Healthcare in India
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Healthcare in India
Selection of Articles, Opinions, Discussions and News on Healthcare in India from all over the web covering Healthcare Policy, Healthcare Reform, News, Events, #HealthIT , Edipdemics, Chronic Diseases, #mHealth, #hcsmin ,
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Morphine available to just 1% cancer sufferers

Morphine available to just 1% cancer sufferers | Healthcare in India |

 When the winter session of Parliament begins on December 5, millions of cancer patients hope lawmakers will clear a long-awaited amendment that will allow them easier access to morphine.

Morphine, one of the best known pain-control medicines, is available to barely 1% of all patients suffering from pain arising out of their cancer or HIV/AIDS infection, say experts. "India has 2.4 million cancer patients who need pain relief and another 2.5 million living with HIV. These patients sometimes suffer unbearable pain that is best relieved by morphine," said Thiruvananthapuram-based Dr M R Rajagopal, who is often referred to as the father of palliative care in India.

Last two sessions of the houses failed to take up the amendment to the Narcotic Drugs and Psychotropic Substances Act, 1985. Dubbing its poor access as a human rights violation, Dr Rajagopal said, "We hope the amendment will be passed this time.''

Morphine is classified as a narcotic under the NDPS Act, resulting in tight restrictions to prevent misuse. The law states that anybody found with 250 grams of morphine without adequate licences could face up to 10 years of rigorous imprisonment.

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Online Profile Management for Oncologists

An understanding of Online Profile Management for Oncologists, with an Indian perspective. 

Covers Digitally Aware Patients and Social Networks, The Need for Online Profile Management, an understanding of Local Reputation vs Global Reputation, Tips for How to do it while avoiding the traps and describing techniques for Maximizing Online Exposure for Oncologists 

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Tackling corruption in Indian medicine

Some doctors and non-governmental organisations are taking up the fight against corruption in Indian medicine, which many observers claim is widespread in the country. Dinsa Sachan reports.

When a cheque landed on the desk of 63-year-old doctor Himmatrao Saluba Bawaskar, from a diagnostic centre under the guise of “professional fee”, Bawaskar not only returned it, but he also filed a complaint against the centre with the Medical Council of India (MCI), the national watchdog for medical education and doctors. His case is currently being heard by the state medical council of Maharashtra.

Kickbacks have been part of the Indian medical practice since the beginning, says Puneet Bedi, a leading gynaecologist based in New Delhi who has appeared on Indian television to speak about medical ethics in the country. He notes that many hospitals and clinics routinely issue cheques to doctors under sanitised names such as “professional fee” to encourage them to recommend their services to their patients.

K K Aggarwal, a Delhi-based physician on the ethics committee of MCI, says there's no method at present to document the percentage of doctors taking kickbacks, but he admits that the practice exists.

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Medical Negligence: Supreme Court Awards Record Compensation To US Doctor

Medical Negligence: Supreme Court Awards Record Compensation To US Doctor | Healthcare in India |

India's Supreme Court awarded a record compensation payment of almost a million dollars for medical negligence to Kunal Saha, an HIV/AIDS doctor.

While in India during the summer of 1998, Anuradha Saha, a 36-year-old child psychologist, contracted toxic epidermal necrolysis but was incorrectly diagnosed and given an overdose of steroids that caused her death. Today, a full 15 years later, India's Supreme Court made steps to rectify this wrong by awarding a record compensation payment of Rs. 5.96 crore (almost a million dollars) for medical negligence to her husband.

Ohio resident Kunal Saha, an HIV/AIDS specialist of Indian origin, said the ruling set vital precedents and would help save lives. After being awarded a far smaller payout by a consumer dispute commission in 2011, Saha appealed to the Supreme Court seeking greater compensation, leading to today’s judgment. He noted the large compensation sum would deter both doctors and hospitals from acting with negligence in the future.

"It's closure of a personal battle for justice for my wife," Saha told AFP by phone. "The purpose was served,” Saha told Agence France-Presse. “The medical community in India will sit up and the courts will have to think."

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Infant mortality down by 30% in past decade

Infant mortality down by 30% in past decade | Healthcare in India |

Setting a blistering pace, Tamil Nadu has halved its infant mortality rate (IMR) in the past decade while a bunch of other states — Maharashtra, Punjab, Karnataka — have shown significant decreases of around 40%. The overall IMR for the country has gone down by a third. This emerges from the latest vital statistics data for 2012 collected under the Sample Registration Scheme by the Census office.

