FROM THE PRESS
A deadline to wait for
The
Delhi government has constituted a committee to review existing free treatment
facilities extended by charitable and other hospitals allotted land on
concessional terms by the government.
The committee will suggest suitable policy guidelines for free treatment
facilities for needy and deserving patients uniformly in the beneficiary
institutions. It will also recommend a proper referral system for optimum
utilisation of free treatment by needy patients and a suitable enforcement and
monitoring mechanism for this, including a legal framework.
It should submit its recommendations within three months.
UNI: Panel to review free treatment facilities. The Times of India,
September 10, 2000.
IVF to get around the law
A public interest litigation in the
Supreme Court calls for action to stop clinics from offering sex-selection with
in-vitro fertilisation. Sabu George (co-petitioners include CEHAT, Mumbai and
MASUM, Pune) has called for a move to ban this effort to bypass the law
preventing prenatal sex selection.
Rakesh Bhatnagar: SC urged to intervene against feminicide The Times of
India, September 11, 2000.
Remember the oath you took?
The chairperson of the Indian
National Human Rights Commission urged members of the medical profession to
adhere strictly to the Hippocratic oath to protect the human rights of patients
and of people as a whole. Speaking at a seminar in Bhopal on human rights and
the medical profession, Mr Justice JS Verma called the medical profession one of
the noblest of vocations since it deals directly with the right to life and
physical and mental security. Referring to the report of an AIDS patient who was
turned away by hospital authorities in Sagar, Madhya Pradesh, the chairperson
said that doctors had a great responsibility to appreciate the human rights of
AIDS patients.
NHMRC chairperson calls upon medical professionals to protect human
rights of patients NHRC newsletter, July 2000.
The guardians of our health
A drunk government doctor
created havoc in a primary health centre at Mahim near Palghar, Maharashtra. Dr
VV Patil, newly transferred from Talasari, used to be drunk all day. On one
occasion, he entered the PHC, threw papers around and abused staff. After the
incident was reported the police took a blood tests to check his alcohol level.
The district health officer has promised ‘stringent action´ against the doctor
once the test report is received. The remote location of this PHC apparently
encourages doctors to play truant. More interesting details: the compounder,
Ramesh Pander, on whose complaint the police took action, apparently did so
because he wanted to assert his political clout; he´s known for his ‘roving
eye´. And another, senior doctor at the PHC, Dr Raut, passes his time gambling
with medical workers while on duty.
Ram Parmer. Docs drinking and gambling on duty. Mid-day, September 16,
2000.
To observe from afar?
The Indian Medical Association
elections for the post of national president degenerated into fisticuffs between
an impassioned observer and contestant at the Tardeo office in Mumbai. Some
1,800 members of the IMA were to cast their vote by secret ballot. However, the
three observers authorised by various candidates to ensure that no unfair
practice was followed, were prevented from entering the voting room. A verbal
duel ensued, and the police were called in.
Express News Service: Fisticuffs erupt at IMA election. Indian Express,
August 10, 2000
Out of stock
More than 300 nurses from the Sassoon
hospital in Pune, and part of the Maharashtra Government Nurses Federation
demonstrated outside the hospital to protest the inadequate supply of basic
equipment. Basic items like bed sheets, soaps and life-saving drugs are in short
supply. “When a patient is admitted we can´t give them a clean mattress.” Even
sterilisation facilities are inadequate, and needles and saline sets are in
short supply. About 5,000 patients visit the hospital on any given day.
Staff reporter: Sassoon nurses allege inadequate supply of health care
items. The Times of India, August 8, 2000
Panel for genome research
The Indian government´s
department of biotechnology has set up a National Bioethics Committee to prepare
guidelines for research in genomics. The committee has been set up to fulfill
obligations under the UNESCO Declaration on the Human Genome and Human Rights,
to which India is a signatory.
The panel will be different from the proposed Ethical Review Committee to be
set up by the Indian Council of Medical Research (ICMR), which is currently
finalising a comprehensive set of ethical guidelines to regulate biomedical
research involving human participants.
“There will be some overlap in functioning of the two panels. Probably there
could be some sort of co-operation between them later on”, commented an ICMR
official . However, the biotechnology department feels that ICMR will be
providing only broad guidelines and that will apply to all medical research. The
panel set up by the department will focus on genomic research alone and will
have powers of implementation.
