Morning MEDtalks with Dr KK Aggarwal 12^th September 2018

TEDx Video: Doctor-patient relationship: 

https://www.youtube.com/watch?v=i9ml1vKK2DQ

Competition concerns in the healthcare sector (Advocate Anupam Sanghi and Dr KK Aggarwal): The Competition Commission of India (CCI) has formed a prima facie view that Max Super Speciality Hospital is dominant in the market of “provision of healthcare services by super speciality hospitals in Delhi” and is abusing its dominant position by charging a higher price of Disposable syringe, with needle size 10ml of B. D. Emerald Brand’, in terms of higher MRP, which is almost double the price of the same product available in the open market. 

The CCI has directed an investigation in the matter by the Director General (DG). The matter would open up investigation in entire super speciality healthcare services. CCI has earlier given prima facie views against few entities that resulted in entire industry being investigated. For eg. in the automobile, pharmaceutical and insurance sector to name a few.

The repercussions of CCI’s investigation could be serious –

Financial impact / monetary penalties

1. Heavy Penalties - up to 3 times of the profit of the last 3 preceding financial years or
2. Up to 10% of average turnover of the last 3 preceding financial years
3. Third parties claims
4. Significant legal costs

Impact on individuals/ officers

1. Penalty up to 10% of average income of the last 3 preceding  financial years
2. Impact on the management
3. Penalty up to 1 crore for not complying with the direction of the CCI or the DG
4. Penalty up to 1 crore for furnishing wrong information to the CCI or the DG
5. Imprisonment by the Criminal Court
6. Loss of management time and distraction
7. Damage to goodwill / reputation of the organization

Impact on agreements and business transactions

1. Modifications or revocation of agreements
2. To discontinue and not to re-enter into agreements

What needs to be done?

1. Prepare a defensive strategy based on critical competition analysis of CCI’s order
2. Representation before the DG / CCI, Appellate Tribunal (NCLAT) and Courts
3. Identify the risk and liabilities and suggest mitigating measures
4. Compliance and Training

Do you know medical errors are estimated to be the third-biggest killer in the US? In the UK, as many as one in six patients receive an incorrect diagnosis from the National Health Service.

No NTG in acute heart attack if: inferior wall infarct with RV involvement, patient is pregnant, if the chest pain is trauma-related, if the patient is allergic to nitrates or if the patient has used erectile dysfunction medications recently.

Heart attacks, strokes and other cardiovascular issues contributed to 2.2 million hospitalizations in the US in 2016, according to CDC’s Morbidity and Mortality Weekly Report published Sept. 7.

The HIV AIDS (Prevention and Control) Act 2017, which had been passed by the Parliament has been now implemented. The Act provides for the prevention and control of the spread of HIV-AIDS and for the protection of human rights of the affected persons including the rights of healthcare providers. In a notification issued by the Ministry of Health and Family Welfare, dated 10th September, 2018, the Govt. said, “In exercise of the powers conferred by sub-section (3) of section 1 of the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 (16 of 2017), the Central Government hereby appoints the 10th day of September, 2018, as the date on which the provisions of the said Act shall come into force.”

The first case of monkeypox has been recorded in the UK in a Nigerian national staying at a naval base in Cornwall who probably contracted the infection before travelling to the UK, as per Public Health England. Monkeypox is a rare disease that is caused by infection with monkeypox virus. It was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then monkeypox has been reported in humans in other central and western African countries... (Medscape, CDC).

WHO and the World Bank Group convened the first meeting of the Global Preparedness Monitoring Board (GPMB), a new body set up to monitor the world’s readiness to respond to outbreaks and other health emergencies. The GPMB is chaired by Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General and Mr Elhadj As Sy, Secretary General of the International Federation of Red Cross and Red Crescent Societies, and includes some of the most notable leaders in global health.

Conditions which Yoga can help manage: Yoga works at the level of wave particle duality of the body. By shifting from sympathetic to parasympathetic mode it can heal and help various conditions as below.