The infant mortality rate is a count of deaths of infants under one year of age per 1000 live births in one year. It is considered a key indicator of health services, nutritional levels, poverty and educational level of the people. Reduction of IMR is one of the millenium development goals set by the UN with a deadline of 2015.

The wide gap between rural and urban areas in infant death rates continues in India but is declining . Rural IMR in 2012 was 46 infant deaths per 1000 live births while the urban rate was 28. In fact, the rural IMR declined by 30% compared to the urban decline of 28% since 2003.

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Kristen Trammell's curator insight, March 23, 2015 11:49 PM

I. Tamil Nadu has halved its infant mortality rate in the past decade while many other states have decreased their mortality rate by 40%. Infant mortality rate is viewed as a key marker of wellbeing administrations, healthful levels, neediness and instructive level of the individuals. 


II. In developing countries, infant mortality is caused from a lack of medical attention. Developing countries do not have the technology needed for childbirth, ultrasounds and x-rays in order to perform diagnostics on pregnant women. However, with today’s extensive and better run primary health services, some women can get the attention they need. 

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Deadly duo: Urban India battles diabetes and high blood pressure

Deadly duo: Urban India battles diabetes and high blood pressure | Healthcare in India |

Twenty per cent of India's population in the metros and above the age of 30 years suffer from the deadly duo of diabetes and high blood pressure according to a large-scale government study released recently.

Over 4 crore people from across the country screened under the Government's National Programme for Prevention and Control of Cancer, Diabetes, cardio-vascular Diseases and stroke (NPCDCS) has revealed that 6.34 per cent of the population is suspected to be suffering from diabetes and over 6 per cent are hypertensive.

Dr Upendra Kaul, Executive Director and Dean Cardiology, Escorts Heart Institute and Fortis Hospital says, "Unless we take strict measures, the deadly duo of high BP and diabetes will continue to take a high toll of our population. It leads to heart attacks, brain strokes, chronic kidney and early blindness and is preventable by taking preventive measures early in life."

The survey results in urban areas of the country, including Delhi, Bangalore, Ahmedabad, Chennai and Kamrup (Assam) has pointed out trends that almost 11 per cent people are suspected to be suffering from diabetes and 13 per cent are hypertensive.

Madhya Pradesh recorded the lowest diabetes(2.61 per cent). From the overall (16.91 lakh) of those tested, 44,133 people were found to be diabetic and 49,391 were hypertensive.

Sikkim recorded the highest prevalence of diabetes (13.67 per cent) as well as hypertension (18.16 percentage).

Gujarat had the second highest prevalence of diabetes (9.57 per cent) followed by Karnataka (9.41 percent) and Punjab (9.36 per cent).

States that recorded comparatively lower per centage of diabetes are Assam (4.91 per cent), Haryana (4.80 per cent), Kerala (4.79 per cent), Rajasthan (4.43 per cent) and Uttar Pradesh (4.32 per cent).

The remaining states which fell in the middle order rung for diabetes among those surveyed are as follows.

Andhra Pradesh (7.42 per cent),

Tamil Nadu (6.50 per cent)

West Bengal (6.34 per cent),

Jharkhand (5.44 per cent),

Jammu and Kashmir (5.61 per cent),

Maharashtra (5.64),

Himachal Pradesh (5.78 per cent),

Bihar (5.83 per cent),

Oissa (5.89 per cent),

Chhatisgarh (5.92),

Uttarakhand (5.44 per cent)and

Delhi (5.02 per cent).

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75% fear public spaces are disease hubs: Survey

In India the top three illness concerns are seasonal cold (47.3%), skin infections (37.1%) and seasonal flu (31.9%), reveals a Global Hygiene Council 2013 study. The survey was carried out on over 18,000 adults across 18 countries, including India.

When it comes to contracting an infectious disease, Indians are most cautious. About 95% are concerned about themselves or their family contracting one. As many as 77% Indians ensure they and their families wash their hands with soap after going to the toilet and before eating.

On the risky places for contracting disease, 75% of the respondents in India perceive public places as the riskiest, while 49% adults around the world (including India) picked mass gatherings. Also, 20% said they avoided attending mass gatherings to pre-empt infections.

About 68% of adults from across the globe believe public transport is one of the riskiest places for picking up infectious diseases while 11% view the home as potential disease carriers.

The biggest (30%) infectious disease concern across the world is seasonal flu, but it varies widely across the world.

