Regulating healthcare

Regulating healthcare (The Tribune: 20180530)

http://www.tribuneindia.com/news/editorials/regulating-healthcare/596863.html

PROFITEERING seems to be the cardinal principle of corporate healthcare as private

hospitals continue to slap astronomical bills on unsuspecting patients. Who in India does not

have a sob story to corroborate the rampant medical malpractices? Overcharging is such a

norm that patients and relatives, already bogged down by sickness and disease, often have

little recourse to address their grievance about overcharging. The Delhi Government’s draft

policy to humanise patient care has several pragmatic suggestions that could curb, if not

completely make the corporate healthcare behemoth fall in line.

Most of the Delhi Government’s proposals — capping medical costs, regulating medical

packages, prescribing drugs only from the National List of Essential Medicines — are well-

meaning. As of now, the move to partially waive the bill of a patient who dies within

stipulated hours of being taken to medical emergency may appear contentious. But, if the

efficacy of all services lies in its delivery why can’t the same logic be applied to healthcare,

which, anyway, is being run like any other business? The argument that public health

facilities need to be shored up and government spending on health deserves a massive boost

is not at cross purpose. But nor are these an answer to the ills that plague corporate health-

givers. The significance of private care in disbursing tertiary medical treatment can’t be

wished away. Only its model and tenets must change.

Devil’s advocates may consider the proposed measures too harsh, which may sound the death

knell of private healthcare. The policy, while making a strong case for patients, has not

ignored the other side of the picture. It makes room for unusual, especially high risk, cases

and has suggested several checks and balances. If philanthropy seems an impossible goal for

the corporate health sector, greed can’t be an overriding concern either. Patients can’t be

treated as revenue-generating guinea pigs. They have to be protected and Delhi’s health

policy, which other states too could take a cue from, is a step in the right direction.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayWednesday 20180530

Health: Progress steady- perennial problem of healthcare

Four years of Modi government — Health: Progress steady, but in slow

lane (The Indian Express: 20180530)

http://indianexpress.com/article/india/four-years-of-modi-government-mission-indradhanush-

jp-nadda-hospitals-neet-exam-5196362/

Poor government spend — the perennial problem of healthcare — remains, but at least there

is no downward revision towards the end of the year of the budget estimate.

Seven months after the NDA government took charge, and a month into the tenure of new

Health Minister JP Nadda, India announced its vaccination initiative: Mission Indradhanush.

Few in the country took note of it. International health agencies did, but were sceptical — at a

leisurely 1 per cent per year increase in vaccination coverage, the country had a long way to

go. The most generous take was: at least the government had chosen to target low-hanging

fruit. The government did pluck the fruit — and with aplomb.

In many ways, the Mission Indradhanush (MI) story is emblematic of the government’s

approach to health: slow and steady. Poor government spend — the perennial problem of

healthcare — remains, but at least there is no downward revision towards the end of the year

of the budget estimate.

READ | BJP’s Campaign 2019: Modi as vehicle, Modi in driver’s seat

That is not to say all is hunky dory. The National Health Protection Mission (NHPM) —

which the government hopes will be its health flagship, much like the National Rural Health

Mission was of the UPA government — failed to take off for two years. It was first

announced in the 2016 Budget — Rs 1 lakh health cover instead of the current Rs 5 lakh —

and had a long gestation period.

READ | Mission Indradhanush: How govt vaccinated over 2.55 crore children across the

country

Also, the three Zika cases detected in Ahmedabad were under wraps for several months

before a Parliament question outed the matter.

What’s Done

Mission Indradhanush has been a success story. Launched in December 2014, it was designed

as a “booster” vaccination programme in 201 districts with low immunisation coverage to

ensure that all children under the age of two years and pregnant women are fully immunised.

As per the report of the Integrated Childhood and Immunisation Survey, the first two phases

of MI led to increase in full immunisation coverage by 6.7 per cent in a year.

The global pneumonia and diarrhoea report card by International Vaccine Access Center,

Johns Hopkins Bloomberg School of Public Health, said: “Over its first four phases, MI has

vaccinated about 25 million children in over 500 districts (30)… MI has helped drive the

increases in immunisation coverage.”

