National Integrated Medical Association
Pathardi Branch

Let's unite to provide better health care for our people...

खेड्यांसाठी झटपट डॉक्‍टर :
(सकाळ)

ग्रामीण भागासाठी वेगळे डॉक्‍टर निर्माण करण्याचा केंद्राचा प्रस्ताव चांगला असला, तरी अंमलबजावणीच्या सर्व अडचणींचा विचार करूनच तो प्रत्यक्षात आणावा.

ग्रामीण भागासाठी डॉक्‍टरांची वेगळी फळी निर्माण करण्याच्या हेतूने एक स्वतंत्र साडेतीन वर्षांचा वैद्यकीय अभ्यासक्रम सुरू करण्याचा विचार केंद्रीय आरोग्य मंत्रालय आणि "मेडिकल कौन्सिल ऑफ इंडिया' (एमसीआय) करीत आहे. डॉक्‍टरांनी खेड्याकडे वळावे आणि ग्रामीण भागातही उत्तम प्रकारची आरोग्य सुविधा द्यावी यासाठी आपल्याकडे आतापर्यंत अनेक प्रयत्न झाले, मात्र त्यांना यश आलेले नाही. खेड्यापाड्यांतील आरोग्य यंत्रणा अद्यापही कमालीच्या दुरवस्थेत आहे. छोट्या छोट्या आजारांवरील उपचारासाठीही शहराकडे धाव घ्यावी लागते. खेड्यात प्राथमिक आरोग्य केंद्रे आहेत, तर डॉक्‍टर नाहीत; डॉक्‍टर आहेत तर परिचारिका नाही आणि हे सारे असले, तर औषधे नाहीत अशी स्थिती आहे. म्हणूनच ज्ञानयुग समजल्या जाणाऱ्या आजच्या काळातही खेडुत भोंदूबाबांकडे किंवा वैदूंकडे जातात. या पार्श्‍वभूमीवर आरोग्य मंत्रालयाने पुढे केलेल्या नव्या प्रस्तावाचे स्वागत करायला हवे. मात्र, त्याची व्यावहारिक पातळीवर अंमलबजावणी होऊ शकते काय; तसेच "बीएएमएस' किंवा "बीएचएमएस' यांसारख्या अन्य वैद्यक शाखांच्या पदवीधरांची मदत घेऊन ग्रामीण भागात डॉक्‍टर उपलब्ध करता येतात का हे पाहायला हवे. नव्या प्रस्तावानुसार खेड्यातील विद्यार्थ्यांसाठी साडेतीन वर्षांचा वैद्यकीय अभ्यासक्रम असणार आहे. बारावीच्या विज्ञान शाखेतील विद्यार्थी या अभ्यासक्रमाला प्रवेश घेऊ शकतील. प्रवेशासाठीची यंत्रणा राज्यांच्या वैद्यकीय शिक्षण संचालनालयांना उभी करावी लागणार आहे. अभ्यासक्रमाच्या पूर्ततेनंतर या विद्यार्थ्यांना "बीआरएमएस' ही पदवी मिळेल आणि मग ते ग्रामीण भागात वैद्यकीय सेवा देण्यास पात्र ठरतील. डॉक्‍टर म्हणून त्यांची नोंदणी करण्यासाठी "एमसीआय'कडून समांतर यंत्रणाही निर्माण केली जाणार आहे.
 
