December 17   2015, Thursday

Dr KK AggarwalDr KK Aggarwal Social Science Textbook for Class 7, Social and Political Life-II

Chapter-2: Role of the Government in Health

Report of the changes (pages 22, 23, 24, 26, 29 and 122)

Page 22: (storyboard)

Last paragraph, last line: "He prescribed…. Replace "lots of" with some,

Page 23: (Last panel in the storyboard)

My hospital was nice, but they gave me too many medicines and the whole thing cost more than Rs. 3,500/-
My hospital was nice, but they gave me many medicines and the whole thing cost quite a lot
That much! My treatment cost just Rs. 150/-
Oh! My treatment did not cost much!

Page 24: (Change the sequence of the questions in the left column) 1. Where do you go when you are ill? Are there any problems that you face? Write a paragraph based on your experience

2. What problems did Aman face in the government hospital? How do you think the hospital can work in a better manner? Discuss

3. Why did Ranjan have to spend so much money? Give reasons.

4. What problems do we face in private hospitals? Discuss.

Page 26: Delete the following workd in the paragraph beginning with "In India…

"As these services are run for profit"
"In order to earn more money, these private services encourage practices that are incorrect. At times cheaper methods, though available, are not used. For example, it is common to find doctor5s prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicine can suffice" (45 words)
Some private services encourage incorrect practices to earn more. At times inexpensive alternatives, though available, may not be used. For example, some medical practitioners are found to prescribe superfluous medicines, injections or saline when simple medications may suffice (42 words)

The following box and the question are to be included in the left column on page 26.
The Medical Council of India’s code of Medical Ethics states: "Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs."

How can healthcare be made more affordable? Discuss.

Page 29: Replace the existing table with a new table

Glossary: Include the following terms:
Ethics: Moral principles that influence a person’s behavior
Generic names: These are Chemical names of the drugs. They help in identifying the ingredients. They are globally recognized. For example, acetyl salicylic acid is the generic name of Aspirin.
Profit: An activity or service that is organized by an individual or company for their own profit.
Profit: An activity or service that is organized by an individual or company for their own gain.

Page 122: (References): Include the following:

• Medical Council of India,

• Supreme court of India, Paschim Banga Khet Mazdoor Samity & Ors. Vs State of West Bengal and Anr. (Hakim Seikh case, date of judgement: 6 May, 1996,

• World Health Organization, Essential medicine and health products,
This is to inform you that the matter titled as Indian Medical Association versus UOI (NCERT) was listed for hearing today i.e. 16.12.2015 before the Hon’ble High Court of Delhi. Mr. Rahul Gupta, Advocate appeared and argued the said matter on behalf of Indian Medical Association and had duly submitted before the Hon'ble Court that IMA has certain objections as mentioned in the affidavit filed on behalf of IMA. The counsel appearing on behalf of NCERT has given his consent for the changes as requested by IMA. The amended / revised text of the school book is attached herewith. In view of the said changes / amendments the above matter/case is disposed of.
WMA Welcomes Recognition Given to Health in New Climate Deal

(12.12.2015) Commenting on today’s climate change agreement, Dr. Xavier Deau, Immediate Past President of the World Medical Association said:

‘Today’s ambitious agreement gives us hope that the world’s governments now recognise the serious consequences for health as a result of climate change and the urgent need for global climate action. The final Paris agreement establishes an unprecedented framework to transition away from our carbon–intensive economies and towards protecting health from the devastating effects of climate change.

‘We particularly welcome recognition in the agreement that governments should, when taking action to address climate change, respect, promote and consider their respective obligations on human rights and the right to health of the whole population.

‘It is now vital that the global community works to strengthen health systems. Tackling social inequalities in health, particularly in the developing world, and tackling climate change must go hand in hand. Physicians around the world will continue to support action on climate change to ensure that governments are held accountable to today’s promises.’
Breaking News

Pilot Project Raises Diabetes Awareness in Brazil and India

A school-based educational program piloted in Brazil and India has raised awareness about diabetes and diabetes prevention among children, parents, and school staff. The Kids and Diabetes in Schools (KiDS) project is administered by the International Diabetes Federation and funded by Sanofi Diabetes. Brazil has the fourth-largest population of adults with diabetes in the world, at 14.3 million, and the third-highest number of children with type 1 diabetes, at 30,900. India is number 2 on both measures, with 69.2 million adults with diabetes and 70,200 kids with type 1 diabetes, respectively. Materials are available free at, with separate information packs for teachers, parents of a child with diabetes, parents of school-aged kids without diabetes, and for children aged 6 to 14 years, with or without diabetes… (Medscape)

