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Subject: Health

  • Mental Health in india

    mental wellnessContext

    • How to deal with mental wellness challenges in the uniformed forces

    What is stress?

    • Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stress is your body’s reaction to a challenge or demand.

    What is mental wellness?

    • Mental wellness encompasses emotional, psychological, and social well-being. It influences cognition, perception, and behaviour. It also determines how an individual handles stress, interpersonal relationships, and decision-making.

    Why is Mental Health Important?

    • Mental health is more important now than ever before; it impacts every area of our lives. The importance of good mental health ripples into everything we do, think, or say.

    mental wellnessReasons for Persistence of Mental Illness

    • Stigma to seek help: The staggering figures are void of millions of others directly, or indirectly impacted by the challenge and those who face deep-rooted stigma, many times rendering them unable to seek help.
    • Lack of awareness: This growing challenge in dealing with mental health issues is further compounded by a lack of information and awareness, self-diagnosis, and stigma.
    • Psycho-social factors: Institutions like gender, race and ethnicity, are also responsible for mental health conditions.
    • Post-Treatment gap: There is a need for proper rehabilitation of the mentally ill persons post/her treatment which is currently not present.
    • Rise in Severity: Mental health problems tend to increase during economic downturns, therefore special attention is needed during times of economic distress.

    mental wellnessOngoing challenges in mental wellness regime

    • There is a need to expand understanding of the full scope of what uniformed Services and other mental health experts can achieve.
    • Stigma regarding mental health both domestically and around the world remains strong.
    • There is a lack of trained personnel and healthcare and public health systems in many areas of the world.
    • Training needs are broad and reach beyond direct patient care, especially regarding cultural competence, crisis communication, and consultation.
    • There is a need for expanded support for the value of multi-professional and multi-organizational integration and collaboration.

    Government Policy initiatives

    • National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the NMHP since 1982.
    • Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
    • Rights of Persons with Disabilities Act, 2017: The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide an effective mechanism for ensuring their empowerment and inclusion in the society
    • Manodarpan Initiative: An initiative under Atmanirbhar Bharat Abhiyan aims to provide psycho-social support to students for their mental health and well-being.

    What needs to be done?

    • Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance. This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
    • Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
    • Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.

    Conclusion

    • Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.

    Mains question

    Q. Mental disorders are now among the top leading causes of health burden worldwide, with no evidence of global reduction since 1990. Examine.

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  • Ban on Conversion Therapy for the LGBTQIA+ Community

    The National Medical Commission (NMC), the apex regulatory body of medical professionals in India, has written to all State Medical Councils, banning sexual conversion therapy and calling it a “professional misconduct”.

    What is the news?

    • The NMC has empowered the State bodies to take disciplinary action against medical professionals who breach the guideline.
    • The NMC was following a Madras High Court directive to issue an official notification listing conversion therapy as a wrong, under the Indian Medical Council (Professional Conduct, Etiquettes and Ethics) Regulations, 2002.

    What is Sexual Conversion Therapy?

    • Conversion or reparative therapy is an intervention aimed at changing the sexual orientation or gender identity of an individual.
    • It uses either psychiatric treatment, drugs, exorcism and even violence, with the aim being to make the individual a heterosexual.
    • The conversion therapy umbrella also includes efforts to change the core identity of youth whose gender identity is incongruent with their sex anatomy.
    • Often, the therapy is offered by quacks with little expertise in dealing with the issue.
    • As late as 2018, medical books listed homosexuality and lesbianism as a “perversion”.

    What are the risks?

    • The interventions under conversion therapy are provided under the false premise that homosexuality and diverse gender identities are pathological.
    • They are not; the absence of pathology means there is no need for conversion or any other like intervention.
    • Conversion therapy poses the risk of causing or exacerbating mental health conditions, like anxiety, stress and drug use which sometimes even lead to suicide.

    What is the role of the Madras High Court in the ban?

    On June 7, 2021, Justice N. Anand Venkatesh of the Madras High Court gave a landmark ruling on a case he was hearing about the ordeal of a same-sex couple who sought police protection from their parents.

    • Pending adequate legislation more protective of the community, Justice Venkatesh issued a slew of interim guidelines.
    • It aimed for the police, activists, Union and State Social Welfare Ministries, and the National Medical Commission to ensure their safety and security to lead a life chosen by them.
    • The ruling prohibited any attempt to medically “cure” or change the sexual orientation of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual or of any other orientation) people.
    • It urged the authorities to take action against professionals involving themselves in any form or method of conversion therapy,” which could include the withdrawal of licence to practice medicine.
    • On July 8, 2022, the court gave an order to the NMC directing it to issue necessary official notification by enlisting ‘Conversion Therapy’ as a professional misconduct.