Dinesh Sharma: India creates bioethics panel for genomics research.
Lancet, August 5, 2000.
Doctor versus doctor? Sorry…
Patients claiming damages for
medical negligence are often unable to prove their allegations because doctors
are unwilling to testify against other doctors. This was one of the conclusions
of a study by the Voluntary Organisation in Interest of Consumer Education, New
Delhi, after examining grievance redressal mechanisms in 81 large hospitals and
small clinics and 86 cases of alleged medical negligence filed in consumer
courts in Delhi, Hyderabad, and Lucknow. The study was supported by the Indian
health ministry and the World Bank.
More than half the hospitals surveyed did not have mechanisms to manage
complaints from patients or their relatives. Patients usually turned to consumer
courts only after trying to resolve their grievances with their doctors or
hospitals, according to the study. Yet doctors refuse to testify, and hospitals
refuse to provide patients their medical records.
Ganapati Mudur: Indian doctors not accountable, says consumer report.
BMJ, September 9, 2000.
Infected material kills
The use of infected, date expired
items in the Gobind Ballabh Pant hospital in Delhi contributed to the deaths of
at least 26 patients in the 1990s, an expert inquiry team has found.
The team was appointed on the basis of complaints filed in 1998 by the
People´s Union of Civil Liberties against the hospital, several of its doctors,
and a former health minister of Delhi. The case refers to major corruption deals
through irregular purchases in the 1990s running into several crores of
rupees.
The date expired material implicated in hospital acquired infections and
deaths was purchased in the early 1990s and used on patients until around
1998.
The expert committee said that hospital records demonstrated an organised
attempt by the hospital administration, through orders and circulars, to use the
expired materials, which included catheters and heart valves, many of which were
more than five years old. There was damage, discoloration, visible fungal
growth, and overall contamination of these items.
Hospital records showed that some non-expired materials also had growth of
Staphylococcus aureus. Date expired materials were sterilised again but still
tested positive for contamination and were used anyway.
Rohit Sharma: Time expired materials “contributed to 26 deaths”. BMJ,
September 9, 2000
Rules for hospitals at last!
Country-wide guidelines for
minimum standards in hospitals and nursing homes will be the first step towards
regulation of these health facilities, several of which function without
laboratories, technical assistants and the minimum equipment. Out of 23 cities
with populations of above one million, only nursing homes in Delhi and Mumbai
are covered under certain municipal laws, says the Voluntary Health Association
of India, and these deal more with the housing facilities than technical
requirements.
The guidelines will need to be adopted by the states and the monitoring
authority will be the state governments. However, they will not cover the
conduct of medical professionals — an area which the Medical Council of India
has to take up.
The guidelines provide a schedule of the basic infrastructure
for a hospital including blood banking facilities, laboratory support, operation
theatres and equipment. If adopted and enforced through adequate regulatory
mechanisms, several hospitals in the country would be forced to either update
their equipment or simply close down.
Kalpana Jain: Govt framing rules for hospitals, nursing homes. The Times
of India, August 28, 2000.
Counseling AIDS patients
The recent suicide attempt in
Mumbai by an AIDS patient who also poisoned his wife and killed his two minor
children, has raised concern regarding the counselling given to HIV positive
patients in public hospitals.
While counselling is mandatory in all public hospitals, there are not many
professionally qualified counsellors, especially compared to the number of
patients coming to these hospitals every day, and the time spent with each
patient is insufficient to discuss all aspects of the disease and coping with
it.
“Counselling of HIV positive patients requires skilled counsellors and it
cannot be done by the junior-most person in the department, which is the case in
hospitals at present,´´ says a senior doctor in a public hospital, adding that
the counselling patients get when the doctor gives them the report is not
enough. Patients should be told they can lead a normal life with proper diet and
exercise, and take charge of their lives..
Roli Srivastava: AIDS patients get little counseling. The Times of India,
August 28, 2000.
We get it free and charge you..
Patients in the Jaslok
Hospital cardiology department are being charged Rs 40,000 for coronary stents
that the company supplied free to the doctors for “pre-marketing trials”. When
Mr GNV died following treatment by Dr AB Mehta, his son noticed that the
hospital bill included two S-7 coronary stents worth Rs 40,500 each and two
angioplasty balloons worth Rs 15,000 each. The S-7 stent manufactured by
Medtronics Inc is under pre-marketing trials and supplied free to cardiologists.
Dr Mehta claims this was a billing mistake.
Why is the company conducting trials in India for a product which has not yet
been cleared for marketing in the West? Because in the West, clinical trials can
only be conducted with FDA permission or after the hospital ethics committee
examines the proposal in excruciating detail and satisfies itself that proper
safeguards are in place. In India, patients often do not know they are being
treated by trial equipment.
Sumit Ghosal: Angioplasty patients being exploited by trial stents,
http://www.healthindia.com/, July 28, 2000.
The poor pay more
The Rajkumar kidnapping has overshadowed
a prolonged agitation launched by various organisations in Mysore to protest the
hike in consultation, treatment and ward charges at government-run hospitals.
Dalit leader Govindaraju said, “Although the state government feels it has
calculated the new rates scientifically, and the lower middle class may not feel
the effect, just think of the community below that line.” He alleged that
hospital staff collect double the amount of fees prescribed from the poor. S.O.
Palekar, chief secretary of Health and family planning department, medical
education, claims the government has implemented the decision only after talking
to all sections of people besides considering the hi-tech services provided at
the hospital and increase in the cost of manufacturing medicines.
TOINS: Hike in govt hospitals; poor worst hit. The Times of India,
Bangalore. August 26, 2000
A supportive fraternity
An income-tax raid on Ketan Desai,
president of the Medical Council of India (MCI), president-elect of the Indian
Medical Association (IMA), and chairman of the Academic Committee of the All
India Institute of Medical Sciences (AIIMS) led to calls for his resignation,
but Dr Desai says he will not quit because none of the allegations have been
proved. The IMA´s secretary general says, “A mere income tax raid does not prove
anything. If he is prosecuted, then the matter would go to our ethics
committee.” The health minister responded to a demand to remove him from various
posts with the comment: “Let the investigations be over then we will see.” Desai
said “it was not a tax raid, but a routine survey.”
Dinesh C Sharma: Medical body chief under cloud of suspicion in India.
Lancet August 12, 2000
Something´s glowing in the dark
The government-run Mehdi
Nawaz Jung cancer hospital has lost 73 million milliCurie of radioactive seeds
used for treating tumours. Anyone in close contact with them could develop
serious health problems. The seeds are Caesium 137 with a half-life of over 30
years. They went missing in June-end but hospital authorities kept the incident
under wraps for fear of public outcry.
R Shankar: Radioactive material missing from hospital: loss of lethal 73
milliCurie of radio-active seeds sends the N-establishment into a tizzy. The
Indian Express, August 17, 2000.
Drug deal
The United States has offered 24 countries in
sub-Saharan Africa five-year loans totalling $1billion, at 7% annual interest,
to buy anti-AIDS drugs. The drug would have to be bought from US manufacturers.
The offer has been condemned by Oxfam as “a debt that tomorrow´s AIDS orphans
will be forced to pay.”
“The deal amounts to a credit-line which locks poor countries into buying
expensive patented drugs, when what they need is help to make or buy low cost
generic equivalents,” Oxfam said in a press release.
Oxfam accused the United States of setting up the deal to help the drug
companies fight off competition from generic drugs that can be manufactured
locally. Brazil and India, for example, currently manufacture anti-AIDS drugs at
a fraction of the cost of those marketed by multinational pharmaceutical
companies.
Annabel Ferriman: $1bn drug deal creates debt for “tomorrow´s AIDS
orphans”. BMJ, July 29, 2000
Cloning is okay
An expert panel´s recommendations for a
limited form of human cloning have been endorsed by the UK government. The
panel´s proposals include: approval for the use of early embryos to investigate
the potential of new medical treatments; scrutiny of all research proposals by
the Human Fertilisation and Embryology Authority; approval only if there are no
other ways of getting the information; embryos should not be retained for more
than 14 days in the growth cycle; no cloning technology mixing cell materials of
humans with those of other animals; specific consent from donors for use of eggs
or sperm in stem cell research; and cloning for the purpose of creating a baby
remains illegal.