हा प्रस्ताव वरकरणी चांगला वाटतो; मात्र नेमकी किती महाविद्यालये सुरू केली जाणार आहेत, ती सरकारकडून स्थापन होणार की खासगी क्षेत्राकडून यांसारखे प्रश्‍न निर्माण होतात. सध्याचा वैद्यकीय अभ्यासक्रम साडेचार वर्षांचा आहे. शिवाय एक वर्ष इंटर्नशिप करावी लागते. अशा रीतीने साडेपाच वर्षानंतर "एमबीबीएस' डॉक्‍टर तयार होतो. दोन वर्षांचा कालावधी कमी करून ग्रामीण डॉक्‍टर तयार केले जाणार असतील, तर त्यांना पुरेसे वैद्यकीय ज्ञान मिळेल काय, असाही प्रश्‍न उपस्थित होतो. किंबहुना वैद्यकीय क्षेत्रात ही चर्चा सुरू झाली आहे. याबाबत फेब्रुवारी महिन्यात देशभरातील सुमारे तीनशे वैद्यकीय महाविद्यालयांच्या अधिष्ठात्यांची कार्यशाळा घेतली जाणार आहेत. त्यामध्ये यांपैकी बहुतेक प्रश्‍नांची उत्तरे मिळतील.
ग्रामीण डॉक्‍टर ही संकल्पना अगदीच नवीन नाही. महाराष्ट्रात तीस-एक वर्षांपूर्वी अशा प्रकारचा प्रयोग राबविण्यात आला होता. त्या वेळी आलेल्या अडचणींची दखल घ्यावी लागेल. ग्रामीण डॉक्‍टरांसाठी स्वतंत्र अभ्यासक्रमाची कल्पना त्या वेळी "एमसीआय'च्याच गळी उतरली नव्हती. आता खुद्द "एमसीआय'च यासाठी पुढे आली आहे. ग्रामीण डॉक्‍टर अशी स्वतंत्र वर्गवारी केल्याने काय अडचणी येतात याचीही "एमसीआय'ने आताच चाचपणी करायला हवी. ग्रामीण डॉक्‍टर म्हणून शिक्षण घेऊन शहरात वैद्यकीय सेवा सुरू करण्याचा प्रकारही होऊ शकतो. त्याचबरोबर ग्रामीण डॉक्‍टरांना "फार कळत नाही,' असा एक समज-गैरसमजही निर्माण होऊ शकतो. यामुळे "भारीतल्या डॉक्‍टरां'कडे जाण्याचा खेड्यातील काहींचे आकर्षण कायम राहू शकते. या सर्व बाबींचा ऊहापोह होणे आवश्‍यक आहे. त्याचबरोबर "बीएएमएस' किंवा "बीएचएमएस' या अन्य वैद्यक शाखांतील ज्यांना खेड्यात सेवा सुरू करायची आहे, त्यांना प्रोत्साहन देता येईल काय, याचाही विचार "एमसीआय'ने करायला हवा. सध्याचे चित्र फारच चिंताजनक आहे. महाराष्ट्रासारख्या "पुरोगामी' राज्यातही ग्रामीण भागातील डॉक्‍टरांची संख्या अत्यल्प आहे. शहरी भागांत एक लाख लोकांमागे १४० "एमबीबीएस' डॉक्‍टर उपलब्ध आहेत.
 
ग्रामीण भागात हे प्रमाण केवळ २४ आहे. महाराष्ट्रात ही स्थिती असेल, तर "बिमारू' म्हणून आधीच बदनाम झालेल्या बिहार, मध्य प्रदेश, राजस्थान, उत्तर प्रदेश या राज्यांमध्ये काय स्थिती असेल? म्हणूनच भारतात आरोग्याच्या बाबतीत कमालीचा विरोधाभास दिसतो. सार्वजनिक आरोग्याच्या क्षेत्रात भारताचा क्रमांक बांगलादेश, श्रीलंका या देशांहून खालचा आहे; मात्र खासगी आरोग्यसेवेबाबत तो जगातील पहिल्या दहा देशांत आहे. एकीकडे शहरांमध्ये पंचतारांकित रुग्णालयांची नवी संस्कृती निर्माण झाली आहे, तिथे "सुपर-सुपर स्पेशालिटी' असलेल्या तज्ज्ञ डॉक्‍टरांची फौज उभी आहे, नाना प्रकारच्या चाचण्या करण्यासाठी लॅबोरेटरीजची साखळी तयार आहे. तर दुसरीकडे खेड्यापाड्यांत सुसज्ज आरोग्य केंद्रेही नाहीत. एकीकडे आपण शहरी भागात "मेडिकल टूरिझम'ची संकल्पना पुढे आणत परदेशांतील रुग्णांना आकर्षित करण्याचा प्रयत्न करतो आहोत; तर दुसरीकडे आपल्याच खेड्यांमधील अनारोग्याकडे दुर्लक्ष करीत आहोत. या वृत्तीमुळे अद्यापही भारतात कुपोषणाचे बळी पडताहेत, प्रसूतकाळात मृत्यू होत आहेत, ऍनिमिक मुलांची संख्या वाढत आहे. त्याचबरोबर मलेरिया, डेंगी, चिकुनगुनिया यांसारख्या रोगांचा प्रादुर्भावही वाढतो आहे. वास्तविक आरोग्यासारख्या कळीच्या मुद्‌द्‌यावर राजकीय पक्षांत फारसे मतभेद नाहीत. तरीही त्यांमध्ये आरोग्य सुविधा वाढविण्यासाठीची प्रबळ इच्छाशक्ती दिसत नाही. ही स्थिती बदलली पाहिजे. ग्रामीण डॉक्‍टर या संकल्पनेद्वारा याबाबतची कृतिशील पावले पडली, तर अनारोग्य कमी होईल. भारताला सुदृढ बनवायचे असेल तर हे करावेच लागेल.
Madhu Milan

Tainted Medical Concil Dissolved...

NEW DELHI: Tainted with charges of corruption, the 76-year-old Medical Council of India was on Saturday dissolved and replaced by a six-member panel of eminent doctors to carry out its duties.

An ordinance dissolving the all-powerful body, formed to regulate medical education in the country, was signed by President Pratibha Patil and notified by the law ministry.

The Union Cabinet had discussed the ordinance on Thursday following which it had gone to the law ministry for consultations.

The six-member panel is headed by eminent gastroenterologist from Delhi Dr S K Sarin. The other five members are: former director of National Institute of Immunology Prof Ranjit Roy Chowdhary, Dr Sita Naik from SGPGIMS, Dr Gautam Sen, cardiac surgeon, Dr Devi Shetty and former head of Safdarjung hospital Dr R L Salhan.

Union health secretary K Sujatha Rao told TOI, "This committee will not have an advisory role but will actively run the MCI including issuing licences and permissions, conducting inspections and regulating medical education, for a maximum of one year. It will also suggest ways to reform MCI which will help in preparing the bill which we plan to introduce in the monsoon session of Parliament."

MCI till now was the sole body that granted recognition to medical degrees, gave accreditation to medical colleges, registered medical practitioners and monitored medical practice in the country.

However, allegations of corruption against the MCI have been rife for years now. On April 22, MCI's president Dr Ketan Desai was arrested by the CBI for allegedly taking a bribe of Rs 2 crore to recognize a medical college in Punjab though it did not meet MCI standards. The ministry said it plans to bring in a new law for the formation of an overarching body to regulate medical education in the country.

According to Rao, the draft law for the formation of such a body would be formulated within a month. Sources say MCI would be made a body to regulate medical professionals, which would be in line with the original mandate of the MCI.

An earlier effort by the ministry to amend the Indian Medical Council Act of 1956, giving more powers to the ministry, was turned down by the parliamentary standing committee on health, which argued that the move would destroy the council's autonomy. Health minister Ghulam Nabi Azad said the ordinance "was required as there is no law that empowers us to take action against MCI as it was created by an act of Parliament."

Medical education needs seprate body...

New Delhi, May 17 (IANS) Amid reports that medical education would be brought under the ambit of the proposed National Commission for Higher Education and Research (NCHER), the health ministry has objected to such a move, saying medical studies need a separate governing body.
“Medical education has a very wide field. It needs a separate governing body,” a senior official of the ministry told IANS Monday.

“Health secretary (Sujatha Rao) has written to the human resource development (HRD) ministry giving a sketch of the problems that may arise if medical education is brought under the NCHER,” he said.

The speculations arose after President Pratibha Patil Saturday signed an ordinance dissolving the Medical Council of India (MCI) and replacing it with a seven-member committee.

The government decided to bring the ordinance after a crisis hit the regulatory body when its president Ketan Desai was arrested April 22 by the Central Bureau of Investigation (CBI) for allegedly taking a bribe of Rs.two crore to accord recognition to a medical college in Punjab though it did not meet MCI standards. Desai gave his resignation to the health ministry Wednesday.

A seven-member panel, led by eminent gastroenterologist S.K. Sarin, will replace the MCI and serve for a period of one year.

The official said that there were little chances of revival of the MCI, which had been tasked to oversee the standards of medical education in India, grant recognition to medical degrees, give accreditation to medical colleges, register medical practitioners and monitor medical practice in the country.

“The MCI may or may not be revived, but medical education should be left with the health ministry,” he said, adding talks are likely to be held between the two ministries this week.

The letter written to HRD Secretary Vibha Puri Das included issues like affiliation of medical college to universities, problems that may come in drafting and approving the syllabus and possibility of conflicts between the college management and hospital management to which the colleges are attached.

“Since medical education is linked with hospitals, it is not good to have them under different ministries,” the official said.

The letter also expressed the health ministry’s desire to have a separate National Council for Human Resources in Health as announced by President Patil in her speech to the joint session of Parliament last year.

