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Thursday, April 26th, 2012
Any doctor travelling to the United States for higher medical studies from this year onwards will have to sign a bond with the government, promising to return to India after completing his / her studies.
This has been done to prevent doctors from leaving the country on the pretext of higher studies and eventually settling down there.
“Any student travelling for further medical education to the US will have to give us a bond that he will return after completing the studies. In the last three years, 3,000 doctors went abroad for studies and didn’t return. If a student doesn’t return from the US, he won’t be allowed to practise there,” Union Health and Family Welfare Minister Ghulam Nabi Azad said on 23.04.2012.
‘Bond obligation’
From this year onwards, the United States is insisting on a government NOC from every student enrolling with an American institute. “No other country is asking for this NOC,” the Minister said. “If they don’t fulfil the bond obligation, we can write to the US to deny the student permission to practise.”
Vested interest
On the proposed three-year Bachelor of Rural Health Care course, which seeks to create a separate cadre of public health professionals to serve in rural areas, Mr. Azad hoped that the Medical Council of India (MCI) would approve the course. “Doctors’ organisations are opposing the course. I have no hesitation in saying that they have a vested interest to increase their practice.”
“The curriculum is also ready. States are free to implement the course, as Assam is doing, but we want the MCI’s recognition to provide uniform standards for the course across India. We hope the MCI will move fast,” he said.
Mr. Azad also favoured increasing the duration of the MBBS course from the existing 5.5 years to 6.5 years. The Medical Council of India was working on the proposal. “I don’t mind increasing the duration of MBBS to 6.5 years. In the US, students have to go for six years of additional study to be able to prescribe medicines and practise,” he said.
Mandatory rural service
The proposed one-year increase in MBBS duration is being contemplated to set aside an additional year for mandatory rural service. The proposal is to award the MBBS degree only after the completion of 5.5 years of regular MBBS course and one year of rural posting, which would be linked to the National Rural Health Mission (NRHM).
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Thursday, April 26th, 2012
K.S. Parthasarathy
Former Secretary, Atomic Energy Regulatory Board
Low dose CT screening for lung cancer is recommended only for 55-74-year-olds who have smoked a pack daily for 30 years
On April 23, 2012, the American Lung Association (ALA) released its interim guidance recommending low dose computed tomography (CT) screening for diagnosing lung cancer among smokers. The recommendation is based on the first report of the ALA lung cancer screening committee, chaired by Dr. Jonathen Samet from the University of Southern California.
The Recommendation
ALA recommends screening only for a limited group. These are current or former smokers, aged 55 to 74 years with a smoking history of at least 30 pack-years and no history of lung cancer.
Smoking history of 30 pack years means smoking a pack of cigarettes daily for thirty years or two packs daily for 15 years etc.
ALA notes that while CT screening for lung cancer may save lives, it should not be recommended for everyone due to many known and unknown risks that may be associated with the screening and subsequent medical evaluation and follow-up. Radiation risk is one of them.
In spite of this caution, Auntminnie.com, a trade journal, stated that the move is a major step toward the development of a population-based CT screening programme in the U.S.
The U.S. National Cancer Institute’s National Lung Screening Trial (NLST), found that low-dose CT can reduce mortality by at least 20 per ecnt compared to chest x-ray, and other reports have pushed the estimated mortality gains even higher. The ALA guidelines followed the results of NLST of smokers at-risk, released in November 2010.
Even in this high risk group, 320 persons had to be screened with CT to prevent one lung cancer death.
The benefit of CT screening for lung cancer cannot be easily estimated for populations with risk profiles that are different from those of the NLST participants.
Can Cause Cancer
According to Centers for Disease Control and Prevention, screening with CT scans is not risk-free. Radiation exposure from repeated CT scans is cumulative and can lead to cancer.
Average effective radiation dose in “low dose” CT in NLST was 1.5 mSv as against 7 mSv in a full diagnostic helical CT.
