Today is Patient Solidarity Day

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Patient Solidarity Day and need for Universal Health care for all

Dr KK Aggarwal
National President-Elect, IMA

In consumer market, the consumer is the most important and in healthcare, a patient is our asset and that too, the most important one. As doctors, we need to lend our ears to his sufferings, practice empathy and not sympathy and be available to him at all times of need. We need to maintain the honor and dignity of the medical profession and treat patients with the same dignity, honor and due respect.

In September 2015, the 194 Member States of the United Nations agreed to develop and put in place practical actions and national frameworks to achieve Universal Health care and other targets, as part of the 2030 Agenda for Sustainable Development (Resolution A/RES/70/1).

On this Patient Solidarity Day (PSD), Saturday 3rd December 2016, the Indian Medical Association (IMA) calls on our members, state and local branches, institutions and stakeholders to support the call for universal health coverage (UHC) for all. UHC can be defined as affordable, high-quality and accessible healthcare for everyone

Sustainable, patient-centered UHC will need significant efforts and firm commitment over the next 14 years from the key actors in the healthcare system: governments, the pharmaceutical industry, healthcare providers and patients’ organizations.

Patient-centered UHC means that all people receive the health services they need, without suffering financial hardship.

The following are the core principles of universal health coverage

• Accessibility: All patients have the right to access the healthcare they need and when they need it.
• Patient-centeredness and equity: All people, regardless of disease or condition; age, gender, race or ethnic background; sexual orientation; geographic location; socio-cultural background, economic or legal status, must have fair and impartial access to quality healthcare.
• Choice and empowerment: All patients have the right to know about the healthcare services that are available. Patients must be able to be meaningfully involved in healthcare decision-making in a variety of ways at the local, national, regional and global level.
• Quality: It is not enough for all patients to have access to healthcare. Provision needs to be safe, of the highest attainable standard and include a commitment to learning and improvement. Patients need to define what constitutes quality in healthcare.
• Partnership and collaboration: Patients have a moral and ethical right to play a meaningful role at all levels; in health and in other areas that can have an impact on health and wellbeing.
• Sustainability and the value of healthcare: All stakeholders need to recognize the value of healthcare when considering investing in universal health coverage.
• Accountability and transparency: Accountability and transparency are vital to delivering safe, effective and affordable healthcare. All stakeholders need to be held accountable on commitments they have made to implement universal health coverage, and be accountable to the patients that they serve.

IMA initiative: Key messages

• Leave no-one behind.
• UHC is only truly patient-centered when health services are universally accessible, affordable, and of high quality.
• IMA members to take responsibility for implementing robust national frameworks and appropriate measures to achieve patient-centered UHC.
• Healthcare stakeholders to be held accountable for their commitments to achieve UHC.
• Collaborative decision-making, based on genuine patient involvement, is key to ensuring that no-one is left behind.

As a board member of PSM (Partnership for Safe Medicine), both myself and IMA are committed to the patients.

I will be taking over as the National President IMA on 28th December and have included the important issues of ‘Patient Safety’ and ‘Patients’ Rights’ in my agenda.

IMA will be closely working with Bejon as an advisor and PSM to take this forward.

I am sorry I will not be able to join you all in Varanasi due to viral fever. But, I wish the event all success.

(Speech at Varanasi, on the occasion of Patient Solidarity Day, Organized by PSM India)

Delhi High Court sets aside Centre’s decision to ban 344 fixed dose combination medicines Dec 1, 2016

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The Delhi High Court has set aside the Centre’s decision to ban 344 fixed dose combination (FDC) medicines, including well-known brands like Corex cough syrup, Vicks Action 500 Extra and D’Cold, reports TOI.

The court gave the order after hearing arguments of companies like Pfizer, Glenmark, Procter and Gamble and Cipla, the central government and some NGOs like All India Drug Action Network (AIDAN).

The court had on March 14 stayed the Centre’s March 10 ban on 344 FDC drugs and this interim order was passed in each and every case filed before it thereafter.

According to the drug companies, the government has not properly implemented the powers under section 26A (power to prohibit manufacture of drugs and cosmetics in public interest) of Drugs and Cosmetics Act, under which the ban was ordered. The ban order was passed without considering clinical data and the grounds that safer alternatives were available. The government had banned over 300 FDC drugs on the ground that they involve “risk” to humans and safer alternatives were available.

As per the March 10 notification, “On the basis of recommendations of an expert committee, the central government is satisfied that it is necessary and expedient in public interest to regulate by way of prohibition of manufacture for sale, sale and distribution for human use of said drugs in the country.”

The Centre had argued that the FDC medicines are “new drugs” and thus, require licence from Drugs Controller General of India (DCGI) for sale and manufacture. Also there were no valid licences for making any of the banned FDCs and added it was difficult to implement any action at state level. However, it had also said that the lack of approval for these FDCs were a secondary issue and the primary focus was that they “lacked safety and efficacy” and thus, “ban was the only answer”. According to them, the banned FDCs had no “therapeutic justification”.

AIDAN, argued that there were nearly 40,000 FDC drugs in Indian market and since the regulatory control over such medicines was allegedly “illusory”, the Centre’s decision to ban some of them “was the only move”.

IMA View

IMA is only concerned with safety and quality of a drug. The job of DCGI is to maintain both. If the DCGI cannot take the guarantee of the quality and safety of any drug, how will doctors treat patients?

