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Journal of the Academy of Hospital Administration

Notes, News and Journal Scan

Author(s): S. Satpathy*

Vol. 13, No. 2 (2001-07 - 2001-12)

India to promote integratrion of traditional and modern medicine

The Ministry of Health and Family Welfare, government of India proposes to promote the concept of "medical pluralism" and expose students of modern medicine to the Indian Systems of Medicine (ISM), such as Ayurveda and Yoga. It has also recommended that ISM and homeopathy should be integrated into various national health-care programmes and delivery systems. The first National ISM Policy was released by Health Minister Dr. C.P. Thakur on Oct. 19 with the following features/suggestions. The ISM education system should be thoroughly revamped, and that graduates of modern medicine should be taught the principles of ISM. In addition, ISM graduates should be taught to diagnose and treat conditions for which allopathy was little to offer. In the health-care delivery system, the report recommends that at least on ISM physician should be appointed in every primary health-care centre. Posts lying vacant due to non-availability of allopathic doctors in rural areas should be filled by ISM physicians. Also, an ISM wing should be created in all rural and district hospitals. While primarily using ISM treatment, the policy says, ISM practitioners in rural areas should be allowed to prescribe over-the-counter drugs and other essential treatments, such as pain killers. Some states are already appointing ISM practitioners to fill up vacant posts in rural areas. The policy has evoked strong reactions from the medical community. "It is a retrograde step that will only promote quackery. Every system of medicine is based on a separate set of principles and methods. You just can't mix them like this", says Sanjiv Malik, secretary general of the Indian Medical Association. Job officials of IMA and MCI have said that exposing students to different streams of medicine could promote ambiguity, confusion, and even quackery. This new systems would allow graduates in modern medicine (allopathy) to prescribe ayurvedic medicines after tomited exposure which would tantamount to qurchery. Similarly practitioners of traditional medicine would use this policy to prescribe allopathic drugs without being qualified to do so.

The Lancet, Vol. 358. No. 3, 2001; BMJ Vol. 323, 10 Nov. 01


Unethical Cancer Drug Trial Controversy - Investigation Begins

The Indian Government and John Hopkins University, Baltimore, USA have launched separate inquiries into an alleged violation of rules governing clinical trials at an Indian cancer research institute

The drug, M4N, was developed by Ru Chih Huang a scientist at Jons Hopkins's Kriegner School of Arts and Sciences, and is designed to treat patients with oral and cervical malignancies. The scientist did not submit the protocol for the study at RCC to the university's institutional review board. According to a statement by Johns Hopkins (www.jhu.edu), the university only found out about the trial in March, 2001. The trials were done from November, 1999, to April, 2000.

The case came to light in India in mid-July when Dr. V N Bhattathiri, Associate Professor of Clinical Radiology at the RCC, filed a petition with the Kerala State Human Rights Commission alleging that patients' rights had been violated in the trials of M4N Bhattathiri also alleged that the drug had been imported without approval by the DCGI.

He has stated that patients waiting for surgery were given these injections four days before surgery the purpose of which was to experiment and not treat them. He has also alleged that when it was the time to test the drug on humans, after testing satisfactorily on mice, the researcher moved their experiments to India.

Doctors associated with the cancer trials have defended the study, saying. It was done with the informed consent of the patients and approval from hospital ethics committees.

"The drug also did not harm any patient and it did not interfere with standard therapy, whether surgery or radiation. Says "Dr. M Krishnan Nair, director of the Centre. He said approval for the study was obtained through "discussions" with the drugs controller's office, and the patients had been informed that the drug was experimental.

The controversy has sparked concerns that India is emerging as an attractive testing ground for experimental drugs. "India has a vast pool of patients, qualified doctors, and good hospitals that make it an attractive site," says Ashwini Kumar. India's chief drugs controller.

Earlier this year health authorities began asking how 16 patients in a private hospital in New Delhi received vascular endothilial growth factor, an experimental treatment for coronary artery disease that was developed by doctors in the United States.

The Lancet. Vol. 358. Aug. 4, 2001.


Revised National Health Policy; Draft Published

The Indian government has released a revised National Health Policy for the first time in 18 years. The draft policy was published on Sept. 4 by India's health minister C P Thakur and hopes to correct the decades of under investment in health by successive governments.

Public health investment in India has decreased from 1.3% of gross domestic product in 1990 to 0.9% in 1999.. In the states investment has declined from 7% of total state budget to 5.5 during the 1990s. The draft policy notes that it is チeno surprise that the reach and quality of public health services has been below the desirable standard:.

The draft notes that the current health policy, which was last updated in 1983, had some success but has had many shortcomings. For example, the achievements have been inconsistent over urban and rural areas and "the national averages of health indices hide wide disparities in public health facilities and health standards in different parts of the country".

Among the proposals the report suggests that medical curriculum should be revised and that a commission should be created to fund medical colleges. "The quality of education is highly uneven and in several instances, even sub-standard", notes the report. The report recognises the fact that the syllabi are excessively theoretical. "Making it difficult for the fresh graduate to effectively meet even primary health care needs of the population".

