People working in irregular shifts at a higher risk of acquiring Type 2 diabetes

Health Care, Heart Care Foundation of India, Medicine Comments Off

Inculcating healthy eating habits at the outset can help in averting this condition

New Delhi, 15 February 2018: According to a recent study, people working irregular or rotating shifts with usual night shifts were 44% more likely to have Type 2 diabetes. In addition, compared to day workers, all shift workers were more likely to have Type 2 diabetes, except for permanent night shift workers. WHO statistics indicate that the global prevalence of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. The majority of people with diabetes are affected by Type 2 diabetes.

Type 2 diabetes is typically brought on by poor eating habits, too much weight and too little exercise. In this condition, the cells cannot use blood sugar (glucose) efficiently for energy. This happens when the cells become insensitive to insulin and the blood sugar gradually gets too high.

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, “Type 2 diabetes was formerly known as non-insulin-dependent or adult-onset diabetes due to its occurrence mainly in people over 40. However, it is now becoming more common in young adults, teens and children and accounts for roughly 90% of all diabetes cases worldwide. One of the primary reasons for this is the lifestyle people lead today. On-the-go and fast-paced lives mean people skip their breakfast and end up eating unhealthy, quick-fix meals through the remainder of a day. Type 2 diabetes is closely linked to obesity and it’s well–known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.”

Type 2 diabetes is also known as the silent killer. This is because by the time people are diagnosed with the condition, the other health complications of diabetes may already be present.

Adding further, Dr Aggarwal, who is also Group Editor of IJCP, said, “Foods which reduce the risk of Type 2 diabetes such as vegetables, fresh fruit, whole grains and unsaturated fats need to be more affordable and more widely available. Most of all, it is important to start the day with a healthy breakfast as this can help prevent the onset of type 2 diabetes and effectively manage all other types of this condition as well. This will be an important topic of discussion at the 25th Perfect Health Mela to be held this year by the HCFI.”

Here are some tips to manage Type 2 diabetes in young adults.

  • Maintain a healthy weight by exercising every day and consuming a healthy diet.
  • Get your blood glucose levels monitored at regular intervals.
  • Do not consume refined sugar in any form as this can get absorbed into the blood stream more easily and cause further complications.
  • Reduce stress through activities such as meditation and yoga.

Essential medicines should be perennially available

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Only a small fraction of these is available in private pharmacies, says study

New Delhi, 6th February 2018: A recent research has revealed that India lacks access to essential medicines, despite the approval of thousands in an attempt to generate wider availability. It has found that the policy to open up the market has generated a large number of brands of medicines, but there are still not enough available in the pharmacies.

Although multiple brands of selected medicines are listed in professional and commercial databases — running into thousands — only a small fraction is available in private pharmacies. Apart from this, the medicines are also available in fixed dose combinations (FDCs), where two or more drugs are combined in a set ratio in a single dose form, usually a tablet or capsule. There are concerns in India over the safety and effectiveness of these products.

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, “Essential medicines are those that satisfy the priority health care needs of the population. These should be available at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. Essential drugs satisfy the priority healthcare needs of a majority of the community. The NLEM assumes importance in India where out-of-pocket expenditure on health care is quite high and only a few have health insurance.”

The Alma Ata Declaration adopted by the World Health Assembly in 1978 was the first international declaration, a milestone, which brought primary health care to the forefront. It outlined provision of essential drugs as one of the essential components of primary health care. In the same year, the World Health Assembly passed a Resolution urging Member States to establish national lists of essential medicines and adequate procurement systems.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Of the thousands of drugs in the market, as many as 70% are duplicative or ‘me-too’ drugs and hence nonessential. Therefore, it is important to derive a system to facilitate selection of fewer drugs from the numerous that are available. Essential medicines are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectiveness.”

Many criteria are considered to include a drug in the NLEM.

  • The medicine should be approved/licensed in India.
  • The medicine should be useful in disease which is a public health problem in India.
  • The medicine should have proven efficacy and safety profile based on valid scientific evidence.
  • The medicine should be cost effective.
  • The medicine should be aligned with the current treatment guidelines for the disease.
  • The medicine should be stable under the storage conditions in India.
  • When more than one medicine is available from the same therapeutic class, preferably one prototype/ medically best suited medicine of that class to be included after due deliberation and careful evaluation of their relative safety, efficacy, cost-effectiveness.
  • Price of total treatment to be considered and not the unit price of a medicine.
  • Fixed Dose Combinations (FDCs) are generally not included unless the combination has unequivocally proven advantage over individual ingredients administered separately, in terms of increasing efficacy, reducing adverse effects and/or improving compliance

Homeopaths will they risk practicing modern medicine?

Health Care, Medicine Comments Off

The first batch of homeopaths who pursued a year-long certificate course in modern pharmacology is set to pass out from the states medical colleges this year, reported Swatee Kher in TOI Pune on January 23, 2018. The story quotes the instance of a homeopath, who has been practicing homeopathy for almost 25 years and studied for the certificate course in the last year.

The Maharashtra University of Health Sciences (MUHS), Nashik, which was authorized to conduct the course through affiliated colleges, had stated in the information brochure that after acquiring this qualification, homeopathic practitioners will be allowed to use modern medicine in their practice to a limited extent. The one-year course was open to graduates and diploma holders in homeopathy registered with Maharashtra Council of Homeopathy, stated the public relations section of the MUHS in an email response.

The state government had approved the course in 2014, but the decision was challenged in the Bombay high court by the Indian Medical Association. The final court order in the matter is awaited. “Maharashtra is the only state that is offering this course. The first batch has just appeared for the final examination and successful candidates will be able to practice in Maharashtra only,” said Ajit Funde, president, Maharashtra Council of Homeopathy.

During MBBS, the subject of pharmacology is taught in the 2nd Prof, where students learn the basics about various drugs, their mechanisms of action, indications and contraindications of use, adverse effects, interactions among other aspects of drug administration. They are also taught how to write a prescription… though only in a classroom at this point of time. Pharmacology is also an applied science.

During the 3rd Prof, students start to learn the application of principles of pharmacology in the ‘real world’ in patients.

But, a student who has cleared his MBBS is still not allowed to independently write a prescription. He has to wait to complete his internship before he is allowed to write a prescription for a patient.

Except for tincture homeopathy, the principles of homeopathy are very different from those of  modern system of medicine. A homeopath cannot learn everything about modern drugs in a certificate course.

Courses such as this and the ‘bridging course’ as proposed in the NMC Bill, 2017 will only produce half-baked doctors and it will be the patients, who would be the ultimate losers.

Such courses would promote irrational prescribing of drugs, which may cause adverse drug reactions, result in health hazards, most notable being antimicrobial resistance, a major public health problem globally.

The rational use of medicines as described by the WHO is “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”.  Anything contrary to these principles would mean an irrational use of medicine/s.

Irrational prescribing may be of five types: under-prescribing, over-prescribing, incorrect prescribing, extravagant prescribing and multiple prescribing (Pharmacy (Basel). 2016 Dec;4(4):35).

Similarly, off-label use of drugs should be done very carefully and not without the approval of the Ethics Committee. Where will be the check on such practices?

Another likely outcome of such courses would be that homeopaths and other Ayush doctors would have dual registration. Which council will address mistakes? Who decides accountability in case of mishaps or negligence?

Lastly,  the exercise will harm homeopathy as a science. It will abolish over a period of time with the message going that homeopaths cannot  even treat minor ailments.

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

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