(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
Over the last couple of weeks, some key issues sprung up in India, decisions on which will influence in a significant way health care and treatments in the country. From insisting on explanations while prescribing antibiotics, to revising the ICU guidelines and revising the current National Essential Diagnostics list for the first time, it has been a notable fortnight, as far as we are concerned.
Primary among these new changes is the Union Health Ministry’s order mandating doctors to write the indication (reason/justification) while prescribing antimicrobials, and directed pharmacists to stop the over-the-counter sale of antibiotics, and sell them only with the prescription of a qualified doctor, as Bindu Shajan Perappadan reports, here. As its own rationale for issuing the order, the Ministry cites the misuse and overuse of antimicrobials, which it said is one of the main drivers of antimicrobial resistance (AMR). Recently, data from the National Centre for Disease Control plunged intensivists into despair as it revealed rampant and broad-based misuse and overuse of antibiotics. For an overview, see this piece from the data team: Over 38% of patients in India were given more than one antibiotic. A timely wake-up call, indeed given that estimated bacterial AMR is directly responsible for 1.27 million global deaths in 2019, while 4.95 million deaths were associated with drug resistant infections.
According to the Ministry’s direction, the change must begin from the medical college itself. It notes that medical colleges not only provide tertiary healthcare in the country but are also hubs for the education of the younger generation of doctors, so this makes it important that doctors at medical colleges set an example of the judicious use of antimicrobials for the next generation of doctors who will face crises in much more severe forms. Pharmacists have been told to implement Schedule H and H-1 of the Drugs and Cosmetic Rules, and sell antibiotics with only one valid prescription. “It is important that doctors mention exact indications on their prescriptions while prescribing antimicrobials,” the communication noted. Naturally enough, this direction was welcomed by doctors, as Siddharth Kumar Singh reported: Directive mandating explanation for antimicrobial prescription lauded.
Another significant story in the health sector this week, was ICMR beginning to revise the current National Essential Diagnostics List, (NEDL) for the first time. While this is a work in progress, this is consultative and hopes to come up to scratch with the latest requirements, and as such is a welcome move. The list contains the minimum diagnostic tests that should be available at healthcare facilities; ICMR asks stakeholders to submit suggestions on the addition and deletion of tests by the end of February. Considerable time has passed, in face aeons, since the first such list was released in 2019, after the WHO recommended that nations develop such an NEDL, to indicate the essential and most basic tests that should be available at various levels of healthcare in the country, including at the village level, in sub-health centres, health and wellness centres, and primary health centres. ICMR has now asked stakeholders to consider factors such as how essential a test is, the disease burden, and the alignment with Indian public health standards before proposing any additional tests to the existing list. It defined essential diagnostic tests as those that satisfy the priority healthcare needs of the population and are selected with due regard to disease prevalence and public health relevance, evidence of efficacy and accuracy, and comparative cost-effectiveness. For more on this, stop by at the link above.
There has been much debate in the country about the Union Health Ministry’s recently released list guidelines that list out criteria for ICU admissions and discharges, the role of intensivists or critical care specialists in the ICU and the patient as well as the family’s right to refuse admission revision of ICU guidelines. If you want to know more, do listen in to Zubeda Hamid talking to Dr. Ram E. Rajagopalan, head of intensive care at Sri Ramachandra Medical Centre in Chennai - What do we know about India’s new ICU guidelines in the In Focus podcast.
Some hopeful news was unveiled this past week, in the health and diagnostics sector. Indian Immunologicals unveiled indigenously developed Hepatitis A vaccine. Currently, Hepatitis A vaccines are being imported by India. IIL’s vaccine, which comes after eight years of work, according to its managing director K. Anand Kumar. It was being rolled out following extensive studies ranging from pre-clinical toxicology studies in animals, phase I trial in human beings to phase 2/3 trials in eight centres involving nearly 500 healthy volunteers across various age groups.
Mini Muringatheri reported on researchers from Kerala identifying a compound from ‘Indian tobacco’ that has the potential to ease Alzheimer’s symptoms. Based on a paper on their study, she wrote that with the help of computational biology, it was discovered that structural modifications to lobeline yielded novel chemical compounds with potential applications against Alzheimer’s. Lobeline was extracted from a plant Lobelia inflata, commonly known as ‘Indian tobacco’.
