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Dec 22
Next, a chain of birthing centres for the bulge bracket
The maternity ward is becoming passe, at least for those with money.

Birthplace Health, a Hyderabad-based start-up, has come up with a concept of birthing centres, as they are branded, exclusively meant for child birth.

Targeted at the premium segment, the company is looking to set up a network of such centres, which would provide ambience and several facilities for hassle-free deliveries, across the country.

The premium segment (delivery costing Rs50,000 and more) is about 30% of the Rs11,000 crore birthing market in India.

Birthplace is setting up a proof-of-concept facility in Hyderabad at an investment of about Rs20 crore, which will start in March.

"Delivering a child is an emotional moment of a woman. This is also an occasion for the entire family to celebrate unlike in any other medical need. So, a hospital, which has a variety of people including very sick people seeking treatment, is not the right place for delivering a child. Pregnancy is not a disease and is a moment of joy for the entire family. With this concept, we have been working on a business plan for the last one year," Tarun Siripurapu, managing director of Birthplace Healthcare, said.

The company plans to open over a dozen facilities in various locations like Vizag, Chennai and Coimbatore by 2017. Each centre is expected to cost between `10 crore and `15 crore depending on the location.

The company is funding the first centre through internal resources while it is keen on tapping banks, private equity and venture capital firms for expansion.

"Everything in the birthing centre would be exclusively designed for the would-be mother. The doctors, nurses would be of her choice. We would even provide music of her choice. There is also a library with a good collection of books. Moreover, we don't want to treat the visitors to the centres as typical attendants in a hospital. There are no visiting hours and when to allow people inside is left to the choice of the mother," he said.

The centre also offers facilities like yoga and Lamaze classes, apart from mother and baby exercises, diet and nutrition advice. It also offers training to the fathers on simple issues like changing the baby diapers.

But, all that has a cost to it. Typically, a normal delivery at the centre would cost `80,000 and Caesarian Section would cost less. "Our attempt would be to encourage normal delivery and we would like to charge less for a C Section," he said pointing to the popular perception that the hospitals and nursing homes perform more C Sections to charge more.

According to Siripurapu, a former McKinsey executive in New York, the first centre is expected to take a year to break even and translate into about 1,000 deliveries. "During the first year, we are expecting about 80% of deliveries to happen through referral mode from other gynaecologists in the city," he said. The company is targeting to capture about 8-10% of the premium segment once its network is in place.

Dec 21
Use of birth control pills leads to clogged veins
A study has revealed that usage of birth control pills puts one at a greater risk for developing clogged veins and arteries. Shalini with more on that. Popular birth control pills, Yaz and Yasmin, may leave one at a higher risk of clogged veins and arteries. In the US, the FDA has asked for new warning labels, which is something pharma major Bayer has said it will do.

Yaz and Yasmin are the part of a new generation of birth control pills that contain the compound drospirenone. The US FDA study found that women who use these are twice as likely to develop blood clots than those on older contraceptives.

Most birth control pills contain another compound, levonorgestrel, which is why one needs to consult with their gynaecologist on which low dose birth control pill is the best.

"We will have to be careful with women with a history of heart disease, or obesity or if she smokes," said Dr Geeta Chadha of Apollo Hospital.

But the US FDA's study estimated that while women on older contraceptives had only about a six in 10,000 chance of getting a blood clot, the newer drug had a 10 in 10,000 chance.

All birth control pills have side effects, and do increase the chance of getting blood clots. And even a slightly higher risk of clotting can trigger heart attacks or a stroke.

But doctors say the benefits outweigh the risks, especially in a certain set of patients.

"It's prescribed to women who have certain hormonal imbalances and who get too much acne or too much hair growth," Dr Geeta Chadha said.
For now, Yaz and Yasmin are among the top-selling contraceptives in the US and in India, doctors say these pills form ten per cent of the birth control market.

Dec 20
Parents beware: Noisy toys may harm kids ears
Parents, give a second thought the next time you pamper your children by giving them noisy toys.
A new study by the University of California says that the noise of some of the most popular Christmas toys can be as loud as a chainsaw and risk permanently damaging toddlers' hearing, the Daily Telegraph reported.

For their study, researchers from the University of California, Irvine tested the levels of two dozen separate toys and took 10 of the loudest to a specialist soundproof laboratory . All of the 10 exceeded 90 decibels and several reached 100 or more, which is equivalent to the noise of a chainsaw or an underground train.

Among the toys tested were the Tonka Mighty Motorised Fire Truck, Marvel Super Shield Captain America, Whac-A-Mole game, Sesame Street Let's Rock Elmo and Toy Story Buzz Lightyear Cosmic Blaster.

Hamid Djalilian, who led the study, said problems could arise if a noisy toy was held too close to a child's ears.

"Children are very sensitive to loud and high-pitched sounds. Unfortunately, hearing loss from noise damage is permanent and not currently curable," he said.

Djalilian said that someone buying a noisy toy for a child should hold the toy as a youngster would and listen to its sound. "If it hurts your ears then it's probably too loud for a child," he said.

Dec 19
Daily dose of Vitamin B 'can fight memory loss and help protect against Alzheimer's
A daily dose of vitamin B can dramatically combat memory loss in old age and even protect against Alzheimer's, a study has found.

People taking the pill had lower levels of a brain protein known to lead to a rise in the risk of dementia.

Researchers found it also slowed mental decline in older people who have slight problems with their memory.
More than 800,000 people in Britain suffer from dementia and the number is forecast to double within a generation, but previous drug trials have been unsuccessful.
Around a sixth of people over 70 are thought to suffer from mild cognitive impairment and about half develop dementia, usually within five years of diagnosis.

The research suggested dementia could be treated with a food supplement rather than by taking complicated medicines.

More than 250 people took part in the study, at Oxford University, including people with mild cognitive impairment who were aged 70 years or older.

They were given vitamin B - found naturally in food such as beans, meat, wholegrains and bananas - or a placebo over a two-year period.
Taking the food supplement appeared to help maintain mental processes, such as planning, organising and recalling information.

An earlier study showed B vitamins slowed the rate of brain shrinkage compared with a group receiving a placebo.

Dec 17
Delhi government wakes up to contain japanese encephalitis
With 17 blood samples of the 81 slaughtered pigs testing positive for Japanese encephalitis (JE), the alarmed brass of the Delhi government and MCD on Friday decided to identify the source of the infection in pigs before initiating more drastic measures to check the spread of the disease.

Since JE has already killed more than 500 people in Uttar Pradesh and its spread in the Capital is a scary possibility, the decision was taken at an emergency meeting between senior officials of the MCD and the health department.

Health minister Dr A. K. Walia said: "The first thing we will investigate before the next meeting is the source of the infection. The samples of another 100 pigs are being tested. Since this is the winter season, even the number of mosquitoes - which are the primary carriers of the disease from animals to humans - is quite less."

The MCD had sent the samples for testing to the National Research Centre for Equines at Hisar, Haryana, in late November. Eight of the 17 samples that tested positive had been collected from the Civil Lines area of the Capital, six from Shahdara South and three from Sadar Paharganj.

One of the key instructions issued by the jittery government brass to the MCD authorities was about regular fogging and checking the presence of mosquitoes, particularly in the resettlement and unauthorised colonies. Pigs are known hosts of JE, which spreads from them to humans via mosquitoes.

Based on the preconditions that help the disease spread, the authorities have already identified the "high risk" zones.

Most of these are resettlement colonies with poor hygiene conditions and the presence of pigs, mosquitoes and birds in close proximity to one another. These include Raghubir Nagar, Mangolpuri, Shastri Park, Rohini, Bawana and Trilok Puri, among others.

Though the culling of pigs isn't allowed in the national Capital, the state government's health officials said on the condition of anonymity that it was "the best and the safest option" to check the spread of the disease.

"But since most of these areas have a high population density, the culling of pigs by the government/ civic administration could become a significant political issue in the forthcoming civic elections. Such a move will most likely affect a certain votebank. Therefore, it'll be a tricky decision to take for the political parties," a senior health department official said.

In fact, the issue of compensation to the owners of pigs that may ultimately have to be slaughtered across the city would also be discussed at the crucial meeting on JE, which is scheduled for next week.

Walia confirmed that the state government was aware of the financial aspect of such a decision. "We will discuss a range of issues, including the financial ramifications, at the meeting next week," Walia said.

JE had surfaced in the Capital for the first time this year in October, when four persons tested positive for it. Since then, 14 persons have tested positive for the virus. The areas from where these cases were reported included Gole Market, Bawana and Jahangirpuri .

Dec 17
No study on depression cases in India
There is no study on whether number of depression cases in the country have increased or not, even as a mental health programme has been underway since 1982, parliament was informed Friday.

In a written reply in the Lok Sabha, Health Minister Ghulam Nabi Azad said that the national mental health programme was introduced in the country in 1982.

"A total of 123 districts in 30 states and uniot territories have been covered under the district mental health programme to provide detection, management, and treatment of mental disorders," he said.

The minister however also said that there was "no long term population based study in India to suggest that the number of cases of depression and consumption of antidepresseant drugs are increasing."

According to a study conducted by the World Health Organization, India has the highest rate of major depression in the world.

Around nine percent of people have been reported having an extended period of depression within their lifetime and nearly 36 percent suffered from "major depressive mode".

Dec 16
Andhra Pradesh: Botched eye surgery camp blinds five
A botched eye surgery camp blinded five persons, while 11 others developed serious complications in Nandyal town of Kurnool district in Andhra Pradesh.

St Werburghs Hospital conducted the free camp on November 14, but the hospital authorities tried to hush up the goof-up by referring the victims to hospitals in Guntur, Kurnool and Hyderabad. The incident came to light when the victims approached the district health authorities and the media on Thursday.

Kurnool district health officer Venkatapathy said as many as 33 people went to the camp for cataract surgery.

The patients returned to their villages after the operation. But 16 of them developed infections and went to the hospital for post-surgery followup. "The medical officer there rudely told us to go to bigger hospitals," a patient said.

But for five of them, it was too late. They were already blinded. The National Eye Care Project officials will probe the incident.

Dec 15
Only 30 hospitals have fire safety systems
Vishakhapatnam: Even as Visakhapatnam has emerged as the health hub of the north coastal Andhra and neighbouring Odisha and Chhattisgarh, fire safety arrangements continue to be poor at a majority of the hospitals in the city, ringing alarm bells for the patients and their families.

It is said that many of the hospitals in Visakhapatnam are deathtraps, in the absence of any fire-fighting mechanism or fire escape arrangements.

About 300 private hospitals and clinics in the city are said to be highly prone to incidents like the one at AMRI Hospital in Kolkata which claimed the lives of more than 90 patients.

In view of the abject disregard for fire safety norms, Greater Visakhapatnam Municipal Corporation authorities have decided to crack the whip.

The Greater Visakhapatnam Municipal Corporation will start a joint exercise with the fire department to assess fire prevention and safety mechanisms in all the hospitals in the city and will also be organising a meeting with the managements of various hospitals on Wednesday to discuss the fire safety issues.

Station fire officer of GVMC's fire prevention wing U Sarath Babu said out of the 300 hospitals and nursing homes in the city, around 20 come under large establishment's category. He admitted that only less than 10 per cent of the hospitals have minimum fire safety mechanisms.

Sources said some of the establishments do not even seek the mandatory No Objection Certificate (NOC) from the GVMC and the fire department to start operations. Some of the hospitals are extremely vulnerable to mishaps of the Kolkata kind not only on account of not adhering to safety rules, but also due to their location in narrow lanes, where fire tenders could not pass.

Sarath Babu said the Greater Visakhapatnam Municipal Corporation will seal the hospitals if managements continue to flout fire safety norms.

He said those found violating the norms would be issued show-cause notices first and would be made liable for action under relevant laws. Greater Visakhapatnam Municipal Corporation will start issuing notices after the review meeting on Wednesday and will give one month time to hospitals to comply with regulations.

Several hospitals don't have the ramp to shift patients to safety during a fire mishap. If a fire breaks out, what about those immobile patients undergoing treatment in Intensive Care Units or Trauma Care Units?

So far, Greater Visakhapatnam Municipal Corporation and the fire department had issued notices to around 80 hospitals in the city in July but none of them have installed fire safety equipment yet. Fire officials noticed that there was no trained staff in the hospitals to tackle fire mishaps.

According to rules, the hospitals should have elaborate mechanisms to facilitate easy movement and escape of patients in case of fire.

There should be mandatory fire exits on every floor with wide stairways. Firefighting equipment should be installed at every level. But many hospitals, including Care, Seven Hills, Queens NRI and Manipal, are crowded at any given time and if fire breaks out, the casualties could be very high.

District fire officer SV Narasimham said fire safety remains the least priority for hospitals, commercial establishments and educational institutions despite repeated warnings and notices.

Convener of the Forum for Better Visakha EAS Sarma said unsafe buildings should have been closed by the authorities, but they have either been lax or colluding with building owners.

People say the Kolkata incident should be an eye-opener to the district and Greater Visakhapatnam Municipal Corporation officials. In fact, every multi-storied building should be put under the scanner, they say.

Dec 14
Low-carbohydrate diets better for easing weight: study
A low-carbohydrate diet is better than a standard, calorie-restricted one for cutting down weight and lowering blood levels of cancer-promoting hormone insulin, a British study has found.