    What were some of the other guidelines issued by the court?

    • The court asked the Ministry of Social Justice & Empowerment to draw up a list of NGOs and other groups which could handle the issues faced by the community, and gave it a time of 8 weeks from the date of the order.
    • The court said the community should be provided with legal assistance by the District Legal Services Authority in coordination with law enforcement agencies.
    • It asked agencies to follow the Transgender Persons (Protection of Rights) Rules, 2020, and the Transgender Persons (Protection of Rights) Act, 2019, in letter and spirit.
    • The court said it was imperative to hold sensitisation programmes for an all-out effort to understand the community and its needs.

    Way forward

    • Schools and colleges must effect changes in curricula for a better understanding of the community.
    • People of a different sexual orientation or gender identity often narrate harrowing tales of bullying, discrimination, stigma and ostracization.
    • Gender-neutral restrooms should be compulsory in educational institutes and other places.
    • Parents too need to be sensitised, because the first point of misunderstanding and abuse often begins at home, with teenagers being forced to opt for “conversion” therapies.
    • Health professionals point out that even adults opting for sex reassignment surgeries need to get proper guidance like therapy pre and post operation.

    Back2Basics: Transgender Persons (Protection of Rights) Act, 2019: Key Features

    Defining Transperson

    • The act defines a transgender person as one whose gender does not match the gender assigned at birth.
    • It includes trans-men and trans-women, persons with intersex variations, gender-queers, and persons with socio-cultural identities, such as kinnar and hijra.

    Prohibition against discrimination

    • It prohibits the discrimination against a transgender person, including denial of service or unfair treatment in relation to education, employment, healthcare, access to, or enjoyment of goods, facilities, opportunities available to the public.
    • Every transgender person shall have a right to reside and be included in his household.
    • No government or private entity can discriminate against a transgender person in employment matters, including recruitment, and promotion.

    HRD measures

    • A transgender person may make an application to the District Magistrate for a certificate of identity, indicating the gender as ‘transgender’.
    • Educational institutions funded or recognised by the relevant government shall provide inclusive facilities for transgender persons, without discrimination.
    • The government must provide health facilities to transgender persons including separate HIV surveillance centres, and sex reassignment surgeries.

    Grievances redressal

    • The National Council for Transgender persons (NCT) chaired by Union Minister for Social Justice, will advise the central government as well as monitor the impact of policies with respect to transgender persons.
    • It will also redress the grievances of transgender persons.

    Legal Protection

    • The Bill imposes penalties for the offences against transgender persons like bonded labour, denial of use of public places, removal from household & village and physical, sexual, verbal, emotional or economic abuse.

     

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  • Bhang, Ganja, and criminality in the NDPS Act

    While granting bail to a man arrested on June 1 for possessing 29 kg of bhang and 400 g of ganja, Karnataka High Court recently observed that nowhere in the Narcotic Drugs and Psychotropic Substances (NDPS) Act is bhang referred to as a prohibited drink or prohibited drug.

    What is Bhang?

    • Bhang is the edible preparation made from the leaves of the cannabis plant, often incorporated into drinks such as thandai and lassi, along with various foods.
    • Bhang has been consumed in the Indian subcontinent for centuries, and is frequently consumed during the festivals of Holi and Mahashivratri.
    • Its widespread use caught the attention of Europeans, with Garcia da Orta, a Portuguese physician who arrived in Goa in the 16th century, noting that, “Bhang is so generally used and by such a number of people that there is no mystery about it”.

    Bhang and the law

    • Enacted in 1985, the NDPS Act is the main legislation that deals with drugs and their trafficking.
    • Various provisions of the Act punish production, manufacture, sale, possession, consumption, purchase, transport, and use of banned drugs, except for medical and scientific purposes.
    • The NDPS Act defines cannabis (hemp) as a narcotic drug based on the parts of the plant that come under its purview. The Act lists these parts as:
    1. Charas: “The separated resin, in whatever form, whether crude or purified, obtained from the cannabis plant and also includes concentrated preparation and resin known as hashish oil or liquid hashish.”
    2. Ganja: “The flowering or fruiting tops of the cannabis plant (excluding the seeds and leaves when not accompanied by the tops), by whatever name they be known or designated.”
    3. “Any mixture, with or without any neutral material, of any of the above forms of cannabis or any drink prepared therefrom.”
    • The Act, in its definition, excludes seeds and leaves “when not accompanied by the tops”.
    • Bhang, which is made with the leaves of the plant, is not mentioned in the NDPS Act.

    Cannabis and criminal liability

    • Section 20 of the NDPS Act lays out the punishment for the production, manufacture, sale, purchase, import and inter-state export of cannabis, as defined in the Act.
    • The prescribed punishment is based on the amount of drugs seized.
    • Contravention that involves a small quantity (100 g of charas/hashish or 1 kg of ganja), will result in rigorous imprisonment for a term that may extend to one year and/or a fine which may extend to Rs 10,000.
    • For a commercial quantity (1 kg charas/ hashish or 20 kg ganja), rigorous imprisonment of not less than 10 years, which may extend to 20 years, including a fine that is not less than Rs 1,00,000 but may extend to Rs 2,00,000.
    • Where the contravention involves quantity less than commercial, but greater than small quantity, rigorous imprisonment up to 10 years is prescribed, along with a fine which may extend to Rs 1,00,000.

    Also read:

    [Burning Issue] Substance Abuse in India

     

     

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  • National Digital Health Mission

    digital healthContext

    • The covid-19 pandemic has presented a watershed moment, bringing the world’s healthcare systems to a halt, forcing us to rethink existing healthcare delivery models and embrace the digital health transformation of the sector.

    Definition of digital health care

    • Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise.

    Digital Health: A Backgrounder

    • The National Health Policy 2017 had envisaged creation of a digital health technology eco-system aiming at developing an integrated health information system.
    • A Digital Health ID was proposed to reduce the risk of preventable medical errors and significantly increase the quality of care.
    • It recognised the need to establish a specialised ecosystem, called the National Digital Health Mission (NDHM).

    digital healthThe National Digital Health Mission

    • The NDHM is a digital health ecosystem under which every Indian citizen will now have unique health IDs, digitized health records with identifiers for doctors and health facilities.
    • The mission will significantly improve the efficiency, effectiveness, and transparency of health service delivery and will be a major step towards the achievement of the UN Sustainable Development Goal 3.8 of Universal Health Coverage, including financial risk protection.

    Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise.Significance of digital health

    • Prioritizing patients: Say, mortality from Covid-19 is significantly increased by comorbidities or the presence of other underlying conditions like hypertension or diabetes.With digital health records, doctors can prioritise patients based on their test results.
    • Portability of health records: Portability of records fairly eases in a patient with the first hospital visit, or her/his most frequently visited hospital. If she/he wishes to change a healthcare provider for cost or quality reasons, she can access her health records without carrying pieces of paper prescriptions and test reports. People will able to access their lab reports, x-rays and prescriptions irrespective of where they were generated, and share them with doctors or family members — with consent.
    • Easy facilitation: This initiative will allow patients to access healthcare facilities remotely through e-pharmacies, online appointments, teleconsultation, and other health benefits. Besides, as all the medical history of the patient is recorded in the Health ID card, it will help the doctor to understand the case better, and improved medication can be offered.
    • Technology impetus in policymaking: Meanwhile, it is also not just individuals who could emerge beneficiaries of the scheme. With large swathes of data being made available, the government too can form policies based on geographical, demographical, and risk-factor based monitoring of health.

    Critical point to remember

    In the case of lung cancer, only 18.5 % of patients survive five or more years once diagnosed. These are threats that data-led technology will help address.

    Major privacy issues involved

    • Informed Consent:The citizen’s consent is vital for all access. A beneficiary’s consent is vital to ensure that information is released.
    • Data leakages issue:Personalised data collected at multiple levels are a “sitting gold mine” for insurance companies, international researchers, and pharma companies.
    • Digital divide:Other experts add that lack of access to technology, poverty, and lack of understanding of the language in a vast and diverse country like India are problems that need to be looked into.
    • Data Migration:The data migration and inter-State transfer are still faced with multiple errors and shortcomings in addition to concerns of data security.

    Other challenges

    • Existing digitalization is yet incomplete:India has been unable to standardise the coverage and quality of the existing digital cards like One Nation One Ration card, PM-JAY card, Aadhaar card, etc., for accessibility of services and entitlements.
    • Lack of healthcare facilities:The defence of data security by expressed informed consent doesn’t work in a country that is plagued by the acute shortage of healthcare professionals to inform the client fully.
    • Lack of finance:With the minuscule spending of 1.3% of the GDP on the healthcare sector, India will be unable to ensure the quality and uniform access to healthcare that it hoped to bring about.

    Conclusion

    • With an enabling ecosystem, supported by effective policies for digital healthcare and increased innovation, the promise of digital solutions in healthcare is immense. It’s not long before precision healthcare becomes central to the health and well-being of every citizen.

    Mains question

    Q. The covid-19 pandemic has presented a watershed moment, bringing the world’s healthcare systems to a halt, forcing us to rethink existing healthcare delivery models. In this context discuss challenges and opportunities of digital health ecosystem in India.

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  • Equitable education and health care needed for better future

    Equitable health and educationContext

    • To create the foundation for the next century, we need to invest in equitable education and health care in the next 25 years not just for the elite, but for all.

    What is current status of education?

    • Expenditure on Education: The expenses on education as a percentage to GDP, India lags behind some developed/ developing nations.
    • Infrastructure deficit: Dilapidated structures, single-room schools, lack of drinking water facilities, separate toilets and other educational infrastructure is a grave problem.
    • Student-teacher ratio: Another challenge for improving the Indian education system is to improve the student teacher ratio.

    What is current status of healthcare?

    • Weak delivery: Current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
    • Unpreparedness: Public health experts believe that India is ill-equipped to handle emergencies.
    • Technical glitches in urban areas: It is not prepared to tackle health epidemics, particularly given its urban congestion.

    A systemic approach to reforming education system in the country needs

    • Dynamic pedagogy: Academic interventions involve the adoption of grade competence framework instead of just syllabus completion.
    • Directional efforts: Effective delivery of remedial education for weaker students like after-school coaching, audio-video based education.
    • Administrative reforms: that enable and incentivize teachers to perform better through data-driven insights, training, and recognition. Example: Performance based increments in Salary.

    equitable education and healthA systemic approach to reforming healthcare system in the country needs

    • Universal health coverage: Access to healthcare in India is not equitable—the rich and the middle class would survive the COVID-19 or any other crisis but not the poor.
    • Increasing healthcare professionals in numbers: India has handled the COVID-19 pandemic exceptionally well. However, India is in dire need of more medical staff and amenities.
    • Revamping medical education: If the government wants to stay successful in fighting the COVID-19 pandemic, it needs to rapidly build medical institutions and increase the number of doctors.
    • Cross-subsidization of health-care: How the poor managed without, or even with, any government insurance scheme is a big question. They can make up for the loss by cross-subsidizing treatments of patients with premium insurance policies.

    Recent initiatives

    • PLI scheme: In view of these challenges, the government announced various policies like PLI scheme for domestic manufacturing of active pharmaceutical ingredients (APIs).
    • National Digital Health Mission: It also announced the National Digital Health Mission.

    Way forward

    • India’s healthcare system is too small for such a large population.
    • There seems to be a long battle ahead. The public healthcare system cannot be improved overnight.
    • The country needs all hands on deck during and after this crisis—both public and private sectors must work together and deliver universal health coverage for all citizens.

    Conclusion

    • Providing expanded access to high quality education and healthcare supports—particularly for those young people who today lack such access—will not only expand economic opportunity for those individuals, but will also likely do more to strengthen the overall state economy.

    Mains question

    Q. To create the foundation for the next century, we need to invest in education and health in the next 25 years not just for the elite, but for all. Critically examine

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  • Anganwadi scheme

    Context

    • The economic fallout of COVID-19 makes the necessity of quality public welfare services more pressing than ever.
    • The Integrated Child Development Services (ICDS) programme is one such scheme.

    What is ICDS?

    • ICDS caters to the nutrition, health and pre-education needs of children till six years of age as well as the health and nutrition of women and adolescent girls.

    What is anganwadi scheme?

    • The scheme was started in 1975 and aims at the holistic development of children and empowerment of mother.
    • It is a Centrally-Sponsored scheme. The scheme primarily runs through the Anganwadi centre. The scheme is under the Ministry of Women and Child Development.

    Need for focus on early childhood care and education (ECCE)

    • Low enrolment: The National Family Health Survey-5 (NFHS-5) finds only 13.6 per cent of children enrolled in pre-primary schools.
    • Weakest link: With its overriding focus on health and nutrition, ECCE has hitherto been the weakest link of the anganwadi system.
    • Low awareness: Unfortunately, due to a lack of parental awareness compounded by the daily stresses of poverty, disadvantaged households are unable to provide an early learning environment.

    Data to remember

    According to government data, the country has 13.77 lakh Anganwadi centres (AWCs).

    A meaningful ECCE programme in anganwadis

    • Activity-based framework which reflect local context: To design and put in place a meaningful activity-based ECCE framework that recognises the ground realities with autonomy to reflect the local context and setting.
    • Remove non-ICDS work: Routine tasks of anganwadi workers can be reduced and non-ICDS work, such as surveys, removed altogether.
    • Extend Anganwadi time: Anganwadi hours can be extended by at least three hours by providing staff with an increase in their present remuneration, with the additional time devoted for ECCE.
    • Change in policy mindset: ICDS needs a change in policy mindset, both at central and state levels, by prioritising and monitoring ECCE.
    • Engagement with parents: Anganwadi workers must be re-oriented to closely engage with parents, as they play a crucial role in the cognitive development of young children.

     

    Case study / value addition

    In Andhra Pradesh and Telangana, anganwadi centres have been geotagged to improve service delivery.

    Gujarat has digitised the supply chain of take-home rations and real-time data is being used to minimise stockouts at the anganwadi centres.

    Way forward

    • Government must act on the three imperatives. First, while infrastructure development and capacity building of the anganwadi remains the key to improving the programme, the standards of all its services need to be upscaled.
    • Second, states have much to learn from each other’s experiences.
    • Third, anganwadi centres must cater to the needs of the community and the programme’s workers.

    Conclusion

    • Nearly 1.4 million anganwadis of the Integrated Child Development Services (ICDS) across India must provide ECCE for the millions of young children in low-income households.

    Mains question

    Q. Some educationists have suggested that owing to the high workload of anganwadi workers, ECCE in anganwadis would remain a non-starter. Critically examine this statement and give dynamic suggestions to improve EECE in anganwadis.

     

     

     

  • Drugs shortage haunts HIV-positive community

    People living with HIV are facing an acute shortage of life-saving drugs, say protesters who have been camping outside the National AIDS Control Organisation (NACO) office.

    What is NACO?

    • The NACO established in 1992 is a division of India’s Ministry of Health and Family Welfare.
    • It provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies.
    • It is the nodal organisation for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India.

    Functions of NACO

    • Along with drug control authorities and NACO provides joint surveillance of Blood Bank licensing, Blood Donation activities and Transfusion Transmitted infection testing and reporting.
    • NACO also undertakes HIV estimations biennially (every 2 years) in collaboration with the Indian Council of Medical Research (ICMR) – National Institute of Medical Statistics (NIMS).
    • The first round of HIV estimation in India was done in 1998, while the last round was done in 2017.

    Why in news?

    • Activists allege rationing of medicines, arbitrary change in the drug regimen and even complete deprivation of life-saving paediatric drugs.
    • They fear that treatment will be interrupted, leading to drug resistance and deaths from AIDS.

    NACO stand

    • The protesters noted that the NACO, in its public communication, had claimed that 95% of the recipients had not faced any shortage.
    • Going by the figure, 5% of 14.5 lakh, or 72,500 people, are being affected by the current shortage and stock-out.
    • The impact is severe and far-reaching.

    What drugs are protestors talking about?

    • Protestors are for a stock-out of ART (antiretroviral) drugs such as Dolutegravir 50 mg, Lopinavir/Ritonavir (adult and child doses), and Abacavir in several states.

    What is ART?

    • The medicines that treat HIV are called antiretroviral drugs.
    • There are more than two dozen of them, and they fall into seven main types.
    • Each drug fights the virus in your body in a slightly different way.
    • Research shows that a combination, or “cocktail,” of drugs is the best way to control HIV and lower the chances that the virus will become resistant to treatment.

    Back2Basics: HIV/AIDS

    • HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases.
    • First identified in 1981, HIV is the cause of one of humanity’s deadliest and most persistent epidemics.
    • It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex, or through sharing injection drug equipment.
    • If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).
    • The human body can’t get rid of HIV and no effective HIV cure exists.

    Treating HIV

    • However, by taking HIV medicine (called antiretroviral therapy or ART), people with HIV can live long and healthy lives and prevent transmitting HIV to their sexual partners.
    • In addition, there are effective methods to prevent getting HIV through sex or drug use, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

     

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  • When pharma companies cross red lines

    pharma companiesMarketing practices of pharma companies are under scrutiny after tax officials searched the premises of a drugmaker, and an association of medical representatives moved the Supreme Court alleging unethical marketing practices by drugmakers.

    paharma companiesThe Dolo controversy

    • Bengaluru-based pharmaceuticals company Micro Labs Ltd came under the spotlight recently over the promotion of its anti-fever drug Dolo 650, which was widely used during the covid-19 pandemic.
    • Surprisingly, this drug which contained paracetamol was widely endorsed by doctors all across the India.
    • The Supreme Court last week ordered the central government to respond to a petition filed on the issue of unethical marketing practices by drug makers.
    • The Income Tax department too has accused it of claiming unallowable expenses made on freebies meant to boost sales.

    How do drugmakers incentivize doctors?

    • While many medical professionals claim that financial incentives do not influence their practice, some say that private sector doctors are enticed by pharmaceutical companies’ marketing agents to promote their drugs.
    • Pharma companies’ sales executives visit doctors to brief them about new drugs or a new drug component.
    • They try to impress upon them to prescribe their brands and in return, doctors are offered some gifts name reminders such as pens, writing pads, books and sometimes expensive gifts and holidays.
    • Such benefits extended to doctors depend upon the kind of drug, the disease burden etc.

    pharma companiesIs this a widespread industry practice?

    • A government doctor said no pharma firm can sustain without marketing its drug.
    • It mostly happens when there is an outbreak, or if there is great demand for a particular drug or when a drug is being launched.
    • Unlike in the case of other products, the decision to buy a drug is not made by the consumer, but by the doctor.
    • This makes pharma a marketing-driven industry.

    Are hospitals incentivized too?

    • Yes; doctors at a top private hospital which treated a large number of covid-19 patients said drug giants do try to incentivize hospitals.
    • The possibilities increase when a large corporate hospital chain operating across the country buys a drug in bulk.
    • A doctor at a corporate hospital does not have any control over the drugs sold in the in-house pharmacy of the hospital.
    • Doctors running small clinics see limited patients, and they do not have pharmacies; so, the issue of incentivization does not arise.

    What does the I-T dept find wrong in this?

    • While pharma companies treat freebies as a marketing expense which is deducted while computing their taxable income, getting the beneficiary of this spending to report it as his income has been a challenge.
    • In some cases, tax officials have denied promotional expenses as a deduction.
    • Hence, the government introduced a 10% tax to be deducted at source (TDS) effective 1 July, so that doctors and social media influencers report such benefits in their tax returns and pay tax on what it is worth.

     

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  • What rules govern Disposal of Seized Narcotics?

    The Narcotics Control Bureau (NCB) has destroyed 30,000 kg of seized drugs at four locations – Kolkata, Chennai, Delhi and Guwahati — in the virtual presence of Union Home Minister.

    Destruction of Seized Narcotic Drugs

    • Section 52-A of the Narcotics Drugs and Psychotropic Substances (NDPS) Act, 1985 allows probe agencies to destroy seized substances after collecting required samples.
    • Officials concerned must make a detailed inventory of the substance to be destroyed.
    • A five-member committee comprising the area SSP, director/superintendent or the representative of the area NCB, a local magistrate and two others linked to law enforcement and legal fraternity is constituted.
    • The substance is then destroyed in an incinerator or burnt completely leaving behind not any trace of the substance.

    Exact procedure that is followed

    • The agency first obtains permission from a local court to dispose of the seized narcotic substances.
    • These substances are then taken to the designated place of destruction under a strict vigil.
    • The presiding officer tallies the inventory made at the storeroom with that material brought to the spot.
    • The entire process is videographed and photographed.
    • Then one by one, all the packets/gunny bags of the substance/s are put in the incinerator.
    • As per rules, committee members cannot leave the place until the seized drugs have been completely destroyed.

    Which agency is authorized to carry out such an exercise?

    • Every law enforcement agency competent to seize drugs is authorized to destroy them after taking prior permission of the area magistrate.
    • These include state police forces, the CBI and the NCB among others.

    Why destroy seized drugs?

