Discussion in 'Members Corner' started by Daredevil, Jun 13, 2009.
This thread will be used to gather health-related news and discussion pertaining to it.
A lot of people on shoutbox have asked me about cancer and the reasons for developing cancer. Here, I'm attaching a PDF file (6MB) that is a powerpoint presentation done on Cancer during my course. I hope it will answer many of the questions you might have regarding the cancer. It might be more scientific but you will be able to understand it.
Link for Presentation
Here is a video about 'What is Cancer'?
YouTube - 3D Medical Animation - What is Cancer?
A Video about "How cancer Develops?"
For much better understanding of cancer, go through below videos.
YouTube - Understanding Cancer (Cancer #1)
YouTube - Risk Factors for Cancer (Cancer #2)
YouTube - Treating Actinic Keratoses (Skin Cancer #3)
YouTube - Treating Cancer (Cancer #4)
A very good move initiated by Dare devil kudos for you starting the thread , it is surely helpful and the posts and the presentations are gems regarding the curse of the disease called 'Cancer'.
With request from one my best friend and respected Moderator in this forum Riteshji, I am starting to discuss different Yogasan (Yoga ) postures and their effects
Information source: Wikipedia
Uttanasana - Wikipedia, the free encyclopedia
In forward bend position ,
Uttanasana (forward bend) is a hatha yoga posture, one of the most 'popular', utilized in most hatha yoga classes.
The posture consists of standing with feet together, then hinging forward from the hips, letting the head hang, with palms placed flat on the floor near the feet.
Practitioners suggest that this posture provides these benefits:
* Provides a complete stretch to the entire back side of the body.
* Rejuvenates the spinal nerves.
* Removes depression, makes the mind peaceful and calm.
* Tones the kidneys, liver, and spleen.
* Increases flexibility of the spine, hips, sciatic nerves, tendons, and ligaments of the legs.
* Improves blood circulation in the legs.
* Calms and rejuvenates the nervous system as it soothes the brain cells.
* Releases anxiety.
* Provides nourishment to the facial skin, scalp, and hair roots.
* Improves eyesight and hearing.
* Stretches the hamstrings.
Because of its great popularity, this posture has a very large number of variations and associated techniques.
YouTube - Sivananda Style Yoga: Sun Salutations and More : How to Do the Uttanasana Forward Fold
OMG! My mom had been doing yoga for almost 3 years. Just recently I started doing yoga with mom after our 45 min evening walk and its killing me. My entire leg is sore now. But its feels great yaaar! I noticed that it also reduces the leg pain that I always had. I should be totally committed to it.....
LOL That's the easy one. I don't feel pain with this one. This one is piece of cake. The one that my mom makes me do is the killer one. Ouchhhh it still hurts so bad......
"What is Alzheimer's Disease"?
YouTube - Understanding Alzheimer's Disease (Alzheimers #1)
YouTube - Stages of Alzheimer's Disease (Alzheimers #2)
YouTube - Treating Alzheimer's Disease (Alzheimers #3)
Tips for keeping away Heart Diseases
Not only read, also propagate this . Kindly take print out of this and give it to those who are not connected to Internet.
There was a chat, arranged by WIPRO for its employees, with Dr.Devi Shetty, Narayana Hrudayalaya (Heart Specialist). The transcript of the chat is given below:
What are the five thumb rules for a layman to take care of his heart?
Dr Devi Shetty:
1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour's walk, at least five days a week; avoid lifts and avoid sitting for a longtime
3. Quit smoking
4. Control weight
5. Control blood pressure and sugar
Is eating non-veg food (fish) good for the heart?
Dr Devi Shetty: No
It's still a grave shock to hear that some apparently healthy person gets a cardiac arrest. How do we understand it in perspective?
Dr Devi Shetty: This is called silent attack; that is why we recommend everyone past the age of 30 to undergo routine health checkups.
Are heart diseases hereditary?
Dr Devi Shetty: Yes
What are the ways in which the heart is stressed? What practices do you suggest to de-stress?
Dr Devi Shetty: Change your attitude towards life. Do not look for perfection in everything in life.
Is walking better than jogging or is more intensive exercise required to keep a healthy heart?
Dr Devi Shetty: Walking is better than jogging since jogging leads to early fatigue and injury to joints
You have done so much for the poor and needy. What has inspired you to do so?