Clean factor

75% respondents in India view public places as disease carriers

49% of adults around the world view mass gatherings as risky

77% Indians wash their hands with soap after going to toilet and before eating

Illness concerns

India - seasonal cold, skin infection and seasonal flu

UK - stomach upset, diarrhea and vomiting and staph infection

Nigeria - seasonal colds, waterborne illnesses and skin infections


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Clinical Trials and Safety: Not Mutually Exclusive

Clinical Trials and Safety: Not Mutually Exclusive | Healthcare in India |

India was once hailed as a fertile ground for clinical trials with a large drug-naïve population. Today, the international community, and its own apex court, is unconvinced. 

On September 30, the Supreme Court directed the Union health ministry to halt clinical trials in 162 cases where it had given approval until it provided assurances on safety regimes. It has given two weeks to the ministry before announcing a formal ban on clinical trials in the country. Nearly 40 trials involving the US National Institutes of Health are also on hold.
The industry has already shrivelled. McKinsey had projected the clinical trials industry in India to reach $1 billion by 2010, but it was under $500 million in 2012. 

As India struggles to clean up its regulatory mess, it should heed the latest study published in PLOS Medicine which shows that clinical trial outcomes are more complete in unpublished reports than in published sources (which contain less information about the benefits and potential harms of an intervention). 

The Indian clinical trial registry says those conducting trials “are expected to regularly update the trial status” but the reality is far from it. This is a global phenomenon, says the PLOS study. 

Now that the health ministry is forced to submit a safety regimen, it may be a good idea to take a long-term view and make it mandatory for all institutions and drug companies to make trial data public.

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US Pharma v. India Patent Act: Myths Abound

US Pharma v. India Patent Act: Myths Abound | Healthcare in India |

The U.S. pharmaceutical industry and its Big Brother Chamber of Commerce have launched an all-out disinformation campaign against the India Patent Act and decisions rendered thereunder. 

They have enlisted allies in the U.S. government, including Members of Congress, the United States International Trade Commission, Secretary of State Kerry, and even President Obama, to carry their claims to the highest levels of the Indian government.  They have threatened to insist that the U.S. file a WTO trade complaints against India in 2014 and that India no longer be permitted to export duty-free products to the U.S. under the Generalized System of Preferences. 

As evidence for their campaign, the representatives of Big Pharma have claimed that India is violating US-based global norms for protecting patent rights, that it is adopting new patenting criteria not authorized by international law and allowing generic competition when it is not permissible, and that it is discriminating against U.S. pharmaceutical companies in favor protectionist policies that shield Indian generic companies and steal U.S. jobs.  Each and every one of these claims is false – and false in multiple ways.

The U.S. cannot unilaterally impose global IP norms binding India

In challenging each of the “dirty dozen” patent cases that U.S. and European pharmaceutical companies have lost in India in the past few years, the U.S. industry makes a background claim that the drugs at issue had been patented in the U.S. and in many other countries and therefore that India’s actions are illegal.

Apparently, Big Pharma wishes that the U.S. could impose its pro-monopoly IP laws on every other country in the world, but in fact international norms are set by the WTO Agreement on Trade-Related Aspects of Intellectual Property (TRIPS).  The U.S. and Big Pharma got much of what they wanted in TRIPS in 1994 but not everything.  In particular, TRIPS preserved significant general interpretative flexibilities for Member States in Article 1.1 and explicit flexibilities concerning patentable subject matter, applicant disclosure requirements, and standards of patentability in Article 27. 

It allows countries to seek a balance between the interests of IP owners and users, allows countries to prioritize public, and promises technology transfer, Article 7 and 8.  TRIPS expressly allows limitations and exceptions to IP rights, Article 30; compulsory and government use licenses on any ground whatsoever, Article 31; and use parallel importation of the same goods from other countries where they are sold cheaper, Article 6.  TRIPS allows opposition procedures and payments of royalties in lieu of injunctions.

It is simply irrelevant legally whether a particular U.S. pharmaceutical company has received a patent in another country.  Countries have flexibilities to enact much more stringent standards for patents than does the U.S. or Europe and that is exactly what India has done. 

In particular, it has decided to draw a line in the sand against granting secondary, evergreening patents on minor modification of existing medicines or medical ingredients, on new uses of existing medicines, and on combinations of previously existing substances.  India can legally justify this choice either by resort to its definition of patentable subject matter or by its test for inventive step.  In fact, India has gone further towards liberalization than it needs to because it provides patent protection for incremental changes when they have a significant therapeutic benefit.

What’s really going on?