Specialists have criticised low-dose CT screening due to the large number (as high as 25 per cent) of false-positive results, meaning that the positive finding did not prove to be lung cancer following diagnostic investigations. People who receive false-positive results may be subjected to unnecessary testing, including more radiation exposure, invasive diagnostic and surgical procedures, complications, and even death, diminishing the benefit of early cancer detection.
Over-diagnosis due to screening must have revealed indolent cancers which may never progress into full blown cancer. They may end up undergoing an invasive intervention that they would not otherwise need.
According to ALA, individuals should not receive a chest X-ray for lung cancer screening as it has low sensitivity.
ALA Committee suggested that ALA should ask hospitals and screening centres to: establish ethical policies for advertising and promoting lung cancer CT screening services; develop educational materials to assist patients in having careful and thoughtful discussions between patients and their physicians regarding lung cancer screening and to provide lung cancer screening services with access to multidisciplinary teams that can deliver the needed follow-up for evaluation of nodules.
Smoking, major cause
Lung cancer is a fatal disease. Currently, specialists believe that smoking causes up to 80-90 per cent of lung cancer cases.
The significance of the guidance is evident as the five-year survival rate for lung cancer presently stands at 15.6 percent as compared to an over 90 percent survival rate for breast, colon and prostate cancers.
ALA recommendation may lead to many undesirable developments. Hospitals may start direct-to-consumer advertising to recruit patients who might have resources to pay out-of pocket for low-dose CT screening.. “…the promotion of such services should not prey upon the public’s fear of lung cancer while leading them to believe that low-dose CT screening will eliminate all risk from lung cancer,” ALA warned.
“Unfortunately, even before the NLST results were released, CT screening for lung cancer was being offered by some institutions and subsequent to the release an increasing number of well-respected medical centres throughout the country are offering lung cancer screening to their constituents at markedly reduced prices.” ALA observed.
Public cautioned
“Never starting smoking and quitting smoking still remains the best way to prevent lung cancer”, Dr Norman H. Edelman, Chief Medical Officer, American Lung Association cautioned the public.
Individuals have to take their own decisions on screening based on inputs from allreputable sources. Do not trust advertisements glorifying CT screening.
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Wednesday, April 11th, 2012
Scientists have identified a new hormone that can lower a person’s blood sugar levels, a finding, which they claim could pave the way for a new and effective treatment for diabetes.
A team at the University of Texas says this new fat-derived hormone would appear to be a useful alternative or add-on to insulin; it can do essentially the same job, sending glucose out of the bloodstream and into muscle.
“It’s like you’ve opened the door and now the glucose can come in,” Jonathan Graff, who led the team, says in the Cell Metabolism journal.
For its research, the team manipulated a key developmental pathway in the fat stem cells of mice to find that the animals showed remarkably low blood sugar levels.
The animals’ muscles were taking up glucose at two to four times the usual rate thanks to an abundance of glucose transporters at their surfaces. That discovery was all the more striking because the animals also lacked fat stores, a condition known as lipodystrophy that normally results in just the opposite — high blood sugar and diabetes.
The mice could respond normally to insulin, but insulin surprisingly had nothing to do with the muscles’ unusual appetite for sugar. The source for the change wasn’t anything inherently different in the muscle itself either; it was something about those manipulated fat stem cells.
Further experiments revealed that the mouse muscles continued to take up extra sugar when they were isolated in the lab and exposed to blood serum. “It showed these effects were likely secondary to blood-borne signals sent by the manipulated fat cell progenitors,” Mr. Graff says.
That signal can be generated only by fat stem cells, not mature fat cells. “If we can purify this factor and give it to people, there is potential for its use to lower and help control blood sugar,” Mr. Graff says.
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Wednesday, April 11th, 2012
Scientists claim to have developed a universal cancer vaccine that can train patients’ own bodies to seek out and destroy tumour cells.
