No specific target for elimination of cervical cancer, govt tells Parliament in reply to question on HPV vaccine

MediBulletin Bureau
-
0
No specific target for elimination of cervical cancer, govt tells Parliament in reply to question on HPV vaccine

Cases of both cervical and breast cancer have been rising in India, with over 81,000 cases of cervical cancer being reported in 2023

Despite the fact that cervical cancer cases in India are steadily rising, with over 81000 cases being reported in 2023, there is no specific target for the elimination of the disease, government told Parliament Tuesday.

Cervical cancer is the second most common cancer among women in India. In a written reply to Rajya Sabha, minister of state for health Anupriya Patel on a question about the rollout of HPV vaccination said: “The HPV vaccine roll out is being implemented in the following states as on date:  Sikkim: The Government of Sikkim introduced the HPV vaccination program in 2018, targeting girls aged 9-14 years.  Bihar: The state introduced the HPV vaccination for girls aged 9 to 14 years under the Mukhyamantri Balika Cancer Immunization Scheme, from 6 th October, 2024. (f) There is no specific target for the elimination of cervical cancer in the country.”

HPV is the commonest cause of cervical cancer and India now has an indigenous HPV vaccine manufactured by Serum Institute of India.Conceding in another reply that the cases of both cervical and breast cancer are increasing in the country, the government listed out possible reasons for the increase.

“The increase in cancer cases could be due to : (i) Cancer is known to be a disease that increases in incidence with increasing age; (ii) Control of communicable diseases has increased life expectancy and therefore more population being exposed towards the development of cancer; (iii) The increase in population due to growth also contributes to the increase in the number of cancer cases; (iv) Improved literacy, greater consciousness about health in general and cancer in particular makes more and more people seek medical advice at an earlier stage and (v) Availability of sophisticated and improved diagnostic techniques aid in detection of tumors that would have been missed at earlier times,” Patel said, also in a written reply.

Over 1000 hospitals de-empanelled, Rs 122 crore in penalties levied for PMJAY misuse

MediBulletin Bureau
-
0
Over 1000 hospitals de-empanelled, Rs 122 crore in penalties levied for PMJAY misuse

NHA uses artificial intelligence technologies to detect potential cases of misuse, govt tells Parliament

 

Seven years since its inception, despite stringent checks and balances, irregularities continue to dog Pradhan Mantri Jan Arogya Yojana, the tertiary care arm of the NDA government’s flagship health programme Ayushman Bharat.

A total of 1,114 hospitals have been de-empanelled, 549 hospitals have been suspended and penalties amounting to ₹122 crore have been levied on over 1,504 hospitals, ministry of health and family welfare told the Rajya Sabha on Tuesday. Under PMJAY, eligible families are entitled to an annual health cover of Rs 5 lakh per year.

“To eliminate ineligible beneficiaries from the scheme, AB-PMJAY beneficiaries are verified through Aadhaar e-KYC at the time of creation of the card. Further, beneficiaries have to undergo Aadhaar authentication at the time of availing services. Aadhaar-authentication helps establish the identity of the eligible beneficiary,” MoS health Prataprao Jadhav said in  written reply.

To eliminate ineligible beneficiaries from the scheme, AB-PMJAY beneficiaries are verified through Aadhaar e-KYC at the time of creation of the card

He added: “National Health Authority (NHA) has adopted a zero-tolerance policy towards misuse and abuse and has been taking steps for prevention, detection, and deterrence of different kinds of irregularities that could occur in AB-PMJAY at different stages of its implementation. NHA uses artificial intelligence technologies to detect potential cases of misuse in AB-PMJAY. Technologies deployed include rule-based triggers and Machine Learning algorithms, fuzzy logic, image classification and de-duplication, etc.”

Cases of misuse of PMJAY have been reported from various states. In the most recent instance, a hospital in Gujarat was found to be doing angioplasties in people who did not need them as the public health insurance programme was paying. The matter came to light when some of the patients expired and scrutiny of documents revealed that the test reports did not back up the need for angioplasty.

 

Greens on your plate can help keep cancer at bay, but no need to shun meat and eggs entirely

MediBulletin Bureau
-
0
Greens on your plate can help keep cancer at bay, but no need to shun meat and eggs entirely

February 4 is observed as World Cancer Day. It is 25 years since the Charter of Paris Against Cancer was signed at the World Summit Against Cancer for the New Millennium

Higher proportion of greens on your plate can help stave off cancer; but there is no need to shun meat and eggs altogether. Moderation is key.