U.S. IP industries, including Big Pharma, are salivating to exploit middle- and upper-income consumers and patients in India and in other so-called pharmemerging countries.  These are Big Pharma’s regions of expected sales expansion and their new profit centers.  U.S. drug companies want to beat back generic competition and secure an uneven playing field where the big boys always win – where the golden goose of innovation always lays huge gleaming eggs for them.  To ensure this outcome, the U.S. pharmaceutical industry and its agents will always try to corral and hamstring the Indian generic industry or turn it into its junior partners.  If Pharma can’t win fair and square, it will malign generics, usually about quality, and seek to change the law through any means possible.

However, Big Pharma also wants to forestall the emerging trend of other countries copying India-style strict standards of patentability.  It’s no surprise that the timing of the Big Pharma disinformation offensive is right around the time that Brazil and South Africa are launching their own patent law reforms, following in the footsteps of India.  If Big Pharma and the U.S. can bully India into changing its patent law and making it consistent with U.S. law, then other countries will think thrice before crossing the U.S.  Any doubts about the U.S. and Europe’s long term objectives to secure monopoly rights for their IP industries should be resolved by looking at the EU’s proposals in the EU-India FTA negotiations or the U.S.’s IP on steroids demands in the Trans-Pacific Partnership Agreement negotiations.

So far, India has stood firm.  It has countered Pharma propaganda with facts and it has done so politely.  But sometimes it’s appropriate to call a lie a lie, instead of merely trying to cure it with information.  Pharma hopes if it repeats its myths and misrepresentations often enough, a gullible public will believe it.  But India must stand firm and protect its high-standard patent regime.  It must protect its status are the pharmacy of the developing world – millions of lives are at stake.

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Healthcare in India cheap but not for most Indians

Healthcare in India cheap but not for most Indians | Healthcare in India |

India’s healthcare costs may be among the lowest in the world but they are still out of the reach of a vast majority of its citizens. For instance, one cycle of chemotherapy and radiation therapy at AIIMS Cancer Centre costs just R750. But 40% of those getting treated there can’t afford it and request the bill be waived.

“Advances in medical technology and new medicines are indeed a boon, but to work in India they have to be value for money. Most people can’t even afford conventional treatments at subsidised prices in public hospitals,” says Dr MC Misra, director, AIIMS.

Low on cost, high on quality of care and with a wide range of treatments available — the Indian healthcare system draws over 1.3 million patients from abroad each year. The sector is expected to generate $3 billion by the end of 2013. In Harvard Business Review’s November issue, a study by authors Vijay Govindarajan and Ravi Ramamurti gave private hospitals in India a thumbs-up for “delivering world-class health care, affordably”.

Yet, 99% of India’s population cannot afford these services, shows World Bank data.

Each year, 39 million people are pushed into poverty by out-of-pocket payments for healthcare, with households on average devoting 5.8% of their expenditures to medical care, the data reveals.

Manali Shah (name changed on request), a 33-year-old software engineer working in the private  sector, lost her savings of eight years in a day when her father, 65, underwent a liver transplant in a private hospital. “Not only did my savings go, I also had to borrow money from the family to foot the bill. The procedure and hospitalisation cost almost R30 lakh, and we have to continue spending R10,000 each month for medicines, follow-up consultations and diagnostics,” she says

Each round of chemotherapy and radiation costs her almost R1 lakh, but she didn’t consider AIIMS because the radiotherapy machine there is booked for the next seven months.

“I worry what will happen should the rest of my family — mother, my younger sister or me — need healthcare. We need a monthly income of a few lakh to meet health expenses,” she says


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Emulate India's innovation in healthcare: Harvard study

In a rare case of heaping praise on India's healthcare, a study in Harvard Business Review (HBR) has urged the West to emulate India's economically viable healthcare facilities for its new-age innovation and cost-cutting techniques.

The study describes ultra-low costs and innovations in technology in Indian hospitals from constant experimentation, adaptation and necessity are pointing the way to move forward at a time when the global healthcare industry has been hit by the economic slowdown.

HBR, which is a wholly-owned subsidiary of Harvard University, reporting to Harvard Business School, published the study by authors Vijay Govindarajan and co-author Ravi Ramamurti, who hold key posts in top biz schools overseas, in its November 2013 issue.

The authors studied more than 40 hospitals practicing innovative strategies.

Nine among them, treating eye, heart, kidney, bones, cancer and maternity care, were selected for an in-depth study and were found to be providing world class healthcare at 95% lower costs compared to US hospitals.