At a time when the availability of vaccines against COVID-19 has become iffy, there is a great deal of rejoicing over this announcement: COVID vaccine Corbevax gets WHO’s emergency use listing. N. Ravi Kumar reports that 100 million doses of India’s first indigenously developed COVID-19 vaccine based on the protein sub-unit platform, Corbevax, were utilised in pan-India immunisation campaigns, mainly in 12-14-year-old children. Corbevax was approved by the Drugs Controller General of India (DCGI) for restricted use in emergencies among adults, adolescents and young children in a sequential manner from December 2021 to April 2022. Biological E managing director Mahima Datla explained: “The EUL will help us to use the platform to continue developing COVID-19 vaccines as and when it starts impacting public health. We are confident this endorsement from WHO will bolster our global fight against Covid-19.”
This week, an idol was consecrated in a temple in India, and the way these things usually function, spilled over to every other area in the country. Not the least is health care. With the government issuing a half-day holiday for Central Government employees on January 22 in view of the Pran Prathistha of Ram Lalla in Ayodhya, Central Government health institutions also declared a similar holiday, immediately running into a storm of protests on social media and in the courts.
It began with this: AIIMS to run only critical care services till 2.30 p.m. and in the wake of opposition to its move to declare a half-day holiday, AIIMS clarified that critical clinical services will remain open on January 22. Other institutions followed suit: Siddharth Kumar Singh reported that AIIMS Bibinagar would remain shut for half a day on January 22, and NIMHANS declared a half-day holiday on Monday while the Madras High Court allowed Jipmer in Puducherry to be closed for half a day after it gave an understanding that no critical procedures were scheduled for the period, Mohamed Imranulllah recorded.
Meanwhile, of course, there was this as well: Cashing in on the fervour whipped up on the occasion of the consecration, Amit Bhelari reported that Bihar CM Nitish Kumar dedicated a 500-bed hospital named after Lord Ram and goddess Sita in Samastipur.
With just over a week left for the Interim budget, there were a lot of expectations that were articulated via the media. The Healthcare industry, for one, made clear expectations including incentives to promote private investment, R&D, et al. Representatives of the industry sought greater incentives to promote private investment, and sustained incentives for research and development particularly in antibiotic research, while calling for action to address escalating Active Pharmaceutical Ingredient cost, including incentives for domestic manufacturers and a reduction in GST. They have also demanded accelerating growth of bed strength in the country to reach close to the World Health Organization’s mark of 3.5 beds per 1,000 population. This, they believe will be the tool that could deliver effective universal health coverage. For more on the subject, hit the link above.
Turning the gender lens on this week, there were issues concerning the health care of women that we brought to the attention of our readers, including court cases. The right of a woman to decide bearing children is litigated with an annoying frequency in this country. Two such cases also went to the courts this week:
Centre moves Delhi HC to recall order allowing termination of pregnancy. Earlier, the Delhi High Court allowed a widow to terminate her 29-week pregnancy, the appeal urged the court to consider protecting the right to life of the unborn child to allow it a “fair chance of survival”. In another case, Rajasthan HC turned down a minor rape survivor’s plea to terminate pregnancy, on the same ground — that a fully developed foetus also has the right to life and live a healthy life without any abnormalities. It has become routine for such cases to be dragged to court questioning the woman’s agency over her own body, and asserting the might of the State over this basic right, even as debates about the right of the unborn continue.
Afshan Yasmeen reports on a significant study that found that a low dose of calcium supplement taken regularly during pregnancy can reduce the risk of preeclampsia and preterm birth. Provided there was good compliance on the part of the patient, researchers from St. John’s Research Institute and Medical College have found that the required dose of calcium for risk-reduction of preeclampsia in pregnant women could be reduced to 500 mg/day. Pre-eclampsia (PE) is a hypertensive disorder that typically starts after the 20th week of pregnancy, and manifests with an increased blood pressure and the appearance of protein (albumin) in the mother’s urine. The incidence of PE during pregnancy varies from 5% -15% in India. The severe form of preeclampsia is eclampsia, which varies from 0.18% to 3.7 % in India and is characterised by seizures, and even mortality in some cases.
