Monday, April 8, 2019

AYUSH drugs must involve domain expert, says AYUSH advisory

SCIENCE

Study of AYUSH drugs must involve domain expert, says AYUSH advisory

The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) has issued an advisory on April 2 asking all non-AYUSH researchers and institutions to “involve appropriate expert/institution/research council of AYUSH” while carrying out any “scientific study, clinical trial or intervention” using AYUSH drug or treatment.
The involvement of AYUSH experts is also needed for “vetting of the publication” [that arises from the research] for its “outcomes and findings”.
Though the note is an advisory to researchers in modern medicine, it concludes with, “are urged to take note of the advisory for compliance” thus making it mandatory to involve an expert for carrying out research on AYUSH systems of medicine.
Enforcement issue
The advisory has been issued in order to “protect [the] public image of AYUSH” and to “prevent incorrect, arbitrary and ambiguous statements and conclusions about AYUSH”.
The advisory is also meant for editors of medical and scientific journals. It is not clear how the Ministry would be able to enforce this on editors, particularly editors of international journals.
According to the advisory, research papers and scientific studies on AYUSH drugs and treatments have been “published by non-AYUSH scientists/researchers with unfounded statements and conclusions to damage the credibility and sanctity of the whole system”. It says that such studies have been carried out by non-AYUSH researchers without involving qualified AYUSH experts.
Cannot jeopardise AYUSH potential’
Further, “arbitrary statements and unfounded conclusions in the scientific studies and research publications related to AYUSH” cannot be allowed to jeopardise the potential and scope of AYUSH in public healthcare and distract or dissuade people from resorting to AYUSH.
“I am quite disturbed by this notification. If such curbs are placed on researchers and research journals, it has a bad portend,” says Subhash C. Lakhotia of Banaras Hindu University, Varanasi. He has been working to understand the mechanism of action of some standard Ayurvedic rasayanas. “If we want to get results as desired by AYUSH ministry or AYUSH practitioners, then that is not research,” asserts the professor.
A knowledge black box
While he concurs that it is desirable to involve AYUSH experts in a study, he is peeved that it is now being made mandatory. “How can the Ministry insist that every study should involve an expert? It should be left to the choice of the researchers,” he says. He believes that the need of a domain expert would be context-dependent and should not be a mandatory requirement in every case. The domain expert has to be a collaborator rather than a monitor, says Prof. Lakhotia.
According to him, Ayurveda as currently practiced remains a black box. Unless people from other fields contribute to its understanding, it will only worsen the situation. “The way Ayurveda has been practiced is not evidence-based but largely remains experience-based. Only good quality, unbiased research can provide the evidence for or against what has been believed. Results of such studies may even change some of the basic principles. Any domain of knowledge has to remain dynamic and results/opinions contrary to the so-called established view must not be rejected and taken as damaging the credibility,” explains Prof. Lakhotia.
Different views
However, Dr. Mitali Mukerji, scientist at the Institute of Genomics and Integrative Biology (CSIR-IGIB) who has been studying the principles of Ayurveda for over a decade says it is essential to collaborate with an Ayurveda expert while carrying out a scientific study. Taking a closer scientific look at Ayurvedic medicine using modern technologies should be in the interest of all stakeholders — patients and doctors and researchers - says the researcher. “I have gained much by collaborating with Dr. Bhavana Prasher an Ayurveda expert and scientist at IGIB,” shares Dr. Mukerji.
“Any research work on Ayurveda drug or treatment should involve an Ayurveda expert. A domain expert is necessary. What is wrong in that?” questions Dr. Samir K. Brahmachari, former Director General of the Council of Scientific & Industrial Research (CSIR) and founding Director CSIR-IGIB.

Sunday, February 17, 2019

New MBBS syllabus

New MBBS syllabus offers AYUSH as option(ht)

The new syllabus received final approval from the BoG last month and will be implemented from August, when the new academic session (2019-20) begins. The 3-month module will be designed by Ayush ministry.

EDUCATION Updated: Feb 16, 2019 07:37 IST 
Rhythma Kaul 
New Delhi

Undergraduate medical students will be given the option of choosing Ayush (ayurveda, yoga and naturopathy, unani, siddha and homoeopathy) systems as an elective subject from the 2019-20 academic year, a top functionary of the board of governors that oversees medical colleges said. The initiative is aimed at introducing future doctors to alternative systems of medicine,
The government had in September 2018 dissolved the Medical Council of India and constituted the board of governors (BoG) to supersede the medical regulator. The new syllabus received final approval from the BoG last month and will be implemented from August, when the new academic session (2019-20) begins. The 3-month module will be designed by Ayush ministry.
“It is to give a hang of the alternative systems of medicine to the students of allopathy. Ayush systems can play a great role in promoting preventive health. However, it will not be mandatory for medical students,” said Dr V K Paul, chairman, BoG. “The students will get to visit Ayush hospitals, attend outpatient departments (OPDs), etc,” he added.

Friday, February 1, 2019

ESIC's Ayush Hospital

Corporation has started process to fill 5,000 vacant post of medical and para-medical personnel to meet staff shortage, said on Thursday.
"post would be filled. There were some difficulties. But there will be no difficulties. All difficulties would be removed before implementation of model code of conduct (for Lok Sabha poll due in May)...we have decided to fill 5000 posts of medical/para-medical staff. We have already advertised the posts to meet staff shortage," said.
was at a function to inaugurate OPD (out patient department) Wing of at Narela here.
The said the government is committed for good health of work force and informed the gathering that the inaugurated hospital is the first dedicated of the ESIC, which is being constructed in two acres area with a cost of Rs 30 crores.
All the facilities under Ayush, such as Ayurvedic, Homeopathic, Siddha, Unani and Yoga will be provided in this hospital.
He further said that one allopathic dispensary will also be opened in this hospital.
The ESIC is opening (DCBO) in every district of the country in phased manner and so far 29 DCBOs have been opened.
During the function, Gangwar also launched Health Passbook for ESI Beneficiaries. The Health Passbook will serve as a user friendly mechanism for beneficiary identification, recording of clinical findings and consultation advice by the doctor /medical practitioner(s).
Besides, ESIC handed over a cheque of Rs 2.31 crore to the for
(This story has not been edited by Business Standard staff and is auto-generated from a syndicated feed.)
First Published: Thu, January 31 2019. 20:46 IST

BUD GET-2019

New Delhi, February 1

BUDGET-2019

Reaching out to a large electorate ahead of the Lok Sabha polls, the Modi government on Friday announced a cash dole for small farmers, a mega pension scheme for the unorganised sector and doubled the threshold tax exemption limit to Rs 5 lakh.
Presenting the interim 2019-20 Union Budget in Parliament, Finance Minister Piyush Goyal said Rs 6,000 per year cash support would be given to small and marginal farmers that would cost the exchequer Rs 75,000 crore annually, in a bid to provide relief to the distressed farm sector. 
Under the scheme called ‘Pradhan Mantri Kisan Samman Nidhi’, Rs 6,000 will be transferred into bank accounts of farmers holding up to two hectares of land in three equal instalments.
Goyal said it would benefit 12 crore farmers and would be implemented from this fiscal itself.
He said Rs 20,000 crore had been provided for current fiscal and also announced allocation of Rs 75,000 crore for the next fiscal.
Unveiling the mega pension yojana for the unorganised sector workers that will benefit 10 crore people, Goyal said they would get assured monthly pension of Rs 3,000 after reaching the age of 60.
“We are launching Pradhan Mantri Shram Yogi Mandhan today. The scheme will provide assured monthly pension of Rs 3,000, with contribution of 100 rupees per month, for workers in unorganised sector after 60 years of age,” Goyal said.
Goyal, who is standing in for Arun Jaitley undergoing treatment in the US, informed the House that the government would also provide a matching contribution of Rs 100 for every unorganised worker covered under the scheme.
“The scheme will benefit 10 crore workers in unorganised sector, and may become the world’s biggest pension scheme for unorganised sector in five years.”
In a major relief for the middle class, Goyal proposed to double the threshold tax exemption limit to Rs 5 lakh and increased the standard deduction from the existing Rs 40,000 to Rs 50,000.
The announcement was greeted with thumping of desks by Prime Minister Narendra Modi and members of the treasury benches.
The proposal would benefit 3 crore middle-class taxpayers, Goyal said.
Doubling the threshold exemption limit is expected to cost the exchequer Rs 18,500 crore.
Goyal said an individual having an income of Rs 6.5 lakh per annum would not be required to pay any tax provided he invested in the specified tax saving schemes of the government.
The TDS threshold on interest from bank, post office deposits was also raised from Rs 10,000 to Rs 40,000.
“This is not just an Interim Budget, this is a vehicle for the developmental transformation of the nation,” Goyal said.
He also announced a hike in the defence budget to over Rs 3 lakh crore. PTI
HIGHLIGHTS
*Healthy India is ninth dimension of our vision for India: FM Goyal
*Persons with gross income of Rs 6.5 lakh annually will not have to pay any tax after considering investments of Rs 1.5 lakh in tax saving schemes: FM
*Rs 76,800 crore allocated for welfare of SCs/STs for 2019-20, up from Rs 62,474 crore in 2018-19: FM
*Individuals with income up to Rs 5 lakh will not have to pay any income tax
*India is on the way of becoming global manufacturing hub, including automobiles, electronics and defence
*Building physical and social infrastructure for USD10 trillion economy, says FM outlining 10 year vision in the Interim Budget speech
*We are poised to become a USD 5 trillion economy in next five years and aspire to become USD10 trillion economy in next 8 yrs
*NDA govt has laid foundation for India’s growth and development for times to come 
*More than 1.06 crore people filed I-T returns for first time in 2017-18, the year after demonetisation
*Anti-black money measures, including demonetisation, led to discovery of undisclosed income of Rs 1.3 lakh cr, seizure of Rs 50,000 cr
*Govt committed to eliminating ills of black money
*Fiscal deficit for 2018-19 to be 3.4 per cent as against 3.3 per cent targeted; breach primarily because of farm income support
*GST has continuously reduced, relief of Rs 80,000 cr to consumers; most items of daily use for poor and middle class are now in 0-5% tax bracket: FM
*India will be modern, technology driven, equitable and transparent society by 2030 
*As many as 34 cr Jan Dhan accounts opened in 5 years, Aadhaar ensured benefits reach poor, says FM
*Impactful steps taken to reduce tax, bring benefits for middle class citizens
*Single window clearance for film-making to be made available to Indian film-makers, anti-camcording provision to be introduced to Cinematography Act to combat privacy
*Cost of data, voice calls in India is now possibly lowest in world; mobile and mobile part manufacturing companies have increased from 2 to 268
*Budget allocation to North East region increased by 21 per cent to Rs 58,166 crore for 2019-20
*1 lakh digital villages to be created in next five years
*In last 5 years under all categories of workers, minimum wages increased by 42 per cent which is the highest ever
*India leading world in mobile data consumption; mobile consumption data has risen by 50 times
*Construction of rural roads tripled; 15.8 lakh out of total 17.84 lakh habitations connected with pucca roads under PMGSY. PMGSY allocated Rs 19,000 crore in 2019-20
*Average monthly GST tax collection Rs 97,100 cr as compared to Rs 89,700 cr last year
*Govt to launch mega pension yojana for 42 cr unorganised sector workers; assured monthly pension of Rs 3,000 after reaching the age of 60
*Vande Bharat Express will provide speed, service and safety to citizens and will give boost to Make In India: FM
*Urgent steps needed to boost domestic oil and gas production to cut imports: FM
*99.54 per cent of all returns were accepted without scrutiny, transforming I-T department, return to be processed in 24 hours, processed simultaneously
*Capital expenditure programme of Railways at all-time high of Rs 1.58 lakh cr in next FY: FM
*We have eliminated all unmanned railway crossings in the country: FM
*In next two years even tax returns selected for scrutiny will be done without any personal interface, electronically, says FM
*Simplification of direct tax system to benefit taxpayers; direct tax reduced and tax interface made simpler and faceless to make life easier
*Substantial hike in military service pay has been announced
*Tax collection increased to Rs 12 lakh crore this year, returns filed to 6.85 crore
*Rs 35,000 cr given under OROP in last three years
*Defence budget increased to over Rs 3 lakh cr in 2019-20
*27 km of highways built each day, projects stuck for decades completed; SagarMala will help faster handling of import and export cars
*Nine priority areas identified; National Artificial Intelligence Portal to be developed soon
*Indian Railways has witnessed its safest year in history; all unmanned crossings on broad gauge network have been eliminated
*India is fastest highways developer in the world, says FM
*Rs 1 crore loan can now be obtained under 59 minutes: FM
*Country now has 100 operational airports; passenger traffic has doubled in last five years 
*Over 1 crore youth trained under skill initiatives of government, says FM
*India has become second largest hub of startups
*Under the Mudra scheme, govt has sanctioned 15.56 lakh loans amounting Rs 7.23 lakh crore
*75 pc of women beneficiaries under Mudra Yojana, 26 weeks’ maternity leave and Pradhan Mantri Matritva Yojana are all empowering women
*Out of 8 cr free LPG connections under Ujjwala, 6 cr connections to poor women have already been provided
*Ujjwala Yojana providing free cooking gas connection is a remarkable success story
*More than 70 per cent of MUDRA yojana beneficiaries are women
*Gratuity limit increased from Rs 10 lakh to Rs 30 lakh
*High growth, formalisation of economy has resulted in increased EPFO membership by 2 cr in last two years
*Farmers affected by severe natural calamity will get 2 pc interest subvention on all rescheduled crop loans and additional 3 per cent on timely repayment
*High growth and formalisation of economy has led to rise in EPFO membership by 2 cr in last two years
*Farmers hit by natural calamities to get 2 per cent interest subvention; 3 per cent more on timely repayment of loans
*2 pc interest subvention to farmers involved in animal husbandry and fishery
*Govt to provide Rs 750 crore in FY to support animal husbandry and fishing
*There is need for structured income support for poor, landless farmers to meet input cost
*Govt to implement special strategy for uplift of nomadic tribes
*Govt has fixed MSP for 22 notified crops at 50 per cent higher than cost of production
*Pension scheme for unorganised sector workers to be implemented from this fiscal
*Cheaper drugs being provided through Jan Aushadi stores: FM
*AIIMs established or operating in country, of which 14 sanctioned since 2014. Another to be set up in Haryana
*10 lakh patients have been treated so far under Ayushman Bharat scheme, world’s largest health care programme
*Use of LED bulbs saved power bill of about Rs 50,000 crore, says FM
*As many as 1.53 crore houses constructed during 2014-18 under Pradhan Mantri Awaas Yojana
*143 crore LED bulbs were made available for lower and middle class families
*Farmers to be provided Rs 6,000 per year in three instalments, to be fully funded by the central government 
*We plan to provide urban facilities in rural areas while preserving ‘soul of village’, says FM
*Construction of rural roads tripled under Pradhan Mantri Gram Sadak Yojana: FM
*2.5 cr families were without electricity in 2014; we have provided power to almost all families: FM
*Govt spent Rs 1.7 lakh crore to supply food grains at cheaper price to poor in 2018-19 as against Rs 92,000 crore in 2013-14
*Allocation to MNREGA hiked to Rs 60,000 crore for 2019-20
*Govt announces the Pradhan Mantri Samman Nidhi for small and marginal farmers; farmers to get Rs 6,000 per year
*Govt has provided 10 per cent reservation for economically weaker section; job quota to provide 2 lakh seats in educational institutes  
*We have worked to bridge the urban-rural divide
*About 5.4 lakh villages made open defecation-free 
*Poor have the first right over nation’s resources
*I hope other banks too would soon come out of PCA framework
*Realty Law RERA has helped in bringing transparency in real estate sector
*India has achieved over 98 per cent rural sanitation coverage: FM
*We have run a corruption-free government
*Insolvency and Bankruptcy Code helping in recovery of  non-performing loans. Even big businessmen are now worried about loans: FM
*BoI, OBC and Bank of Maharashtra have been removed from the PCA framework of RBI
*3 lakh crore recovered from big corporate loan defaulters: FM
*Our govt had the guts to ask RBI to look at bad loans and present correct picture to nation: FM
*We have stopped culture of phone banking, says FM referring to allegations of rampant loans over phone during UPA regime.
*We have liberalised FDI allowing more investment through automatic route
*We have undertaken path-breaking structural reforms by introducing GST and other reforms
*Fiscal deficit will be 3.4 per cent of GDP; Current Account Deficit to be 2.5 per cent of GDP
*Current Account Deficit likely to be 2.5 pc of GDP this year 
*India attracted USD 239 bn in FDI in last five years
*If we had not controlled inflation our families would have been spending 35-40 per cent more on daily use items
*NDA govt contained double digit inflation; Govt has broken the back of high inflation 
*India is fastest growing major economy in world; GDP growth in last 5 yrs higher than under any previous govt
*India has been recognised as brightest spot in the world in the past 5 years
*We have got decisive mandate to continue structured reforms. We have reversed policy paralysis
*We are moving towards realising New India by 2022: FM
*Goyal begins interim budget speech, wishes Union minister Arun Jaitley speedy recovery and good health
*Finance Minister Piyush Goyal rises to present Interim Budget for 2019-20
*Cabinet approves Interim Budget for 2019-20. PTI

Monday, October 1, 2018

Ayush Dr. Perform Sonography; Radiology

AYUSH Council Proposes Govt to allow Ayurveda Practitioners Perform Sonography; Radiologists see RED

Mumbai According to recent media reports, that the Central Council of Indian Medicine (CCIM) under the ambit of AYUSH Ministry proposed proposed this amendment to the Preconception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 in order to allow Ayurveda practitioners perform sonography and imaging tests which was sent to the Health and Family Welfare Ministry on September 19 for perusal. Confirmation to this effect was made by Dr Vanitha R, CCIM national president to Hindustan Times
“The 11 executive committee members had a detailed discussion in this regard on August 27 and we have chalked out our proposal.” said Dr Vanitha. “The amendment would be most beneficial to rural patients where there is a dearth of doctors and where Ayurvedic doctors practice in large numbers,” she added Dr Kuldeep Kohli, Director, AYUSH, Maharashtra chapter justified the proposal adding that it would benefit patients in rural areas,, “Given the dearth of radiologists and sonologists in India, more than 50% machines are being shut down in the country due to misuse. It is important that doctors from other branches of medicine forms are given permission to practice radiology and sonology. Allowing Ayush doctors to perform sonography under amended PCPNDT Act would be a revolutionary step,” he said. While the AYUSH practitioners have lent full support to the clause, radiologists are seeing red with the proposal The Maharashtra State Branch of Indian Radiological and Imaging Association (MSBIRIA) have decided to move to the Bombay High Court while condemning the proposal. Dr Sandeep Kawthale, President, MSBIRIA told , “The amendments proposed by the Council are extremely absurd. They are firstly Ayurveda doctors and belong to an altogether different stream of medicine. We fail to understand on what basis they have proposed such amendments.” HT Qualified radiologists are allowed to perform or open a radiology or sonography centre only after securing an MBBS and MD degrees or a two years diploma in radiology, he noted informing that the council has proposed six months training in imaging and radiology after MD in Ayurveda. “How six months training could be adequate?” he wondered. Accepting the amendments could prove extremely dangerous to public health, the MSBIRIA’s President added


Friday, September 28, 2018

act 497

Adultery law case: Supreme Court strikes down Section 497 of IPC; CJI says 'husband is not the master'

The Supreme Court on Thursday struck down the adultery law, pertaining to Section 497 of the Indian Penal Code (IPC) and Section 198 of Code of Criminal Procedure (CrPC), as unconstitutional through a unanimous judgement.
The Chief Justice of India (CJI) Dipak Misra read out the judgment on behalf of himself and Justice AM Khanwilkar. "Thinking of adultery as a criminal offence is a retrograde step," the CJI said in court. Mere adultery can't be a crime unless it attracts the scope of Section 306 (abatement to suicide) of the IPC, the CJI held.
"Adultery might not be the cause of an unhappy marriage, it could be the result of an unhappy marriage," Misra said as he read out his judgment that declared Section 497 as arbitrary.
The CJI stated before the apex court that adultery as an act is not criminal in China, Japan and in many other western countries and remarked that it "dents the individuality of a woman". "In case of adultery, the criminal law expects people to be loyal which is a command which gets into the realm of privacy," the CJI stated. Coming to the Indian Constitution and the protection it guarantees, the CJI said, that the beauty of our Constitution is that it includes "I, me and you". Thus, as the adultery law violated Article 14 15(1) and 21 of the Constitution and offends the dignity of a woman, it was declared as manifestly arbitrary by the CJI. "A woman cannot be asked to think how a man or society desires. Her husband is not her master and servitude of one sex is unconstitutional," the CJI noted in his judgment.
File photo of the Supreme Court of India. Reuters
File photo of the Supreme Court of India. Reuters
Justice Rohinton Fali Nariman also concurred with the CJI and Khanwilkar's judgment and termed the archaic law as unconstitutional. "Ancient notions of a man being perpetrator and woman being a victim no longer holds good," Nariman said in the top court.
Interestingly, Misra stated that he relied heavily on the triple talaq judgment by Nariman to come to his judgment on the case. The CJI also said that mere adultery cannot be a crime, but if any aggrieved spouse commits suicide because of life partner's adulterous relation, then if the evidence is produced, it could be treated as an abetment to suicide.
"Section 497 is based on a notion that a woman loses her agency upon marriage. Human sexuality is an essential aspect of the identity of an individual. The current law deprives a woman of her agency as it is founded on the notion that a woman, on entering marriage, loses her voice and agency," the CJI noted. He also spoke of how the Constitution enshrines the golden triangle of fundamental rights and judicial sensitivity is needed in this regard. Thus, the court ruled that adultery can be a ground for civil issues including dissolution of marriage, ie divorce, but it cannot be a criminal offence. Justice DY Chandrachud also concurred with the other judges on this and said that "Section 497 deprives a woman of agency and autonomy and dignity... Autonomy is intrinsic in dignified human existence and Section 497 denuded the woman from making choices," he said.
Justice Indu Malhotra also maintained that, "Adultery could be a moral wrong towards spouse and family but the question is whether it should be a criminal offence?", leading to a unanimous decision of the Supreme Court scrapping the adultery law.
A five-judge constitutional bench headed by the Misra on 8 August had reserved its verdict after Additional Solicitor-General Pinky Anand, appearing for the Centre, concluded her arguments.
The hearing in the case by the bench, that also comprised Nariman, Khanwilkar, Chandrachud and Justice Indu Malhotra, went on for six days, having commenced on 1 August.
The Centre had favoured retention of a penal law on adultery, saying that it is a public wrong that causes mental and physical injury to the spouse, children and the family. "It is an action willingly and knowingly done with the knowledge that it would hurt the spouse, the children and the family. Such intentional action which impinges on the sanctity of marriage and sexual fidelity encompassed in marriage, which forms the backbone of the Indian society, has been classified and defined by the Indian State as a criminal offence in an exercise of its constitutional powers," the Centre had said.
Section 497 of the 158-year-old Indian Penal Code (IPC) says: "Whoever has sexual intercourse with a person who is and whom he knows or has reason to believe to be the wife of another man, without the consent or connivance of that man, such sexual intercourse not amounting to the offence of rape, is guilty of the offence of adultery."
On 5 January, the apex court had referred to a five-judge Constitution bench the plea challenging the validity of the penal law on adultery. The court had taken a prima facie view that though the criminal law proceeded on "gender neutrality", the concept was absent in Section 497.
With inputs from PTI and Bar and Bench
Updated Date: Sep 27, 2018 20:00 PM

Thursday, September 27, 2018

Doctor & Diagnosis

Many doctors in India miss tuberculosis signs: Study

Health
Updated Sep 26, 2018 | 18:53 IST | PTI

The most common mistake, according to Tuesday's study, is that doctors simply do not order the tests necessary to make a diagnosis, such as testing lung fluid or a chest x-ray.

Representational image
Representational Image  |  Photo Credit: Thinkstock
Washington: Many private sector doctors in India miss the signs of tuberculosis and therefore provide patients inadequate treatment, according to a new study involving people hired to act out the symptoms. Tuberculosis or TB, an airborne infection, remains a major public health issue in India, China and Indonesia, among other countries. It killed 1.7 million people in 2017, according to the World Health Organization, and a global health summit will be held at the United Nations on Wednesday to raise funds to eradicate the disease.
But the primary care physicians who see patients when they start coughing are the weak link in the fight against the pandemic - at least in the two cities where the study took place, the metropolis of Mumbai and eastern Patna. The experiment was financed by the Bill and Melinda Gates Foundation and led by a team of researchers from McGill University, the World Bank and Johns Hopkins University. The results were published in PLOS Medicine. It took place across 10 months between 2014 and 2015. Twenty-four "simulated patients" went to 1,288 private sector doctors, presenting symptoms ranging from a simple cough to a cough presented as a possible relapse.
In 65 percent of interactions, medical practitioners - which includes both qualified doctors, unqualified ones and those who practice traditional medicine - responded in a manner inconsistent with Indian and international standards of care. In some cases where a doctor suspected a problem linked to air pollution, they prescribed an antibiotic or syrup and asked the patient to return a few weeks later. Doctors with formal medical training, particular in Mumbai, did slightly better, offering the correct course of treatment in roughly half of the cases, according to the results.
Doctors without formal training, who are very common in rural zones, are doing worse, as are those who provide traditional medicine including ayurveda, unani, and Siddha medicine, collectively known as "ayush." Jishnu Das, a World Bank economist, explained that the problem wasn't so much that doctors were following one alternate treatment course as much as just doing "everything you can find." "Some guy is giving antibiotics and fluoroquinolone, somebody else is giving steroids and fluoroquinolone, somebody else is giving cough syrup and antibiotics," Das said, explaining that such haphazard methods can harm patients, not to mention boost antibiotic resistance.
By 2040, 12.4 percent of TB cases in India will be multidrug-resistant strains, said one study published in 2017 in the medical journal The Lancet, especially as medications like antibiotics are easy to buy without a prescription there. The most common mistake, according to Tuesday's study, is that doctors simply do not order the tests necessary to make a diagnosis, such as testing lung fluid or a chest x-ray.
"Doctors are actually doing too little," said Das. "They are not just picking up that the guy might have TB." On the bright side, doctors who make mistakes consistently make the same mistakes. In theory, that "coherence" makes it possible to correct the pattern, if training was upgraded and harmonized. In the near future, according to McGill professor Madhukar Pai, it's vital to refer patients to the right doctors and provide them with subsidized public programs for the most effective anti-TB drugs - instead of sending them home with the wrong pills.
India's overburdened public health system suffers from a lack of doctors and hospitals. Medical treatment is largely free in government-funded hospitals but long queues and poor service force many to seek private care. The private sector provides almost 80 percent of outpatient care, and is the first point of contact for tuberculosis for 50 to 70 percent of patients.