"Necessity spawns innovation. Apollo Hospitals asked suppliers to shorten the length of sutures after it found that its doctors routinely discarded one-third of each suture," says Vijay Govindarajan, professor of International Business at Tuck School of Business at Dartmouth, Hanover, USA.

Many innovations, sparked by the need to overcome constraints in emerging markets have been highlighted.

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Paulo Machado's curator insight, November 1, 2013 1:31 PM

Many lessons can be learned from outside the US - key challenge will be how to align incentives & reduce costs.  The US has gotten used to a multi trillion $ industry...  Leveraging emerging health tech to create efficiencies will lead to significant margin compression & headcount reduction. 

Connected Digital Health & Life's curator insight, December 1, 2013 3:35 AM

setting low cost feasable sustainable examples - go india!

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India Simplifies Barcode Procedures For Pharma Companies

India Simplifies Barcode Procedures For Pharma Companies | Healthcare in India |

To simplify barcode procedures for pharmaceutical companies, the Indian government has decided to treat mono cartons containing medicines also as primary level packaging, reports said, quoting Directorate General of Foreign Trade (DGFT).

He said, "Mono cartons containing strips/vials/bottles shall be treated as Primary level packaging."

A barcode helps in tracking and tracing of origin of drugs, which in turn helps in minimizing the chances of genuine drugs being considered spurious, sub-standard or counterfeit.

Primary level packaging is the first-level product packaging such as the bottle, can, jar, tube, that contains the saleable items.

The government had asked pharmaceutical companies to build track and trace capability for their exported medicines using barcode technology at three levels of packaging - primary, secondary and tertiary.


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Children with drug-resistant tuberculosis has experts worried

Children with drug-resistant tuberculosis has experts worried | Healthcare in India |

A recent study conducted by Kokilaben Hospital in Andheri, has shown that 72% of the 21 children with tuberculosis and admitted in the hospital contracted the disease from their community and not their immediate family. Also, these children had contracted the dreaded TB strain – MDR TB which is resistant to multiple drugs, and thus treating them is all the more difficult for the doctors. Out of these, a teenager tested positive for XXDR TB, which is resistant to all drugs.

What is MDR TB? 

MDR TB refers to Multi-Drug-Resistant Tuberculosis. It is a type of tuberculosis that is resistant to the first line anti-TB drugs. It is often caused because people stopping their medication midway instead of following the complete regimen as prescribed by the physician. It is spread in the same manner as tuberculosis. 

What are its symptoms?

Symptoms are same as regular TB and include severe cough which lasts for three weeks or longer, producing bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain in breathing or coughing. However, in these cases, the symptoms progressively get worse and may cause complications and death since the patient does not respond to most anti TB drugs. 

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Privatising public healthcare in India, one report at a time

Privatising public healthcare in India, one report at a time | Healthcare in India |

Public health experts and activists are attacking a proposal by India's leading government think tank that recommends handing many of the country's healthcare responsibilities to the private sector.

The document, written by India's Planning Commission, proposes eliminating the government as the primary healthcare provider. Instead, it would focus on specific areas such as immunisation and HIV testing. Getting rid of many of its other responsibilities would amount to a shortcut to its goal of universal healthcare. Patients would get private healthcare at a cost that the government would negotiate with the private sector, and service providers could be reimbursed for each medical prescription.

The proposal, which is similar to the managed care system in the United States, caused such a ruckus that some of the major parties who contributed to the plan have distanced themselves from it. Members of the High Level Expert Group set up by Prime Minister Manmohan Singh, say that the commission has distorted their recommendations.

"Planning Commissions' document calls for a 'managed healthcare' approach where the role of the government is reduced from a provider to that of a manager," said Rakhal Gaitonde, a public health researcher and state coordinator for the government's National Rural Health Mission in Tamil Nadu.

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Why is India's healthcare in critical condition?

Why is India's healthcare in critical condition? | Healthcare in India |

 India's health parameters are amongst the worst in the world right now and a child born in India today has less chances of survival than in Nepal or Bangladesh. On The NDTV Dialogues, Dr Srinath Reddy, Kiran Mazumdar Shaw, Dr Binayak Sen and Dr Ashok Seth join NDTV's Sonia Singh to look at why India's healthcare is in a critical condition.

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Doctors must be dealt with strictly for medical negligence: Supreme Court

Doctors must be dealt with strictly for medical negligence: Supreme Court | Healthcare in India |

Doctors and medical establishments must be dealt with strictly for their negligence in giving treatment to patients, the Supreme Court on Thursday held and asked the government to enact laws for effective functioning of the private hospitals and nursing homes. 

