Draft policy- private hospitals and nursing homes

Draft policy seeks to cap hospital profits (The Times of India: 20180529)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/

The Delhi government on Monday put the draft prepared by it on capping of profits by

private hospitals in the public domain for scrutiny and feedback.

After 30 days, the government will make amendments to the Delhi Nursing Homes

Registration Act to make the draft policy changes legally binding, state health minister

Satyendar Jain said. TOI had reported about the government’s plan on May 6.

As per the policy draft, private hospitals and nursing homes will have to preferably prescribe

from the National List of Essential Medicines, the prices of which are regulated by the central

government.

Flouting of norms to cost hospitals licence

If any hospital or nursing home is found to be flouting the rule thereafter (once the act is

amended), its licence will be cancelled,” Jain said.

“For non-NLEM drugs and even disposables, we have decided that hospitals can charge a

maximum 50% as mark-up against administrative/handling charges over and above its

procurement or maximum retail price (MRP), whichever is lesser,” the state health minister

said, adding that there have been instances in the past in which private hospitals were found

to have charged 1,000% to 1,700% margins on medicines and consumables.

Compared to that, a 50% profit recommendation will be drastic cut. However, it is not clear

how the government will ensure that the procurement price itself is not inflated to circumvent

the process.

The only printed information is MRP, which is found to be inflated in most cases to

accommodate margins. When asked, Jain said they will match the procurement price of

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayTuesday 20180529

suspicious hospitals with that of state-run hospitals. “We also buy medicines. If the difference

in procurement cost is significant, we will audit them and take action as per the law,” the

health minister explained.

In the case of implants, too, many consumer groups and patients have been raising the issue

of over-pricing and profiteering by private hospitals. The Delhi government said it has fixed a

mark-up of not more than 35% above the procurement price for that. “For investigations, the

nine-member committee constituted by us could not come to a conclusion on the capping so

the government has decided to form a separate committee to decide on that,” Jain said.

The government draft has also suggested fixed pricing for packages for various procedures.

Also, it suggests that any additional procedure performed on the patient who has opted for a

particular package shall be charged at 50% of its original rate and that patients should be

offered the choice of opting for a high-risk package that covers all possible complications and

that it should not cost more than 20% higher. Jain said he often gets complaints that a hospital

gave an estimate of say Rs 1 lakh for a procedure but the final bill was over Rs 5 lakh due to

complications.

“How will a middle-class person budget for such an escalation in estimated price? They

should be told about it in advance,” he added. The health minister clarified that if the package

rate of a particular hospital is too high, patients will have the choice to opt for a hospital with

a cheaper package rate. One controversial suggestion made by the government committee is

that if a patient dies within six hours of admission, 50% of the charges should be waived.

And if the patient dies within 24 hours of admission, 20% fees must be waived. Officials said

the committee members were themselves divided on this and it will be included in the

amendments if the public feedback favours the suggestion.

The Delhi government’s proposal is sweeping and, health experts say, it may face legal

hurdles. “If the government is going to decide the profit margin on the basis of procurement

price, why have MRP? I am sure someone will go to court and get a stay on such orders,”

said the owner of one hospital.

Dr D S Rana, chairman of the board of management of Sir Ganga Ram Hospital, said that

ideally the drug regulator should ensure no drug is overpriced like the way it does for

essential medicines. “The government is asking the private sector to give discounts for

additional surgeries and in case of death within 24 hours. But there’s nothing for the hospital

in the policy draft. Also, the government will have to decide whether hospitals should follow

MRP or the procurement price as the benchmark for deciding profit,” said Alok Roy, cochair

of the health services committee of the Federation of Indian Chambers of Commerce and

Industry.

Medicines- Delhi Medical Association-

Capping profit margin: doctors say wider consultation needed (The Hindu:

20180529)

http://www.thehindu.com/news/cities/Delhi/capping-profit-margin-doctors-say-wider-

consultation-needed/article23806883.ece

Delhi Medical Association seeks meeting with Satyendar Jain on proposal by govt

Doctors and members of the medical industry have welcomed the move to “cap profit

margins in healthcare” proposed by the Delhi government, but said that there “should have

been a wider consultation to ensure that a balanced approach is adopted for patients’ well-

being”.

Emergency meeting

The Delhi Medical Association (DMA) held an emergency meeting on Monday to discuss the

issue of the government looking at capping the hospital profits and maintained that the

maximum retail price (MRP) of medicines etc. should be capped and the blame should be

shifted from the doctors who are wrongly being accused of pushing up medical treatment

costs, said DMA president Ashwani Goel.

