Personal opinion vs official opinion

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Dr KK Aggarwal

As individuals we all have different opinions or viewpoints at the same time on any situation or a particular topic. At times, opinions may overlap when opinions are similar in some ways but not in every way. These are personal opinions.

An official opinion is the opinion of any organization or association i.e. an organized body of authority. It is the collective viewpoint of all members who make up that body and reflects the policy.

The National President or Hony Secretary General of the Indian Medical Association (IMA) usually voice the official stand of the association on any issue. But, they may have their personal opinion too or their own interpretation of a situation or issue.

When they state that this is the opinion of IMA, it has to be based on the collective consciousness of IMA. The opinion of the house has to be unanimous i.e. everyone is in total agreement with the said opinion.

I usually put a viewpoint on an issue/situation in public domain and invite suggestions. Once I receive all suggestions and comments then it becomes IMA’s stand.

All Spiritual and Mind Body blogs that I write are my personal columns and views and do not reflect the stand of IMA on the topics covered therein.

Disclaimer: The views expressed in this write up are entirely my own.

Aao School Chalen: A national project undertaken by IMA

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School health is very important as schools are not just centers that impart formal education, they also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated during childhood. These habits learned during childhood last through to adulthood and all their lives. Moreover, children are naturally inquisitive and keen learners. So, they are both beneficiaries of any health-related activity and agents of change in their family.

To this end, the Indian Medical Association (IMA) has adopted “Aao School Chalen Project” initiated by Delhi Medical Association in the recent past as a National Project. The 5th of every month has been designated for any activity related to this project.

Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be long-drawn talk, but should be a short talk of 10-15 min duration. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records.

We have identified few topics for the coming months and there will be common points for discussion for uniformity.

The first topic for 5th August is “vector-borne diseases”. The 10 uniform messages for first lecture are as follows:

1. Mosquito-borne diseases are preventable and manageable if detected early.
2. Do not allow water to stagnate in or around the houses, particularly in plastic containers.
3. Wear full sleeves clothes during monsoon season.
4. All patients suffering from dengue, malaria, chikungunya, Japanese encephalitis should use bed nets while sleeping.
5. Treatment of malaria should be started early; it can be for 3 days or 14 days depending on the type of malaria.
6. All patients with dengue do not require platelet transfusion.
7. IMA Slogans: “Katwaieyga to nahi” (I hope you will not get me bitten by a mosquito) or “My premises are mosquito-free, you are invited at my premises”.
8. Look for mosquitoes: inside or outside the house; both small and big containers, during day or night; in the room or on the roof; floor or up on the walls; larvae or the mosquito.
9. Let all schools be declared by the principal as being mosquito-free.
10. Let every child speak a slogan: “From now onwards my house will be mosquito free”.

The schedule of the talks is as under:

• 5th September: Lifestyle
• 5th October: Menstruation myths
• 5th November: Health and Hygiene
• 5th December: Substance Abuse

States and Local Branches of IMA are requested to circulate this information to all the members.

Since, this is a national health project, IMA requests all its members to participate to make it a success.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

Rational use of medicines: What does the word ‘rational’ mean?

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As doctors taking care of patients, our guiding principles remain ‘beneficence (act in the best interest of the patient)’ and ‘non maleficence (do no harm)’. Medicines cure, control and prevent disease. Hence, rational use of medicines is a very important aspect of patient care as it impacts patient outcomes.

What does the word ‘rational’ mean? The dictionary meaning of the word ‘rational’ as defined in the Oxford English Dictionary is that which is “based on reasoning or reason” or that which is “sensible, sane and moderate”.

In 1985, the World Health Organization (WHO) convened a Conference of Experts on the Rational Use of Drugs in Nairobi in 1985, which defined the rational use of medicines as “The rational use of drugs requires that patients receive medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and the community”.

The ‘Five Rights’ of safe medication administration by the Institute of Healthcare Improvement also advocate the same: Right patient, Right drug, Right time, Right dose and Right route. Four more ‘Rights’ have been added to this: Right documentation, Right action (reason for prescribing the medication), Right form and the Right response.

So, why is rational use of drug important? Globally, medicines are being overused, underused or misused. Common types of irrational medicine use include:

• Polypharmacy i.e. use of too many medicines in a patient
• Use of antimicrobials, often in inadequate dosage, for non-bacterial infections
• Over-use of injections when oral formulations would be more appropriate
• Not prescribing drugs as per clinical guidelines
• Inappropriate self-medication, often of prescription-only medicines

Irrational use of drugs may cause adverse drug reactions, wastes precious resources and results in health hazards, most notable being antimicrobial resistance, which has now become a major public health problem, one which will leave us practically with no options to treat infections, if not checked in time.

Lack of knowledge or being unaware about drugs and their adverse effects has often been cited as a prime reason for irrational use of medicines, which also has legal implications.

Ignorance therefore is not a defense. Doctors should be aware of the drugs used in the National List of Essential Medicines (NLEM). They should appreciate that drugs included in the NLEM are comparable to non-NLEM drugs; they are also significantly chea

Doctors should also know about the concept of ‘Price to Retailer’ i.e. the price of a drug at which it is sold to a retailer which includes duties and does not include local taxes. This ‘Price to Retailer’ is fixed by the government.

My definition of rational use of medicine is “Optimal drug, optimal duration, minimum time, earliest IV to oral switch and affordable”.

Indian Medical Association (IMA) has launched a series of initiatives in this regard. “Jaroorat Bhi Hai Kya” is one such campaign to promote rational use of drugs and/or rational ordering of investigations and hospitalizations. Off-label use of drugs and/or procedures should be used very carefully and not without the approval of the Ethics Committee. We have planned similar campaigns “Use Wisely not Wildly”, “Will it benefit” and “Think Before you Ink”.

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