Cruciferous vegetables such as kale, cabbage, cauliflower, turnips and radishes are known to protect cells from DNA damage that can predispose them to cancerous growth. These vegetables are also known to have properties that can make potential carcinogens less lethal. In some studies they have been found to have effect on the incidence of breast and lung cancers. February 4 is observed as World Cancer Day to mark the anniversary of the signing of the Charter of Paris Against Cancer was signed at the World Summit Against Cancer for the New Millennium 25 years ago. 

According to Rachel C. Miller, a registered dietitian at the University of Kentucky Markey Cancer Center, there is existing evidence to suggest that a plan based diet can lower cancer risk. “Plant foods are powerful cancer fighters. They contain natural compounds called phytochemicals and antioxidants that work together to keep our cells healthy and protect them from damage. Colorful fruits and vegetables are especially rich in these protective compounds. A plant-based diet helps maintain a healthy weight. Excess body weight increases risk for several types of cancer, and plant foods are naturally low in calories and high in fiber while being filling and satisfying,” Miller has written in a piece circulated by the University.

She also says that this does not mean one needs to entirely shun meat. “This approach is flexible – you can still enjoy lean proteins like chicken, fish, eggs and low-fat dairy. The key is to fill most of your plate with plant foods first,” is her take.

In 2024 a study in Korean women reported that a diet rich in green and white coloured fruits and vegetables may lower the risk of breast cancer. A study by researchers from the School of Public Health at Imperial College London found that people consuming leafy greens, such as spinach, cabbage and broccoli could have a significantly reduced risk of colorectal cancer.

 

National Medical Commission agrees to hear patient complaints in negligence cases

MediBulletin Bureau
-
0
National Medical Commission agrees to hear patient complaints in negligence cases

This is a significant shift from the commission’s earlier stance that only doctors can approach it with complaints

In a significant shift in stance, the National Medical Commission has agreed to hear complaints from patients who allege that they have faced medical negligence. The decision was taken in the 16th meeting of the commission last September.

In the past the NMC has maintained that only doctors can approach it with complaints. This is the domain of the Ethics and Medical Registration Board (EMRB) of the NMC. There are existing rules that allow EMRB to take up complaints from patients’ families should the respective State Medical Council not act in time but the matter has been under discussion within the commission for some time now. 

The minutes for the September 16 meeting of the commission read: ”NMC has agreed that all appeals received by the EMRB will be entertained…Further, with regard to action not being taken by SMCs, on complaints filed by non medicos even after issuance of reminders by the boards. It was decided to send a communication by EMRB to SMCs to complete the process in a time bound manner.” The minutes were obtained by activist Dr K V Babu through a Right to Information application. 

Dr Babu has been vocal on the matter for a long time. In past the NMC has rejected applications from non medicos  even when they have not been addressed in other fora. Medical Negligence has been a fraught issue in India for lone with citizens often at a loss where to take their complaints to before taking the legal route while doctors’ bodies have been in denial mode, causing an impasse. On the other hand healthcare costs have been on a steep upward trajectory with doctors often blaming defensive medicine – a tendency to do more tests in patients to better defend themselves should there be a litigation in the future.

 

Laboratory chain introduces self sampling HPV DNA testing for cervical cancer

MediBulletin Bureau
-
0
Laboratory chain introduces self sampling HPV DNA testing for cervical cancer

WHO recommends use of this test for screening; India contributes a fifth of the global burden of cervical cancer

A pathology laboratory chain in collaboration with Roche Diagnostics India has introduced the  self-sampling human papillomavirus (HPV) DNA test for cervical cancer screening. The aim is to make screening more accessible for women across the country but particularly in Tier 2, Tier 3, and Tier 4 towns.

While the government of India uses visual inspection with acetic acid (VIA) for screening under the national programme, HPV DNA which is an polymerase chain reaction based test, is recommended by the World Health Organisation for screening. India has one of the highest burdens in the world of cervical cancer with the disease estimated to kill 77,000 women annually, many of them because they were diagnosed too late.

“Considering that as per a 2020 NHFS survey, only about 1.9% women in India are currently being screened, it is clear that more needs to be done to make cervical cancer screening accessible across India. Our cobas HPV DNA test provides women with a solution that allows them to overcome the potential embarrassment and discomfort that some may feel about undergoing cervical cancer screening process. I am confident that Metropolis Healthcare’s vast and established laboratory footprint will allow India to adopt cervical cancer screening at a large scale, especially in underserved areas.” said Mr. Rishubh Gupta, Managing Director, Roche Diagnostics India and Neighbouring Markets.

WHO South-East Asia Region had 2.4 million new cases of cancer in 2022, including 56,000 children, and 1.5 million deaths

 Cervical cancer is preventable and yet, India contributes to 21% of the world’s total cases of cervical cancer. The HPV DNA test detects 14 high-risk HPV types in a single tube and is a clinically validated, FDA-approved, and WHO-prequalified solution. 