The association has also sought a meeting with Delhi Health Minister Satyendar Jain on the

issue.

Dr. Goel also said that it is impractical to expect the hospital to show their procurement costs

during every billing.

A nine-member committee was set up five months ago to suggest the scope of profit margins

on medicines and consumables. The committee comprised members of the Delhi Medical

Council, Indian Medical Associations and some bureaucrats from the health department.

It is understood that the Delhi government will issue a policy based on the recommendation

of the committee in the next few days.

The panel has suggested capping of the profit margin for drugs and devices at a maximum of

50% above the manufacturing price or procurement cost, whichever was lower.

Meanwhile, the Medical Technology Association of India (MTaI), which represents leading

research-based medical technology companies with significant manufacturing investments in

India, released a statement.

MTaI’s statement

“In the interest of the patients, it is necessary to come out with a policy after hearing all

stakeholders and assessing their importance in maintaining a state of good health. The current

constitution of the committee is limited and it is unlikely that resultant policy would be a

balanced one. We have not even been formally informed of the formation of such a

committee,” it stated.

The group said that while they support the profit margin of 50%, “we differ on what should

constitute ‘the base’”. Acceptable criteria, to both industry and the Central government

stakeholders is suggested in the Report of The Committee of High Trade Margins in the Sale

of Drugs, commissioned by the Department of Pharmaceuticals, GOI,” it noted.

MTaI has said that it is important for Delhi government to avoid looking at a wrong base of

manufacturing cost, which is open to manipulation through artificial inflation of raw material

and intermediary costs.

“A perspective, so informed, will also ensure uninterrupted supply of critical-care products

and thus enduringly protect patients’ interest,” MTaI added.

The group has asked the State health department to “give them an opportunity to explain their

views in detail to enable formation of a widely acceptable policy”.

“To ensure lasting success of the policy, the State government should proceed only after all

stake holders, including the medical technology industry, have been heard and their

contentions have been understood thoroughly,” the group said.

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Smoking -e-cigarette -impairs lung function

Widely used e-cigarette flavouring impairs lung function (The Tribune:

20180529)

http://www.tribuneindia.com/news/health/widely-used-e-cigarette-flavouring-impairs-lung-

function/596341.html

Widely used e-cigarette flavouring impairs lung function

''When used in e-cigarettes cinnamaldehyde, like toxic aldehydes in cigarette smoke,

significantly disrupts normal cell physiology in ways that may have implications for the

development and exacerbation of respiratory disease.

A common e-cigarette flavouring has toxic chemicals similar to those found in tobacco

smoke, which disrupts the lungs' antibacterial defence system, a study has found.

"Our data suggest that when used in e-cigarettes cinnamaldehyde, like toxic aldehydes in

cigarette smoke, significantly disrupts normal cell physiology in ways that may have

implications for the development and exacerbation of respiratory disease," said Phillip Clapp,

at the University of North Carolina in the US.

"Our finding that cinnamaldehyde impairs normal airway cilia motility is significant because

it demonstrates that a common, food-safe flavoring agent, in the context of e-cigarette use, is

capable of dysregulating a critical anti-bacterial defence system in the lungs," said Clapp.

Cinnamaldehyde is the chemical that gives cinnamon its characteristic flavour and odour.

Researchers performed their experiment by exposing human bronchial epithelial cell (HBEC)

cultures to diluted cinnamon e-liquids and e-liquid aerosols from a third generation e-

cigarette device.

The frequency of movement of hair-like projections (cilia) that clear mucus and dirt from the

lungs - that is, cilia beat frequency (CBF) - was measured over 120 minutes using a high-

speed digital camera and a video analysis system.

The cinnamaldehyde content of each e-liquid was determined, and HBECs were then exposed

to various concentrations of cinnamaldehyde to determine if cilia beat frequency changed as

the dose increased.

The researchers evaluated changes in mitochondria oxidation phosphorylation, the process by

which cells generate the majority of their cellular energy.

Several different reactive aldehydes, a group of chemicals also found in cigarette smoke,

cause lung inflammation, and increase susceptibility to bacterial and viral infections.

In recent years, e-cigarettes have emerged as potentially safer alternatives to traditional

cigarettes because they provide the sensation of smoking and the desired nicotine effect

without burning tobacco.

"E-cigarette emissions contain chemicals that have not been evaluated for inhalation

toxicities," said Clapp.

"The inhalation of flavouring agents, which are frequently reactive aldehydes, poses a

significant unknown in regards to the potential health risks of e-cigarette use as many of these

chemicals are structurally similar to toxic aldehydes in cigarette smoke," he said.