A team from Tel Aviv University and drug company Vaxil Biotheraputics say the therapy targets a molecule found in 90 per cent of all cancers, and could soon pave the way for a universal injection that allows patients’ immune systems to fight off common cancers including breast and prostate cancer.
Preliminary results from early clinical trials have shown that the vaccine can trigger an immune response in patients and reduce levels of disease, The Sunday Telegraph reported.
Now, the scientists hope to conduct larger trials in patients to prove it can be effective against a range of different cancers.
In fact, they believe it could be used to combat small tumours if they are detected early enough or to prevent the return of the disease in patients, who have undergone other forms of treatment such as surgery.
Cancer cells usually evade patient’s immune systems because they are not recognised as being a threat. While the immune system usually attacks foreign cells such as bacteria, tumours are formed of patient’s own cells that malfunctioned.
The scientists have, however, found that a molecule called MUC1, found in high amounts on the surface of cancer cells, can be used to help immune system detect tumours.
The vaccine uses a small section of the molecule to prime the immune system so that it can identify and destroy cancer cells, say the scientists.
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Wednesday, April 11th, 2012
The earlier the detection of Alzheimer’s disease the more likely it is that decline could be slowed or even stopped.
The testing currently on offer is invasive and expensive, and scientists around the world are looking for a cheaper and easier method. Researchers at Newcastle University say they are making progress in coming up with a blood test that could complement brain imaging.
“We detect it very late with imaging techniques,” said research leader Pablo Moscato. “When a lot of damage has been done in your brain, it’s unlikely we can come up with a solution.” The aim is for a 50-dollar blood test with a high level of accuracy.
“If we can catch this early, then the possibility of drug intervention is there because the drug companies would see a market and try and come up with one,” Professor Moscato said.
In a paper published in the PLoS (Public Library of Science) ONE journal, the team delivered a progress report on their work in developing a cheap two-part blood test that could determine whether a mild intellectual impairment was going to progress to Alzheimer’s.
“We’re looking at pairs of markers,” Moscato said. “The best possible measurement is if you take them at the baseline and then again in 12 months. Then you compare the variation between the pairs of proteins over that 12 months.” What the team look for acceleration. “It’s the rate of change of values that rings the bells,” he said. “If it grows and grows exponentially then we know we have something wrong.”
People with mild cognitive impairment do not inevitably develop Alzheimer’s. Some maintain a level of functioning and some progress to another form of dementia.
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Monday, April 2nd, 2012
IANS
The concept of exposing infants to germs in order to build up immunity is known as the hygiene hypothesis. Now, researchers of Brigham and Women’s Hospital (BWH) have come up with evidence supporting the hygiene hypothesis for the first time.
They studied the immune system of ‘germ-free mice’ and compared them to mice living in a normal environment with microbes, the journal Science reported.
They found that ‘germ-free mice’ had exaggerated inflammation of the lungs and colon resembling asthma and colitis, respectively, caused by the hyperactivity of a unique class of T cells (immune cells).
These immune cells had been previously linked to these disorders in both mice and humans, said a university statement.
Most importantly, researchers discovered that exposing the germ-free mice to microbes during their first weeks of life, but not when exposed later in adult life, led to a normalized immune system and prevention of diseases.
Moreover, the protection provided by early-life exposure to microbes was long-lasting, as predicted by the hygiene hypothesis.
“These studies show the critical importance of proper immune conditioning by microbes during the earliest periods of life,” said Richard Blumberg, chief for the BWH Division of Gastroenterology, Hepatology and Endoscopy, and study co-author, working with Dennis Kasper, director of BWH’s Channing Lab.
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Tuesday, March 13th, 2012
Dr. Ashley L. J. D’cruz
Today, no one doctor can claim to have a full grasp of his specialisation
“There are many ways to skin a cat,” is a metaphorical expression often heard at professional conferences when opinions differ on the management of a medical problem. Thus, medicine remains both a science and an art. Opinions will differ and, in certain circumstances, cause considerable confusion and anxiety in the patient’s mind.
