• Objections of K Sujatha Rao, Former Union Health Secretary,  to NMC are as follows:

o    Over centralization: The over centralization of the NMC and the near control over it by the central government, ranging from appointing all the 77 members for the various bodies; being the appellate for a variety of routine technical matters rejected by the autonomous bodies and the whole NMC such as, granting permission to set up colleges; granting exemptions to criteria; approving courses; setting aside any punishment against a doctor found negligent; allowing doctors trained abroad to do surgery and practice without having to go through any screening or taking the licentiate examination; recognizing degrees and qualifications; and finally having powers to issue directions to state governments and the NMC to comply with any orders it seeks to issue, not to speak of setting the Commission itself aside.

Such wide-ranging powers that will be exercised by the central ministry robs not just the federal nature of the law and reduce the NMC to an advisory role. In fact, the whole nine-year battle for revamping the MCI was mainly centered around the growing politicization of medical education with the powers introduced in the Act in 1992 that made it mandatory for MCI to take prior approval for starting a college, a course and student strength. This is one grouse that those opposing the Bill have.

o    Cross pathy: In view of the shortage of qualified doctors, the urgency to address the primary health needs of the communities and public health that are now largely being provided by unqualified quacks, the government has, since 2010, been requesting the MCI to institute new cadres of public health personnel along the lines of the LMP’s (Licentiate in Medical Practice) during the British days that worked very well.

Instead of mandating the board related to undergraduate education and the NMC to consider such options, keeping in view the current realities prevailing in the country, the Act has introduced a system under which the Commission and the heads of the councils of Ayush can, by a simple voice vote of those present, design bridge courses legalizing Ayush practitioners to prescribe allopathy medicines. At all levels – primary level to postgraduate. Such cross pathy then endangers the credibility of all the systems of medicine and has been severely opposed.

o    NEET: One bold reform pertains to the National Eligibility Entrance Test (NEET), about which much has already been said, and the National Licentiate Examination that all students have to take for getting the license to practice and also pursue postgraduate education. This is a laudable idea as it will enable standardizing the competence levels of the “Indian Doctor”. Currently, the variance between the training and competencies in different colleges and regions is astoundingly wide. So such a reform was sorely required. Yet, there is apprehension that in the absence of standardization of the quality of instruction in the country, it may widen disparities and become inequitable.

With a sizeable number of medical colleges with fake faculty or hopeless infrastructure, the quality of teaching is highly varied resulting in hurting students from backward states, poorer families and rural areas. But of greater importance is the fate of the students who study in accredited colleges, pass approved courses and examination systems and are found fit to practice by the university, but fail in the multiple choice question (MCQ) examination. What happens to them if they cannot afford private tuition to prepare for the licentiate examination?

o    Fees: Assuming that an investment of Rs 400 crores is required to set up a medical college and with a view to attract investment, the Bill permits 60% of seats to be open for managements with unfettered freedom to charge any quantum of fees in order to recoup the investment. This logic is highly debatable. It is apprehended that this will increase rent seeking, corruption and reserve medical education only for the rich and well off.

• Glanders on the rise in animals: Glanders is a highly infectious and often fatal zoonotic disease primarily affecting horses, donkeys and mules. It is a notifiable disease of equines caused by Gram-negative bacterium, Burkholderia mallei. It is a rare disease in humans with cases having occurred in veterinarians, other people working closely with horses, and laboratory workers handling the organism. In addition to animals with clinical disease, asymptomatically infected animals also pose risk to humans. Humans are accidental hosts and human to human transmission is rare.

In 2014-15, disease was noted in three states - Himachal Pradesh, Uttar Pradesh and Jammu and Kashmir. In 2015-16, it was seen in five states - Jammu and Kashmir, Punjab, Uttar Pradesh, Uttarakhand and Gujarat but in 2016-17, it has been seen in nine states – Haryana, Himachal Pradesh, Jammu and Kashmir, Punjab, Uttar Pradesh, Uttarakhand, Gujarat, Rajasthan and Madhya Pradesh.

Glanders has traditionally been clinically categorized into nasal, pulmonary and cutaneous forms based on the most commonly affected organ systems in equines. Glanders can have nasal, pulmonary and cutaneous forms. B. mallei is transmitted to humans through contact with tissues or body fluids of infected animals. The bacteria enter the body through cuts or abrasions in the skin and through mucosal surfaces such as the conjunctiva and nose. The infection may occur by inhaling infected aerosol dust. Animal-to-human and human-to-human transmission of glanders is rare.Despite many reported cases of the disease in equines, no human case of glanders has been reported in India till date.

The clinical symptoms of glanders in humans are non- specific therefore accurate diagnosis and treatment is difficult. The symptoms in humans include low- grade fever and chills, malaise, fatigue, myalgias, backache, headache, rigors, chest pain and lymphadenopathy.

• US Preventive Services Task Force (USPSTF) guidelines currently recommend that cigarette smokers aged 55 to 80 years have annual low-dose computed tomography screening for lung cancer. The guidelines also recommend annual screening for former smokers who have quit within the past 15 years but have a 30-pack-year smoking history (JAMA, December 8, 2017).

• A Supreme Court bench headed by Justice AK Sikri on Friday quashed the FIR lodged by the Orissa police against CBI officials for wrongly reaching the house of a sitting high court judge for search, after CBI officials tendered “unqualified apology”.

• In 2013–2014, approximately one third of adults in the United States were overweight (body mass index [BMI] 25.0–29.9 kg/m2) and approximately one-third had obesity (BMI ≥30 kg/m2).

• Approximately half of US residents are unaware that adults who are overweight or have obesity are at increased risk for cancer.

• The International Agency for Research on Cancer (IARC) states that there is sufficient evidence for an association with excess body fatness, including overweight, obesity, and weight gain, and at least 13 cancers. These cancers include adenocarcinoma of the esophagus; cancers of the breast (in postmenopausal women), colon and rectum, endometrium (corpus uterus), gallbladder, gastric cardia, kidney (renal cell), liver, ovary, pancreas, and thyroid; meningioma, and multiple myeloma.

• The much-discussed Karnataka Private Medical Establishments (Amendments) Bill has finally got Governor Vajubhai R. Vala’s assent.

• Indian Medical Associations (IMA) proposed biomedical waste treatment plant at Palode seems to have landed in a fresh legal complication as the latest assessment by revenue department found that a major portion of the land purchased by IMA for the purpose is a wetland. As per the report submitted by Nedumangad tehsildar to the district collector, of the 6.80 acres of the project land, five acres are wetland featuring mangroves and groundwater sources, which means that any construction activity in this area would violate Kerala Conservation of Paddy Land and Wetland Act. The report also cautioned on possible law and order problem in the area due to existing public protest against the plant.

• A research published in the New England Journal of Medicine reported the work done by American researchers Li and colleagues.  The scientists have been successful in creating surgical glue that is stretchable, works on wet surfaces, and is nontoxic to humans. Surgical glue strongly adheres to the skin, cartilage and arteries. It also sealed holes in rat liver and pig heart.

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-chief IJCP PublicationsPresident Heart Care Foundation of IndiaImmediate Past National President IMA