Dr Devi Shetty: Mother Theresa, who was my patient.
Can people with low blood pressure suffer heart diseases?
Dr Devi Shetty: Extremely rare
Does cholesterol accumulates right from an early age (I'm currently only 22) or do you have to worry about it only after you are above 30 years of age?
Dr Devi Shetty: Cholesterol accumulates from childhood.
How do irregular eating habits affect the heart?
Dr Devi Shetty: You tend to eat junk food when the habits are irregular and your body's enzyme release for digestion gets confused.
How can I control cholesterol content without using medicines?
Dr Devi Shetty: Control diet, walk and eat walnut.
Can yoga prevent heart ailments?
Dr Devi Shetty: Yoga helps.
Which is the best and worst food for the heart?
Dr Devi Shetty: Best food is fruits worst are oil.
Which oil is better - gingili, groundnut, sunflower, saffola, olive?
Dr Devi Shetty: All oils are bad; the so-called best oil company has the largest marketing budget.
What is the routine checkup one should go through? Is there any specific test?
Dr Devi Shetty: Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.
How different was it in treating Noor Fatima, the little kid from Pakistan ?
Dr Devi Shetty: It was extremely difficult, Because of the media attention. As far as the medical treatment is concerned, she is like any other child
with a complex heart problem.
What are the first aid steps to be taken on a heart attack?
Dr Devi Shetty: Help the person into a sleeping position, put an aspirin tablet under the tongue with a sorbitrate tablet if available, and rush him
to a coronary care unit since the maximum casualty takes place within the first hour.
How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?
Dr Devi Shetty: Extremely difficult without ECG.
What is the main cause of a steep increase in heart problems amongst youngsters? I see people of about 30-40 yrs of age having heart attacks and serious
Dr Devi Shetty: Increased awareness has increased incidents. Also, edentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.
Is it possible for a person to have BP outside the normal range of 120/80 and yet be perfectly healthy?
Dr Devi Shetty: Yes.
Marriages within close relatives can lead to heart problems for the child. Is it true?
Dr Devi Shetty: Yes, co-sanguinity leads to congenital abnormalities and you may not have a software engineer as a child
Many of us have an irregular daily routine and many a times we have to stay late nights in office. Does this affect our heart? What precautions would you recommend?
Dr Devi Shetty: When you are young, nature protects you against all these irregularities. However, as you grow older, respect the biological clock.
Will taking anti-hypertensive drugs cause some other complications (short / long term)?
Dr Devi Shetty: Yes, most drugs have some side effects. However, modern anti-hypertensive drugs are extremely safe.
Will consuming more coffee/tea lead to heart attacks?
Dr Devi Shetty: No.
Are asthma patients more prone to heart disease?
Dr Devi Shetty: No.
How would you define junk food?
Dr Devi Shetty: Fried food like Kentucky , McDonalds, samosas, and even masala dosas.
You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food?
Dr Devi Shetty: Every race is vulnerable to some disease and unfortunately, Indians are vulnerable for the most expensive disease.
Does consuming bananas help reduce hypertension?
Dr Devi Shetty: No.
Can a person help himself during a heart attack (Because we see a lot of forwarded emails on this)?
Dr Devi Shetty: Yes. Lie down comfortably and put an aspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary
care unit without any delay and do not wait for the ambulance since most of the time, the ambulance does not turn up.
Do, in any way, low white blood cells and low hemoglobin count lead to heart problems?
Dr Devi Shetty: No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.
Sometimes, due to the hectic schedule we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?
Dr Devi Shetty: Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.
Is there a relation between heart problems and blood sugar?
Dr Devi Shetty: Yes. A strong relationship since diabetics are more vulnerable to heart attacks than non-diabetics.
What are the things one needs to take care of after a heart operation?
Dr Devi Shetty: Diet, exercise, drugs on time. Control cholesterol, BP, weight.
Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?
Dr Devi Shetty: No.
What are the modern anti-hypertensive drugs?
Dr Devi Shetty: There are hundreds of drugs and your doctor will chose the right combination for your problem, but my suggestion is to avoid the drugs and
go for natural ways of controlling blood pressure by walk, diet to reduce weight and changing attitudes towards lifestyles.
Does dispirin or similar headache pills increase the risk of heart attacks?
Dr Devi Shetty: No.
Why is the rate of heart attacks more in men than in women?