“We can have a body overlooking all aspects of medical education including nursing, dentistry, and other subjects,” he said.

The proposed National Council for Human Resources in Health will separate regulation of medical education from regulation of medical practice. Both will be under the health ministry.

Sources from the HRD ministry said that the draft NCHER bill will be introduced in the monsoon session of parliament.

Democratic norms violated while dissolving MCI: CPI(M)

New Delhi, May 19 (IANS) The Communist Party of India-Marxist (CPI-M) Wednesday alleged that the central government violated “minimum democratic norms” and bypassed the rights of the state governments by dissolving the Medical Council of India (MCI) through an ordinance.
The CPI-M asked the central government to “immediately call a meeting of the Central Council of Health and Family Welfare and ensure that the rights of the states are not bypassed”.

State governments had their representatives in the dissolved Medical Council, it said.

“Since health is a state subject and medical education is on the concurrent list, it was mandatory for the central government to have consulted state governments by calling an emergency meeting of the Central Council,” the party politburo said in a statement.

The CPI-M said the seven-member board of governors now appointed through the ordinance consists entirely of centrally-nominated people. “This is a violation of federal principles and is an injustice to the states,” it said.

The government should have taken parliament into confidence before dissolving an autonomous body set up by an Act of parliament, the CPI-M said.

President Pratibha Patil Saturday signed an ordinance dissolving the statutory regulatory body and replacing it with a seven-member committee.

The party said the ordinance reflected a policy of overcentralisation of powers in the hands of the central government, which did damage to the federal character of the constitution.

The party, however, welcomed the removal of Ketan Desai from the post of director of MCI, calling it “a much belated and required step”.

“The prima facie evidence of corruption at the top levels of MCI required firm government intervention,” it said.

The government decided to bring the ordinance after a crisis hit the regulatory body when its president was arrested April 22 by the Central Bureau of Investigation (CBI) for allegedly taking a bribe of Rs.2 crore to recognise a medical college in Punjab even though it did not meet MCI standards.

Desai had given his resignation to the health ministry last Wednesday.

The MCI, a statutory body tasked to oversee the standards of medical education in India, granted recognition to medical degrees, gave accreditation to medical colleges, registered medical practitioners and monitored medical practice in the country.

–Indo-Asian News service

Ketan Bhai Desai...

AHMEDABAD: He has had a vice-like grip over the Medical Council of India (MCI) for almost 20 years now. The Chennai-based Sri Ramachandra University (SRU), which demanded Rs 40 lakh from students seeking admission in a capitation fee racket unearthed by TOI-Times Now, is just one of the numerous medical colleges across the country which need to have Dr Ketan Desai, the MCI chairman, on their side.

itimes: Share your experience on seat-for-sale scam

You can’t do without Dr Desai if you run a private medical college in the country. You either have him or his nominee on the board of management if you want to circumvent merit and sell an estimated 2,500 countrywide ‘management quota’ seats available in MBBS colleges, despite an explicit Supreme Court ban on capitation fee. At a conservative average of Rs 20 lakh per seat, the management quotas fetch capitation fees worth a staggering Rs 500 crore annually and the business has steadily grown during the years Desai has been in power.

In December 2008, former Union minister TR Baalu stayed in a posh city hotel for four days to meet Desai in order to sort out a problem a medical college in Tamil Nadu was having with MCI. Baalu sought the intervention of some leading business barons of Gujarat Inc. when Desai refused to give him an audience.

When HD Deve Gowda was prime minister in 1997, he took time out during an official visit to Gujarat to meet Desai at his Ahmedabad residence to persuade him to reverse an MCI decision against a medical college in Karnataka. That was the time when Dr Desai, who has been an MCI member since 1990, had begun to take complete control of MCI after becoming its chairman in 1996. After Gowda’s visit, the college was recognised by MCI. Since then, he has only tightened his grip over the business of medical education. He even became the Indian Medical Association (IMA) president in 2001, establishing control over the entire medical fraternity. From 1999, he has had an unbroken run as head of Gujarat Medical Council, the state level body of MCI.

Even after the setback in 2001 when he had to quit the MCI post after Delhi High Court described the MCI as a “den of corruption”, he controlled the institution through his nominees till he returned as chairman in March 2009, after winning a prolonged legal battle.

An alumnus of Ahmedabad’s BJ Medical College (BJMC), from where he did his MD in Urology, Desai is also professor and head of the urology department in the college. Even though he never formally taught in the college, his clout was evident in 1995 when he bagged the prestigious Dr B C Roy Award for excellence in teaching medicine. Even today, nothing moves in BJMC without Desai’s consent. When former state health minister Ashok Bhatt tried to tame him in 2003 by appointing a dean who was not of his choice, the college erupted in an agitation which forced Bhatt to relent. The dean was soon replaced.

But then, Bhatt was just a state minister. In 2005, Dr Desai even took on former Union health minister Anbumani Ramadoss who tried to bring a legislation to curtail and regulate MCI’s powers. The amendment has not seen the light of day because Desai’s influence now traverses across political lines where vested interest in medical education runs deep.

For evidence, you just have to visit his personal website which has photographs clicked with several politicians, including one of him sharing a dais with DMK chief M Karunanidhi at a Chennai function hosted by the controversial Sri Ramachandra University. It could well be that Baalu had come to Desai’s durbar trouble-shooting for SRU. Desai didn’t pick up his phone after numerous calls TOI made on Saturday. 

Homeopathy is witchcraft says British Medical Association

May 16th, 2010

PTI

Describing homeopathy as "witchcraft", a body of junior doctors in Britain has voted overwhelmingly to seek a blanket ban on the practice of the alternative
medicine. Hundreds of members of the British Medical Association (BMA) have passed a motion denouncing the practice of homeopathy, saying taxpayers should not foot bills for remedies which have no scientific basis to support them. They demanded an end to all placements for trainee doctors who teach them homeopathic principles.
Dr Tom Dolphin, deputy chairman of the BMA's junior doctors committee in England told the conference: "Homeopathy is witchcraft. It is a disgrace that nestling between the
National Hospital for Neurology and Great Ormond Street in London there is a National Hospital for Homeopathy which is paid for by the NHS." The motion could become the official policy of the organisation if it is agreed upon by
their full conference next month. Latest figures show that 54,000 patients are treated each year at four NHS homeopathic hospitals in London, Glasgow, Bristol and Liverpool, at a cost of 4 million pounds. A fifth hospital in Tunbridge Wells in Kent was forced to close last year when local NHS funders stopped paying for treatments. The BMA had previously expressed scepticism about homeopathy, arguing that the rationing body - the National Institute for Health and Clinical Excellence, should examine
the evidence base and make a definitive ruling about the use of homeopathic remedies in the NHS. Crystal Summer, chief executive of the British Homeopathic Association said attempts to stop the NHS funding alternative medicines ignored the views of the public, especially patients with chronic conditions. "Homeopathy helps thousands of people who are not helped by conventional care. We don't want it to be a substitute for mainstream care, but when people are thinking about making cuts to funding, I think they need to consider public satisfaction, and see that homeopathy has a place in medicine," she said. She said junior doctors' call for an end to any training placements based in homeopathic
hospitals ignored the lessons alternative medicine could provide in terms of how to diagnose patients. The alternative medicine, devised in the 18th century by German physician Samuel Hahnemann, is based on the theory that substances which cause symptoms in a healthy person can cure the same problems in a sick person when vastly diluted.
Proponents say the resulting remedy retains a "memory" of the original ingredient - a concept dismissed by scientists.

 

Homeopathy is a placebo treatment: British House of Commons

Homeopathy is unsupported by the collective weight of modern scientific research. The extreme dilutions used in homeopathic preparations usually leave none of the original material in the final product. The modern mechanism proposed by homeopaths, water memory, is considered implausible in that short-range order in water only persists for about 1 picosecond.[95][96] Pharmacological effect without active ingredients is inconsistent with the observed dose-response relationships of conventional drugs,[97] leaving only non-specific placebo effects[10][98][99] or various novel explanations. The proposed rationale for these extreme dilutions – that the water contains the "memory" or "vibration" from the diluted ingredient – is counter to the laws of chemistry and physics, such as the law of mass action.[95] The lack of convincing scientific evidence supporting its efficacy[26] and its use of remedies without active ingredients have led to characterizations as pseudoscience and quackery,[27][29][30][100] or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst."[31] Use of homeopathy may delay or replace effective medical treatment, worsening outcomes or exposing the patients to increased risk.[6][8][12][101]

Referring specifically to homeopathy, the British House of Commons Science and Technology Committee has stated:

In the Committee’s view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice-which the Government claims is very important-as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.[14]

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