READ | Four years of Modi government — Finance, Part II: GST on course, noose on black

money tightened

India eliminated maternal and neonatal tetanus in 2015. The dramatic reduction in prices of

cardiac stents and knee implants last year benefited many.

What’s in Progress

Since its (re)announcement in the Budget, there has been frenetic activity in the Health

Ministry and Niti Aayog around NHPM. A clutch of new officers has joined the ministry to

work on Ayushman Bharat, a two-pronged health programme with NHPM as one arm and

setting up of health and wellness centres — a preventive component — as its other arm. The

target is to formally launch the project on Independence Day, or latest by Gandhi Jayanti.

READ | Four years of Modi government: Roads on course, rivers next, says Nitin Gadkari

Rapid strides have also been made in tuberculosis control, spurred by the suo motu

commitment of Prime Minister Narendra Modi to eliminate the disease by 2025, five years

ahead of the global deadline.

The UPA plan of six new

AIIMS as apex centres of tertiary care has been taken forward — 18 AIIMS are coming up.

However, faculty shortage has meant the six functioning ones have a long way to go.

READ | Four years of Modi government — Telecom and IT: Digital push reaches Bharat;

telecom stress remains

The common medical entrance test — NEET — again a UPA legacy that got stuck in courts,

is back. Now there is one each for undergraduate, postgraduate and superspeciality courses.

However, officials admit there may be some more legal and format issues before they are

perfected.

What’s Stuck

Finance Minister Arun Jaitley in his Budget speech said that the government had prepared an

action plan to eliminate Kala-Azar by 2017. That deadline was missed

In fact, endemic blocks have increased from 61 to 68 in 17 districts of Bihar and Jharkhand.

This is the third time India has missed the KA elimination deadline.

The malaria situation remains grim. In 2017, the World Malaria Report claimed that in India

the malaria surveillance mechanism detects a mere 8 per cent of cases, among the lowest in

the world.

READ | Four years of Modi government — Finance: Tax net widened; private funds still

elusive

Much like its predecessors, the NDA government’s efforts to effect medical education

reforms by replacing the controversial Medical Council of India with a National Medical

Commission have been thwarted by opposition from doctors.

When the Bill was tabled in Lok Sabha, doctor MPs from even the BJP spoke out against it.

The Bill was referred to the standing committee.

Two controversial provisions of the Bill are set to have a quiet burial unless the government

chooses not to go by the recommendations of the committee.

READ | Four years of Modi govt — Education: Warming up after initial slumber

The human papilloma virus vaccine has received an in-principle clearance from the highest

technical body on vaccines for introduction in the universal immunisation programme, but

the vaccine remains a hot potato, with saffron organisations claiming that it is actually

designed to control population.

J P Nadda, Health Minister: We started Amrit, through which 50 lakh patients have benefited.

There is 60-90 per cent reduction in MRP of medicines. We are enhancing capacity and

budget is increasingly accordingly… We spent Rs 900 crore yearly on Pradhan Mantri

Dialysis Yojana… Health secretaries are, on a weekly basis, asked for what they need. The

21,000 villages taken under Gram Swaraj Yojana have been totally immunised in five days,

this has been validated by an external party.

Randeep Surjewala, Congress communication department head: Health is the biggest casualty

under the Modi government. The latest health insurance scheme being sold as Modicare is

actually a jumla. Second, in the last four years, construction of not a single AIIMS has been

completed. No decision taken on increasing availability of doctors, and no new medical

institution has been created. Change of health ministers has marred implementation of

schemes.

Skin cancer

AI outperforms doctors in detecting skin cancer: study (The Hindu:

20180530)

http://www.thehindu.com/sci-tech/health/ai-outperforms-doctors-in-detecting-skin-cancer-

study/article24026910.ece

Useful for faster diagnosis of disease, allowing surgical removal before it spreads

A computer was better than human dermatologists at detecting skin cancer in a study that

pitted humans against machine in the quest for better, faster diagnostics, researchers said on

Tuesday.

A team from Germany, the U.S. and France taught an artificial intelligence system to

distinguish dangerous skin lesions from benign ones, showing it more than 100,000 images.

The machine — a deep learning convolutional neural network or CNN — was then tested

against 58 dermatologists from 17 countries, shown photos of malignant melanomas and

benign moles. Just over half the dermatologists were at “expert” level with more than five

years of experience, 19% had between two and five years’ experience, and 29% were

beginners with less than two years under their belt.

“Most dermatologists were outperformed by the CNN,” the research team wrote in a paper

published in the journal Annals of Oncology. On average, flesh and blood dermatologists

accurately detected 86.6% of skin cancers from the images, compared to 95% for the CNN.

“The CNN missed fewer melanomas, meaning it had a higher sensitivity than the

dermatologists,” the study’s first author Holger Haenssle of the University of Heidelberg said

in a statement. It also “misdiagnosed fewer benign moles as malignant melanoma... this

would result in less unneccessary surgery.”

The dermatologists’ performance improved when they were given more information of the

patients and their skin lesions.

An aid to doctors

The team said AI may be a useful tool for faster, easier diagnosis of skin cancer, allowing

surgical removal before it spreads. But it is unlikely that a machine will take over from

human doctors entirely, rather functioning as an aid.

Melanoma in some parts of the body, such as the fingers, toes and scalp, are difficult to

image, and AI may have difficulty recognising “atypical” lesions or ones that patients are

unaware of. “Currently, there is no substitute for a clinical examination,” experts Victoria

Mar from Monash University and Peter Soyer of the University of Queensland wrote in an

editorial. There are about 232,000 new cases of melanoma, and 55,500 deaths, in the world

each year, they said.

Physical Fitness

Exercise may help treat addiction (The Tribune: 20180530)

http://www.tribuneindia.com/news/health/exercise-may-helps-treat-addiction/596827.html

Aerobic exercise can help treat drug or alcohol addiction by altering the brain's reward

system, a study has found.

Also known as "cardio," aerobic exercise is brisk exercise that increases heart rate, breathing

and circulation of oxygen through the blood, and is associated with decreasing many negative

health issues, including diabetes, heart disease and arthritis.

It also is linked to numerous mental health benefits, such as reducing stress, anxiety and

depression.

Scientists at the University at Buffalo in the US identified a key mechanism in how aerobic

exercise can help impact the brain in ways that may support treatment and prevention

strategies for addiction.

"Several studies have shown that, in addition to these benefits, aerobic exercise has been

effective in preventing the start, increase and relapse of substance use in a number of

categories, including alcohol, nicotine, stimulants and opioids," said Panayotis Thanos, senior

research scientist at University at Buffalo.

"Our work seeks to help identify the underlying neurobiological mechanisms driving these

changes," Thanos said.

Using animal models, researchers found that daily aerobic exercise altered the mesolimbic

dopamine pathway in the brain.

Dopamine is a key neurotransmitter associated with substance use disorders, playing an

important role in reward, motivation and learning.

"Current work is looking at whether exercise can normalise dopamine signalling that has

been changed by chronic drug use, as this may provide key support of how exercise could

serve as a treatment strategy for substance abuse," he said.

"Further studies that focus on people with substance use disorders should help researchers

develop new methods to integrate exercise into treatment regimens that may help prevent

relapses," Thanos said. – PTI

Popular vitamin, mineral pills

Popular vitamin, mineral pills provide no health benefit (The Tribune:

20180530)

http://www.tribuneindia.com/news/health/popular-vitamin-mineral-pills-provide-no-health-

benefit/596826.html

The most commonly consumed vitamin and mineral supplements provide no consistent

health benefit or harm, a study has found.

Researchers from the St Michael's Hospital and the University of Toronto in Canada

conducted a systematic review of existing data and single randomised control trials published

in English from January 2012 to October 2017.

They found that multivitamins, vitamin D, calcium and vitamin C - the most common

supplements - showed no advantage or added risk in the prevention of cardiovascular disease,

heart attack, stroke or premature death.

Generally, vitamin and mineral supplements are taken to add to nutrients that are found in

food.

"We were surprised to find so few positive effects of the most common supplements that

people consume," said David Jenkins, lead author of the study published in the Journal of the

American College of Cardiology.

