Morning MEDtalks with Dr KK Aggarwal 14^th September 2018

TEDx Video: Doctor-patient relationship: 

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

The Ministry of Health and Family Welfare has prohibited the manufacture for sale, sale or distribution for human use of 328 Fixed Dose Combinations (FDCs) with immediate effect. It has also restricted the manufacture, sale or distribution of six FDCs subject to certain conditions.

The Drugs Technical Advisory Board recommended, amongst other things, that there is no therapeutic justification for the ingredients contained in 328 FDCs and that these FDCs may involve risk to human beings. The Board recommended that it is necessary to prohibit the manufacture, sale or distribution of these FDCs under section 26 A of the Drugs and Cosmetics Act, 1940 in the larger public interest. With regard to six FDCs, the Board recommended that their manufacture, sale and distribution be restricted subject to certain conditions based on their therapeutic justification. Fifteen FDCs out of the 344 prohibited on the 10th March, 2016, which were claimed to be manufactured prior to 21stSeptember, 1988, have been kept out of the purview of current notifications… (Press Information Bureau, Ministry of Health and Family Welfare, September, 12, 2018)

Women with even mild cases of untreated gestational diabetes have a higher risk of developing prediabetes or type 2 diabetes later in life, research released this week suggests. The study, published in September 2018 in the Journal of the American Medical Association, also found that their children had a higher risk of being overweight or obese compared with children of mothers who did not have gestational diabetes. 

As many as one in three hospitalizations and deaths related to cardiovascular events in 2016 involved adults in middle-age — between the ages of 35 and 64 — yet up to 80% of the events were preventable, new findings from the Centers for Disease Control and Prevention (CDC)s Million Hearts 2022 initiative suggest.

Nearly 800,000 people commit suicide every year in the world, the second leading cause of death amongst people aged 15-29 in 2016, according to the WHO. 

A new systematic review and meta-analysis published online September 5 in the BMJ has found that at best, prostate cancer screening using a PSA blood test leads to a small reduction in disease-specific mortality over 10 years, but it is no effect on overall mortality.

All India Organisation of Chemists and Druggist (AIOCD), announced that they plan to strike on September 28 to oppose online sale of medicines. "We are observing one day strike on Friday, September 28 to protest against any move by the government allowing sale of medicines through internet or allowing e-pharmacies to operate in India in any form," AIOCD said in a statement. If the government does not consider our appeal positively then AIOCD shall not have any option but to go for nationwide indefinite agitation against online sale of medicine, AIOCD president JS Shinde said… (PTI, Sept. 11, 2018).

"In patients with E. coli or K. pneumoniae bloodstream infection and ceftriaxone resistance, noninferiority of piperacillin-tazobactam for the primary outcome of 30-day mortality could not be demonstrated when compared with meropenem," Patrick Harris, MBBS, from the University of Queensland, Brisbane, Australia, and colleagues report. "These findings do not support use of piperacillin-tazobactam in this setting," they conclude. The study was published online September 11 in JAMA.

Can a doctor advertise to solicit patients? (Dr KK Aggarwal and Advocate Ira Gupta) No, it is unethical for doctors to advertise in order to procure patients. The physician or the medical practitioner cannot advertise his medical practice which has the effect of advertising himself or soliciting practices.

• As per the provisions of Clause 6.1.1 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, soliciting of patients directly is unethical. Further, as per the provisions of Clause 6.1.1 of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, the medical practitioner is only allowed to make formal announcement in the press about his starting practice, change of type of practice, change in address, etc. and nothing else.

• Also, as per the provisions of Clause 6.1.2 of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, printing of self-photograph, or any such material of publicity in the letter head or on sign board of the consulting room or any such clinical establishment is regarded as acts of self-advertisement and unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of human system is not treated as unethical.

• Further as per the provisions of Clause 7.11 of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, the physician is not allowed to contribute to lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices.

The Food Safety and Standards Authority of India (FSSAI) on Friday declared Kankaria Lake area in Ahmedabad as country’s first ‘clean street food hub’. In the next one year, the food regulator hopes to designate 150 such streets across the country. The parameters include best practices for garbage disposal, maintaining personal hygiene, demarcating cooking and non-cooking area, working street lights, pest control and overall cleanliness among other things… (HT-FSSAI, Sept. 8, 2018)

Alexandra Rouquette, MD, PhD, Paris-Saclay University, France and colleagues have identified "bridge symptoms" in childhood that could be central indicators of anxiety or depressive disorders in later life. They discovered that bridge symptoms, such as irritability and rejection, were associated with the development of anxiety disorders or major depression in early adulthood. They noted that several mental disorders are among the top 20 causes of global disease burden (August 15 in JAMA Psychiatry).

For urge incontinence, you can try timed voiding (urinating on a schedule) and bladder guarding, which teaches you to cope with triggers that set off the urge to go, such as washing dishes or hearing the sound of water. You squeeze your muscles to hold in urine before a trigger, which sends a message to the brain that this is not the time to go. Other lifestyle changes include watching fluid intake; quitting smoking, to reduce coughing and pressure on the bladder; and minimizing bladder irritants such as caffeine, alcohol, and carbonated drinks.

Dr KK AggarwalPadma Shri AwardeeVice President CMAAOPresident HCFI