    • The hazardous nature of narcotic drugs or psychotropic substances, their vulnerability to theft, substitution, and constraints of proper storage space are among the reasons that make agencies destroy them.
    • There have been instances when seized narcotics were pilfered from the storeroom.
    • To prevent such instances, authorities try to destroy seized drugs immediately after collecting the required samples out of the seized substances.

     

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  • Monkeypox outbreak: It’s time to act, not panic

    Context

    Monkeypox was previously limited to the local spread in central and west Africa, close to tropical rainforests, but has recently been seen in various urban areas and now in more than 50 countries.

    About monkeypox

    • A virus belonging to the poxviruses family causes a rare contagious rash illness known as monkeypox.
    • This zoonotic viral disease (a disease transmitted from animals to humans) has hosts that include rodents and primates.
    • It is a self-limiting disease with symptoms lasting two to four weeks and a case fatality rate of 3-6 per cent.
    • Symptoms: A skin rash on any part of the body could be the only presenting symptom.
    • Swollen lymph nodes are another distinguishing feature. Aside from these, other symptoms of a viral illness include fever, chills, headache, muscle or back aches, and weakness.
    • Mode of transmission: Touching skin lesions, bodily fluids, or clothing or linens that have been in contact with an infected person can result in transmission.
    • It’s also worth noting that monkeypox does not spread from person to person through everyday activities like walking next to or having a casual conversation with an infected person.
    • Treatment: Monkeypox is mostly treated by managing symptoms and preventing complications if it is diagnosed.
    •  In the minor proportion who are immunocompromised, complications can occur; pulmonary failure was the most common complication with a high mortality rate.

    Containment Measures

    • Because symptoms usually appear 5-21 days after exposure, people with rashes, sores in the mouth, rash, eye irritation or redness, or swollen lymph nodes should be monitored.
    • When symptoms appear, it is critical to isolate the infected from other people and pets, cover their lesions, and contact the nearest healthcare provider.
    • It is also critical to avoid close physical contact with others until instructed to do so by our healthcare provider.
    • It is preferable to use home isolation whenever possible.
    •  Priority should be given to educating grassroots workers about symptoms, specimen collection, disease detection, acquiring sample collection equipment, and maintaining cold storage of specimens.
    •  Increased surveillance and detection of monkeypox cases are critical for controlling the disease’s spread and understanding the changing epidemiology of this resurging disease.
    • Preventive health measures, such as avoiding infected animal or human contact and practising good hand hygiene, are the best option.

    Vaccines and drugs

    • In the US, pre exposure vaccination with JYNNEOS® is available to healthcare workers and lab workers exposed to this group of poxviruses.
    • The smallpox vaccine is 85 percent effective against the disease.
    • Another vaccine, ACAM2000, is a live vaccinia virus vaccine that is otherwise recommended for smallpox immunisation and can also be used for high-risk individuals during monkeypox outbreaks.
    • In addition, Tecovirimat, an antiviral drug used to treat smallpox, is recommended for monkeypox.
    • Challenges: Smallpox vaccination programmes have been discontinued for the past 50 years, resulting in a scarcity of effective vaccines.
    • There are approved drugs and vaccines, but they are not widely available to scale up controlling monkeypox.

    Why WHO declared it as international concern?

    •  The increase in monkeypox cases in a short span of time in many countries necessitated the declaration of public health emergency of international concern  (PHEIC) and additional research studies.
    • It is unclear whether the recent sudden outbreaks in multiple countries result from genotypic mutations that alter virus transmissibility. SARS-CoV-2 and monkeypox virus co-infection can alter infectivity patterns, severity, management, and response to vaccination against either or both diseases.
    • As a result, there is a need to improve diagnostic test efficiency.

    Way forward

    • Plan for pandemic preparedness: This is not the last such difficulty we will face, as the world is still witnessing more such public health crises.
    • Zoonotic diseases are caused by various factors, including unchecked deforestation, climate coupled with a failure to prioritise public health, poverty, and climate change.
    • Instead, a robust plan for pandemic preparedness should be accelerated, guided by a single health agenda.
    •  The world is yet to recognise emerging and re-emerging infectious diseases as a genuine threat.
    • The immediate priority is to strengthen the surveillance infrastructure, including hiring public health professionals and field workers who can participate in outbreak detection and response during many future PHEICs.

    Conclusion

    Without prioritising public health strengthening, the threat of new and re-emerging infectious diseases, as well as the enormous social and economic challenges that accompany them, is real and grave.

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