New Guideline for diagnosis of Fetal Alcohol Spectrum Disorder

A new Canadian guideline for diagnosing fetal alcohol spectrum disorder (FASD) updates recommendations last issued in 2005 and is specifically designed for multidisciplinary diagnostic teams. The guideline, published online December 14 in the Canadian Medical Association Journal, includes a change in terminology. Previously, the cluster of birth defects (including restricted growth, craniofacial abnormalities, and intellectual disabilities) caused by prenatal exposure to alcohol was known as fetal alcohol syndrome (FAS). The new terminology includes a wider spectrum of disabilities and presentations... (Medscape)
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Specialty Updates
• Herpes zoster is linked to increased rates of acute cardiovascular events such as ischemic stroke and myocardial infarction, or heart attack, suggested new research published in PLOS Medicine.

• A new study, published in the Journal of Health and Social Behavior, revealed that women who had their first child between the age of 25-35 reported better health at the age of 40 than those who had their first child as a teenager (15–19) or in early adulthood (20-24).

• The interaction of two appetite hormones, leptin and ghrelin, may prove key to developing new drugs to treat alcohol use disorder (AUD), suggests a new study presented at the American Academy of Addiction Psychiatry (AAAP) 26th Annual Meeting.

• Breast cancer patients treated with trastuzumab had significantly lower risk for left ventricular (LV) dysfunction and consequent treatment interruptions when treated prophylactically with heart failure medications, suggests new research presented at San Antonio Breast Cancer Symposium (SABCS) 2015.

• Smoking high-potency cannabis may cause white matter damage in the corpus callosum, thus interfering with communication between the right and left hemispheres of the brain, suggests new research published online in Psychological Medicine.

• A new study, published in the journal Preventing Chronic Disease, revealed that employees enrolled in a workplace intervention program as a group lost more weight, showed greater reductions in fasting blood sugar and ate less fat than employees who received only written health guidelines for diabetes prevention.

• Active individuals who enjoy participating in higher impact activities may need to maintain higher vitamin D levels to reduce their risk of stress fractures, suggests new research published in The Journal of Foot & Ankle Surgery.

• Central venous pressure (CVP)–guided fluid administration before, during, and after coronary angiography can significantly reduce the risk of contrast-induced nephropathy (CIN) and major adverse clinical events compared with standard protocols, suggests a new study published online in JACC: Cardiovascular interventions.
The Five Interior Powers

To be in a state of happiness, bliss and ananda is what the ultimate goal of life is. Everybody is born with certain inherent powers, which if cultivated in the right direction will lead to inner happiness.

The ancient Shiva Sutra text talks about the concept of Shiva and Shakti. Shiva is silence, Shakti is power; Shiva is creativity, Shakti is creation; Shiva is love, Shakti is loving.

In computer terminology, Shiva is the knowledge or the information and Shakti is the operational software. Shiva and Shakti both together form consciousness, in other words, the soul. The Shiva sutra – teaching about Shiva – describes five inherent powers of Shakti which everybody is born with. These are "Chitta Shakti", "Ananda Shakti", "Gyan (Gnana) Shakti", "Ichha Shakti" and "Kriya Shakti". Kriya Shakti is the one which is most visible. Kriya is not same as karma. Karma is action born of cause and effect. Kriya Shakti is at the level of body and mind.

Ichha Shakti is the inherent desire, which controls the mind. Gyan Shakti is the inherent desire to learn and is at the level of intellect. Both Ananda and Chitta Shakti are at the level of consciousness and represent the desires or aim to be blissful.

These five powers also decide the needs of a person, which can be at the level of physical body, mind, intellect, ego or the soul. The needs activate the Shakti which in turn leads to action. The purpose of life should be to direct the needs and the Shaktis towards the soul and not towards the ego. The power of Kriya Shakti should have all the actions directed towards the soul; Gyan Shakti should be directed towards the knowledge of the true self; Ichha Shakti towards the desire or intention to unite with the self; Anand Shakti and Chitta Shakti towards the awareness of God and to experience the bliss of God.

All thoughts, speech or actions in life should be directed on two basic goals: providing happiness to others and achieving self-happiness. Every action and relationship in life should involve these five powers to attain inner happiness. Most computers in the body require a key to get activated and the key in the case of Shakti is “intention or intent”. Intentions are something, which are under the control of a person, or one can practice control over them.

