Panel Discussions on the occasion of The World No Tobacco Day

Today is the World No Tobacco Day (WNTD). It is observed every year on May 31st. World Health Organisation started observing WNTD from 1987 and it is promoted globally to create awareness about the perils of tobacco abuse and to encourage people to give up using tobacco.

To commomorate the day, I moderated two panel discussions in New Delhi on the harmful effects of tobacco and how can one kick the habit for good. The panelists were all eminent doctors from Max Healthcare. These included Dr. Sandeep Buddhiraja, who is the Director of Internal Medicine practice at Max Hospitals, Dr. Samir Parikh, who is a well-known psychiatrist and also heads the Mental Health institute at Max Healthcare, Dr. IS Virdi, who is the director of Cardiothoracic Surgery at Max Hospitals, Dr. Harit Chaturvedi, who is a Onco Surgeon and the Director of Onco Surgery at Max and Dr. Anupama Hooda, who heads the medical oncology practice at Max. We had a packed house, a very interactive audience and some very interesting discussion.

I have known Dr. Buddhiraja for many years. He is a founding member at Max Healthcare, we worked together for almost 5 years, when I handled the Marketing function at Max. He continues to be my physician and has on numerous occasions treated many members of my family. In all these years I have known him to be a quiet, sincere and thorough professional, somebody whom you can implicitly trust. Today, I discovered another facet of Dr. Buddhiraja, that of a fiery crusader against tobacco abuse. Sandeep, had come prepared with all the facts, which pointed to a huge burden of disease, that is caused by tobacco abuse. He spoke with great passion, while talking about the harmful effects of tobacco. He is clearly much distressed about the increased use of tobacco in its myriad forms, cigarettes, gutkhas, chewing tobacco, pan masala, snuff etc., which is being impudently hawked on our streets. ”On one end of a cigarette is fire and ash and on the other a moron”, is how Sandeep succinctly put it.

Dr. Virdi, made a simple point saying that you can trace almost any lifestyle disease today to tobacco. Be it heart disease, peripheral vascular disease, a stroke and oral and lung cancers, tuberculosis of the chest, all of them are linked to tobacco. This hit home much closer, and I wondered aloud about my father’s illnesses in his almost 60 years as a smoker. He has had tuberculosis twice, a stroke last year and is currently battling with an oral cancer. So much for a puff!!!

Dr. Chaturvedi and Dr. Hooda had a field day, with oral, lung and other cancers having a clear association with tobacco. They too are passionate doctors and see enough and more cancer victims every day, who would be  healthy, if only they had stayed away from tobacco. One can feel their pain and if I may say anger at young people not realizing the grave danger of abusing tobacco, till they reach the office of an oncologist. Dr. Chaturvedi, wondered how is it that once someone is diagnosed with oral cancer, he gives up smoking without missing a beat. My father kicked a 60-year-old habit, the day we told him about his cancer, incidentally diagnosed by Dr. Chaturvedi himself. He wondered that giving up tobacco can not be all that hard.

Dr. Samir Parikh is one of those irrepressible live wires, who have a view on almost everything. Being a psychiatrist and that too one of the most well-known in Delhi, Dr. Parikh counsels and works with lots of people struggling with substance abuse including tobacco abuse. Dr. Parikh and Dr. Buddhiraja talked about how and why one starts with tobacco. Peer pressure, cultural shibboleths including smoking being ”cool”, and myths like ”I can quit anytime”, came up as the most prominent reasons for most people lighting up. Samir and Sandeep, both were emphatic in their pronouncement that tobacco abuse is not merely a habit but a disease. They cited ICD classifications on nicotine abuse and gave medical reasons for nicotine addiction and elaborated on the treatment that can help one kick the disease. They run a tobacco cessation clinic at Max Healthcare and work with smokers, who are keen to quit, but find it hard to get rid of the problem.

My colleague Saurabh Avasthi, who smoked 30 cigarettes a day and then gave up one fine day in October last year also spoke about how he started and how steadily tobacco caught him in its vise like grip and how one day, he just decided that enough was enough. He said that he symbolically buried cigarette sticks and then just never lit up again. The first ten days were hard, when the pull of nicotine, was at its worst and he would count his smoke free days. Over a period of time, he realized that the urge no longer existed and now he says that the stench of tobacco nauseate him.