Meanwhile, on the eve of World Cancer Day on February 4 Saima Wazed Regional Director for WHO Southeast Asia called for a people-centred approach, placing individuals and communities at the heart of health systems to effectively counter the scourge of cancer. WHO’s South-East Asia Region comprises Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. WHO South-East Asia Region had 2.4 million new cases of cancer in 2022, including 56,000 children, and 1.5 million deaths. Among all the WHO regions, our Region had the highest number of cancers of lips and oral cavity, uterine cervix, and childhood cancers. It is estimated that by 2050, there will be 85% increase in the number of new cases and deaths in the Region. Cervical cancer screening has less than fifty percent coverage in seven of these countries, which is much below the target of seventy percent required for elimination of cervical cancer as a public health problem. 

New trial shows the way for shorter regimens for drug resistant tuberculosis

MediBulletin Bureau
-
0
New trial shows the way for shorter regimens for drug resistant tuberculosis

Results of the seven country trial were published in the New England Journal of Medicine; India has a high burden of drug resistant TB

One of the toughest challenges in the battle against drug resistant tuberculosis is the long and difficult treatment regimen. However a new trial has now unveiled shorter treatment regimens that may work for forms of the bacterial infection that do not respond to first and second line antibiotics.

The phase III trial was conducted by a team of international researchers who are part of the endTB (Evaluating Newly Approved Drugs for Multidrug-Resistant Tuberculosis) project. They concluded that all three shorter regimens work for rifampicin resistant tuberculosis. The results were published in the New England Journal of Medicine.

Dr. Lorenzo Guglielmetti, MSF Co-Principal investigator for the endTB clinical trial said in an interview: “The endTB trial results are a milestone in the fight against MDR/RR-TB, a form of tuberculosis that is very difficult to treat because it became resistant to standard medication. In the trial, we saw remarkable cure rates with three new TB regimens – combinations of TB drugs that had not been used as such before. They all are 9-month treatment regimens and include four to five drugs. These regimens significantly reduce the treatment duration compared to the 18-month standard treatment.”

They all are 9-month treatment regimens and include four to five drugs. These regimens significantly reduce the treatment duration

India has a high burden of drug resistant TB and is estimated to be home to a quarter of the drug resistant TB cases in the world. TB pathogen becomes resistant to standard antibiotics when a TB patient is started on a treatment regimen but does not complete it so that the bacteria, exposed to a non lethal dose of the medicine develops resistance to it.

Dr. Guglielmetti added: “They have a similar or increased efficacy. For patients, these results are crucial. Traditional MDR/RR-TB treatment is often a long and difficult battle with considerable side effects. The new regimens tested in the endTB trial can drastically improve the patients’ quality of life. They make it easier for patients to complete the full treatment and ultimately increase the chances of full recovery. The endTB trial results complement other recent research breakthroughs. For the first time in decades, we’re seeing real, sustainable progress in treating this form of TB.”

 

Doctor-patient ratio: Economic Survey contradicts government stand in Parliament

MediBulletin Bureau
-
0
Doctor-patient ratio: Economic Survey contradicts government stand in Parliament

In her reply Lok Sabha last year, minister of state Anupriya Patel had claimed that doctor patient ratio in India is already better than the WHO standard

The Economic Survey 2024-25 has acknowledged that India has some distance to cover before it reaches the ideal doctor patient ratio as prescribed by the World Health Organisation (WHO). It set 2030 as the year when India is likely to reach the milestone. This, interestingly, contradicts the government’s stance in Parliament when it had included Ayush practitioners in its tally to claim that India has already surpassed the WHO benchmark.

The survey, while talking about the structural challenges in the creation of medical infrastructure and training of manpower said: “There are 13.86 lakh practitioners of modern medicine registered as of July, 2024,79 which converts into current availability for the whole population of the country in the ratio of 1:1263.80 The WHO standard norm of 1:1000 seems to be attainable by 2030 with a conservative 50,000 doctors being licensed every year till 2030. Thus, numerical shortage of physician availability in India is perhaps no longer a primary concern. However, there are some larger concerns warranting attention.”

However in August last year when she was replying to a question in the Lok Sabha, minister of state for health and family welfare Anupriya Patel had given the impression that India has already surpassed the WHO standard. She had included in her analysis practitioners of alternative systems of medicine too.