"Our review found that if you want to use multivitamins, vitamin D, calcium or vitamin C, it

does no harm - but there is no apparent advantage either," said Jenkins.

The study found folic acid alone and B-vitamins with folic acid may reduce cardiovascular

disease and stroke. Meanwhile, niacin and antioxidants showed a very small effect that might

signify an increased risk of death from any cause.

"These findings suggest that people should be conscious of the supplements they're taking

and ensure they're applicable to the specific vitamin or mineral deficiencies they have been

advised of by their healthcare provider," Jenkins said.

His team reviewed supplement data that included vitamins A, B1, B2, B3, B6, B9 (folic

acid), C, D and E; beta-carotene; calcium; iron; zinc; magnesium; and selenium.

The term 'multivitamin' in this review was used to describe supplements that include most

vitamins and minerals, rather than a select few.

"In the absence of significant positive data - apart from folic acid's potential reduction in the

risk of stroke and heart disease - it's most beneficial to rely on a healthy diet to get your fill of

vitamins and minerals," Jenkins said.

"So far, no research on supplements has shown us anything better than healthy servings of

less processed plant foods including vegetables, fruits and nuts," he said. – PTI

Dengue cases

Check on warming can prevent dengue cases

First Study To Show Health Benefits Of Cooler Planet Calls For Capping

Rise In Temp At 2°C (Times of India: 20180530)

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

More than three million cases of dengue fever, the world’s fastest-spreading tropical disease,

could be avoided annually if global warming is capped at 1.5°C, said a study that purports to

be the first to show the health benefits of a cooler planet.

The mosquito-borne viral infection causes flu-like symptoms and can be fatal if it develops

into severe haemorrhagic form. The annual number of cases has increased 30-fold in the last

50 years, says the World Health Organization (WHO).

Using computer models, researchers from the University of East Anglia in Britain found that

capping warming at 2°C could cut annual dengue cases in Latin America and the Caribbean

by up to 2.8 million by the end of the century. A further half a million cases could be

prevented if the rise in global temperatures is kept down to 1.5°C, the report said, with parts

of South America most likely to benefit.

“There is growing concern about the potential impacts of climate change on human health,”

said lead author Felipe Colón-González. “This is the first study to show that reductions in

warming from 2°C to 1.5°C could have important health benefits.”

Since the year 2000, climate change has caused severe harm to human health by stoking more

heatwaves, the spread of some mosquitoborne diseases and under-nutrition as crops fail,

according to a Lancet report last October. Current national pledges to curb emissions put the

world on track for a warming of about 3°C above pre-industrial times, far above the goal of

“well below” 2°C set at a 2015 summit in Paris.

The WHO has previously estimated there could be 250,000 extra deaths a year between 2030

and 2050 because of climate change. “Understanding and quantifying the impacts of warming

on human health is crucial for public health preparedness and response,” said co-author Iain

Lake in a statement. “Clearly a lot more needs to be done to reduce (carbon dioxide) and

quickly if we are to avoid these impacts,” he said.

Dengue infects around 390 million people worldwide each year, with an estimated 54 million

cases in Latin America and the Caribbean, according to the study, published in the

Proceedings of the National Academy of Sciences. REUTERS

Stress

Stress in infancy can affect organs (Times of India: 20180530)

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

Suffering from emotional stress during infancy can cause significant and far-reaching effects

on the organs of the body, leading to diseases later in life.

Psychological stress in infancy dramatically changes the amount of an important class of

proteins, called GABAA receptors, which in turn may alter the workings of the heart, lungs,

kidneys and bladder, researchers said. It was already known that changes in the amounts of

GABAA receptors causes some brain disorders, but researchers at the University of

Portsmouth in the UK are the first to show that stress can also alter their expression in other

organs.

Researchers studied the way GABAA receptors behave in secondary organs in mice which

had first been exposed to stress.

The study, published in ‘Frontiers in Molecular Neuroscience’, provides hope that drugs

targeting these receptors can now be developed to treat conditions such as hypertension,

asthma, diabetes and inflammatory bowel diseases. PTI

Emotional Stress (The Asian Age: 20180530)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10772854

Cryptocurrency ‘addicts’

A clinic to treat cryptocurrency ‘addicts’ (Times of India: 20180530)

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

A Scottish addiction clinic has begun treating people who are hooked on trading

cryptocurrencies.

Traders can become addicted to cryptocurrencies like bitcoin as their volatile price

fluctuations can be as thrilling but potentially costly as gambling, according to therapists at

Castle Craig clinic near Edinburgh.

Cryptocurrency addicts are offered treatments such as a 12-step programme, cognitive

behavioural therapy (CBT), trauma therapy and equine therapy.

Chris Burn, a gambling therapist at Castle Craig Hospital, said, “The high risk, fluctuating

cryptocurrency market appeals to the problem gambler.

“It provides excitement and an escape from reality. Bitcoin, for example, has been heavily

traded and huge gains and losses were made. It’s a classic bubble situation,” he said.

Castle Craig has treated over 10,000 patients for various addictions since it opened in 1988,

and says the majority have gone on to achieve long-term abstinent recovery. Prices start from

£1,360 (Rs 1,22,346) per week for an extended treatment programme, and detox and

intensive care starts from £2,975 (Rs 2,67,632) per week at the clinic.

Some treatments at the centre will be led by Tony Marini, a former gambling and cocaine

addict, who said introducing a life structure is key for addicts.

“I see cryptocurrency trading as a way for people to escape from themselves, into another

world, because they don’t like the world they’re in,” he said.

“The first stage of treatment is to join other addicts in group therapy and share their life

stories. This helps them realise that they’re not alone.” AGENCIES

Heart Function (The Asian Age: 20180530)

http://onlineepaper.asianage.com/articledetailpage.aspx?id=10772853

Postmenopausal women

Postmenopausal women with high testosterone at heart disease risk (New

Kerala: 20180530)

https://www.newkerala.com/news/read/3250/postmenopausal-women-with-high-

testosterone-at-heart-disease-risk.html

Postmenopausal women with a higher blood level of the testosterone male hormone and a

higher ratio of the oestrogen hormone could be at a higher risk of developing heart disease

later in life, finds a study.

Among post-menopausal women, a higher ratio of testosterone/oestradiol -- a major

oestrogen produced in the ovaries -- was associated with an elevated risk for incident

cardiovascular disease (CVD), coronary heart disease and heart failure events, while higher

levels of testosterone were associated with increased CVD and coronary heart disease.

On the other hand, higher oestradiol levels were associated with a lower coronary heart

disease risk.

"Although sex hormone levels may be linked to future cardiovascular events, it is unclear

what the best intervention is to modify sex hormone levels for risk reduction," said Erin D.

Michos, Associate Professor at the Johns Hopkins University in Maryland, US.

"However, a sex hormone profile higher in male hormones may identify a woman at higher

risk for cardiovascular disease who may benefit from other risk reduction strategies," Michos

added.

The risk for cardiovascular disease is much lower in women than men until women reach the

age of 50 years of age, then risk rises dramatically after menopause.

Previous studies have demonstrated that higher androgen and lower oestrogen levels are

associated with risk factors for heart disease in post-menopausal women; however, other

studies show conflicting results, so the relationship between sex hormones and cardiovascular

events in post-menopausal women remains unclear.

The new research, published in the Journal of the American College of Cardiology, evaluated

the association of sex hormone levels with incident cardiovascular disease, over a 12-year

follow-up in 2,834 post-menopausal women free of cardiovascular disease at baseline.

Sex hormone concentrations were measured using fasting serum samples. Sex hormone levels

after menopause were associated with women's increased risk of CVD in later life.

Personalised obesity treatments

Personalised obesity treatments

Processes in gut help develop personalised obesity treatments (New Kerala:

20180530)

https://www.newkerala.com/news/read/3477/processes-in-gut-help-develop-personalised-

obesity-treatments.html

A recent study has identified certain processes in the gut that drive fat build-up around the

waist.

Scientists at King's College London analysed the faecal metabolome (the community of

chemicals produced by gut microbes in the faeces) of 500 pairs of twins to build up a picture

of how the gut governs these processes and distributes fat.

The King's team also assessed how much of that activity is genetic and how much is

determined by environmental factors.

The analysis of stool samples identified biomarkers for the build-up of internal fat around the

waist. It's well known that this visceral fat is strongly associated with the development of

conditions including type 2 diabetes, heart disease and obesity.

By understanding how microbial chemicals lead to the development of fat around the waist in

some, but not all the twins, the King's team hopes to also advance the understanding of the

very similar mechanisms that drive the development of obesity.

An analysis of faecal metabolites (chemical molecules in stool produced by microbes) found

that less than a fifth (17.9 per cent) of gut processes could be attributed to hereditary factors,

but 67.7 per cent of gut activity was found to be influenced by environmental factors, mainly

a person's regular diet.

This means that important changes can be made to the way an individual's gut processes and

distributes fat by altering both their diet and microbial interactions in their gut.

On the back of the study researchers have built a gut metabolome bank that can help other

scientists engineer bespoke and ideal gut environments that efficiently process and distribute

fat.

The study has also generated the first comprehensive database of which microbes are

associated with which chemical metabolites in the gut. This can help other scientists to

understand how bacteria in the gut affect human health.

Lead investigator Dr Cristina Menni said, "This study has really accelerated our

understanding of the interplay between what we eat, the way it is processed in the gut and the

development of fat in the body, but also immunity and inflammation. By analysing the faecal

metabolome, we have been able to get a snapshot of both the health of the body and the

complex processes taking place in the gut."

Head of the King's College London's Twin Research Group Professor Tim Spector said,

"This exciting work in our twins shows the importance to our health and weight of the

thousands of chemicals that gut microbes produce in response to food. Knowing that they are

largely controlled by what we eat rather than our genes is great news, and opens up many

ways to use food as medicine. In the future these chemicals could even be used in smart

toilets or as smart toilet paper."

Dr Jonas Zierer, first author of the study added, "This new knowledge means we can alter the

gut environment and confront the challenge of obesity from a new angle that is related to

modifiable factors such as diet and the microbes in the gut. This is exciting, because unlike

our genes and our innate risk to develop fat around the belly, the gut microbes can be

modified with probiotics, with drugs or with high fibre diets."

Yellow spots in eye

Yellow spots in eye could be new biomarker for dementia: Study (New

Kerala: 20180530)

https://www.newkerala.com/news/read/3033/yellow-spots-in-eye-could-be-new-biomarker-

for-dementia-study.html

Do you have tiny yellow spots in the eye? Watch out, it could be an early indicator of

dementia, a new study suggests.

According to the researchers, the spots known as "hard drusen" are made of fat and calcium

deposit that form in a layer underneath the retina and can be seen in scans.

A common signs of ageing, the spots have long been thought to be harmless. But, the

findings showed that 25 per cent of people with Alzheimer's have more number of such spots

compared to four per cent of healthy people.

"We found that there were more areas associated with drusen deposition in Alzheimer's

disease," lead author Imre Lengyel from Queen's University in Belfast, Northern Ireland, was

quoted as saying to the DailyMail.

The results also showed that, people with Alzheimer's had thicker blood vessels which may

slow down the blood flow.

Thus, scanning for the spots and examining the eye's blood vessels could be a valuable tool in

Alzheimer's disease monitoring, the researchers said.

"A brain disease is difficult to diagnose through the eye. But we can use ophthalmologic

imaging to chart progression of the disease and monitor the effectiveness of medications used

to combat it," Lengyel added.

"An eye imaging session would comprise 20 seconds of time and is very non-invasive. It's

exciting. We really hope that eye imagining will be a powerful tool in monitoring

Alzheimer's progression."

In the study, published in the journal Ophthalmic Research, the team conducted eye test on

117 patients aged between 60 to 92 years.

The researchers hope that the study may be helpful in early detection of dementia so that

early precaution is taken in order to combat the disease.

Vitamin Supplements

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20180530)

http://epaper.livehindustan.com/textview_21617_87039914_4__24_30-05-2018_1_0.html

Pollution (Navbharat Times: 20180530)

http://epaper.navbharattimes.com/details/5-32834792-1.html