1. Yoga can relieve chronic stress:A small study done at the University of Utah conducted in experienced yoga practitioners, people with fibromyalgia and healthy volunteers showed that yoga increased tolerance to stress. People who had a poorly regulated response to stress were also more sensitive to pain, while the yoga practitioners had the highest pain tolerance (Harvard Health).
2. Yoga can reduce anxiety: Twelve sessions of regular hatha yoga exercise significantly reduced stress, anxiety and depression in women suggesting its role as complementary medicine, which also reduces treatment cost by reducing the use of drugs (Masoumeh Shohani, et al. The effect of yoga on stress, anxiety, and depression in women. Int J Prev Med. 2018;9:21).
3. Yoga can reduce depression: A study of older men, average age 61 years, with high levels of depression, presented at the 125th Annual Convention of the American Psychological Association in 2017 showed that following a twice-weekly hatha yoga program reduced the symptoms of depression after eight weeks of intervention; they also enjoyed the yoga classes (https://www.yogajournal.com/poses/new-study-finds-yoga-significantly-reduces-depression-in-male-veterans).
4. Yoga can improve heart health: Yoga improves cardio-metabolic health including improved BMI, systolic BP, LDL cholesterol, HDL cholesterol and thus may reduce the risk of heart disease (Chu P, et al. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2016;23(3):291-307).
5. Yoga can alleviate chronic low back pain: Yoga is a safe and effective intervention for chronic low back pain as it reduced functional disability and was more effective in reducing pain severity or “bothersomeness” of the chronic low back pain compared to usual care or no care (Chang DG, et al. Yoga as a treatment for chronic low back pain: A systematic review of the literature. J Orthop Rheumatol. 2016;3(1):1-8).
6. Yoga can keep the brain healthy: Healthy elderly women who practiced hatha yoga for at least 8 years had greater cortical thickness in the left prefrontal cortex (lateral middle frontal gyrus, anterior superior frontal gyrus and dorsal superior frontal gyrus), which relates to cognitive behavior, compared to a group of matched controls. (Afonso RF, Balardin JB, Lazar S, et al. Greater cortical thickness in elderly female yoga practitioners-a cross-sectional study. Front Aging Neurosci. 2017;9:201).
7. Yoga can help control anger: In a study of 152 participants from nine Swedish correctional facilities randomly assigned to a 10-week yoga group, yoga improved emotional well-being. Positive affective states (such as calm, relaxed, and content) increased, while negative affective states (such as hostile, upset and nervous) decreased (Kerekes N, et al. Yoga in correctional settings: a randomized controlled study. Front Psychiatry. 2017;8:204).
8. Yoga can improve balance and prevent falls: Yoga classes reduced self-reported falls and improved balance measures. Right leg stand time improved from a mean of 13.3s to 17.1s and standing forward reach distance from 26.0cm to 29.6cm. The number of falls in older adults reduced by 48% after six months of yoga classes (Hamrick I, et al. Yogas effect on falls in rural, older adults. Complement Ther Med. 2017;35:57-63).
9. Yoga can improve thyroid function: Yoga improved thyroid function in patients with thyroid disorders. Significant differences were noted between thyroid hormone status before and after the intervention with improvement in tiredness, hair loss, constipation, weight loss, tremors and laziness (Sharma K, et al. The effect of yogic practices on thyroid functions. Indian Journal of Applied Research. 2017;4(7):526-7). In another study, 6 months practice of yoga improved cholesterol level, serum TSH, may also help in reducing the thyroxine requirement in female patients suffering from hypothyroidism (Nilakanthan S, et al. Effect of 6 months intense Yoga practice on lipid profile, thyroxine medication and serum TSH level in women suffering from hypothyroidism: A pilot study. J Complement Integr Med. 2016;13(2):189-93).
10. Yoga can improve control of diabetes: Yoga led to significant reduction in blood glucose levels, both fasting and post prandial, in patients with type 2 diabetes suggesting a potential role of yoga in preventive and management strategies for type 2 diabetes (Chimkode SM, et al. Effect of yoga on blood glucose levels in patients with type 2 diabetes mellitus. J Clin Diagn Res. 2015;9(4):CC01-3).
11. Yoga can enhance immune system: Chronic stress can weaken the immune system. By reducing stress, yoga improves symptoms (Harvard Health).Yoga and meditation-based lifestyle intervention significantly reduced the rate of cellular aging in apparently healthy population. Compared to baseline values, significant improvements were noted in both the cardinal biomarkers of cellular aging and the metabotrophic biomarkers influencing cellular aging After 12 weeks of the intervention (Tolahunase M, et al. Impact of yoga and meditation on cellular aging in apparently healthy individuals: a prospective, open-label single-arm exploratory study. Oxid Med Cell Longev. 2017;2017:7928981).

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI