Morning MEDtalks with Dr K K Aggarwal 20^th July 2018

Predicting a dengue outbreak

A global consortium of researchers has developed an early warning system to alert authorities on the Caribbean island of Barbados when a dengue outbreak is likely to strike. The study, published in the journal PLOS Medicine, has shown that a period of drought, followed by intense rainfall four or five months later provide the optimum conditions for an outbreak of the disease.

They found that there is most likely to be an epidemic five months after a drought. However, if there is intense rainfall after the drought an outbreak is even more likely.

During periods of drought people tend to store water in containers, providing an ideal breeding ground for mosquitoes, which lay their eggs in pools of standing water.

The researchers believe that after a drought people are more likely to leave water containers out. So, next time there is a period of intense rainfall there are more places for water to collect and therefore more breeding grounds for mosquitoes.

Fenugreek and onion prevents cardio-vascular diseases

Scientists from CSIR-Central Food Technological Research Institute, Mysore induced diabetic condition in mice. The animals were either given their normal diet or normal diet supplemented with fenugreek or onion, in combination or alone. By examining cardiac tissues, scientists reaffirmed that the cardiovascular health of mice fed with fenugreek and onion was better.

More production of ACE enzyme and AT1 of renin-angiotensin system receptor in cardiac tissues of diabetic patients is a known cause of heart-related disorders. Both the enzyme and receptor are produced less in mice supplemented with fenugreek and onion.

Fenugreek and onion individually were able to ameliorate heart-related disorders in diabetic rats, it was found that they worked better in combination. The research results have been published in journal Cardiovascular toxicology.

The fibre-rich fenugreek seeds and sulfur compound-rich onion are health friendly.

 Around the globe

1. In an analysis published Monday in JAMA Internal Medicine, researchers found 46% of urgent-care patients in 2014 had conditions that did not require an antibiotic but received a prescription. 40% of all outpatient antibiotic prescriptions are now written at an urgent-care center or retail health clinic.
2. A new report from the CDC shows overdose deaths caused by the synthetic opioid, fentanyl nearly doubled in the last two years.
3. Ceftazidime-Avibactam Resistance: Ceftazidime-avibactam is approved by the US Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal and urinary tract infections, and has activity against carbapenem-resistant Enterobacteriaceae (CRE). Resistance to ceftazidime-avibactam is reported in 10% of patients; all were Klebsiella pneumoniae carbapenemase (KPC)-3 subtypes. 
4. Despite good glycemic control with continuous glucose monitoring (CGM) and intensive insulin management throughout pregnancy, women with type 1 diabetes still had babies who were large for gestational age, shows a small retrospective study the June issue of Diabetes Technology and Therapeutics.
5. Five-year stroke rates were lower in patients with multivessel or left main coronary artery disease who underwent percutaneous coronary intervention (PCI) than in those who had coronary artery bypass grafting (CABG), new research shows in July 16 in the Journal of the American College of Cardiology.
6. A new CDC study points to major concerns about the number of Americans dying from liver cancer. Between the years 2000 and 2016, the death rate of Americans diagnosed with liver cancer was up by 43 percent. With obesity, its the fat that gets deposited inside the liver and causes a cascade of inflammation and scar tissue to form inside the liver. Thats when little cancer cells decide to start growing.
7. Detectable faecal haemoglobin is associated with death from a wide range of causes, not just colorectal cancer (CRC), according to a new study in July 16 issue of the journal Gut.
8. Ovarian cancer is the fifth-most-common cancer among women and 5-year overall survival is still below 50%.
9. Low-dose aspirin is commonly used to prevent cardiovascular disease, its use in oncology is less accepted, although the US Preventive Services Task Force now recommends low-dose aspirin for primary prevention of cardiovascular disease and colorectal cancer for adults aged 50–59 years at high cardiovascular risk and low risk of bleeding who are willing to take aspirin for 10 years.
10. The U.S. Food and Drug Administration (FDA) on 13 July 2018 issued a recallon pharmaceuticals containing the active ingredient valsartan with  N-nitrosodimethylamine (NDMA).

In the customs, excise & service tax appellate tribunal, West block no.2, r.k. Puram, new delhi-110066 Bench-db- court –ii

Service Tax Appeal No. ST/52555/2014 [DB]

(Arising out of Order-in-Original No. 18-19/ST/SRB/2014 dated 04.02.2014 passed by the Commissioner, Service Tax Adjudication, New Delhi)]

M/s. Indian Medical Association   ...........…Appellant

Vs.

C.S.T., Delhi                                                                                   … Respondent

Present for the Appellant     : Mr. Sarvagya Sharma, Advocate Present for the Respondent: Mr. Amresh Jain, D.R.

Coram: HON’BLE MR. V.PADMANABHAN, MEMBER (TECHNICAL) HON’BLE MRS. RACHNA GUPTA, MEMBER (JUDICIAL)

Date of Hearing/Decision : 04.06.2018 FINAL ORDER NO. 52504/2018

PER: RACHNA GUPTA

Present is an appeal as being filed being aggrieved of Order of Commissioner Adjudication dated 04.02.2014 vide which appellant, the Indian Medical Association, is held to have been rendering/ receiving services in lieu of membership of club  or  association  service. 

Accordingly,  the  demand  of  Rs. 1,16,26,461 has been confirmed along with the interest and consequent penalty has been imposed.

2. The factual matrix relevant for the purpose is as :-

M/s Indian Medical Association (IMA) is registered with Service Tax Commissionerate w.e.f. 05.09.2008. However, during an audit conducted by the Department under Rule 5(A) of Service Tax Rules, 1994 on 15.12.2009 it was observed that for a period from 01.04.2010 to 31.03.2012, appellant despite providing and receiving club or association service was not discharging the service tax liability on the plea of exemption on ground of it being a charitable trust.  Department observed that the said exemption is not available to the appellant and accordingly a show cause notice dated 15.10.2010 was issued and served upon the appellant demanding the impugned levy. The said demand has been confirmed vide the Order under challenge.

3. We have heard Mr. Sarvagya Sharma for the appellant and Shri Amreesh Jain, Ld. DR for the Department.

4. The appellant has impressed upon that the appellant association is the one for the doctors which is registered as society since the year 1928. The main objective is to maintain the honour and dignity and to uphold the interest of medical profession and to promote the improvement of public health and medical education in India. Also, to achieve equality among all members (doctors) of the profession. It is  impressed upon that the object of the association is therefore, for the betterment of public at large and hence the same is covered under sub-clause (iii) of Section 65(25 a) of the Finance Act, 1994. In addition, it is impressed upon that the association is a group of qualified doctors to assist the member doctors in their profession and to do some charity work and as such they are covered under exemption for any tax liability.

5. It is further submitted on behalf of appellant that the appellant being one of the members of World Medical Association (WMA). It is submitted that the appellant are not actually receiving any services from WMA. The object of membership is impressed upon as a goal to expend WMA membership to be representative of all the countries of the world. In as such, no levy of service tax as demanded is applicable upon the IMA. Relying upon the decision of the Gujarat High Court in Sports Club India Case 2013 (7) TMI 510 and decision of the Jharkhand High Court in Ranchi Club India Case 2012 (6) TMI 636, the appellant has prayed for Order under challenge to be set aside and appeal to be allowed.
6. While rebutting these arguments, it is submitted by the Ld. DR that the very objective of IMA covers the service as defined under Section 65 (25 a) and as such the appellant is liable to pay the service tax with respect to the membership fee. It is denied that they are discharging any charitable function and thus are denied to be covered under exemption of 65(25a) of the Act. With respect to membership of appellant  to the World/International Medical Organisation (WMA), it is submitted that the same also is club and association service being provided by a non resident or a person located outside India to a recipient in India in as such service tax liability  would be applicable on reverse charge basis w.e.f. 01.01.2005 in furtherance of CBEC Circular dated 26.09.2011 and accordingly, the appellant was liable to pay the service tax.

7. The appellant has been charged under the category of Club & Association Service which stands held as ultra vires by the High Court of Gujarat in the case of Sports Club of India 2013 (64) VST 191 (Gujarat) as also by the High Court of Jharkhand in the case of Ranchi Club 2012 (26) STR 401 (Jharkhand). By following the above decisions, we set aside the demand for service tax on the appellant under the category of Club or Association Service, rendered to its members.

8. Now coming to the levy as has been made on the account of appellant having been paid subscription in foreign currency for obtaining membership of World Medical Association under reverse charge mechanism.  The objectives of WMA were impressed upon by the Ld. Counsel that they are more into activities having objectives which are in the nature of public service. The objectives as provided by the Ld.  Counsel are perused. It is observed that WMA is discharging the functions as are the objectives of organisations like UNICEF, WHO, etc., i.e. about creating international awareness on public health providing means to combat the medical issues which are globally common. It is also observed that though  the appellant have given the membership fee to WMA but the authority below has failed to check for any document which may prove that the appellants have received any service from WMA which is situated abroad, prior making them liable for service tax under reverse charge. During the course of  hearing, the Ld. Advocate has submitted a brief write up about the membership charges paid by the appellant to World Medical Association. After the perusal of the same, we are unable to see clearly what is the nature of service received by the appellant from WMA. Consequently, we set aside the demand of service tax on such amounts paid to WMA and remand the matter to the original authority to examine whether any service has been received by the appellant from

WMA which is liable for payment of service tax and pass denovo Orders on the subject.

9. In the result, we set aside the demand of service tax on the consideration received by the appellant from various doctors across the country. With reference to the charges paid to WMA, the issue is remanded for denovo decision.

Participate in survey on Inflammatory bowel disease:

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Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO