No plans to open up PMJAY beyond beneficiary base, health ministry tells Parliament

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There was expectation that the expansion for senior citizens would be part of the Union Budget; all eyes will now be on the prime minister’s Independence Day address

 

Skirting a direct question about the expansion of the Pradhan Mantri Jan Arogya Yojana (PMJAY) to include senior citizens – an election promise of the BJP – and a possible increase in annual limit of spending, government of India has told Parliament that there are no plans to throw the scheme open for citizens who do not meet the current eligibility criteria against payment of premium.

PMJAY is the tertiary care arm of Ayushman Bharat, the flagship health programme of the NDA government. Under the scheme eligible families get an annual health cover of Rs 5 lakh for fixed diseases and procedures. Replying to  question from Lok Sabha MP N K Premachandran, minister of state for health and family welfare Prataprao Jadhav said: “Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the world’s largest publicly funded health assurance scheme which provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 55 crore individuals corresponding to 12.34 crore families. All members of the eligible families irrespective of age are covered under the scheme. The scheme is being implemented in 33 States/UTs except NCT of Delhi, West Bengal and Odisha. Currently, there is no proposal to open the scheme beyond the existing beneficiary base on contribution of premium.”

Expansion of PMJAY for senior citizens aged above 70 years had also found mention in the President’s address to the joint session of Parliament. There had been widespread expectation of the expansion for senior citizens to be announced in the Union Budget but with that not happening, all eyes will now be on the prime minister’s Independence Day address from the ramparts of the Red Fort.

Launched in 2018, PMJAY has so far managed to enrol more than 34 crore of the 55 crore target population.

The minister also told the Lower House that initially, 10.74 crore beneficiary families under AB PM-JAY were identified on the basis of the Socio-economic Caste Census (SECC) of 2011 using select deprivation and occupational criteria separately for rural and urban areas. In January 2022, the beneficiary base was expanded to 12.34 crore families and States/UTs have been given the flexibility to use other digitized databases of similar socio-economic conditions for identification of beneficiaries under the scheme. Accordingly, States/UTs have provided Aadhaar-seeded databases of poor and vulnerable families for verification under the scheme.

Breast and lung cancers account for 3L new cases/year; an explainer on the exempted drugs

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Trastuzumab Deruxtecan, Osimertinib, and Durvalumab are used to treat breast, lung and biliary tract cancer

Breast cancer is the commonest cancer in women in india, accounting for an estimated quarter of all new cancer cases detected every year. Lung cancer is the 4th most common cancer accounting for 5.9% of all cancers detected in the overall population. Biliary tract cancer is less common in India. Every year an estimated 1.5 lakh cases of each of these two cancers are detected in India.

That is why the exemption given to the three cancer drugs – Trastuzumab Deruxtecan, Osimertinib, and Durvalumab – has been hailed by the industry as a game changer. The three drugs are primarily used to treat breast, lung and biliary tract cancer. The last is relatively less common in India and is found largely in the west or in China and Thailand in our part of the world.

In a statement Wednesday the Union ministry of health said: “The request (for duty exemption) was forwarded by the Ministry of Health and Family Welfare (MoHFW) to the Ministry of Finance in view of the 27 lakh cancer patients in the country. To improve the affordability of these drugs, Ministry of Finance has exempted them from the customs duty.”

What are these drugs?

Trastuzumab Injection 440mg/50ml is a scheduled drug under National List of Essential Medicines 2022. This means that the ceiling price of the drug has been fixed by the National Pharmaceutical Pricing Authority (NPPA). Current applicable ceiling price is Rs. 54725.21 per vial, fixed in March this year. However, its other strength variants are not under the scheduled list. Trastuzumab comes in different strengths and dosages with a combined annual turnover of more than Rs. 276 crores.

The other two medicines i.e., Osimertinib and Durvalumab are non-scheduled medicines under the Drug Price Control Order, 2013. Hence, NPPA monitors the maximum retail price (MRP) of the non-scheduled formulation to ensure that the same does not increase by more than 10% of MRP during the preceding twelve months.  The Annual turnover of Durvalumab for the year 2023-24 was Rs. 28.8 crore

Osimertinib is covered under the list of 42 anti-cancer drugs for which trade margin was regulated under Trade Margin Rationalisation.  As per the data available with NPPA, the annual turnover of Osimertinib for the year 2023-24 was Rs. 52.26 crore.

Inspired by CAR-T, researchers report technique to ‘turbocharge’ B cells into producing targeted antibodies

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The research by the University of Southern California (USC) has been published in Nature Biomedical Engineering

Scientists may have found a way to use the antibody producing B cells into surveillance machines that can pump out antibodies that specifically target cancer cells or HIV.

In a research that has been published in Nature Biomedical Engineering, faculty from the University of Southern California (USC) have reported  a technique for editing the genes of immune cells called B cells, turbocharging them to fight even the sneakiest invaders. The work is an important advance in harnessing the power of antibodies to treat conditions ranging from Alzheimer’s disease to arthritis.

“In some diseases or conditions, the natural antibodies made by B cells are just not good enough,” said senior author Paula Cannon, a Distinguished Professor of Molecular Microbiology & Immunology at the Keck School of Medicine of USC. “HIV is a very good example of that. It mutates constantly, keeping one step ahead of whichever antibodies are being thrown at it. We thought a checkmate move might be persuading B cells to make an antibody that was so broad in its ability to ‘see’ HIV that HIV couldn’t easily mutate around it.”

The beauty of the technique, the researchers said, is it can be adapted to produce a broad range of different antibodies.

For this project, the researchers took inspiration from chimeric antigen receptor (CAR) T cells, “living drugs” designed to target specific things. They’ve revolutionized treatment for blood cancers like leukemia and lymphoma. With CAR T treatment, T cells — sister cells to B cells — are removed from a patient’s blood and genetically modified to identify cancer cells by recognizing a marker on their surface. Millions of the cells are then infused into the patient’s body, where they fight disease and then fade away.

B cells behave differently, making them more suitable for fighting chronic conditions. They function as both a security system and antibody factory, residing long-term in the bone marrow, lymph nodes and spleen — and firing up when needed.

 

In Maharashtra’s remote Chandrapur, this young couple is bringing healthcare to villagers

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Dr Suraj and Dr Janki Maske completed their MBBS and BDS and have settled in a tiny hamlet to fulfil their obligation to society

Bang in the middle of the COVID19 pandemic, a young couple arrived in a remote village of Maharashtra’s Chandrapur district and made it their home. They also brought with them, two degrees – one MBBS and one BDS – some social service lessons and resolve.

Three years later, Sobat Foundation set up by Dr Suraj Maske and his wife Dr Janki Maske run a health (with dental) clinic in Geora village, with day care facilities, an attached generic medicine pharmacy, an ambulance and are serving 50 villages in the district. “We have clocked 34000 OPD visits so far,” says Dr Maske proudly. Born to parents in Chandrapur who had not cleared high school, he had been determined to fulfil his grandfather’s dream of serving the poor. With that goal he entered the Nagpur Indira Gandhi Medical College, but remained uncertain how to go about it. All he knew is that in neighbouring Gadchiroli, Dr Abhay and Dr Rani bang had set up the Society for Education, Action, Research in Community Health (SEARCH) that had been serving the community while doing groundbreaking health research for decades.

“One day in my second year of MBBS I went to SEARCH to ask them about their work. I could not meet them but learnt about a programme SEARCH runs for young people to encourage them to take up this work. I joined Nirman and there has been no looking back. I also receive a monthly fellowship from SEARCH for doing this work,” says Dr Maske. Nirman is a programme run by SEARCH that was set up with the goal of building a bench strength of young people committed to social service in various capacities.

Setting out on his own was not an easy decision but what worked in his favour is the fact that he had already been working in a primary health centre in the area as the first MBBS doctor in many years. When after a falling out he quit that job, both the decisions to stay back and start his own clinic and the demand from the people to do so, happened organically. In the last three years he has also moved to a more holistic approach, trying to address people’s issues beyond healthcare. “We have started fruit plantations in several villages which we have handed over to widows or unsupported women so that they can get some subsistence out of it. We have also started sports events in villages to encourage the youth and for community building,” he says proudly. The medical services are highly subsidised but not free. “People often do not value a service which is completely free,” he explains

He has also been lucky in his choice of a life partner.

Dr Sooraj Maske
Dr Suraj and Dr Janki Maske

Dr Janki Maske, a trained dentist grew up in these parts and has no problem living a life where there are few luxuries. The couple’s tiny setup atop their clinic is simple; everywhere there are signs that this is in essence an extension of their work. The tiny balcony is crowded with guava saplings for the plantations. But Dr Janki’s challenges go beyond lifestyle. Dentistry is not a very common thing in these parts and people are reluctant to sit in the dentist’s chair even though oral hygiene is poor and rampant use of oral tobacco makes the region a hotbed of oral cancers. “Few people here use toothpaste, only the young do. There are mostly tree barks and other things used. People are scared to come and show me. But even among those that have managed to detect oral cancers in fairly advanced stages, many did not even make it,” she says.

Sobat (meaning companionship in Marathi) Foundation works both at the clinic level and the field level where camps are held at regular intervals. The terrain is such that the first requirement of a medical setup is a sturdy SUV; Dr Maske started off with a second hand vehicle in which he travels to remote locations for house calls. On occasions, particularly in the monsoon season, the car has to travel through overflowing river and canal waters that submerge the roads. No other vehicle would even dare to traverse those roads which exist only in name.

His working conditions do not bother Dr Maske. He is already looking for another challenge – the increasing plastic waste in these villages and how to go about solving the problem.

Industry welcomes cancer drug exemptions, reduction in GST and import duty of APIs

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Finance minister Nirmala Sitharaman announced an allocation of Rs 89,287 crore for health

With finance minister Nirmala Sitharaman stopping short of any big ticket announcement for health in the Union Budget 2024-25, industry captains welcomed the reduction in GST and import duty on APIs and the decision to grant exemptions to three cancer drugs. Sitharaman allocated Rs 89,287 crore for the health sector.

“To provide relief to cancer patients, I propose to fully exempt three more medicines from customs duties. I also propose changes in the BCD on x-ray tubes & flat panel detectors for use in medical x-ray machines under the Phased Manufacturing Programme, so as to synchronise them with domestic capacity addition,” the finance minister said in her speech. She also announced that new medical colleges will be established in Bihar.

Reacting to the Budget, Dr. Jay Goyal, Eye Surgeon, Director, Surya Eye Hospital said: “ “We are pleased that the government has allocated Rs 89,287 crore to develop, maintain, and improve the country’s healthcare system. This investment is crucial for providing basic healthcare services to every citizen, including those in the most remote areas. We strongly advocate for a significant portion of this healthcare budget to be dedicated to eye care. Blindness and eye-related problems result in an annual economic loss of $27 billion for India. Addressing this issue at the primary level is essential for reducing this burden and enhancing overall productivity. Additionally, we welcome the proposal to exempt three more cancer medications from customs duties, which will significantly reduce the financial strain on cancer patients. In India, 1 in every 16,000 children is diagnosed with a rare eye cancer. The tax exemption on these medications will enable us to help many children restore their eyesight, thereby improving their quality of life and future prospects.”

The decision to reduce GST and import duty on APIs was also hailed as a move that would help India achieve self sufficiency in manufacturing essential drugs. “Vaibhav Jain, CEO, Aayush Bharat said: “We also welcome the proposal to exempt three more cancer medications from customs duties, which will help reduce the financial burden on cancer patients. Additionally, the government has allocated Rs 2,143 crore for the Production Linked Incentive Scheme (PLI) for the pharmaceutical industry. With the US set to adopt the Biosecure Act, which prohibits US federal government bodies from sourcing equipment and services from Chinese pharma companies, this support will propel the Indian pharma industry to new heights.

In the mood for some raucous celebration? Binge drinking can cause heart rhythm to go awry 

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Binge drinking – five drinks in two hours for men and four in the same time for women – can lead to atrial fibrillation

Repeated episodes of binge drinking can lead to altered heart rhythms or even a condition known as atrial fibrillation which is the most commonly found condition where the heart rate fluctuates beyond the normal range. The association between binge drinking and altered heart rate has been an observed phenomenon for long, leading to the coinage of the term “Holiday Heart Syndrome.”

An animal study presented at the American Heart Asocation’s basic Cardiovascular Sciences Scientific Session linked binge drinking  (five drinks within two hours for men and four drinks within two hours for women) to abnormal heart rhythms. “Around the holidays, opportunities for celebration, often accompanied by heavy drinking” occur during a brief period of time. Unfortunately, this sometimes sends revelers, even those with no previous heart condition, to the hospital with a racing or abnormally beating heart,” said Saugat Khanal, Ph.D., lead author of the study and a post-doctoral scholar in the department of physiology & cell biology at The Ohio State University College of Medicine in Columbus, Ohio.

In the study, more than 70% of the mice that were given alcohol mimicking binge drinking developed atrial fibrillation.

Khanal added: “Our study in mice explored the mechanism of alcohol-induced arrhythmia and a possible way to prevent it in the future. Repeated binge drinking can lead to serious arrhythmias. This includes AFib, which is the most common type of arrhythmia. AFib can raise the risk of stroke and heart failure. About one-third of new AFib diagnoses are related to alcohol use. Recurrence of AFib is common in habitual binge drinkers. The link between repeated binge drinking and arrhythmia at times of celebration is so well-known that medical professionals call it holiday heart syndrome which is caused by repeated binge drinking over the holidays.”

The study was limited because researchers used a mouse model to replicate human holiday heart syndrome. Although the mouse model showed promising results, it may not have fully captured the complexities of binge drinking in humans and related cardiovascular consequences.

Chandipura virus is suspected to have killed 15 people in Gujarat: all you need to know

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The virus causes inflammation in the brain and fever. Symptoms are similar to flu but the outcome can be deadly

The death of a four-year-old girl in Gujarat on Wednesday is the latest in a series of deaths in the state attributed to the Chandipura vesiculovirus, commonly known as the Chandipura virus, named after the small town in Maharashtra near Nagpur where it was first isolated.

Till date 29 cases of the viral infection that is a form of encephalitis where there is inflammation in the brain, have been reported in Gujarat and at least 14 other patients, state health officials suspect, may have succumbed to it. Medibulletin brings you an explainer.

What is the Chandipura virus?

Chandipura virus is a virus belonging to the Rhabdoviridae family which is so called cause of the rod-like shape of these entities. It was isolated from a resident of Nagpur in 1965 when during a dengue/chikungunya outbreak one man was suffering from fever that could not be traced to any pathogen known to medical science at that point of time. The virus has been subsequently identified from sandflies.

What are the symptoms associated with the infection?

A person infected with the virus usually presents with high fever and symptoms that can seem like flu accompanied by diarrhoea and vomitting. However the virus causes inflammation in the brain that is sometimes associated with a loss of consciousness. It usually affects children.

Why is the Chandipura virus feared?

The virus is associated with high mortality, particularly in young children. In a piece in the Indian Journal of Medical Research, scientists from the National Institute of Virology wrote in 2016: “Chandipura virus (CHPV) (Vesiculovirus: Rhabdoviridae) garnered global attention as an emerging neurotropic pathogen inflicting high mortality in children within 24 h of commencement of symptoms. The 2003-2004 outbreaks in Central India witnessed case fatality rates ranging from 56-75 per cent in Andhra Pradesh and Gujarat with typical encephalitic symptoms. Due to the acute sickness and rapid deterioration, the precise mechanism of action of the virus is still unknown.”

How is the viral infection treated?

No antivirals are available specifically for the Chandipura virus. Treatment is usually symptomatic with doctors focussing on keeping the fever at bay and treatment the vomiting etc with appropriate medication.

 

Did the makers of the mysterious Stonehenge succumb to plague? Possible, say scientists

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Neolithic plague was widespread, detected in at least 17% of the sampled population and across large geographical distances

 

About 5300 to 4900 years ago, the people inhabiting vast areas of Europe who introduced smarter farming methods to these locations, saw a period when their numbers dwindled rapidly. Scientists now say that the reason for this could have been the plague.

People inhabiting various parts of Europe is what is known as the Neolithic (New Stone) Age, affected radical lifestyle changes as they made the shift from the prehistoric hunter gatherers to farmers who would settle in one place, produce surplus crop and have enough security and leisure to look at things beyond subsistence, such as art and culture. These are also the people who are believed to have constructed the mysterious Stonehenge in England.

However, the cause of this so-called Neolithic decline is still debated. Some argue for an agricultural crisis resulting in the decline, others for the spread of an early form of plague. Here we use population-scale ancient genomics to infer ancestry, social structure and pathogen infection in 108 Scandinavian Neolithic individuals from eight megalithic graves and a stone cist. We find that the Neolithic plague was widespread, detected in at least 17% of the sampled population and across large geographical distances. We demonstrate that the disease spread within the Neolithic community in three distinct infection events within a period of around 120 years,” scientists from the University of Copenhagen reported in the journal Nature.