Dr Devi Shetty: Nature protects women till the age of 45.
How can one keep the heart in a good condition?
Dr Devi Shetty: Eat a healthy diet, avoid junk food, exercise everyday, do not smoke and, go for a health checkup if you are past the age of 30 for at least once in two yrs. And work very hard...
Have a good Health and a beautiful life ahead!
New cancer drug 'shows promise'
New cancer drug 'shows promise'
The treatment was tested on breast cancer patients
Researchers say a new type of cancer treatment has produced highly promising results in preliminary drug trials.
Olaparib was given to 19 patients with inherited forms of advanced breast, ovarian and prostate cancers caused by mutations of the BRCA1 and BRCA2 genes.
In 12 of the patients - none of whom had responded to other therapies - tumours shrank or stabilised.
The study, led by the Institute of Cancer Research, features in the New England Journal of Medicine.
Julian Lewis, 62, was treated with olaparib after being diagnosed with advanced prostate cancer.
Within a month or two levels of a key chemical marker of cancer went down to a low level, and have now stayed low for more than two years.
In addition, secondary tumours in his bones have almost disappeared.
He has experienced minor side-effects, such as stomach discomfort and mild nausea, but he said: "I hope to carry on with this for as long as possible.
Partly the aim is the obvious one of keeping my cancer cells in check, but there's a broader goal too: to help find out how long this drug can be used safely in other people."
One of the first patients to be given the treatment is still in remission after two years.
Olaparib - a member of a new class of drug called PARP inhibitors - targets cancer cells, but leaves healthy cells relatively unscathed.
The researchers, working with the pharmaceutical company AstraZeneca, found that patients experienced very few side-effects, and some reported the treatment was "much easier than chemotherapy".
Researcher Dr Johann de Bono said the drug should now be tested in larger trials.He said: "This drug showed very impressive results in shrinking patients' tumours.
"It's giving patients who have already tried many conventional treatments long periods of remission, free from the symptoms of cancer or major side-effects."
Olaparib is the first successful example of a new type of personalised medicine using a technique called "synthetic lethality" - a subtle way of exploiting the body's own molecular weaknesses for positive effect.
In this case the drug takes advantage of the fact that while normal cells have several different ways of repairing damage to their DNA, one of these pathways is disabled by the BRCA mutations in tumour cells.
Olaparib blocks one of the repair pathways by shutting down a key enzyme called PARP.
BRCA1 or BRCA2 mutations weaken the cells' ability to repair DNA damage
They are thought to be responsible for about 5% of breast and ovarian cancers, and about 1-2% of early onset prostate cancers
Women with a BRCA mutation have a risk of up to 85% on breast cancer, and up to 60% on ovarian cancer
Men with a BRCA mutation have a risk of up to 15% on prostate cancer
This does not affect normal cells because they can call on an alternative repair mechanism, controlled by their healthy BRCA genes.
But in tumours cells, where the BRCA pathway is disabled by genetic mutation, there is no alternative repair mechanism, and the cells die.
Cancer cells with the BRCA1 or BRCA2 mutations are the first to be shown to be sensitive to PARP inhibitors.
But there is evidence that olaparib will also be effective in other cancers with different defects in the repair of DNA.
Professor Stan Kaye, who also worked on the study, said: "The next step is to test this drug on other more common types of ovarian and breast cancers where we hope it will be just as effective."
The researchers say the process of drug evaluation and registration may have to be revamped to take consideration of the fact that new generation cancer drugs target specific molecular defects, rather than types of cancer.
Dr Peter Sneddon, of the charity Cancer Research UK, said: "It is very encouraging to see the development of 'personalised treatment', tailored to the requirements of the individual patient, becoming a reality as it offers the opportunity to design new drugs that are truly selective.
"Although development of this drug is in its early stages, it is very exciting to see that it has the potential to work when other treatment options have failed."
'Baldness calculator' helps predict hair loss in men
25 Jun 2009, 2152 hrs IST, ANI
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LONDON: Men who value hair more than health can add one more item to their long list of creams, potions and medicines: 'Baldness calculator'.
The pioneering new computer program predicts if and when men will go bald.
After being a huge hit with men in other countries, 'baldness calculator' -- said to be the world's first reliable tool for predicting hair loss -- is being offered to British men.
The program calculates the exact age at which someone will go bald or have lost most of their hair or provides reassurance by predicting that they will still have a full head of hair in old age, reports The Telegraph.
More than half a million German men used it within ten days of it being unveiled there and three million men have tried it out globally so far.
As far as its operation is concerned, the program devised by German scientists asks users about their age, marital status and occupation, where they live, what their current hairline is, hair loss in their family and their stress levels.
Dr Adolf Klenk, head of research and development at hair care firm Dr Kurt Wolff, said: "More and more men value full hair but especially younger men.
"They are looking for a partner and are at the peak of their social lives. They are very conscious about their looks and being accepted within their social groups.
"They get concerned that if they lose their hair, they will cease to be attractive to others whereas older men don't care so much."
Dr Klenk added: "Genetic predisposition is by far the most common cause of baldness. But other factors include severe, long-term emotional stress, perhaps associated with a divorce or the loss of a close relative.
"A poor diet can fail to provide the hair with sufficient nutrients and men who wear headgear in call centres or helmets on construction sites motorbikes may be putting their hair roots at risk of being pulled out or losing density.
"We have developed the male baldness calculator to raise awareness among men."
'Baldness calculator' helps predict hair loss in men - Health - Health & Science - The Times of India
Alpecin Baldness calculator
Alpecin: Baldness calculator
Ayurveda drug for cancer: Experts - Bhubaneswar - Cities - The Times of India
Ayurveda drug for cancer: Experts
3 Jul 2009, 2216 hrs IST, Minati Singha, TNN
BHUBANESWAR: Experts in ayurveda claim to have come up with medicines which can make life more comfortable for patients suffering from HIV/AIDS, cancer or some physical deformity. The Central Council for Research in Ayurveda and Siddha (CCRAS), the apex body that oversees research in ayurvedic medicine, has developed the drugs. The council has also begun clinical trials in different hospitals across the country.
Director general of CCRSA, G S Lavekar said, "The traditional system in association with modern technology can do wonders in medical science. The age-old practice has been adopted by developing countries and our medicines are in much demand in abroad. Diseases such as HIV/AIDS, cancer and mental illness may not be totally cured but the drugs can definitely improve the standard of life of the patients."
Lavekar said they have the credit of obtaining as many as 22 patents including one international patent right on drugs. "After vigorous clinical trials, seven drugs developed by the council are in the market while seven others are on the pipeline. These include one for HIV/AIDS, cancer, psoriasis and disabled persons," he added.
For cancer treatment, the council has developed QUOL2C drug, which aims to increase the quality of life for those undergoing chemo and radio therapy. Clinical trial for the drug is conducted in four major hospitals including St John Medical College and Hospital in Bangalore, AIIMS, New Delhi and Tata Institute of Cancer, Mumbai.
Similarly QOL2A, a medicine for HIV infected and AIDS patients, has been launched for multi-centric clinical trials. "We developed this medicine in association with Indian Council of Medical Research's two frontal organizations National AIDS Research Institute (NARI) and National Institute of Virology," he said.
Ayush-Manas, a medicine for mentally disabled people is being tested in Ram Monohar Lohia Hospital in New Delhi and NIMHANS, Bangalore.
The council has also developed Triple 7 oil for cure of psoriasis, a chronic skin disease, Ayush-64 for treatment of malaris, Balgutti-a tonic for children.
"These drugs are in high demand in the international market particularly in countries like Mauritius and West Asia. The council is also working on different metabolic diseases such as hyper-tension, stress, anxiety, fatigue and others," Lavekar said.
The council recently signed an MoU with Utkal University for further research in Ayurveda and Siddha under which several multi-disciplinary projects will be taken up.
Shared keyboards lead to infections - Health - Wellness - Lifestyle - The Times of India
Shared keyboards lead to infections
2 Jul 2009, 1619 hrs IST, IANS
Do you frequent a cyber cafe? If yes, then think twice as shared keyboards in cyber cafes and elsewhere are swarming with deadly germs and are potential sources of infection, according to a recent study.
Shared keyboards are hot spots for
infection (Getty Images)
Conducted by researchers from Swinburne University of Technology (SUT), Australia, the study examined the number and type of micro-organisms on computer keyboards in three large, multiple-user facilities on the university campus.
These were compared with staff computers that were generally handled by only one person. The study found almost five times the number of micro-organisms on the keyboards of multiple user computers as on single-user computers.
Almost half the multiple-user keyboards were found to harbour Staphylococcus aureus, also known as golden staph, compared with one-fifth of the single user keyboards, said a SUT release.
"High use, multiple user Internet cafes and computer labs are potential hot spots for harbouring micro-organisms," said Enzo Palombo, study co-author.
"Given that computers are not routinely disinfected, the potential for transmitting disease is great. Organisations need to be more rigorous in keeping shared equipment clean.
"Keyboards and other hand contact areas such as a computer mouse should be regularly cleaned and disinfected, especially for multiple-user workstations," Palombo said.
The study is slated for publication in the July issue of the American Journal of Infection Control.
Permanent diet may equal longer life
With a reduced-calorie diet, monkeys were less likely to die of an age-related disease -- cancer, heart disease or diabetes, reports a study in the journal Science.
By Karen Kaplan
8:23 PM PDT, July 9, 2009
Scientists tracked 76 rhesus monkeys for as long as 20 years. The one on the left is on a reduced-calorie regimen, the right on a normal diet.
For a country in which roughly 200 million people are overweight or obese, scientists today have discouraging news: Even those who maintain a healthy weight probably should be eating less.
Evidence has been mounting for years that the practice of caloric restriction -- essentially, going on a permanent diet -- greatly reduces the risk of age-related diseases and even postpones death. It has been shown to significantly extend the lives of yeast, worms, flies, spiders, fish, mice and rats.
Now, in a much-anticipated study funded by the National Institutes of Health, many of the same benefits have been demonstrated in primates, the best evidence yet that caloric restriction would help people.
The findings, published in the journal Science, tracked rhesus monkeys that were on a reduced-calorie regimen for as long as 20 years. The animals' risk of dying from cancer, heart disease and diabetes fell by more than two-thirds.
The study comes as some validation to the cadre of several hundred true-believing Americans who profess to practice caloric restriction in their daily lives. It was also welcomed by scientists who study the biological mechanisms of aging and longevity.
"It adds to the evidence piling up that caloric restriction, independent of thinness, is a healthy way to stay alive and healthy longer," said Susan Roberts of the Human Nutrition Research Center on Aging at Tufts University, who wasn't involved in the study. "Less diseases in old age has to be something most everyone wants."
Is caloric restriction the solution?
"Mild caloric restriction is beneficial to everybody," said Dr. Luigi Fontana, a medical professor at Washington University in St. Louis.
In his examinations of people who have been practicing caloric restriction for an average of 6 1/2 years, Fontana found their heart function was equivalent to those of people 16 years younger.
Though the regimen sounds grueling, it is hardly a starvation diet, experts said.
It typically begins with an in-depth assessment to determine how many calories an individual needs to consume to maintain a healthy weight. Then that number is shaved by 10% to 30%.
People on caloric restriction can eat three meals a day. A typical menu includes cereal with fruit and nuts for breakfast, a big salad for lunch, and dinner featuring lean meat and reasonable portion sizes. There's also room for a couple of snacks and even a small dessert from time to time.
Caloric restriction has consistently produced health benefits for animals.
In the new study, scientists tracked 76 adult rhesus monkeys from the Wisconsin National Primate Research Center starting in 1989. Half the animals were fed a typical diet of lab chow, and the rest got a version with a higher concentration of vitamins and minerals to make up for the 30% reduction in chow quantity.
Over the course of the study, the monkeys that ate the regular diet were three times more likely to die of an age-related disease than their counterparts on caloric restriction. Fourteen deaths in the control group were attributable to age-related diseases, compared with five such deaths among the animals that ate 30% fewer calories, according to the study.
The rates of cardiovascular disease and pre-cancerous cell growths were twice as high in the control group compared with the reduced-calorie group.
The researchers also noted that although five of the control monkeys became diabetic and 11 were classified as pre-diabetic, all the calorie-restricted animals remained diabetes-free.
Brain scans revealed significantly less atrophy of gray matter in the monkeys that ate less.
They even looked less wrinkled and flabby.
In all, the monkeys on caloric restriction "appear to be biologically younger than the normally fed animals," the researchers wrote in their report.
Scientists aren't sure why eating less slows the aging process, but theories abound.
There's evidence from mice that caloric restriction induces the body to activate fewer genes related to inflammation, which many scientists suspect plays a key role in aging.
Another theory holds that starved organisms hunker down in maintenance mode, shutting down activities such as reproduction that put wear and tear on the body.
Or perhaps caloric restriction reduces body temperature, thus limiting production of dangerous free radicals that gradually break down the body by damaging tissues and DNA.
"It's all speculation," said Dr. Sergei Romashkan of the National Institute on Aging, who is overseeing a clinical trial on caloric restriction in people.
Authors of the monkey study won't be able to calculate how much caloric restriction extended the animals' average life span -- or whether it boosted their maximum life span -- until all the animals have died.
That could take 10 to 15 years, said senior author Richard Weindruch, a medical professor at the University of Wisconsin-Madison.
Also left unanswered are questions about the psychological state of monkeys who spend most of their adult lives on a forced diet, Roberts said.
Are they happy? Are they hungry? Can they think as fast?
When UCLA evolutionary biologist Jay Phelan put mice on caloric restriction, he got the distinct impression that they didn't appreciate it.
"They bit people and were more agitated," he said. In contrast, the mice who ate a normal diet "would just sit around and let you pick them up."
It also isn't clear whether caloric restriction would extend human lives by very much, Phelan said. He has combined results from animal studies with data on men on the Japanese island of Okinawa who ate 17% fewer calories than men in Tokyo. He calculated that reducing intake by 35% would extend the human life span by just two years.
"The trade-off just isn't worth it," said Phelan, who said he personally would have a hard time giving up doughnuts.
Weindruch said he was under no illusion that the monkey findings would prompt many people to adopt caloric restriction. He has started a company to create drugs that would provide the same health benefits without the need for extreme dieting.
Physiologists agreed that instead of promoting caloric restriction, a more pressing goal is to help the two-thirds of Americans who are overweight or obese shed their extra pounds.
"That would be tremendous for the health of the nation," said David Baer, a research physiologist at the U.S. Department of Agriculture's Human Nutrition Research Center in Beltsville, Md.
So, people have a limited calorie intake and you can look younger as ever .
There Is A cure
Chittorgarh shows the way to affordable healthcare—generic drugs at cost price
Kalulal Lakhan (left) has come a fair way to buy medicines for his daughter
Just What The Doctor Recommended
A combination of information and persuasion has led to a dramatic fall in drug prices
Despite a long history of battles and a still-intact fort, dusty, small-town Chittorgarh doesn’t quite look like a place where revolutions still happen. But thanks to a project that started last July, this hilly district in south Rajasthan has quietly overthrown the prevailing regime of high-priced medicines—a key failure of India’s healthcare system. In its stead, it has introduced another that dramatically lowers the cost of drugs, making access to healthcare easier for even the very poor. The usual ‘medical shops’ that sell at maximum retail price still exist, but in 16 stores run by the Central Cooperative Bank essential medicines are being supplied as part of a ‘Generic Drugs Initiative’—prices here are 40-50, sometimes 90 per cent lower.
Chittorgarh is among the 50 worst performing districts on the human development index, with poverty widespread and access to social services dismal at best. It’s in this milieu that the cooperative stores have come forward to sell generic versions of hundreds (564 to be precise) of drugs. The stores have opened near hospitals and, no surprises, patients are flocking to them. So much so, the administration now believes there’s room for a further drop in prices.
Another round of price cuts may sound far-fetched—the popular stress relief medicine Diazepam, for instance, already sells at the cooperative store for Rs 2.48 per injection instead of the usual Rs 21. Similarly, the price of a two-day supply of the blood pressure-regulating drug, Simvastatin, has gone down from Rs 120 to less than Rs 35. The cooperatives manage the price cuts because they sell only generic versions—copies of drugs whose patents have expired. The law says once the patent expires on a medicine, any drug company can manufacture it. Without the associated R&D, marketing and advertising costs, generics can retail at far lower prices.
N.C. Saxena, who assists on UNICEF health and access projects, says that “unlike the rest of the country where regulating drug prices has become a very difficult task, the Chittorgarh model shows how much a government can achieve if it decides to make cheaper medicines accessible”. But it’s not always about prices, for many patients have doubts about the efficacy of generics. At the same time, for Indians 80 per cent of healthcare spends come out of their own pocket, and most of this goes for medicines. For Dr Samit Sharma, Chittorgarh district collector since July 2008, it was imperative that change happened in both areas.
“The Chittorgarh model shows how much a government can achieve if it makes cheaper medicines accessible.”
—N.C. Saxena, Consultant, UNICEF
First, he tightened the grip on government-run hospitals and its doctors. They were disallowed from prescribing medicines by brand names; doctors can now only prescribe a “salt” name—the final choice of drug to be bought, generic or branded, remains with the patient. Sharma then launched a campaign to promote generics: every third street corner in Chittorgarh and the government-run community health centre in nearby village Bassi have signs emblazoned—‘Buy generic drugs: They cost less’ or ‘Ask your doctor for generic medicines: They are just as effective.’ The messages were placed on prescriptions as well. Needless to add, doctor’s prescriptions are also being monitored.
The results were encouraging. Doctors in the town—which has two large hospitals and about 50 private doctors’ practices—report that patient numbers have increased by 15-40 per cent, a sign that people are now more confident that they can afford medical care. The state’s medical bill for pensioners and others (who access the government health system) has also declined for the first time, by about Rs 4 crore, mostly because people are spending less on medicines.
Sharma, who was a doctor in Jaipur before he sat for the ias, is now a household name—even rickshaw drivers will tell you about him. “If the government is serious about reducing healthcare costs, it will have to take some cost-related measures—either price controls or ensuring that doctors prescribe generics,” says Sharma. In fact, similar orders have been passed all over the country (by the Medical Council of India in 2002) but no one has seen about implementation.
But when it’s tackled, medicines seem to be one field where the trickledown theory has worked. Lower-priced drugs in government-run stores have put pressure on private practitioners to follow suit. Private medical stores, who have started to lose business to sarkari stores, are cutting prices. Central Cooperative Bank MD Pradeep Sahay says the impact is spreading to other parts of Rajasthan too. Nine districts including Jaipur, Bhilwara, Jalore and Sirohi are now procuring drugs from the Chittorgarh cooperatives. In fact, in districts such as Jhalawar and Bundi, drugs must now be procured at “Chittorgarh rates”. “In some cases, just by removing the middleman there is sometimes as much as a 700 per cent reduction in prices,” says Ram Singh Sankhla, general manager with the bank.
Six months on, even individual patients from adjoining districts have now started rushing to Chittorgarh for medical supplies. At any given time, orders worth Rs 2-3 crore are waiting to be shipped to nearby districts by the cooperative. The medical store at the district hospital for women is in a perpetual state of flux because of the demand. This is where the government’s ‘godown’ for generic drugs is. Letters exchanged with Pali district show an order worth over Rs 5.7 lakh. Another from Kota is a demand for Rs 1 crore worth of (generic) cetrizine. Each order is placed in cardboard boxes and loaded on to buses.
Meawhile, private-practice doctors like B.S. Kothari, whose clinic is in a row of houses next to the cooperative drugstores, look on. “I’ve come around to the view that one should try generic medicines—they are very good, particularly ones manufactured by established companies,” he says. Kothari says he now tends to prescribe more generic drugs.
According to experts, the fear of fake drugs, and of generic medicines not being effective enough, must go. For most generics have such low manufacturing costs that it’s rarely profitable to fake them. In Chittorgarh, a technical panel of doctors has pre-selected 22 drug companies (now being expanded to 57) who are welcome to participate in the tenders. “Surprise checks” on the cooperative’s medicines show they have “the same results as branded drugs”.
“Except, I believe, in the case of cancer drugs, you’ll get the same treatment and results with generics,” says Ranjit Roy Chaudhury, who runs the Delhi Society for Promotion of Rational Use of Drugs, an ngo that led a similar project in the late ’90s in Delhi’s government hospitals. Chaudhury’s project did not encourage generics—it was too premature for that, he says. But when procurement was centralised and tendering cleaned up, he found 50 per cent of supplies had shifted, with little effort, to generics, from almost none earlier.
“Seriously, it’s difficult to imagine low medical costs in India without generic drugs,” says Kumar Bikram, a UNICEF official in Chittorgarh who has been working closely with the administration on social sector projects. Other states have tried making drug access easier on the pocket—such as Tamil Nadu—but on bigger budgets, while no concerted effort has been made to supply low-cost drugs countrywide. Sharma has indeed made a start in Rajasthan. What happens to this model when he is posted elsewhere is anybody’s guess.
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