Assuming 80% availability of registered allopathic doctors and around 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is around 1:836

“As per information provided by National Medical Commission (NMC), there are 13,86,136 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) as on July, 2024. Assuming 80% availability of registered allopathic doctors and around 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is around 1:836 which is better than the WHO standard of 1:1000,” Patel had said replying to a question asked by MP Khalilur Rahman.

The Economic Survey has also highlighted a slew of challenges in boosting availability of medical manpower in the country including low pass percentage (16% in 2023) of foreign medical graduates in the qualifying examination  here and the geographical skew in medical colleges.

“The availability of opportunities for medical education appears to be geographically skewed, apparent from the fact that 51 per cent of undergraduate seats and 49 per cent of postgraduate seats are in the southern states. Further, the availability is skewed in favour of urban areas with the urban to rural doctor density ratio being 3.8:1. These patterns tend to follow the pattern in availability of healthcare services in general. It has been estimated that 75 per cent of dispensaries and 60 per cent of hospitals are in urban areas, where 80 per cent of doctors serve. The imbalance in distribution can be attributed to the state/region level of economic development, demand for and expansion of healthcare services, and increasing market for medical value travel,” says the survey

Additional seats in medical colleges, PMJAY health cover for gig workers in Union Budget

MediBulletin Bureau
-
0
Additional seats in medical colleges, PMJAY health cover for gig workers in Union Budget

In the next year, 10,000 additional seats will be added towards the goal of adding 75,000 seats in the next 5 years

The Union Budget 2025-26 announced a hike in nutritional support for schemes to tackle malnutrition, health insurance cover for gig workers and additional seats in medical colleges and hospitals for undergraduate and postgraduate students. It also announced initiatives that will help cancer patients.

The allocation for the department of health and family welfare for the next financial year stood at Rs 123059.80 while that for the department of health research stood at Rs 3900.69 crore. Last year they were Rs 109551.36 for the department of health and Rs 3300 crore for the department of health research. “ Our Government has added almost 1.1 lakh UG and PG medical education seats in ten years, an increase of 130 per cent. In the next year, 10,000 additional seats will be added in medical colleges and hospitals, towards the goal of adding 75,000 seats in the next 5 years.  Our Government will facilitate setting up of Day Care Cancer Centres in all district hospitals in the next 3 years. 200 Centres will be established in 2025-26,” finance minister Nirmala Sitharaman said in her speech.

She also announced that the cost norms based on which nutritional support is provided for various schemes to tackle malnutrition, will also be revised. Gig workers numbering about 1 crore will now be covered under the Pradhan Mantri Jan Arogya Yojana (PMJAY), making them eligible for an annual family health cover of Rs 5 lakh. Broadband connectivity will be provided to all primary health centres in rural areas.

Specified drugs and medicines under Patient Assistance Programmes run by pharmaceutical companies are fully exempt from basic customs duty

Sitharaman also announced that  36 lifesaving drugs and medicines will be added to the list of medicines fully exempted from Basic Customs Duty (BCD), a move that will benefit patients of cancers and various rare diseases.  “ Specified drugs and medicines under Patient Assistance Programmes run by pharmaceutical companies are fully exempt from BCD, provided the medicines are supplied free of cost to patients. I propose to add 37 more medicines along with 13 new patient assistance programmes,” she added.

The industry welcomed the Budget. “For mental health startups, the government’s move to expand medical education by increasing seats is a welcome push. Additionally, the introduction of credit guarantee cover and the new Fund of Funds is timely, especially as startup investments have declined, leaving many budding ventures in need of a lifeline. However, we recall the launch of the mental health helpline in the COVID-19 budget—and little action beyond that. There remains a critical need for expanded insurance coverage for mental health and related illnesses to address the root causes. Such a step would be both necessary and profoundly impactful,” said Rajat Goel, Co-Founder at Emoneeds.

Dr. Harsh Mahajan, Chair of the FICCI Health Services Committee and Founder & Chief Radiologist at Mahajan Imaging & Labs said: “We welcome the revision of MSME limits and the exemption from income tax for up to Rs 12 lakh, which will significantly benefit those working in the healthcare sector. The exemption of 36 life-saving drugs from basic customs duty, along with the concessional 5% duty on six additional medicines, will make critical treatments more affordable for patients suffering from cancer, rare diseases, and chronic conditions. Furthermore, the inclusion of 37 additional medicines and 13 new patient assistance programs will further ease the financial burden on patients.

 

Animal studies show traffic pollution exposure, even at low levels can cause liver damage

MediBulletin Bureau
-
0
Animal studies show traffic pollution exposure, even at low levels can cause liver damage

Long-term exposure harms the liver and may raise the risk of non alcoholic fatty liver disease; this changes perception about air pollution largely affecting the lungs

Animal studies have revealed that prolonged exposure to even low levels of air pollution can cause liver damage and precipitate non alcoholic fatty liver disease. This changes the long held view that the effects of air pollution are the most pronounced on the lungs.