In the last 50 years, medicine has advanced so rapidly no one doctor can claim to have a full grasp of his own domain of specialisation, much less the various branches of medicine. Other influences that have impacted the way medicine is delivered to the patient include the lack of finance/insurance support, the loss of the family doctor, and more recently, the corporatisation of medicine where a patient becomes a client.
What is Second Opinion?
In this milieu, a patient, already at a disadvantage from ill health and conflicting influences, often wishes he could have a second opinion. This means having another consultant or set of doctors re-examine the patient, review the data and suggest a plan of treatment. It may agree with the one in place, or be entirely new. A cross reference, however, is the request of the primary doctor to another colleague for an expert opinion on a particular issue in the patient’s management.
When is it sought?
Usually, when there is loss of confidence and trust in the opinion or treatment advocated by the doctor — the patient is not getting better, or a certain procedure or investigation is being forced upon the patient.
Or when it comes to a life-changing treatment, e.g., cancer, amputation of a limb, or withdrawal of life support.
The doctor may suggest one if unsure of the diagnosis.
In this information age, the patient may have researched the problem and may wish to see another consultant. However, remember that information on the Internet is often not peer-reviewed and can be misleading.
Is the Patient Entitled?
In health systems where the state bears the burden of health care, like the National Health Service in the United Kingdom, the patient does not have the right to a second opinion but is permitted to seek one.
Similarly, in the organised sector like the government or the military or where medical insurance pays for healthcare, logistically it becomes near impossible to get a second opinion unless the treating doctor allows and/or recommends one. In all other cases the patient reserves the right to a second opinion.
How to Go About It
“Shopping for an opinion” is a very sorry practice in the country. Rather, the patient should have a clear objective and proper preparation before seeking a second opinion. A good approach would be: Inform the doctor that a second opinion is being sought. It builds trust; the doctor may suggest someone of equal or superior ability and provide all the documents and investigation reports. This will save time and money.
Identify a consultant of equal or superior training or stature. It is pointless to have a generalist opine on a specialist’s opinion. Beware of unsolicited advice.
Collect originals and reports of all investigations, including imaging, and have them carefully tabbed. All of these rightfully belong to the patient.
Ensure that the new consultant interviews and examines the patient and then reviews the reports. The patient should be seen as a whole person and not only as a medical report.
Communicate openly and clearly and share the second opinion with the primary consultant. Doctors cannot deny a patient the right to seek a second opinion and should preferably suggest one where appropriate.
No Need for Egos
Notwithstanding our egos and prejudices, we must be sensitive to patients’ rights and be willing to help in every way.
Hopefully, the development of standard treatment guidelines (under way in many specialties) and peer-reviewed, evidence-based protocols if made easily available to the public will empower them to make better informed decisions. Our only objective should be to make patients better: if we cannot, then we must respect their inalienable right to a second opinion.
(The author is the Director and Senior Consultant Paediatric Surgeon/Urologist at the Narayana Hrudayalaya Woman and Child Institute. He is also the Past President Indian Association of Paediatric Surgeons.)
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Tuesday, March 13th, 2012
Cancer-treatment drug Nexavar will soon be available to patients at Rs. 8,880 a pack of 120 tablets, thanks to India invoking an international trade rule allowing the generic production of an unaffordable drug that is patented.
Bayer, a German multi-national, holds the patent for Nexavar (the brand name of sorafenib tosylate), which now sells at Rs.2.84 lakh.
The way for such a huge reduction in the price was cleared on Friday when the Indian Controller-General of Patents, Designs and Trade Marks granted the first-ever ‘compulsory licence’ in India to the Hyderabad-based Natco, a generic drug-maker, for making sorafenib tosylate, which is used to treat kidney and liver cancer.
Natco had sought ‘compulsory licence’ under Section 84 of the Indian Patent Act.