"Intention" always requires the association of its buddy "attention" with it. Attention is the focus of action on that particular intention. The combination of intention and attention can change perceptions of life and ultimately change the reality. It has been an old Upanishad saying that you are what your thoughts are. Right intention leads to the right thought; the right thought to right action; the right action to the right habit; the right habit to the right character and the right character leads you to what you are. The punch–line, therefore, is to have right intention which should be directed towards one of the five Shaktis to acquire spiritual well–being. Health is not mere absence of disease but a state of physical, mental, social, environmental and spiritual well–being. Spiritual well–being now has been added as the fifth dimension of the health. It has been said that the body is the largest pharmaceutical armamentarium in the world and has the capacity to produce each and every drug available in the universe. This is based on the fact that no drug can go into the body without a receptor. The very fact the body has a receptor for every drug means it has the capacity to produce that drug.

All yogic paths to liberation are also directed towards these Shakti. One adopts the path of karma by activating Kriya Shakti, Gyan Marg by activating Gyan Shakti and Bhakti Marg by activating Ichha Shakti. Faulty lifestyle also involves distractions of three of these powers: Ichha, Gyan or Kriya Shakti.

Correct lifestyle involves the correct use of Kriya Shakti in doing actions, correct use of Gyan Shakti by acquiring knowledge about self and healthy behavior and correct use of Ichha Shakti by learning the dos and don’ts of life and controlling the mind towards various addictions of life, which can be addition of food, sex, drugs, alcohol, smoking, sleeping, not walking and or eating faulty Rajsik cum Tamsik high refined carbohydrate diet

Legal Quote
Indian Medical Association Vs. V.P. Shantha & Ors 1996 AIR 550, 1995 SCC (6) 651

In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services.
The Year in Medicine 2015: News That Made a Difference
Psychotropics, analgesics linked to increased risk for homicide

People taking psychotropic medications have a significantly increased risk for homicide, new research shows. Jari Tiihonen, MD, PhD, professor, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, and colleagues found that antidepressants increase the homicide risk by 31% and that benzodiazepines increase the risk by 45%. The use of opiate and nonopiate analgesics was associated with a two- and threefold increased risk for homicide, respectively. Antipsychotics were not associated with an increased homicide risk, the study found. Benzodiazepines can weaken impulse control, Dr Tiiohnen explained. Also, according to earlier research, painkillers affect emotional processing. (Medscape)
Table 2. 2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Organ System, Therapeutic Category, Drugs
Quality of Evidence
Strength of Recommendation
First-generation antihistamines
Diphenhydramine (oral)
Highly anticholinergic; clearance reduced with advanced age, and tolerance develops when used as hypnotic; risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity Use of diphenhydramine in situations such as acute treatment of severe allergic reaction may be appropriate
Antiparkinsonian agents
Benztropine (oral)
Not recommended for prevention of extrapyramidal symptoms with antipsychotics; more-effective agents available for treatment of Parkinson disease
Atropine (excludes ophthalmic)
Belladonna alkaloids
Highly anticholinergic, uncertain effectiveness
Dipyridamole, oral short-acting (does not apply to the extended-release combination with aspirin)
May cause orthostatic hypotension; more effective alternatives available; intravenous form acceptable for use in cardiac stress testing
Safer, effective alternatives available
Potential for pulmonary toxicity, hepatoxicity, and peripheral neuropathy, especially with long-term use; safer alternatives available
Avoid in individuals with creatinine clearance <30 mL/min or for long-term suppression of bacteria
Peripheral alpha-1 blockers
High risk of orthostatic hypotension; not recommended as routine treatment for hypertension; alternative agents have superior risk-benefit profile
Avoid use as an antihypertensive
Central alpha blockers
Reserpine (>0.1 mg/d)
High risk of adverse CNS effects; may cause bradycardia and orthostatic hypotension; not recommended as routine treatment for hypertension
Avoid clonidine as first-line antihypertensive Avoid others as listed
Disopyramide is a potent negative inotrope and therefore may induce heart failure in older adults; strongly anticholinergic; other antiarrhythmic drugs preferred
Worse outcomes have been reported in patients taking dronedarone who have permanent atrial fibrillation or severe or recently decompensated heart failure
Avoid in individuals with permanent atrial fibrillation or severe or recently decompensated heart failure
Use in atrial fibrillation: should not be used as a first-line agent in atrial fibrillation, because more-effective alternatives exist and it may be associated with increased mortality
Avoid as first-line therapy for atrial fibrillation
Atrial fibrillation: moderate
Atrial fibrillation: strong
Use in heart failure: questionable effects on risk of hospitalization and may be associated with increased mortality in older adults with heart failure; in heart failure, higher dosages not associated with additional benefit and may increase risk of toxicity
Avoid as first-line therapy for heart failure
Heart failure: low
Heart failure: strong
Use in heart failure: questionable effects on risk of hospitalization and may be associated with increased mortality in older adults with heart failure; in heart failure, higher dosages not associated with additional benefit and may increase risk of toxicity
Avoid as first-line therapy for heart failure
Heart failure: low
Heart failure: strong
Amiodarone is effective for maintaining sinus rhythm but has greater toxicities than other antiarrhythmics used in atrial fibrillation; it may be reasonable first-line therapy in patients with concomitant heart failure or substantial left ventricular hypertrophy if rhythm control is preferred over rate control
Avoid amiodarone as first-line therapy for atrial fibrillation unless patient has heart failure or substantial left ventricular hypertrophy
Nifedipine, immediate release
Potential for hypotension; risk of precipitating myocardial ischemia