Stem Cell Research: Medical Progress with Responsibility is available free
from the Department of Health, PO Box 777, London SE1 6XH, or can be accessed at
www.doh.gov.uk/cegc/
Akil Fazal: UK government approves limited cloning of human embryos. BMJ,
September 2, 2000
Advertising or public announcement?
SmithKline Beecham
Mackwoods is accused of breaking guidelines of Sri Lanka´s Cosmetic Devices and
Drugs Authority because television advertisements and hoardings for its drug
Panadol do not mention the drug´s generic name, paracetamol. The guidelines are
based on the WHO´s ethical criteria for medicinal drug promotion.
The brand name appears hourly on Sri Lanka´s national television on a clock
face announcing the time.
The company claims, however, that neither the clock face nor the name boards
are advertisements since they do not list the product´s benefits; the clock face
is a ‘public service message´
Regulators suspect that SmithKline Beecham, which is forced to include
generic names in advertisements worldwide, is making an exception in the case of
Sri Lanka because it has limited resources to police the industry.
Dinali Goonewardene: Sri Lanka accuses drug company of flouting
advertising rules. BMJ, September 16, 2000
Awkward alliance
Back to SmithKline…. The manufacturer of
a chickenpox vaccine has linked up with associations of paediatricians and
family physicians in Israel for an ad campaign urging parents to get their
children vaccinated against chickenpox. The health ministry fears it will be
pressurised by parents to include the expensive vaccine in the state-subsidised
immunisation programme despite the high natural immunity to the disease. The
head of the public health service commented that “any immunisation effort
financed by the pharmaceutical company that produces the vaccine poses ethical
problems.” Extra money should be spent on a newer safer vaccine against whooping
cough; chickenpox is a low priority. Also, the public health service favours
giving all children a uniform basket of vaccinations, and not encouraging
well-off parents to give their offspring shots that poor families cannot
afford.
Judy Siegel-Itzkovich: Drug company pays for campaign for chicken pox
vaccination. BMJ, September 16, 2000
Unsafe research
The US government halted all federally
funded human research at the University of Oklahoma College of Medicine charging
that researchers in a melanoma vaccine trial had breached safety regulations and
the university´s institutional review board (IRB) failed to provide adequate
supervision.
Independent auditors found personnel producing the vaccine were unqualified;
participants received vaccines improperly tested for viral and bacterial
contaminants.
Though the trial was stopped following auditors´ recommendations, the
principal investigator wrote to patients and investigators that there were no
safety issues. In addition to this misrepresentation, the Office of Human
Research Protections found that the trial´s informed-consent documents
overstated the possible benefits of participation in the trial, a phase I safety
study. The university´s IRB had not monitored the trial properly, and changes
were made to the trial´s protocol without IRB approval.
Restructuring the university´s system for protecting human participants would
include “changes in leadership and an enhanced institutional commitment to human
subject protections”.
Michael McCarthy: US government suspends clinical research at another
university. Lancet July 22, 2000
The will of God or the law?
As we go to press, the dilemma
continues on whether conjoined twins can be surgically separated so that one can
survive resulting in the certain death of the other twin.
In August, a UK high court judge ruled that the twins can be separated
against their parents´ wishes to save the life of the stronger baby, even though
the operation will kill the weaker twin. The parents have appealed the ruling
and further consultations are now on.
The twins — “Mary” and “Jodie” are the names assigned for the public — were
born to Roman Catholic parents in southern Europe who came to Britain for the
birth after it was realised that the foetuses were conjoined.
Both twins will die within six months unless separated. With an operation,
Jodie is likely to live with some disability, but Mary will die, because she
relies on Jodie´s heart and lungs for her blood supply.
The babies´ parents asked that no operation should be carried out and that
“God´s will” should prevail. They said that their community did not have the
facilities to cope with Jodie´s disabilities and they would have to leave her in
Britain.
A key issue in the case is whether it would be lawful to end Mary´s life to
save Jodie or whether this would amount to unlawful killing. It could come down
to whether Mary, who has a primitive brain, a useless heart, and non-functioning
lungs and relies on Jodie as her life support system, is a person in her own
right.
Clare Dyer: Siamese twins to be separated against parents´ will. BMJ,
September 2, 2000; Parents of Siamese twins appeal against separation. BMJ,
September 9, 2000; Doctrine of necessity could allow separation of twins. BMJ,
September 16, 2000