On the occasion of cervical cancer month in January, here is a public information story on the importance of periodic testing for the Human Papilloma Virus. Officials of the health programme in the State of Tamil Nadu are seeing a disturbing trend: Psychological factors emerging as one of the primary risks in maternal deaths, says National Health Mission head for T.N. Shilpa Prabhakar Satish, National Health Mission Tamil Nadu Director, recently said at a meeting in Chennai: “We have come to understand that it is not easy to classify the causes of deaths as just anaemia, or hypertension, or cardiac issues. Psychological factors are involved. Postnatal depression is something we have to talk about.”
In World affairs, horror stories continue from Gaza with Israel escalating Gaza strikes after the medicine-for-aid deal; and Palestinians are dying in hospitals as estimated 60,000 wounded overwhelm remaining doctors, according to the U.N.
Meanwhile, the Union Cabinet approved memoranda on health products with Netherlands, Dominican Republic, Ecuador.
In med-tech, Apple said it would disable the blood-oxygen feature on premium watches sold in the U.S. to comply with a court-ordered revival of a sales ban stemming from a patent dispute, and a Spanish court ruled that a Facebook moderator suffered work-related mental trauma. In interesting global news, Cameroon started the world’s first malaria vaccine program for children.
In our tailpiece for the week, do read Jacob Koshy as he listens to Nobel Laureate David Julius articulate his research on understanding the body’s perception of pain as the key to evolving new drugs. He says: The sensation of pain, while universal, can also be influenced by culture. Though there is progress in understanding new pathways on how pain is processed at a bio-chemical level in the body, the current class of painkillers that consist of opioids and non-steroidal anti-inflammatory drugs (NSAID) will remain the mainstay of treatment for a long time. More on this fascinating subject in the link.
From the Health page
If you have a few extra minutes today, these are some stories you might want to check out:
Global tobacco use tumbles despite industry lobbying, says WHO.
Serena Josephine M. writes about a model that provides all TB services under one roof in Tamil Nadu.
D. Balasubramanian writes on how to deal with memory loss.
IISC study reveals that aging in cells may increase spread of ovarian cancer.
Here is a selection of regional health content as reported over the week:
Andhra Pradesh
Continuing to report on the strike by Anganwadi workers which continues in the State: Health of fasting Anganwadi workers in Andhra Pradesh ‘deteriorating’.
Two fasting Anganwadi leaders shifted to hospital as their health condition deteriorates.
Rajulapudi Srinivas follows up: Security tightened as protesting Anganwadi staff plan ‘Chalo Vijayawada and Tadepalli’ amid prohibitory orders in Andhra Pradesh.
SVIMS creates record by performing multiple transplant surgeries on a single day.
Take steps to control seasonal diseases like dengue and malaria, GVMC Commissioner directs officials in Visakhapatnam.
Delhi
Nikhil M. Babu reports: Don’t deny treatment in any situation, Delhi govt. hospitals told.
After CBI probe, Delhi Government plans to test medicines before distribution.
Unsigned prescription, absent orderlies: how a man died in Delhi without getting hospital admission.
Maharashtra
Purnima Sah elaborates on the Maharashtra Anganwadi workers’ strike: 46 days of asking for more.
Karnataka
Jayanth R. reports that two government medical colleges are to be started in Ramanagara and Kanakapura.
Afshan Yasmeen reports: Cancer mortality sees over 60% rise in last four years in Kidwai Memorial Institute of Oncology.
Health Department sets up COVID helpline; directs officials to ensure decreasing trend is maintained.
Curbing female infanticide: Health Dept. to seek deputation of police officers to PCPNDT Task Force.
Health experts’ suggestions: Strengthen ICUs, mother and child care, and provide additional budgetary grants for general hospitals in Karnataka.
Kerala
M.P. Praveen reports on the travails of the children of migrant workers in Kerala: A poignant struggle to fit in.
Spreading colours of love in the cancer ward of Kozhikode Govt. Medical College Hospital.
Tamil Nadu
Serena Josephine M. writes on how Chennai’s government hospitals are seeing a steady inflow of other State patients.
Tamil Nadu’s IMR dropped to 8.2 per 1,000 live births during April-December 2023, says Minister.
Tamil Nadu spends more on NCD drugs after the Makkalai Thedi Maruthuvam scheme was introduced, says Health Secretary.
Telangana
End-stage kidney patient receives successful treatment by city doctors.
M. Rajeev reports: Medical devices firm SIGH plans to set up manufacturing facility in Hyderabad with ₹231.5 crore.
As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.