In the final analysis we concluded that there is no running away from the fact that even one cigarette per day is really one too many. In over 150 people, who attended today’s panel discussion, even if one decides to give up tobacco as a result of today’s session, I would reckon, we would have achieved a lot.

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World Heart Day 2010-The State of the Heart Report

Today is the 10th anniversary of the World Heart Day. To commemorate the occasion the World Heart Federation (WHF)  has released its ‘State of the Heart’ report. The report has been put together by the WHF in collaboration with the World Health Organization (WHO) and the World Economic Forum (WEF). The WHF has put out this report ‘ to reflect on the great achievements in cardiovascular disease (CVD) over the past decade, and raises awareness of the challenges still ahead of us in the fight against the number one killer worldwide.’ 

Every year more than 17 mn people die of Cardio-Vascular Disease (CVD). 82% of these deaths are in developing countries like India. Many of these deaths can be easily prevented if adequate awareness is created about the lifestyle modifications needed to combat CVD’s. A balanced diet, regular exercise, management of stress and avoiding tobacco can itself help save many lives, but many people particularly in the developing world either do not know about these simple measures or do not attach much importance to them, until of course they fall prey to the disease. 

The CVD report traces the contours of the global fight against CVD’s and lists ten of its most significant achievements. It also highlights some important challenges, which continue to obstruct the global effort in combating CVD’s.  

The key achievements listed in the report are categorised under 

Policy  

Recognition of non-communicable diseases (NCDs) of which CVD is the number one killer, as an urgent public health priority by the United Nations (UN). On 13th May 2010 the UN General Assembly voted unanimously for UN Resolution 64/265 to hold a Summit on NCDs in September 2011  

The widespread adoption of the WHO Framework Convention on Tobacco Control, which catalyzed global action towards a smoke-free world

The launch of awareness campaigns to highlight the importance of diet and physical activity on heart health

Expanded efforts by organizations to mobilize companies to invest in workplace-wellness initiatives to promote health amongst employees

 Medicine 

Improved recognition of the symptoms and treatment for heart attacks

The introduction of quality improvement programmes within hospitals

Improved public awareness of, and access to, CVD healthcare in developing countries

Science
 
Statin therapy which ‘revolutionized’ the treatment of elevated cholesterol, reducing the risk of heart disease and heart attacks in people with very high cholesterol levels 
 
The development of monitors to assist in the correct diagnosis of atrial fibrillation
 
Advances in diagnosing and treating congenital heart defects.

The report also highlights the ongoing challenges in combating CVD’s and seeks ways and means to partner various stakeholders in this effort. The challenges identified are the following. 

  1. Secure an outcomes statement at the UN High Level Summit on NCDs, taking place in September 2011
  2. Enhance benefits of smoking cessation and implement affordable smoking cessation programmes at the community level
  3. Increase access to affordable, quality essential medicines for CVD in Low and Middle Income Countries (LMIC’s) 
  4. Close disparities in CVD health
  5. Increase the prevalence of workplace-wellness initiatives
  6. Integrate CVD prevention, detection and treatment into primary healthcare setting.
  7. Increase the CVD health workforce
  8. Strengthen global, regional and national partnerships
  9. Improve data collection and monitoring of care provided to coronary heart disease patients

It is easy to see some of these challenges in the Indian context and they do have a ring of truth about them. We need a sustained and concerted effort along these lines to make some progress in fighting CVD’s. We need money, a dedicated task force, governmental support and a single-minded focus to make a serious difference. 

The fight must go on. 

Ref: http://www.world-heart-federation.org/what-we-do/awareness/world-heart-day/world-heart-day-2010/state-of-the-heart-cvd-report/ 

  

   

    

 

The Government’s Apathy to Healthcare in India

The Union budegt presented last month by the finance minister, Pranab Mukherjee, is hugely disappointing for the healthcare sector in the country. For many years now people associated with healthcare in the country have been waiting for big-ticket reforms in the sector, but the government has been turning a deaf ear. This year too, the story is no different.

The healthcare services in the country are not only woefully inadequate but also unevenly distributed. The healthcare industry, which is hugely dependent on private enterprise is just not attracting enough investments. Setting up and managing a hospital till it breaks even and makes money requires huge upfront investments. Presently, India has 860 beds for a million people, way below the WHO’s norm of  3960 beds for a million people. Studies by E&Y and KPMG have indicated that India needs to add 100000 beds per year for the next 20 years to reach close to this figure. This alone entails a spend of Rs. 50000 Cr. per annum. Compare this with what the government proposes to spend on healthcare in the next financial year, Rs. 22300 Cr. While this is 14% more than what the government spent last year, this amount is clearly insufficient.