"Moreover, aldehyde flavouring agents are often used in exceedingly high concentrations in

e-cigarettes, which may lead to high exposure doses," he added.

Researchers decided to conduct this experiment because many food additives "generally

recognised as safe (GRAS)" by the US Food and Drug Administration (FDA) have been

added to e-cigarettes without further study of their effects when inhaled.

They became especially concerned after looking at the chemical structures of various e-

cigarette flavouring agents that have chemical structures similar to those that are found in

cigarette smoke with known toxicities. – PTI

Single-use plastics

EU proposes ban on straws, other single-use plastics (The Hindu:

20180529)

http://www.thehindu.com/news/international/eu-proposes-ban-on-straws-other-single-use-

plastics/article24016487.ece

Move necessitated after plastic waste started showing up in the food chain

The European Union proposed on Monday a bloc-wide ban on single-use plastics such as

straws, cutlery and cotton buds while urging the collection of most plastic drinks bottles by

2025.

The set of proposals are part of a growing EU drive to rid the environment of plastic waste

which has begun showing up in the food chain. “Plastic waste is undeniably a big issue and

Europeans need to act together to tackle this problem,” EU First Vice President Frans

Timmermans said.

No deadline set

“Today’s proposals will reduce single-use plastics on our supermarket shelves through a

range of measures,” Mr. Timmermans added. The proposals call for banning banning plastic

cotton buds, cutlery, plates, straws, drink stirrers and balloon sticks, but it did not set a

deadline.

These items must all be made from sustainable materials instead, according to the plan which

must be approved by the 28 EU member countries and the European Parliament. Member

states must reduce the use of plastic food containers and drinks cups, by promoting

alternatives for sale or ensuring they are not offered free.

Producers must contribute to the costs of waste management and will be offered incentives to

develop less polluting alternatives. For example, it calls for producers of plastic fishing gear

to cover the cost of waste collection from port reception facilities.

Sustainable alternatives

Member countries must collect 90% of single-use plastic drinks bottles by 2025, through

deposit refund schemes, for example. The plan calls for producers to clearly label products

and inform consumers how the waste should be disposed of.

The proposals, plus one in January for all plastic packaging in Europe to be recyclable by

2030, follows China’s decision to ban imports of foreign waste products for recycling.

Gene Survey (The Asian Age: 20180529)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10764468

HPV Vaccine. (The Asian Age: 20180529)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10764474

Brain Activity (The Asian Age: 20180529)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10764467

E-Waste (The Asian Age: 20180529)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10764900

Nipah shadow

Nipah shadow over 9-day yoga tour (Hindustan: 20180529)

http://paper.hindustantimes.com/epaper/viewer.aspx

ONLY 60 OF THE 140 PARTICIPANTS HAVE SAID THEY’D ATTEND THE TOUR

DESIGNED BY THE AYUSH MINISTRY AND THE KERALA GOVT

Fourteen deaths due to the Nipah Virus Disease (NiV) in Kerala seem to have dampened a

nine-day Yoga Ambassadors Tour for 140 professional practitioners from across the globe.

Only 60 of the 140 participants have confirmed participation for the tour beginning June 13,

that was designed by the Union ministry of Ayush and Kerala government as part of the

countdown to the International Yoga Day on June 21. American and German nationals have

written to the organisers raising concerns about visiting the state which is grappling with a

deadly infection.

“We got a couple of emails asking us about the situation in the state and we told them that

north Kerala, which is the affected part (due to Nipah virus), is not in the itinerary,” said

Anish P K, president, association of tourism trade organisations, which is one of the tour

organisers. The participating yoga professionals are from the UK, the US, Italy, South Africa,

Germany and Singapore.

“The other participants could have dropped out because of logistical reasons as they were

supposed to fund their tickets and visa. I would say it is the domestic crowd that is more

affected by the scare, but we are responding in detail to each query that we have received,”

Anish said.

Ranjit Kumar, joint secretary, Ayush ministry, said they were assured by the state

government that “the disease was well contained, and there was no reason to panic”. “The

tour will be conducted as planned,” he said.

The tour is aimed at achieving the larger agenda to develop a yoga and meditation circuit in

south India. Vivekananda Rock in Kanyakumari and Dolmen Caves in Munnar are among the

places identified for the circuit.

“We designed this specific tour because the number of foreign tourists visiting south India for

yoga and meditation was growing each year. We took the proposal to the ministry almost a

year ago and they agreed to support it, and this year we kick start the tour with the yoga day,”

Anish said.

GOA MAN UNDER OBSERVATION FOR SYMPTOMS

PANAJI: Goa Medical College and Hospital has kept under observation a patient, who

arrived here from Kerala and himself suspected that he might be infected with the Nipah

virus. State health minister Vishwajit Rane said the patient’s blood samples have been sent to

the National Institute of Virology in Pune.

Lab-on-a-chip technology- chronic disease

Lab-on-a-chip technology can improve chronic disease diagnoses (New

Kerala: 20180529)

https://www.newkerala.com/news/read/3094/lab-on-a-chip-technology-can-improve-chronic-

disease-diagnoses.html

Researchers have developed a breakthrough lab-on-a-chip technology that reveals how

human cells communicate, opening path to new treatments for cancer and autoimmune

disorders.

The researchers built a miniature optofluidic biosensor that allows scientists to isolate single

cells, analyse them in real time over at least 12 hours and observe their complex signalling

behaviour without disturbing their environment.

Single cell analysis holds great promise for developing new treatments for diseases but a lack

of effective analysis technologies was holding back research in the field, said Arnan Mitchell,

Professor at the RMIT University in Australia's Melbourne.

The new biosensor is "a powerful new tool that will give us a deeper fundamental

understanding of cell communication and behaviour. These insights will open the way to

develop radically new methods for diagnosing and treating disease", Mitchell said.

Human cells communicate that something is wrong in complex and dynamic ways, producing

various chemical substances that signal to other cells what they need to do.

Understanding how individual cells interact and communicate is critical to developing new

therapies for serious diseases, to better harness the power of the body's own immune system

or precisely target defective cells, the researchers said.

For the study, published in the journal Small, the team demonstrated how the technology can

be used to examine the secretion of cytokines from single lymphoma cells.

Cytokines are small proteins produced by a broad range of cells to communicate to other

cells, and they are known to play an important role in responses to infection, immune

disorders, inflammation, sepsis and cancer.

The study found the lymphoma cells produced cytokine in different ways, unique to each cell,

enabling researchers to determine each cell's "secretion fingerprints".

"If we can build up a clear picture of this behaviour, this would help us sort good cells from

bad and enable us to one day develop treatments that precisely target just those bad cells,"

Mitchell said.

Alzheimer's drug

UK to launch first human trials of Alzheimer's drug (New Kerala:

20180529)

https://www.newkerala.com/news/read/3020/uk-to-launch-first-human-trials-of-alzheimers-

drug.html

Scientists in the UK are set to launch the first human trials of a ground-breaking drug shown

to repair DNA damage that contributes to Alzheimer's, the media reported.

The study, also being launched this week in hospitals in France and Spain, will see the neuro-

degenerative condition treated with an agent which acts as a DNA repair kit to restore

memory and reverse behavioural changes such as aggression and social avoidance, the

express.co.uk reported late on Sunday.

The drug, known as ORY-2001, contains a small molecule which inhibits two enzymes in the

brain, LSD1, and MAOB, which are responsible for promoting DNA damage and inhibiting

repair.

By blocking their action, the new drug repairs and prevents further damage.

The drug also stops inflammation in the brain, a key factor perhaps causing mental decline,

the report said.

"Curing Alzheimer's is now on the horizon. The mechanism of this drug may lead to

treatments that protect genetic material from the influences of ageing," Stuart Ratcliffe, chief

scientific officer at St Pancras Clinical Research in London, was quoted as saying.

"I believe this is ground-breaking. Neuro-degenerative diseases are a massive problem so

heading these off is a holy grail of medicine," Ratcliffe added.

Tests on mice have shown that one treatment a day can reverse the disease, giving new hope

that a cure is on the horizon.

The 26-week human trial, which will include 90 patients with mild to moderate Alzheimer's,

could potentially lead to a "cure" for the disease affecting nearly 50 million people

worldwide, the scientists said.

"Alzheimer's is our biggest killer and is spiralling," Ratcliffe said.

"It is therefore paramount that new treatments are discovered and developed, otherwise the

societal and health care costs of Alzheimer's alone could bankrupt us," he added.

Premature mortality

Worsening air quality causing premature mortality in Bihar cities: Report

(New Kerala: 20180529)

https://www.newkerala.com/news/read/2970/worsening-air-quality-causing-premature-

mortality-in-bihar-cities-report.html

Worsening air quality in Patna, Gaya, and Muzaffarpur is one of the reasons behind high

premature mortality in these Bihar cities, a report said on Monday.

The 'Know What You Breathe' report prepared by the Indian Institute of Technology-Delhi

and supported by the Patna-based Centre for Environment and Energy Development (CEED)

revealed a massive spike in air pollution in Patna and Gaya.