The drug is used for the treatment at the advanced stages of kidney and liver cancer. The drug stops the growth of new blood vessels and targets other important cellular growth factors. Though it is not a life-saving drug, it is a life- extending drug. In the case of kidney cancer, it can extend the life of a patient by four-five years, while in the case of liver cancer it can extend life by about six- eight months.
Natco Pharma had applied for the invoking of the provision last July after Bayer declined to accept its request for a voluntary licence to manufacture and sell the drug.
In his order issued on Friday, Controller of Patents P.H. Kurian also directed Natco Pharma to supply the drug free of cost to at least 600 needy and deserving patients every year.
Natco Pharma will also have to pay a royalty to Bayer at the rate of six per cent of the net sales on a quarterly basis, and the licence shall be valid till the entire balance period of the patent — it was granted in 2008 and will expire in 2020.
Welcoming the development, Director-General of the Central government’s Council for Scientific and Industrial Research Samir Brahmachari said it was a heart-warming decision as the drug would be available at just three per cent of the current price.
Dr. Brahmachari, who has initiated an open source drug discovery programme in the CSIR to help develop drugs for tuberculosis and other diseases of public health importance, noted that in the health sector at least there was a need to strike a balance between the rights of the patent-holders and the needs of the users. “There can be profits. But, not profiteering at the cost of the patients.”
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Wednesday, February 22nd, 2012
Sudha Nambudiri,
The world’s first Nanophotomedicine is in its final stages of development in India and the Netherlands, and its phase-I clinical trials in humans will be held in a couple of years. The drug could well be in the market in the next three-four years.
The nanophotomedicine was developed by a group of researchers headed by Dr Manzoor Koyakutty at the Amrita Centre for Nanosciences and Molecular Medicine, and its pre-clinical evaluation was undertaken at the Erasmus Medical Centre in the Netherlands. A Netherlands-based pharmaceutical company, Nano4therapy will undertake Phase-1 (clinical) trial in humans and later commercialize the product. The medicine for neuro-endocrine tumours can eliminate the tumour cells more efficiently than currently available therapies. The medicine, once injected, accumulates in tumour tissues because of the rational design of nanoparticles. After accumulation, a low power laser light is used to activate the nanomedicine and kill the cancer cells. “We have developed a nanomedicine that is a non-toxic and biocompatible polymer. It will be a major alternative to radiation therapy which causes a lot of harmful side-effects to the body. The medicine given during radiation therapy costs around Rs 2-2.5 lakh and spreads all over the body, damaging healthy cells too. But this is a targeted medicine and 85-95% of it will attach itself around the tumours,” Dr Manzoor told.
He said the medicine when launched in India will be cost-effective and prices will be brought down by 60%. “The safety trials will be completed by next year and we hope to start human trials by 2014,” said Manzoor.
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Wednesday, February 8th, 2012
IANS
A possible new blood test based on the presence of a protein released after a heart attack, could help diagnose an attack, new research suggests.
Loyola University scientists said cMyBP-C (cardiac myosin binding protein-C) is a large protein.
“This (cMyBP-C) potentially could become the basis for a new test, used in conjunction with other blood tests, to help diagnose heart attacks,” said study author Sakthivel Sadayappan, assistant professor in molecular physiology.
“A lot of additional studies will be necessary to establish cMyBP-C as a true biomarker for heart attacks,” Sadayappan said.
Sadayappan co-authored the study with Suresh Govindan, postdoctoral researcher in Sadayappan’s lab, the Journal of Molecular and Cellular Cardiology reports.
The Loyola study is the first to find that cMyBP-C is associated with heart attacks. Its large molecular size helps quick detection in blood test, according to a Loyola statement.
Between 60 and 70 per cent of all patients who complain of chest pain don’t have heart attacks. Many of them are hospitalized until a heart attack is ruled out.
An electrocardiogram can diagnose major heart attacks but not minor ones. Only one protein, now used in blood tests, called cardiac troponin-I, is specific to the heart.
But it takes at least four to six hours for this protein to show up in the blood following a heart attack.
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