"The doctors, hospitals, the nursing homes and other connected establishments are to be dealt with strictly if they are found to be negligent with the patients who come to them pawning all their money with the hope to live a better life with dignity," a bench of justices CK Prasad and V Gopala Gowda said. 

The bench directed Kolkata-based AMRI Hospital and three doctors to pay over Rs 11 crore which includes interest to a US-based Indian-origin doctor who lost his 29-year-old wife during their visit to India 14 years ago. 

The bench said that its decision would act as deterrent to people associated with practice of medicine and do not take their responsibility seriously. 

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SC orders video recording of clinical trials of new drugs

SC orders video recording of clinical trials of new drugs | Healthcare in India |

The Supreme Court on Monday ordered the government to video record clinical trials of five new drugs, making it tougher for multinationals to shirk responsibility when testing of their patented medicine reacts adversely on patients.

A bunch of petitions in the apex court had complained about lax implementation of the clinical trial regime and alleged that multinational manufacturers had exploited the loopholes to make India the testing ground of their new drugs.

Countering senior advocate Colin Gonsalves and Sanjay Parekh who argued for halting clinical trial of 162 new drugs permitted by the Drug Controller General till their usefulness for India was established, additional solicitor general Sidharth Luthra said the government had established a three-tier scrutiny system comprising New Drugs Advisory Committee, technical committee and apex committee to examine applications for clinical trials in India.


Estibaliz Undiano Hernandez's curator insight, November 10, 2013 2:11 PM

Este artículo comenta la aceptación por parte del Corte Supremo de la grabación de los ensayos clínicos de nuevos fármacos. Me parece adecuado que se haya tomado una medida así, ya que se está garantizando el principio de seguridad a los participantes. Es decir, en el caso de que exista alguna irregularidad o se detecte algún tipo de riesgo para la salud de los mismos, se puede identificar rápidamente y detener el ensayo. Es una idea que habría que tener muy en cuenta en nuestro país.'s curator insight, November 23, 2014 6:17 AM

La grabación del consentimiento informado de los pacientes es un buen método para asegurar que no haya fraude respecto a los sujetos del ensayo. Sin embargo, debe tenerse cuidado de no infringir el derecho a la intimidad. Las medidas que ayuden al cumplimiento de los derechos básicos evitarán los abusos por parte de las empresas farmacéuticas en su búsqueda de beneficios económicos.

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The era of personalised medicine

The era of personalised medicine | Healthcare in India |

People react differently to drugs based on how they metabolize, and the aim of pharmacogenetics is to assist in choosing the right medication for an individual

I.C. Verma, a senior consultant at the Center of Medical Genetics at New Delhi’s Ganga Ram Hospital, was approached by the parents of a child who suffered from epilepsy and whose whole body was covered with painful blisters.
After carrying out tests, doctors at the hospital determined that the blisters were the result of the child’s adverse reaction to the medicine he had been taking for epilepsy.
The child had a mutation in a gene called HLAB 1502 that caused the allergic reaction. “In India, this mutation is found in only 2% of the population,” said Verma. “We had to change his dosage to suit the mutation to avoid this adverse reaction.”
The Center for Genetics at Ganga Ram Hospital is currently studying the mutation in Indian genes that can cause adverse reactions to anticoagulant medicines such as Warfarin. “We have seen patients who take such medicines for heart diseases, but can have adverse reactions like haemorrhage, due to certain gene mutations,” Verma said.
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Badly run trials behind Indian drug testing freeze

Badly run trials behind Indian drug testing freeze | Healthcare in India |

The Supreme Court in India has halted clinical testing of new drugs following a parliamentary probe into a vaccine trial

"Foreign companies are treating India as a heaven for clinical trials, but it is proving hell for India." So said an Indian Supreme Court judge on 30 September as he pressed the pause button on the country's clinical trials, ruling that all drug trials must be halted for two weeks. That period is now up, but there is no sign of the ban being lifted.

In recent years, India has emerged as the destination of choice for foreign companies looking to conduct clinical trials, attracted by low costs and access to a large pool of research participants.

But while the companies reap the rewards, the Indian people enrolled in the trials may be paying the price. In March, the Indian health minister Ghulam Nabi Azad testified in the Rajya Sabha, the upper house of parliament, that The government has found that between 2005 and 2012, over 2868 deaths were recorded during government-approved clinical trials of new drugs, 89 of which have been directly linked to the trials.

To put this in context, Ken Getz, founder of the Centre for Information and Study of Clinical Research Participation in Boston says the global risk of dying in a clinical trial is 1 in 10,000. In India, the risk in 2011 was an order of magnitude higher.

