The IMA on gifts for doctors
The Indian Medical
Association's newly formulated guidelines on gifts for doctors state that gifts
should not be of substantial value, and should primarily entail benefit to
patients. Textbooks, 'modest meals' and other gifts are okay if they serve
a genuine educational function. Individual gifts of minimal value, like pens and
notepads, are permitted as long as they are related to the physician's work.
Subsidies to continuing medical education conferences or professional meetings
are okay because they help patient care. Likewise funds for medical students to
attend selected educational conferences are okay as long as the academic
institute selected the beneficiaries.
Payments to defray the costs of a
conference should not be accepted directly from the company by the physicians
attending the meet. "And cash payments are absolutely unacceptable," said
IMA national president Sudipto Roy. So are industry subsidies for travel,
lodging or other personal expenses of physicians attending conferences or
meetings.
Anonymous. IMA's New Year 'gift' for doctorswww.rediff.com/news/2004/dec/31ima.htm
Medical research in Bhopal
Twenty years after the
leak of methyl isocyanate gas from the Union Carbide factory in Bhopal,
the government is acknowledging that its research was incomplete. More than half
a million people were exposed to MIC; around 120,000 continue
to suffer from chronic respiratory, ophthalmic, reproductive, endocrine,
gastro-intestinal, musculo-skeletal, neurological, and mental
disorders.
The Indian Council of Medical Research, which followed over 80,000
people exposed to the gas from 1985 to 1994 - but published its first report
only in November 2004 - now wants the super-speciality Bhopal Memorial Hospital
and Research Centre to continue tracking this cohort. But the hospital director
states that this report is of "no public health value" and plans to track
270,000 gas victims to whom the hospital has issued smart cards, for
public-health research in MIC-related ailments as well as unrelated
problems.
In response to NGOs' pleas, the Supreme Court appointed a panel to
develop treatment protocols for gas-related disorders. The panel will
suggest research projects to investigate the long-term health impact of the gas
exposure, including the effect on children born to gas-affected parents. Another
panel was formed to monitor health-care facilities in Bhopal and to look into
complaints from gas-affected patients.
Dinesh Sharma. Bhopal: 20 years
on. The Lancet, January 8, 2005
'India-only' research
Doctors at the Institute of
Immunohaematology in Mumbai used a stem cell therapy developed by the Dublin-
and London-based TriStem Corporation to treat four patients with aplastic
anaemia at King Edward Memorial Hospital. The treatment was supposed to
transform peripheral white blood cells into pluripotent stem cells which were
re-infused into the patients.
The hospital's ethics committee suspended the
study after it discovered the company scientist had contacted the patients and
posted details of the study and the patients' photographs on TriStem's website.
One patient died from a respiratory infection that hospital doctors said was a
complication of the disease not the treatment.
Critics say that the study has
exposed "loopholes" in existing approval mechanisms. They also point out that
the Indian government rejects clinical trials of experimental treatments
developed abroad when they are carried out exclusively on Indian
patients.
The Institute's director said that before the study the institute
had conducted animal tests to establish the safety of the transformed
cells. But regulatory experts argue that stem cells from reverse
differentiation are "bioengineered" entities and should have been approved by
the advisory committee on genetic engineering.
Ganapati Mudur. Indian
researchers accused of violating ethical guidelines. BMJ. January 8, 2005.
'Volunteer' for Rs 5,000
The Hyderabad-based Aurobindo
pharmaceutical company has been accused of exploiting Dalit youth to test its
anti-diabetic drug Metformin. Unemployed youth were promised between Rs 3,000
and Rs 5,000 to take part in bio-availability tests of the drug - a large sum of
money, particularly in an area affected by drought and severe
unemployment.
The district medical and health officer said he was satisfied
with the company's answer that Metformin was not hazardous and had deferred
further investigation till he received the relevant documents.
Hyderabad: City pharma firm uses Dalits as guinea pigs. Deccan
Chronicle. January 16, 2005.
Free medical care can be covered by the CPA
In a
landmark judgement, the Supreme Court held that employees who get free medical
treatment as part of their perks are covered by the Consumer Protection Act and
can file cases relating to medical negligence.
The story goes back 15 years
when Mrs KL Kotgiri, the wife of a Central Railway worker, died during
post-partum tubal ligation at the Byculla railway hospital in Mumbai. The
hospital claimed no responsibility but someone directed Mr Kotgiri to
medico-legal activist MS Kamath, who took the case to the state consumer forum.
But the case was dismissed on the ground that Mr Kotgiri was not a consumer as
he did not have to pay for his treatment.
The case went from the state forum
to the national commission and finally to the Supreme Court. The Court ruled
that since Mr Kotgiri's wife received medical treatment as part of the
conditions of his service, and since the hospital is subsidised by the Union of
India, he is covered by the Consumer Protection Act. The national commission
must now decide whether Mrs Kotgiri's death was due to medical negligence, and
if so, award compensation.
Swati Deshpande. 'Consumer law protects
workers who get free healthcare': landmark apex court ruling allows them to file
for medical negligence. The Times of India. January 24, 2005.
Charity scam I
Under the Bombay Public Trusts Act,
charitable hospitals in Mumbai must reserve a portion of their facilities for
free or subsidised treatment for poor patients. But, according to a report of
the Charity Commissioner, none of the 70 such hospitals in the city provides
free treatment. This was discovered when an ex-mill worker went to court after
being refused treatment by a charitable hospital.
Charitable hospitals
receive various concessions in tax, electricity rates and additional floor space
index for their buildings. Only one hospital, Bombay Hospital, provided
treatment to poor patients at a concessional rate. And violators can currently
be penalised just Rs 2,000 per case.
The High Court asked the hospitals to
come up with a policy for poor patients by March 16, 2005.
Shibu Thomas.
No free treatment for poor at charity hospitals in city. Mid-day. February 24,
2005.
Charity scam II
And in Delhi, some corporate groups
are wooing charitable hospitals for their subsidised land and other such
assets. Since Delhi Development Authority land allotment rules do not
allow charitable institutions to sell their land corporate groups enter into
'management contracts' to run the hospital.
The first to go corporate is
Jessa Ram Hospital, now renamed 'Fortis Jessa Ram Hospital'. Devki Devi
Foundation and Balaji Trust have entered into management contracts with Max
Healthcare.
Anonymous. Corporates cast net on hospitals. Hindustan
Times, New Delhi. January 31, 2005.
How to do 3,100 vasectomies in five days
Twenty-eight-year-old Ramu Burman is one of the four persons, including two
minors, who came forward with complaints of forced sterilisation in Madhya
Pradesh's Satna district where the doctors performed nearly 3,100 vasectomy
operations in five days to create a world record under the leadership of a
maverick IAS officer, Uma Kant Umrao.
Ramu had been seeking fertility
treatment when he met a man who promised to inject a medicine to give him
strength. On the way to this treatment, he was waylaid by a local anganwadi
worker who needed to meet her quota for a sterilisation camp. After the
operation, he was given Rs 265 and a blanket.
When the story broke, others
came forward. A 17-year-old rickshaw puller was tricked into undergoing the
surgery; he was told it was an injection for 'strength' as part of a new
government scheme for poor people.
"These isolated incidents have negatively
impacted the morale of the district administration which is involved in a huge
task," said Umrao. Uma Shankar Gupta, minister in-charge of the district, felt
there was nothing wrong in sterilisation targets but said that he would order an
inquiry.
Deepak Tiwari. Mein kampf controversy: minors sterilised in a
quest for a world record. The Week. February 6, 2005.
An unjust law
Until April 4, 1999, Unbanked
Directed (to a specific patient only) Blood Transfusion (UDBT) was legal. After
an amendment to the Drugs and Cosmetics Act smaller peripheral hospitals may not
transfuse blood unless they have authorised blood banks.
Many rural hospitals
do life-saving surgeries, treatment of complicated childbirths and other
critical interventions, depending on fresh blood transfusion. Rural surgeons
will have to turn away critically ill patients or ask them to purchase blood at
great expense and inconvenience from an authorised blood bank far away.
Thousands of doctors are faced with this choice: Should they follow the rules
and disregard the lives of patients who come to them for treatment? Or should
they ignore a blatantly unjust law, help patients in distress and risk
punishment?
According to an exemption in the Act, UDBT may be done by Armed
Forces Medical Personnel in border areas and smaller hospitals. But it is not
ethical to use it on a farm worker whose arm was pulped in a threshing machine
or a tribal woman with a ruptured pregnancy.
The Association of Rural
Surgeons of India has submitted a petition to the Human Rights Commission
requesting it to study the problems of blood transfusion in villages and make it
legal for doctors to practise giving blood in a safe manner.
Kaveri
Nambisan. Saving lives ... at what cost? The Hindu. February 20, 2005.
Pressures on government doctors
Resident doctors
at Sion hospital were assaulted by the relatives of a newborn baby who died
shortly after birth, provoking them to go on mass casual leave.
"Many
life-saving injections such as adrenalin, efcorlin and liquid soda bicarbonate
used to revive a cardiac arrest patient are not available 90% of the time," says
a resident. Patients' relatives therefore have to be told to fetch the drugs
from outside. "This often consumes time and agitates the relatives who take out
their anger on us."
Then there are 'note' cases - cases given special
attention because of political influence. "Every few days we're asked to attend
to one special patient, sometimes at the expense of emergency cases," says one
doctor.
Seema Kamdar. Doctors ask for security to ward off patient ire.
The Times of India, March 3, 2005.