Source: Medscape
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
One doctor available for every 1,681 persons in country

There is one doctor available for every 1,681 persons in the country. However, if allopathic and AUM (ayurvedic, unani and homeopathic) streams are considered together, then the doctor population ratio stands at 1:893. In a reply in Rajya Sabha, Union Health Minister JP Nadda said that as on June 30, 2015, there were 9,59,198 doctors registered with the State Medical Councils and the Medical Council of India. "Assuming 80 per cent availability, it is estimated that around 7.67 lakh doctors may be actually available for the active service. It gives a doctor-population ratio of 1:1681," he said. Besides, there are 6.77 lakh AUM doctors in the country, the minister said, adding if allopathic and AUM are considered together, "it gives a doctor population ratio of 1:893". To augment the availability of doctors in the country, he said the government has taken various measures such as relaxation in the norms for setting up a medical college, strengthening or upgradation of existing state and central government medical colleges to increase MBBS seats, and establishment of new medical colleges by upgrading district/referral hospitals preferably in underserved districts of the country… (ET Healthworld)
WHO calls for focused, accelerated efforts to prevent and reduce newborn deaths

Nearly 7400 newborns die every day in the WHO South–East Asia Region causing untold misery to mothers and families. Two-thirds of these deaths can be prevented by adopting proven and cost-effective measures, World Health Organization said seeking focused efforts by governments and partners to prevent newborn deaths with a sense of urgency. Led by WHO; UNICEF, UNFPA, World Bank, UNAIDS and UNWOMEN pledged to jointly support the countries in the Region to prioritize accelerated reduction in newborn deaths by ensuring equitable access to essential life-saving interventions for mothers and babies across the Region…(WHO)
C. difficile infection mimics inflamed bowel

A Clostridium difficile infection can be particularly difficult in patients with inflammatory bowel disease (IBD). Even testing for infection can be a problem. Speaking at the Crohn’s and Colitis Foundation of America Advances in Inflammatory Bowel Diseases Conference, Alan Moss, MD said, "Although it is easy for infectious disease physicians to identify the typical symptoms of diarrhea associated with C difficile, they also overlap with most of the symptoms of an IBD flare. About 7% of patients hospitalized for an IBD flare are found to be C diff–positive. PCR is an excellent, extremely sensitive test for C diff infection if you don't have IBD. But if a patient has ongoing IBD and has had a couple of infections, it is very hard to determine whether the symptoms are caused by colonization or a new infection … (Medscape)
Cancer rates on the rise in lower-income countries

According to a new study, many low-and middle-income countries have seen cancer rates rise, partially due to increases in risk factors that are typical of Western countries. Improved screening and detection efforts, combined with decreases in risk factors like smoking, have reduced the incidence and mortality rates from several common types of cancer in many high-income countries. The findings are published in the journal Cancer Epidemiology, Biomarkers and Prevention… (ET Healthworld)
Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

Smita N Deshpande
Head, Dept. of Psychiatry, De–addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse- a doctor- as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):

Responses received

Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar
Can one drive after one peg of alcohol?

Several studies have confirmed that consuming one or two drinks increases the risk of injury. No safe level of alcohol use exists for the use of potentially dangerous equipment. Exposure to alcohol is measured in blood alcohol concentration (BAC) rather than drinks per day or week. BACs of 0.02 to 0.05 percent impair the ability to operate motor vehicles; this level of blood alcohol can occur with even a single drink. The legal BAC limit for driving is 0.03 percent. This corresponds to approximately four drinks for a 200 pound man, but only 2.5 drinks for a 150 pound woman.

