About 60% of cancers are preventable

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Awareness generation and switching to a healthier lifestyle are key

New Delhi, 31 January 2018: A recent report indicates that the BRICS grouping of countries — Brazil, Russia, India, China and South Africa — are losing billions of dollars in productivity owing to cancer. India recorded a total productivity loss of $6.7 billion because of cancer, representing 0.36% of our GDP. The costs and logistical difficulties in implementing screening and treatment programmes in the BRICS countries underscore the importance of cancer prevention.

About 40% of cancers in the country (such as lung cancer and cancers of mouth) are caused by tobacco use and another 20% from infections such as hepatitis B that cause liver cancer and human papillomavirus, which can lead to cervical cancer. Cancer cases in India are rising not just because of better diagnostic facilities but also owing to the shift in the way we lead our lives.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “The burden of cancer cases in India is rising. About one million new cases of cancer occur in India every year. The most common cancer among women is breast cancer, while mouth cancer is the commonest cancer among men. About one-third of cancer deaths are related to 5 leading behavioral and dietary risks namely tobacco, high BMI, low fruit and vegetable consumption, lack of physical activity, and alcohol use. Creating awareness becomes especially important as only 12.5 per cent of patients come for treatment in early stages of the disease.”

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected. Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer.

Adding further, Dr Aggarwal, who is also Group Editor of IJCP, said, “We all know that cancer, if detected early, can be treated at a much lower cost compared to that incurred when diagnosed at an advanced stage. Its mortality rate is also lowered substantially if people report for screening when the earliest symptoms manifest. Unfortunately, nearly two-thirds of cancer cases are diagnosed at an advanced stage, reducing patients’ chances of cure and survival.”

Here are some lifestyle changes one can make to prevent cancer.

Avoid using tobacco in any form: Smoking has been linked to various types of cancer — including cancer of the lung, mouth, throat, larynx, pancreas, bladder, cervix and kidney. Chewing tobacco has been linked to cancer of the oral cavity and pancreas.

Consume a healthy diet: A diet rich in fruits, vegetables, and whole grains is important to prevent the risk of cancer.

Maintain a healthy weight: This can lower the risk of various types of cancer, including cancer of the breast, prostate, lung, colon and kidney. Physical activity every day is important to not just reduce weight but also keep fit.

Avoid risky behaviors: Habits such as unsafe sex and sharing needles can lead to infections that, in turn, might increase the risk of cancer.

Its time to revise the ceiling price of coronary stents

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The National Pharmaceutical Pricing Authority (NPPA) fixed the ceiling prices of coronary stents vide a notification dated February 13, 2017, which was valid for one year. This decision is to be revisited now in February 2018.

As per an order dated January 29, NPPA in its meeting to be held on February 5, 2018 in the Conference Room of NPPA will hear all the stakeholders.

On January 30, the NPPA will have met eminent Intervention Cardiologists and on February 5, a meeting is scheduled with AdvaMed, MTal, AIMED, ISMA, AMCCI, AMCHAM. ASSOCHAM, CM, FICCI, PHDCC&I, Multinational stent manufacturing companies, Indian Stent manufacturing companies and ADEH, AIDAN. CAI, ORF, Oxfam India. PHFI.

Apart from the above-mentioned stakeholders, if any formal stakeholder has been left out and wants to put forward its views, they are requested to send an email in this regard to chairman.nppa@nic.in for getting confirmation for the meeting. Only one representative of a stent manufacturing company may be allowed.

In a memorandum dated November 9, 2017, the NPPA asked domestic and foreign stent makers to submit their representations on stent pricing by December 31.  In the same month Abbott Laboratories refused to introduce their latest stent Xience Sierra in India. Earlier in September, it had received permission to withdraw its premium Xience Alpine metallic stents as well as its dissolving stents.

The stent price cap was also discussed at the October 26 US India Trade Policy Forum in Washington DC.

In September, US trade representative wrote to Indian commerce minister and the prime minister’s principal secretary that the policy had created serious problems for US stent makers in India. He also urged India not to extend caps to other devices. The matter was also discussed during Prime Minister Narendra Modi’s visit to Washington in June last year.

Will NPPA succumb to pressure from the imported device industry. Will the Prime Minister’s ‘Make in India’ policy suffer?

Let’s wait… the NPPA stakeholder consultation will decide the fate of ceiling price of stents and whether it will allow new stents in the future at a higher cost.

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

There is need to revisit the views on MCI

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Even one of the largest representative body for physicians, the WMA, is in opposition of the NMC Bill

New Delhi, 30 January 2018: Recently, the World Medical Association (WMA) came out in strong criticism of the Indian government’s plan to dismantle the professional self-governance of Indian physicians. The Association, in a letter to the Chairman of India’s Parliamentary Standing Committee on Health and Family Welfare, has warned that replacing the Medical Council of India (MCI) with the NMC Bill would lead to more Indian doctors leaving the country, affecting patient care.

The letter goes on to say that there is no evidence that the regulation of a profession is better done by the government. There have been various viewpoints on the decision to replace the MCI with the NMC Bill. However, what stands true is the fact that there have been no specific complaints of corruption of any type and magnitude on part of the MCI. The Council has also been denied the mandatory opportunity of hearing, which the principles of natural justice guarantee.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “The WMA is an international and independent confederation of free professional medical associations, and represents physicians worldwide. The very fact that such a large Association is opposed to the idea of handing over the regulatory powers to the hands of the government and supports the MCI is enough to indicate what the actual scenario is. There has been no quantifiable evidence whatsoever of corruption within the MCI, pointing to the need to revisit the idea of replacing the body with a draconian act that will take away professional autonomy from doctors.”

Professional self-governance facilitates professional autonomy and clinical independence. A shift from a democratically elected, autonomously governed body to a politically established and government directed body would be counterproductive for patients and for furthering the development of the medical profession in India.

Adding further, Dr Aggarwal, who is also Vice President of the Confederation of Medical Associations in Asia and Oceania, said, “Even in the presence of a full-time administrator appointed by the Delhi High Court to supervise the MCI’s functioning for a year, there was not a single event pertaining to the functioning of the Council, which could be said to be contrary to the governing rules. Where then does the question of corruption arise? The MCI has been instrumental in bringing out regulations for the benefit of the medical fraternity and students, an example of which is the NEET. It is, therefore, blatant injustice to make it inconvenient and difficult for Indian physicians to survive and practice in their home country by introducing such acts.”

One of the main contentions for replacing the bill was to get a new corruption-free mechanism but the NMC has the potential to breed corruption. The proposed NMC is not representative of the medical profession in India. The MCI has one representative each from state and practicing doctors. With this being taken away, it remains to be seen how the ethics of practicing doctors providing care to 80% of the population can be managed without having representatives from their own tribe.

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