In the course of their examination of the genome sequencing of the remains of some of these people, the scientists were also able to establish the relationships between them and also the nature of contemporary society. For example, in one instance they say: “Moreover, of all the individuals sampled from Frälsegården, we find that only eight were not related to anyone else at this site and, of these, six are women. This finding confirms the patrilineal social structure at the site and suggests that these six women were married into the family but did not produce offspring who were buried within the tomb. Although it is possible that these women did not give birth before dying, it is perhaps more likely that all their offspring were daughters who moved away and were buried in other tombs,” they wrote.

Yoga can help patients with rheumatoid arthritis and it is not just pain relief, finds AIIMS study

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The study that has been published in Nature Scientific Reports shows that Yoga lowers inflammation

 

Yoga can significantly improve the condition of patients of Rheumatoid Arthritis and it goes beyond mere pain relief, a study by AIIMS New Delhi has found. 

RA is a an autoimmune diseases associated with chronic joint pain. A collaborative study  by Lab for Molecular Reproduction and Genetics, Anatomy Dept, and Dept of Rheumatology AIIMS, ND, supported by the department of science and technology explored the effects of yoga at a cellular and molecular level in RA patients and how yoga may benefit RA patients beyond just pain relief. The findings have been published in Nature Scientific Reports.

The present study was led by Dr Rima Dada. It documented reduced pain perception, improved joint mobility, decreased disability, and enhanced overall quality of life for patients performing yoga. These benefits were attributed to yoga’s ability to establish immunological tolerance and molecular remission. The chronicity and the severity of RA symptoms have made it one of the most debilitating diseases to live with and studies over the years have explored various means including diet to keep it under control.

“It has been discovered that yoga lowers inflammation by controlling cellular damage and oxidative stress (OS). It balances pro- and anti-inflammatory cytokines, raises endorphin levels, and reduces cortisol and CRP levels and maintains melatonin rhythms. This facilitates the disruption of the inflammatory and hyperactive immune system cycle.

At a molecular level, by boosting the activity of the telomerase enzyme and genes involved in DNA repair and cell cycle regulation, it slows down the aging process of cells. Additionally, yoga improves mitochondrial function, which guards against telomere attrition and DNA damage by enhancing energy metabolism and lowering oxidative stress,” the department of science and technology said in a statement.

The department added that this piece of research provides evidence for the potential of yoga as a complementary therapy for RA patients. Yoga may not only manage symptoms like pain and stiffness but could also contribute to disease control and improved quality of life. Unlike drugs, yoga has no side effects and offers a cost-effective, natural alternative for managing severe autoimmune conditions.

Immunisation coverage stalled in 2023, 2.7 million more children left out of net globally

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World Health Organization and UNICEF estimate that 2.7 million additional children are un- and under-vaccinated compared to the pre-pandemic level of 2019

The disruptions in the global immunisation architecture caused by the COVID19 pandemic continue to wreak havoc.

World Health Organization (WHO) and UNICEF estimate that 2.7 million additional children are un- and under-vaccinated compared to the pre-pandemic level of 2019 as the immunisation coverage stalled in 2023.

The WHO and UNICEF estimates of national immunization coverage (WUENIC) – provide the world’s largest and most comprehensive dataset on immunization trends for vaccinations against 14 diseases.

“The latest trends demonstrate that many countries continue to miss far too many children. Closing the immunization gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated, and that overall healthcare is strengthened,” said UNICEF Executive Director Catherine Russell.

According to the findings, the number of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) in 2023 – a key marker for global immunization coverage – stalled at 84% (108 million). However, the number of children who did not receive a single dose of the vaccine increased from 13.9 million in 2022 to 14.5 million in 2023.

More than half of unvaccinated children live in the 31 countries with fragile, conflict-affected and vulnerable settings, where children are especially vulnerable to preventable diseases because of disruptions and lack of access to security, nutrition, and health services.

In 2023, only 83% of children worldwide received their first dose of the measles vaccine through routine health services, while the number of children receiving their second dose modestly increased from the previous year, reaching 74% of children. These figures fall short of the 95% coverage needed to prevent outbreaks, avert unnecessary disease and deaths, and achieve measles elimination goals.

“Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries to close these gaps and protect the most at-risk children as quickly as possible.”