The study, Prolonged exposure to low-dose traffic-derived PM2.5 causes fatty liver disorder in mice, was recently published in the Journal of Environmental Sciences. “We think of air pollution as being harmful to people’s lungs, but it has a broader impact on health including on the liver. The liver is critical for metabolism. It clears toxins, regulates blood sugar, and produces essential vitamins and proteins, among many other functions. If the liver isn’t functioning properly, it can leave people feeling tired and unwell due to disrupted metabolism,” said lead author Professor Hui Chen from the University of Technology Sydney (UTS).

Fatty liver is the commonest liver disease in the world. The findings have particular significance for India which has some of the most polluted cities in the world. Of the top 100 most polluted cities in the world, 83 are in India, with Begusarai in Bihar topping the list. India also has a very high incidence of liver diseases. A 2022 study estimates that one in three adults or children in India have NAFLD.

“The overall pooled prevalence of NAFLD in India is 38.6% among adults and 35.4% among children. The prevalence is similar in males and females. Our analysis suggests that the prevalence of NAFLD in Indian urban and rural populations is higher than the average estimated global prevalence of 25%,” reported researchers from the All India Institute of Medical Sciences, New Delhi. 

The recent animal study found that exposure to air pollution particles caused more immune cells to gather in the liver and it increased inflammation. It also led to more scar tissue forming.

The liver’s fat processing went up, and potentially harmful fats like triglycerides, diacylglycerols, and ceramides also increased. At the same time, the liver stored less sugar for energy.

 

Economic survey flags ultra processed foods, rising incidence of mental health diseases

MediBulletin Bureau
-
0
Economic survey flags ultra processed foods, rising incidence of mental health diseases

Historically, the correlation between poor dietary intake and adverse mental health has been documented, says the annual stocktaking of India’s economic health

The Economic Survey 2024-25 that was tabled in Parliament on Friday has flagged ultra processed foods (UPFs), the role of diet and lifestyle in India’s burgeoning mental health and non communicable disease burden. The survey which is presented one day before the Union Budget is an annual stocktaking of the country’s economic, fiscal and social health.

Drawing on a global survey done by the World Health Organisation that says that 12 billion days are lost to mental health related problems, the survey says that Rs 7000 per day is lost because of depression and anxiety. Among the factors that it acknowledges as contributors to mental wellbeing are workplace culture, hours spent working, and lifestyle, that influence mental well-being.

“The increase in mental health issues in children and adolescents is often linked to the overuse of the internet and, specifically, social media. Jonathan Haidt, in his book ‘The Anxious Generation: How the great rewiring of children is causing an epidemic of mental illness’, which has now been voted as the book of the year by Goodreads,138 provides a researched assessment of adolescent mental health. He suggests that the arrival of the “phone-based childhood” is rewiring the very experience of growing up. The recent announcements by government of Australia to ban the use of social media by children below 16 years of age is a testimony to the gravity of the situation. Similar interventions are being discussed in Sweden and Spain, as per news report,” reads the section of the survey that deals with the social sector.

Highlighting the ubiquity of ultra processed foods such as sweetened breakfast cereals, soft drinks, energy drinks to fried chicken and packaged cookies, the survey links them to anxiety outcomes, mental disorder outcomes, prevalent adverse sleep-related outcomes, heart disease-related mortality, type 2 diabetes, depressive outcomes, wheezing, obesity, and cancer and higher risks of mortality.

“The huge business of UPF segments has been built on hyper palatability of food items and marketing strategies involving misleading advertisements and celebrity endorsements targeting consumer behaviour. Often unhealthy packaged food items are advertised and marketed as healthy products. For example, breakfast cereals, tetra pack juices and chocolate malt drinks, often advertised as healthy and nutritious, come under the category of UPF based on their ingredients. Misleading nutrition claims and information on UPFs need to be tackled and should be brought under the scanner. Setting standards for permissible levels of salt and sugar and ensuring checks for UPF brands to adhere to the regulations are also required,” the survey says.

On NCDs, it draws on the 2017 study report ‘India: Health of the Nation’s States’ by the Indian Council of Medical Research (ICMR), to emphasise that the proportion of deaths due to NCDs in India increased from 37.9 per cent in 1990 to 61.8 per cent in 2016. The four major NCDs are cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs), and diabetes. These diseases share four common behavioural risk factors: unhealthy diet, lack of physical activity, tobacco use, and alcohol consumption.

123...234Page 2 of 234