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Supreme court ruling brings clinical trials to a halt in India

The fate of 162 global clinical trials hangs in the balance, as the top Indian court has asked the government to provide more details on their approval process before they can proceed.

The trials, most of which involve ‘new chemical entities’ (NCEs), were approved by the drug controller general of India earlier this year. During the latest hearing on a petition filed in February last year by Indore-based health pressure group, Health Right Forum, the supreme court allotted the government two weeks to provide details on the mechanism adopted to approve the trials.

Who benefits?

Commenting on the latest court order, C M Gulhati, editor of Monthly Index of Medical Specialities, India, says: ‘It is a good interim order pending final disposal of the case. Testing of NCEs in India does not help the country. It only helps multinational corporations to cut costs and avoid payment of compensation.’

Big business

According to market research firm Frost & Sullivan, the Indian clinical trial industry was worth $450 million (£282 million) in 2010–11. Presently it is growing at 12% a year and is predicted to pass the $1 billion mark in 2016. However, recent developments have derailed progress. R K Sanghavi, head of the medical subcommittee of the Indian Drug Manufacturers Association, says: ‘To be honest, the clinical trial industry in India is in shutdown mode.’

Trials on trial

Recently, a committee headed by leading pharmacologist Ranjit Roy Chaudhury submitted a report recommending ironing out the process of approving and conducting clinical trials. The committee was set up by the government following the supreme court’s harsh criticism of the government’s lax approach to dealing with unethical trials.


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Medical college creates awareness about body donation

With medical students facing a shortage of human bodies for dissection, the JJM Medical College here has started a donors' association to create awareness.

Students of both under-graduate and post-graduate courses need bodies for their anatomy classes. According to the Medical Council of India, at least one body is required for a batch of 10 to 12 under-graduate students in their first-year course. "Now, we're able to provide only one for 24 students," said Dr GF Mavishetter, head of the anatomy department at JJM Medical College. "We require at least 20 bodies every year for the anatomy practicals," he pointed out.

"Earlier we didn't face such a scarcity as many unauthorized bodies were available and there were fewer medical colleges. The shortage has been noticed in the past seven years. We'd get bodies from the district hospitals of Shimoga and Davanagere but not after a government medical college opened in Shimoga. Similarly, the Ashwini Ayurvedic Medical College was started in Davanagere and some bodies are being taken there. Now, we get bodies from other places, including Kottayam, Hyderabad and Bangalore, at higher rates."

"To create awareness, the college started a body donors' association a few years ago," said Dr Muralidhar P Shepur, assistant professor and coordinator of the association. Four annual conferences have been organized by the association to encourage people to donate. The fifth may be held in February 2014, he said.

'We also hold awareness programmes with organizations like the Lions Club and Rotary Clubto remove superstitious beliefs and myths about body donation," the doctor said.

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Barcode norms for pharma companies eased

Barcode norms for pharma companies eased | Healthcare in India |

Simplifying barcode procedures for pharmaceutical companies, the government on Friday said it will treat mono cartons containing medicines also as primary level packaging.

A barcode helps in tracking and tracing of origin of drugs, which in turn helps in minimising the chances of genuine drugs being considered spurious, sub-standard or counterfeit. India exports over $10 billion worth of drugs annually.

Sensing an opportunity, the government wants to increase exports manifold over the next few years from global generic markets.

“Mono cartons containing strips/vials/bottles shall be treated as primary level packaging,” said Directorate General of Foreign Trade in a notice.

Primary level packaging is the first-level product packaging such as the bottle, can, jar, tube that contains the saleable items.

According to the industry, it is essential for Indian pharma firms to ensure quality to tap the market and that barcoding will help in this regard.

The government had asked pharma companies to build track and trace capability for their exported medicines using barcode technology at three levels of packaging -- primary, secondary and tertiary.


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Indian Healthcare IT Market May Zoom To $1,454 Mn In 2018

Indian Healthcare IT Market May Zoom To $1,454 Mn In 2018 | Healthcare in India |

Healthcare information technology market in India is expected to reach $1,454.7 million in 2018 from the present $381.3 million, mainly due to fast adoption of technology by stake-holders, according to Frost & Sullivan.

Healthcare IT is a core component to achieve successful transformative shifts in healthcare. Growth in data, digitisation trends in health information and electronic medical records, improvements in collaborative data exchange, workflows and mobility, and need for better financial management are changing the needs of the hospital enterprise.