In Malay Kumar Ganguly vs Sukumar Mukherjee & Ors on 7 August, 2009, the Supreme Court of India relied on the drug package insert, which is always cleared by the DCGI.

DCGI should either challenge the order or label these combinations as safe drugs.

50 Facts on HIV/AIDS

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Today is World AIDS Day

1. AIDS is caused by the human immunodeficiency virus (HIV), which damages the immune system, lowering the resistance of the body to fight off infections.
2. AIDS is the advanced stage (stage 4) of HIV infection.
3. Progression from HIV infection to AIDS, if untreated, may take 8-10 years. In young children, it usually develops much faster.
4. HIV-positive people may remain asymptomatic but can still pass on the virus to others.
5. 78 million (69.5 million–87.6 million) people have become infected with HIV since the start of the epidemic (end 2015). 6. 35 million (29.6 million–40.8 million) people have died from AIDS-related illnesses since the start of the epidemic (end 2015).
7. 36.7 million (34.0 million–39.8 million) people globally were living with HIV (end 2015).
8. 1.1 million (940 000–1.3 million) people died from AIDS-related illnesses (end 2015).
9. 2.1 million (1.8 million–2.4 million) people became newly infected with HIV (end 2015).
10. 18.2 million (16.1 million–19.0 million) people were accessing antiretroviral therapy (June 2016)
11. People with HIV are at risk of developing active TB disease.
12. Transmission of HIV/AIDS can be prevented.
13. HIV spreads through unprotected sex with an HIV–positive person.
14. HIV spreads through transfusions of unscreened (HIV–positive) blood.
15. HIV can spread from an infected woman to her child during pregnancy and childbirth.
16. HIV infection can be passed from a mother to her child through breastfeeding.
17. HIV spreads by unsterilized infected needles or syringes, especially those used for injecting drugs.
18. Used infected razor blades, knives or tools that cut or pierce the skin also carry some risk of spreading HIV.
19. Touching, hugging, shaking hands, coughing and sneezing will not spread the virus.
20. HIV/AIDS cannot be transmitted through toilet seats, telephones, plates, glasses, eating utensils, towels, bed linen, swimming pools or public baths.
21. Up to 70 % of partners of people with HIV are also HIV positive.
22. Practicing safe sexual behaviors such as using condoms prevents HIV transmission.
23. All pregnant mothers should get HIV test done.
24. A blood test is the most accurate way to tell if someone is infected with HIV.
25. Most tests for HIV/AIDS check for the presence of antibodies to the virus.
26. If the result of an HIV/AIDS test is negative, this means the person tested is not infected or it is too early to detect the virus.
27. Infection may not be detected up to the first few weeks to few months.
28. Even if the first test is negative, the test should be repeated 6 months after any possible exposure to HIV infection.
29. The time period when an infected person does not test as HIV positive is called ‘window period’.
30. All people, including children, are at risk for HIV/AIDS, including occupational risk.
31. People who have a sexually transmitted infection (STI) are at greater risk of getting HIV and of spreading HIV to others.
32. Persons suffering from STIs have a 5–10 times higher risk of becoming infected with HIV if they have unprotected sexual intercourse with an HIV–infected person.
33. If both partners are not treated for a STI, they will continue infecting each other with the sexually transmitted infection.
34. The more sex partners people have, the greater the risk that one of them will have HIV/AIDS and pass it on.
35. Antiretroviral therapy (ART) should be started at the earliest to prevent HIV transmission to sexual or drug using partner/s or from the mother to the infant during pregnancy or breastfeeding.
36. People with STIs should seek prompt treatment and avoid sexual intercourse or practice safe sex.
37. Men with HIV are less likely to be diagnosed and put on ART and are more likely to die of HIV-related causes than women.
38. Internal secretions, which can harbor HIV virus, are blood (including menstrual blood, semen, vaginal secretions, breast milk, peritoneal fluid, brain fluid, pleural lung fluid, pericardial heart fluid etc. These secretions, when mixed with secretions of another person infected with HIV transmit HIV.
39. External secretions, which do not harbor the HIV virus are saliva, tear, sweat, urine and feces. The mixing of these secretions with secretions of an HIV-positive person does not transmit HIV.
40. HIV does not spread by mosquitoes or other insects.
41. HIV counseling and testing can help in the early detection of HIV infection, to get the support services for those who are infected.
42. Counseling helps to manage other infectious diseases they might have, and learn about living with HIV/AIDS and how to avoid infecting others.
43. Counseling and testing can also help those not infected to remain uninfected through education about safer sex.
44. Pre-exposure prophylaxis with tenofovir-emtricitabine in high risk patients and who are committed to medication adherence and close follow-up can reduce the risk of HIV infection by 48 to 75%.
45. Drinking alcohol or taking drugs interferes with judgment. Even those who understand the risks of AIDS and the importance of safer sex may become careless after drinking or using drugs.
46. Young people need to be educated that there is no vaccination and no cure for HIV/AIDS.
47. WHO recommends innovative HIV-self-testing and partner notification approaches to increase HIV testing services among undiagnosed people.
48. Prevention is the only protection against HIV/AIDS.
49. ABC for safe sex: Abstain, Be faithful to your partner and if you cannot, use Condoms.
50. 90–90–90 is a treatment target to help end the AIDS epidemic. By 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.

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