety group also found worrisome chemicals in three ring binders, dry erase markers and two water bottles that had previously been recalled by the USCPS.

Phthalates were found in Jot binders, also sold at Dollar Tree. This set of chemicals helps to give plastic products their flexibility.

There is still some uncertainty surrounding the health effects of phthalates, but scientists have found possible links between the chemicals and everything from asthma to obesity, low IQ to reproduction issues.

Both the LL Bean GSI Outdoors Children’s Water Bottle and the Reduce Hydro Pro Furry Friends bottles, had previously recalled for their high lead contents. The PIRG’s report warned that they still do, and can still be purchased.

The health effects of phthalates are still not entirely clear, and exposure happens when people drink or eat something out of a plastic container that contains the chemicals, so as long as children are not licking their binders, the risk is probably low.

In addition to these products, Expo’s dry erase markers, as well as those made by The Board Dudes were found to contain several carcinogenic chemicals, including benzene, xylene and toluene. 

Two children’s water bottles were found to still be on the market and still contain dangerously lead, even after the USCPS recalled the two products.

Though the notion of toxins in products made specifically to be safe for children is unsettling, this year’s list of dangerous back-to-school products is encouragingly short.

Source

 

0

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


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

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

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

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

 

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

 

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

 

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

 

1

Doctors need genuine Leave – painful barb for others @ Tokyo medical school


Japan medical school admits to altering scores to keep out female applicants

  Usually the kind of work of doctors keep them on toes and it is difficult to have leaves. This may be a global  phenomenon.  Medical systems also are not very comfortable with doctor’s leaves. Scarcity of doctors and difficult replacements makes life of doctors busy and unsocial.  Systematic  denial of genuine leave has been proved by  investigations  at   Tokyo medical school.

 

A Tokyo medical school has confirmed after an internal investigation that it systematically altered entrance exam scores for years to keep out female applicants and ensure more men became doctors. The school wanted fewer female doctors because it anticipated they would become mothers and would shorten or halt their careers. It is extremely important to improve the working environment so that women can pursue their medical professions. School’s purpose in denying women entry was because female doctors often quit working after starting families. Women tend to avoid tough jobs like surgery or work in remote areas. They need to take a break from their careers because of pregnancy and childbirth.

 Tokyo Medical University manipulated all entrance tests results since 2000 or even earlier. The findings released Tuesday by lawyers involved in the internal investigation confirm recent reports in Japanese media.

The manipulation surfaced during an investigation of an alleged wrongful admission of a bureaucrat’s son.

The internal investigation found the school first reduced all applicants’ first-stage scores to 80 percent then added up to 20 points only to male applicants with three or fewer application tries.

The school wanted fewer female doctors because it anticipated they would become mothers and would shorten or halt their careers.

Japan’s government urged a medical university to promptly disclose the results of an investigation into its admissions process Friday after reports alleged it had altered the test scores of female applicants for years to deny them entry and ensure fewer women became doctors.

The school’s public affairs department said it had no knowledge of the reported manipulation but is investigating. The school is already facing a separate scandal involving the inappropriate admission of a top education bureaucrat’s son and was ordered by the education ministry to investigate its admissions records for the past six years. On Thursday, the school said it will combine the examination of the score manipulation allegation with that probe.

The share of female doctors who have passed the national medical exam has stayed at around 30 percent for more than 20 years, prompting speculation that interference in admissions is widespread at Japanese medical schools.

The Japanese medical university’s alleged systematic deduction of entrance exam scores only from female applicants has sparked outrage across Japan. It was reported Thursday that Tokyo Medical University has been slashing female applicants’ entrance exam scores for years to keep female student population low, on grounds they tend to quit as doctors after starting families, causing staffing shortages

Admissions records released to The Associated Press by the school show the percentage of women who passed the entrance exam rose from 24 percent in 2009 to 38 percent in 2010. The figure has since stayed below that level until decreasing to 18 percent this year, when a total of 171 students passed the exam. The ratio of female applicants who were accepted this year was 2.9 percent, compared to 8.8 percent for men.

 

0

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


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

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

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

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

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

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

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

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

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

1

Blog at WordPress.com.

Up ↑