Additionally, patient demographic changes and chronic disease growth, cost control considerations, and importance of patient safety, have all come together to heighten demand for health information technology (HIT) in India, the report said.

"The increase in adoption of electronic health records, mHealth, telemedicine, and web-based services has made electronic patient data expand, necessitating the implementation of robust IT systems in Indian healthcare institutions," according to analysis done by Frost & Sullivan.

"The technology's benefits, which include enabling experts from any part of the world to advise patients on medical care, streamlining operations, and helping hospitals achieve performance targets, have popularised IT in healthcare," it said.


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India's Secret to Low-Cost Health Care

India's Secret to Low-Cost Health Care | Healthcare in India |

The U.S. could learn a thing or two from health care delivery in India.

The ultra-low-cost position of Indian hospitals may not seem surprising — after all, wages in India are significantly lower than in the U.S. However, the health care available in Indian hospitals is cheaper even when you adjust for wages: For example, even if Indian heart hospitals paid their doctors and staff U.S.-level salaries, their costs of open-heart surgery would still be one-fifth of those in the U.S.

When it comes to innovations in health care delivery, these Indian hospitals have surpassed the efforts of other top institutions around the world, as we discussed in our recent HBR article. Today, the U.S. spends $8,000 per capita on health care; if it adopted the practices of the Indian hospitals, the same results might be achievable for a whole lot less, saving the country hundreds of billions of dollars.

A key to this is that, faced with the constraints of extreme poverty and a severe shortage of resources, these Indian hospitals have had to operate more nimbly and creatively to serve the vast number of poor people in need of medical care in the subcontinent. And because Indians on average bear 60% to 70% of health care costs out of pocket, they must deliver value. Consequently, value-based competition is not a pipe dream but a reality in India.

Three major practices have allowed these Indian hospitals to cut costs while still improving their quality of care.

A Hub-and-Spoke Design

In order to reach the masses of people in need of care, Indian hospitals create hubs in major metro areas and open smaller clinics in more rural areas which feed patients to the main hospital, similar to the way that regional air routes feed passengers into major airline hubs.

Task Shifting

The Indian hospitals transfer responsibility for routine tasks to lower-skilled workers, leaving expert doctors to handle only the most complicated procedures. Again, necessity is the mother of invention; since India is dealing with a chronic shortage of highly skilled doctors, hospitals have had to maximize the duties they perform. By focusing only on the most technical part of an operation, doctors at these hospitals have become incredibly productive — for example, performing up to five or six surgeries per hour instead of the one to two surgeries common in the U.S.

Good, Old-Fashioned Frugality

There is a lot of waste in U.S. hospitals. You walk into a hospital in the U.S., and it looks like a five-star resort; half of the building has no relation to medical outcomes, and doctors are blissfully unaware of costs. By contrast, Indian hospitals are fanatical about wisely shepherding resources — for example, sterilizing and safely reusing many surgical products that are routinely discarded in the states after a single use. They have also developed local devices such as stents or intraocular lenses that cost one-tenth the price of imported devices.

Innovation has flourished in the U.S. in the development of new pills, clinical procedures, devices, and medical equipment, but in the field of health care delivery, it appears to have been frozen in time. In too much of the U.S., system, health care is viewed as a craft and each patient as unique. But by applying principles of mass production and lean production to health care delivery, Indian doctors and hospitals may have discovered the best way to cut costs while still delivering high quality in health care.

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51% of Mumbai youth run the risk of heart attack - Health - dna

51% of Mumbai youth run the risk of heart attack - Health -  dna | Healthcare in India |

In a three-year-long study conducted in 12 cities across India, it has been found that 51 per cent of Mumbaikars have low levels of the heart-protecting high-density lipoprotein (HDL), also known as ‘good’ cholesterol. The study has also revealed  that over 70 per cent of the urban Indian population is at the risk of being diagnosed with cardiovascular disease. 

The Saffola Life study covered more than 1.86 lakh people between the ages of 30 and 100. “A sedentary lifestyle, in addition to stressful work conditions and a compromised diet are leading factors in precipitating heart disease risk. This has affected the heart health of people between the ages of 30 and 44,” said Dr Akshay Mehta, senior cardiologist, Asian Heart Hospital.

Of the 29,017 Mumbaikars who participated in the study, 44 per cent reported that they consume preserved or processed foods at least twice a week, and 42 per cent said that they eat fried foods at least twice a week. Additionally, 71 per cent of them were guilty of consuming two or less servings of fibre-rich whole grains in their diet.

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