The draft policy said that 55% of the government's investment in health care should go to primary care. Proposals for health care in rural areas, which is a major weakness in the current policy and underlined by the fact that many recently graduated doctors are reluctant to serve in rural areas, will be made shortly.

Excerpts from India's proposed health policy

  • Increase central government contribution to health from 15% to 25%
  • Patients to pay for care at some secondary and tertiary health care centres
  • Create a medical grants commission to fund medical colleges
  • Encourage specialisation in public health and family medicine
  • Increase government expenditure on medical research from 0.3% of total health spending to 1% by 2005 and 2% to 2010
  • Create a fully integrated disease control network by 2005
  • Eradicate polio and yaws by 2005

The draft will be discussed in public meetings and suggestions will be considered before the revised policy is adopted by the government in the coming month.

The Lancet. Vol. 358; Sept 15, 2001


WHO Report Aims to Increase Understanding of Mental Health

One in four people around the world will be affected by neurological disorders during their lives, but few of these will seek-and far less will receive-help, according to WHO's annual report published on Oct. 4.

The report Mental Health: New Understanding, New Hope appealed to governments and health professionals to make mental health a much higher priority in national and community-level policy and reduce the stigma involved.

"With this report, we hope to break the vicious cycle of neglect and lack of funding and raise awareness of mental-health issues at the highest level of decision and policy making", WHO Director General Gro Harlem Brundtland said.

Currently 450 million people have neurological disorders, including 121 million with depression and 50 million with epilepsy. Every year one million people commit suicide and 10-20 million attempt to take their lives.

Despite the anticipated rise in such problems, about 50% of countries have no mental-health policy. Two-thirds of governments spend 1% or less or their health budget on mental health, and half have only one psychiatrist per 100 000 people, WHO said.

The agency made a series of recommendations to governments: provide treatment within community-based primary care and close remaining mental asylums; make psychotropic medicines more widely available; train more mental-health professionals and educate the public; link mental health policy with programmes to tackle alcohol, drug, and tobacco abuse.

With better policy direction and more resources, results could be spectacular, it suggested. More spectacular, it suggested. More than 80% of people with schizophrenia could be free of relapses at the end of 1 year of treatment with antipsychotic drugs combined with family support. Up to 60% of people with depression could recover with a proper combination of antidepressants and psychotherapy. Up to 70% of people with epilepsy could be seizure free when treated with simple, inexpensive anticonvulsants, it said.

WHO said their was more hope on the horizon. "Through recent advances in neuroscience, neuroimaging, genetics, and behavioral sciences, we know more about brain functioning and behaviour than ever before. This in turn has led to breakthroughs in therapy and medication", Brundtland told a press conference in Geneva, relayed by video linkup to New Delhi, Cairo, Harare, and Copenhagen.

The Lancet, Vol. 358, 13th October 2001.


Decentralised Healthcare Administration and Regulation to Ensure Health Security

Public health experts in India have suggested during The National Consultation on Health Security (26-27th July) to decentralise health care administration & better regulation of private sector health care services. The meeting organised jointly by UNDP and Institute of Human Development has recommended creation of village and district level surveillance systems so as to prioritise resources. The system should work on the principles of community management and locally elected bodies should be empowered to audit the system.

Participants also suggested that links between medical colleges should be strengthened to improve primary health care. Each medical college should be linked to a primary health centres (PHC), instead of the current system where a college is only linked to a teaching hospital, which provides tertiary care, they added. This way the problem of lack of medical staff at PHCs could be overcome.

The present health-care system is weak, deficient, and inequitable", agreed health minister C P Thakur. "For a heterogeneous country like India, there is no single solution. We need a variety of reform options to improve access to public health care and delivery". The minister noted that the government is preparing a law to ensure quality of service and minimum efficiency standards through a regulatory mechanism for the private sector.

The Lancet, Vol. 358, Aug. 4, 2001.


Death Trigger's Fresh Controversy Over Vitamin A Programme in India

Indian doctors have renewed their accusation that international agencies are needlessly promoting the administrations of vitamin A across India to all children aged below 5 years.

Paediatricians and nutritionists launched a barrage of criticism after 14 children died and thousands fell ill last week in the northeastern state of Assam following a vitamin A campaign supported by Unicef. Health officials are investigating the deaths and illness amid suspicions that health workers might have given overdoses to children during the state-wide campaign to deliver vitamin A to three million children aged 1 to 5 years.

Unicef had replaced the traditional 2 millilitre spoons with 5 millilitre cups to pour out vitamin A for the campaign. Health officials suspect that this switch in the method of measuring the vitamin of health workers might have led to overdoses.

A technical consultation initiated by the health ministry last year concluded that existing data were not sufficiently robust to recommend vitamin A supplementation to reduce mortality in children aged 1 to 5 years.

BMJ Vol. 323, 24 Nov. 2001.

* Associate Professor,
Deptt. of Hospital Administration, AIIMS, New Delhi
E-mail: [email protected]

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