1. The risk of involvement in a collision while driving doubles at a BAC of only 0.05 percent.
2. Simulated driving ability is impaired with BACs as low as 0.02 percent.
3. The risk of driving accidents is greatest in the first two years of exposure to alcohol.
4. For pilots the BAC offense level is 0.04 percent.
5. Alcohol is involved in one–half to two-thirds of all homicides, at least one-half of serious assaults, and more than one-quarter of all rapes.
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
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Inspirational Story
A harsh word

A woman bought eggs and butter from a farmer who had a fine reputation not only for the quality of his products, but also for his promptness of delivery. Then one day, when she was expecting guests, he failed to come. On the next delivery, she spoke harshly to him. At the end of her tirade he said quietly, "I'm sorry if I caused you any inconvenience, but I had the misfortune of burying my mother yesterday." Ashamed, the woman determined never to speak harshly to anyone again until she fully understood the cause of the delay. Often we never care for other travails and traumas. Like a frog in the well, our feelings remain confined to our milieu. Even a farmer has his own priorities. Sometimes, we do not empathize with others. What if we had been stricken with some tragedy and someone callously chastised us.
Olfeck's phenomenon is seen due to which component

a. Joint psoriasis
b. Mucosal psoriasis
c. Nail psoriasis
d. Pustular psoriasis

Yesterday’s Mind Teaser: Isotopic response is seen in scars of which condition

a. Orolabial herpes
b. Herpes genitalis
c. Pyoderma gangrenosum
d. Eosinophilic pustular folliculitis

Answer for Yesterday’s Mind Teaser: c. Pyoderma gangrenosum

Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, VISWANATHA SARMA, Dr K Raju, Dr Avtar Krishan.

Answer for 15th December Mind Teaser: d. Epitope spreading phenomenon

Answers received from: Dr Bitaan Sen & Dr Jayashree Sen, Dr K V Sarma, Dr Kailash Chandra Sharma, Dr K Raju.
Readers column
Dear HSG, very good move from IMA. We should safeguard or professional dignity, only IMA can do it. Wish all success and we are behind you, so go ahead with professional issues. Dr. Alex Franklin
It was out anniversary and I asked my wife where she wanted to go, she said: "Please take me somewhere I’ve never been before" So, I took her to the kitchen!!!
Press Release
The health hazards associated with air pollution

Air pollution is linked to increased rates of morbidity and mortality, in particular from cardiovascular and respiratory illnesses. Environmental pollution, especially with high particulate matter PM 2.5 exposure, has also been proved to be linked with an increased prevalence of diabetes.

Research indicates that a decrease in the concentration of the fine particulate pollution (PM2.5) by 10 micrograms per cubic meter is associated with an increased life expectancy of 0.77 year and 15 percent of the overall increase in life expectancy.

Speaking about this, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA in a joint statement said, “A recent study showed an increased risk of heart attack associated with short-term exposure to a variety of air pollutants (carbon monoxide, nitrogen dioxide, and sulfur dioxide); the population attributable risk was estimated as 0.6 to 4.5 percent. With the population levels in Delhi at an all time high, it is imperative that awareness is raised about the health hazards of high air pollution levels and necessary steps each one of us must take to stay healthy. People at high risk include those with existing lifestyle diseases, children and the elderly. This group must not stay in densely polluted areas for a long period of time, wear masks and should avoid engaging in strenuous outdoor activities. It is the duty of each and every citizen to work towards reducing the environmental burden of our country.”

Air pollution is also associated with adverse effects on lung development and decreased lung function in children. In children with and without asthma, improvements in air quality (decreased levels of nitrogen dioxide and particular matter) is associated with improvements in both forced expiratory volume in 1 second and forced vital capacity between age 11 and 15.There is a known correlation between levels of air pollution and lung disease, but the association between air pollution and asthma is less clear.

Asthma is related to specific pollutants, while other respiratory diseases are related to total air pollution.

1. The prevalence rates of asthma and atopy are linked with NO2 levels and CO levels. Particulate matter and ozone levels may have no link

2. The prevalence rates of bronchitis are linked to SO2

Pollution has various hazardous effects on a person’s health. It precipitates asthma, heart attacks and COPD. Pollution is linked to the build up of carbon dioxide leading to global warming, climatic changes, and a multitude of adverse human health outcomes. Release of chlorofluorocarbon gases used in refrigerators destroys the protective ozone layer in the stratosphere, thereby leading to an increase in ultraviolet radiation and skin cancers, particularly melanoma. The time has come for each one of us to make an effort to reduce the environmental burden caused by our day-to-day actions. The future of our civilization lies in each one of our hands.