The National Rural Health Mission, the flagship government programme for providing healthcare services in rural areas is riddled with inefficiencies. The government-run Primary Healthcare Centres are usually understaffed, ill-equipped and provide the most basic level of healthcare. Rural and semi urban India also needs good professionally managed secondary and tertiary care hospitals, which provide reasonably good quality healthcare at affordable rates. It seems that the government does not have the will power or the resources to usher in healthcare reforms.

Amazingly, the private sector entrepreneurs are willing to step in and bridge the gap.  All they need is a little help from the government in the form of tax holidays, duty reduction or abolition of duties on medical devices, easy availability of funding from government institutions at soft rates, longer payback periods and land at concessional rates. The government should also set up a regulatory body, a watchdog, which will keep an eye on hospitals being set up through this mechanism. The watchdog is critical as it will establish guidelines for setting up the hospitals, monitor progress, ensure quality through regular audits, lay down a fair pricing mechanism and in general ensure that the private sector, while availing of government policy benefits delivers on the promise of efficient, good quality and easily accessible care.

This is really not too difficult to achieve. Look at how private participation has revolutionized telecommunications in our country. Today India has more than half a billion mobile phone connections, the tariffs are the lowest in the world and even remote, far-flung and fairly inaccessible areas are connected (I had my phone working in the Nubra valley in Laddakh). The phones generally work, the services are efficient and the private sector companies, who had the foresight to start early are making profits. Some are even planning to go global and compete with the best in the world. The TRAI, which is the government watchdog is seen as an impartial and fairly efficient body, doing its job of advising the government on policy matters and ensuring compliance and a level playing field amongst all the operators.

No country can progress and aspire to be an economic superpower unless its citizens have access to good quality healthcare services. Considering India’s size and a population of over a billion people, (the majority living in rural areas), it is imperative that the government kick-start  reforms in this critical area sooner than later. If no significant policy initiatives have been announced this year, can the healthcare industry bodies (like those associated with CII and FICCI) lobby with the government, initiate debate and fuel informed discussion amongst all stake holders so that public opinion can be rallied in favour of these reforms.

Healthcare services impact the health of the nation. It is time all the healthcare stakeholders including the government sat together to prepare the blueprint for the next generation healthcare services for the country. This is very important because, unless we have robust, universally accessible, reasonably priced healthcare services for our citizens, all our claims about being an economic superpower will remain hollow and truly meaningless.

The Gay Season

gays It seems that the Gay season is upon us.

The gay rights movement seems to be generating unprecedented media attention. The courts are busy hearing petitions against a law framed in the 19th century, which proscribes homosexuality and the punishments for anyone caught in the act includes a maximum of 10 years in jail. The newspapers are writing stories about a gay couple from Israel, who have become parents through a surrogate mother who bore their child in Mumbai and a popular movie, which brings the gay question out of the closet is running to packed theatres across the country.

All this attention to an issue, which is still hardly a matter of discussion even amongst friends (forget family) is quite amazing. Gay rights activists are no longer considered pariahs and they are often seen in the media holding forth on issues that till now have been buried deep underground.   Continue reading

Better

 I recently read ‘Better’ by Dr. Atul Gawande. This is his second book after ‘Complications’, which I had read many years ago. Dr. Gawande is a staff member at the Brigham and Women’s Hospital and Dana Farber Cancer Institute. He is also an Associate Professor of Surgery at the Harvard Medical School, Associate Professor in the Department of Health Policy and Management at the Harvard School of Public Health, and Associate Director for the BWH Center for Surgery and Public Health. Dr. Gawande is also a staffer at the NewYorker Magazine.

‘Better’ is a rare and a wonderful book and I thorughly enjoyed it. ‘Better’ brings forth a great understanding of issues facing the medical fraternity today, the constant quest to do better, to improve the delivery of medicine and care as we know it today. I discovered the importance of hand washing and how this simple act on the part of caregivers in a hospital can avoid infection and save lives. I mean I do know that handwashing is important but had never given a second thought, while I marched into a patient’s room in any of the hospitals I worked in.   Continue reading