AIDS trials under the
microscope
In February 2005 the government of Cameroon suspended a
study of 400 HIV-negative sex workers to evaluate the long-term prophylactic
value of the anti-retroviral tenofovir. Activists had argued sex workers on whom
the drug was being tested were not made fully aware of the potential risks of
participation, and they were not provided adequate health care. Similar protests
had led to suspension of the same trial in Cambodia last year.
On March 11,
Family Health International, the US-based nonprofit organisation that had
organised the Cameroon trial, announced that it was withdrawing from a Nigerian
study of sex workers, citing technical, not ethical, concerns.
A day
earlier, critics of a pending Thailand study involving injecting drug users
(IDUs) funded by the US Centers for Disease Control and Prevention charged
that it "ignores international ethical standards." The study plans to
enroll 1,600 uninfected IDUs who visit methadone clinics. Critics charged that
such recruitment plans would be coercive; that participants who get infected
would not receive anti-HIV drugs, and that they must receive clean needles and
syringes to help prevent HIV infection. This is disputed by the head of
the CDC programme in Bangkok.
Priya Shetty. Cameroon suspends trial of
AIDS drug after protests. SciDev.Net February 18, 2005. Jon Cohen. AIDS clinical
trials: more woes for novel HIV prevention approach. Science. March 18, 2005.
Need for autonomous council in Pakistan
The
Pakistan Medical Association has demanded autonomous status for the
Pakistan Medical and Dental Council (PMDC) to improve standards of medical and
dental education in country.
Because of interference in PMDC affairs,
the council had been recognising medical and dental colleges functioning in
apartments and small bungalows and producing quacks. The PMDC, meant to monitor
the situation, was being rendered ineffective.
The PMA demanded that PMDC
start inspecting colleges and de-recognise institutions delivering low-quality
education. The council should also take notice of the exorbitant fees
being charged by private practitioners and take action against hospitals where
patients would die due to negligence. Doctors coming from abroad should not be
allowed to practice without permission or provisional registration from the
PMDC.
Anonymous. Stop meddling in PMDC affairs, PMA tells govt. Dawn.
January 25, 2005.
"It would be unethical to test"
A guarded ward in
the Xishan Workers Sanatorium in west Beijing has become home to foreign
patients with nervous-system disorders who come for a treatment forbidden in any
other country: the injection of cells from aborted foetuses into their brains
and spines.
The surgery is carried out by Huang Hongyun, a Chinese
neurosurgeon who studied in the USA. Dr Huang admits he cannot fully explain his
results but says he has seen so many improvements in the patients he has treated
that he has no doubt about his method.
Although he has taken video film of
patients before and after surgery and did a survey of 139 patients based on the
criteria for function assessment laid down by the American Spinal Injury
Association, much of Dr Huang's work lacks statistical validity because he has
not tested the method in a trial.
"I don't know anyone who doesn't have an
interest in what he's doing - and I don't know anyone who approves," says
Geoffrey Raisman at the National Institute of Medical Research. Others warn that
Huang is exploiting desperate people to hone a technique that has not undergone
rigorous testing and lacks any long-term follow-up.
Dr Huang has prominent
backers who urge him to conduct double-blind trials to meet western scientific
standards. He refuses, asserting that such studies would be unethical. "These
patients are already suffering. If we open them up just for a placebo test, it
will only do them harm. We would be doing it for ourselves, not for the
patient."
Jonathan Watts. Controversy in China. The Lancet. January 8,
2005.
Complexities of internet transplants
New internet
clearinghouses connecting patients needing organ transplants with altruistic
strangers are raising ethical dilemmas for Canadian physicians.
Transplant
centres are re-examining their policies regarding altruistic and anonymous
donation, under the pressure of long waiting lists, the apparently growing
number of people willing to donate a kidney or piece of their liver, and the
advent of non-profit and fee-based internet donor matching services.
Given that most transplants involve "improving the quality of somebody's
life, rather than saving a life," society must determine whether the benefits of
living anonymous donations outweigh the risks, particularly to the donor, says
Dr Christopher Doig, associate professor of critical care medicine and community
health at the University of Calgary.
Anonymous donations and internet
brokering may be viable alternatives to long waiting lists, says Dr Ed Cole,
director of nephrology for the University Health Network at Toronto's Mount
Sinai Hospital. "I'm not sure we all feel this is the ideal solution to the
problem but we're not prepared to say, no, we won't consider any of this."
Wayne Kondro. Debate over online recruitment of organ donors.
CMAJ. January 18, 2005.
The long arm of the industry
At an inquiry into the
influence of drug companies, UK members of parliament were told that the
companies's influence extends far beyond doctors. Since nurses got the right to
prescribe, drug companies have been sponsoring meetings and running 'diploma'
courses for them, and there is evidence that they are changing their prescribing
practices accordingly. Patient groups are turning to the industry of sponsorship
- it is likely that drug companies will use this to raise awareness of their
products.