"An estimated 290-300 deaths per lakh population took place annually in Patna, Muzaffarpur,

and Gaya due to pulmonary and heart diseases, strokes, lung cancer and acute lower

respiratory infections," the report said.

The report studied the annual mean PM2.5 concentration in 11 cities of Bihar, Uttar Pradesh

and Jharkhand using satellite data of the past 17 years, which estimate premature mortality of

4,082 persons per year in the three cities of Bihar. PM2.5 refers to atmospheric particulate

matter (PM) with diameter less than 2.5 micrometers.

The study collated the air quality data with deaths due to air pollution-related diseases.

The report's data and findings related to the Bihar cities were released on Monday,

underlining the urgency to take stringent steps to curb air pollution.

The report said that PM2.5 level in Patna, Gaya, and Muzaffarpur is 175 per cent to 200 per

cent higher than the national limit and it is disproportionately increasing over the years.

In the last 17 years, the particulate matter pollution has increased to an average 23 Aug/m3,

13 Aug/m3 and 6 Aug/m3 in Patna, Gaya, and Muzaffarpur respectively.

With specific findings related to the sources of pollution and aerosol composition, the study

indicated a higher percentage of sulphates, organic carbons, and black carbon, which are

emitted primarily by anthropogenic sources.

CEED Programme Director Abhishek Pratap said: "Air pollution does not discriminate

between the rich and the poor, but the poorest and the most marginalised sections bear the

brunt of the health burden the most.

"The report is a grim reminder of the fact that air pollution is a public health crisis impacting

the present as well as the future generations."

He emphasised that to prevent air pollution from causing more premature mortality, the

government needed to put it high on its priority list.

The announcement of preparation of an Air Action Plan for Patna is a welcome step, he said.

Speaking on the action required for improved air quality, report author and Associate

Professor Sagnik Dey of the Centre for Atmospheric Sciences, IIT-Delhi, said that a critical

factor in air quality management plan is to set targets in short-, medium- and long-terms of

meeting air quality standards, along with a detailed implementation plan.

To improve the air quality in the region, we need to transit towards cleaner fuel for cooking

on a priority basis, Dey said.

HPV vaccination

HPV vaccination not linked to risk of autoimmune disorders: Study New

Kerala: 20180529)

https://www.newkerala.com/news/read/2906/hpv-vaccination-not-linked-to-risk-of-

autoimmune-disorders-study.html

Taking the quadrivalent human papillomavirus (HPV4) vaccination is not linked with

increased risk of autoimmune disorders in girls, according to researchers.

Human papillomavirus is the most common sexually transmitted disease worldwide, affecting

50 per cent to 75 per cent of sexually active people.

The HPV4 vaccine is effective at protecting against 90 per cent of the strains that cause

cervical and anal cancer.

While several studies have indicated the safety of the vaccine, there have been concerns

about a possible link to autoimmune disorders as lupus, rheumatoid arthritis, Type 1 diabetes

and multiple sclerosis.

"Despite demonstrated effectiveness in real-world settings, concerns continue to persist

regarding the safety of the HPV4 vaccine. In light of these concerns, we wanted to study the

HPV4 vaccination," said Jeffrey Kwong, senior scientist at the Institute for Clinical

Evaluative Sciences (ICES)- Canada-based non-profit.

For the study, published in the journal in CMAJ (Canadian Medical Association Journal), the

team looked at data on 290,939 girls aged 12 to 17 years in Ontario.

Of the total 180,819 girls who received the HPV4 vaccination in school-based clinics, there

were 681 diagnosed cases of autoimmune disorders between one week and two months after

vaccination.

This rate is consistent with the general rate of diagnosed cases in this age group and adds to

the body of evidence for the safety of the vaccine.

"These findings add to the body of evidence on the safety of the HPV4 vaccine and should

reassure parents and health care providers," noted Linda Levesque, from the University of

Toronto, in Ontario, Canada.

Manses (Dainik Gagran: 20180529)

https://epaper.jagran.com/ePaperArticle/29-may-2018-edition-Delhi-City-page_4-1286-6759-

4.html

Manses (Dainik Gagran: 20180529)

https://epaper.jagran.com/ePaperArticle/29-may-2018-edition-Delhi-City-page_4-1286-8798-

4.html

Private Hospital (Navbharat Times: 20180529)

http://epaper.navbharattimes.com/details/76493-70099-1.html

Health Care Services (Navbharat Times: 20180529)

http://epaper.navbharattimes.com/details/76499-68206-1.html

Depression (Dainik Bhasker: 20180529)

http://epaper.bhaskar.com/detail/66094/05290153230169/cph/map/tabs-1/2018-05-

29%2000:00:00/194/1/image/