Researchers at Genesis Prevention Centre at University Hospital in South Manchester, found that restricting carbohydrates two days per week may be a better dietary approach for preventing breast cancer and other diseases.

"It is interesting that the diet that only restricts carbohydrates but allows protein and fats is as effective as the calorie-restricted, low-carbohydrate diet," said Michelle Harvie, research dietician at the Genesis Prevention Centre.

Harvie and her colleagues compared three diets during four months for effects on weight loss and blood markers of breast cancer risk among 115 women with a family history of breast cancer.

They randomly assigned patients to one of the following diets: a calorie-restricted, low-carbohydrate diet for two days per week; an "ad lib" low-carbohydrate diet in which patients were permitted to eat unlimited protein and healthy fats, and a standard, calorie-restricted daily Mediterranean diet for seven days per week.

Data revealed that both intermittent, low-carbohydrate diets were superior to the standard, daily Mediterranean diet in reducing weight, body fat and insulin resistance.

Mean reduction in weight and body fat was roughly four kg with the intermittent approaches compared with 2.4 kg with the standard dietary approach.

Insulin resistance reduced by 22 per cent with the restricted low-carbohydrate diet and by 14 per cent with the "ad lib" low-carbohydrate diet compared with 4 per cent with the standard Mediterranean diet.

Dec 13
Affordable medicines will take more than price controls
The draft National Pharmaceutical Pricing Policy floated in October by the Department of Pharmaceuticals inviting feedback from stakeholders charts out significant changes, but as in most policies that seek to alter decades of established framework, rising voices of dissent have invariably followed.

Two important draft introductions are being opposed by industry and non-governmental organisations alike - first, the clamping of the entire list of essential medicines, numbering a whopping 348, under price control as against the present 74 and second, pricing of drugs based on the average of the top three brands in each category.

These may be genuine concerns, but policy makers cannot be faulted squarely for proposing the new legislations.
Ironically, at some point or the other, the same NGOs that have pointed at the shortcomings in the new policy draft had previously called for a tighter grip on prices of medicines in India, given the appalling healthcare conditions in India and that medicines were not affordable to large sections of the population.
Those pleas were not left unheard. When Ram Vilas Paswan held the charge as minister for chemicals and fertilisers a few years ago, a possibility of all essential medicines being put under the span of price control came closer to reality. The slow process of bureaucracy and the combative industry associations scuttled that move arguing it was retrograde and will derail growth of the health industry.

Instead, what we had in the name of affordable medicines is the Jan Aushadhi scheme. Launched with hopes of bridging the need gap for medicines, the scheme that endeavoured to provide generic drugs in select towns and cities is at best breathing hard to survive now. It remains an unfulfilled task for the government to provide affordable medicines and universal healthcare to its teeming population.

Read closely, the NGOs have a fair point in opposing another issue. In objecting to the proposal to fix a price on the basis of the average of the three leading brands in a particular therapy area, there is sufficient reason to believe the proposal will not be an effective mechanism in curbing the runaway medicine prices. Effectively, what it will translate into is that those who calibrate their brand prices to the lower end of the segment may also be encouraged to tag their product closer to the leader's price, making drugs even more unaffordable.

The NGOs are right in arguing that this amounts to top brands-based pricing rather than market-based pricing. In its enthusiasm to probably liberate the industry from the old rule of cost-based pricing of medicines, the government may have taken a bold but hasty decision.

While it looks practically difficult to calculate the average price of all the brands and then fix a ceiling as demanded by the NGOs, it will also scare away larger companies which have truly invested in building brands and their lifecycle management.

Knowing that wrong pricing strategies can be self-defeating, a few in the industry have learnt their lessons the hard way. Companies that have targeted smaller towns and cities are now striving to bring down the prices of medicines for those particular markets through a dual pricing approach. There are instances of multinational companies aligning with local partners for a deeper reach while at the same time keeping distribution and marketing costs within a limit.

What may be needed from the government's side, besides being judicious to frame a reasonable pricing policy, are steps in creating a robust infrastructure.

For example, vaccination is a hugely unexplored area in India and there is a growing trend of large organisations investing in vaccines needed in emerging markets.

Organisations involved in vaccine projects encounter tremendous hurdles in maintaining quality and safety protocols due to the lack of a cold chain network in India.

In the best interest of the patients - who are under-served in India - it works well if the government, industry and patient groups devise a strategy that yield tangible results. At present, most policy initiatives are lost in endless debates, those that are mostly in the interest of protecting the industry and less pointed at patient outcomes.

It is a fact that though the industry has for decades opposed price controls on 74 drugs, the players have also made decent profits to sustain and shape up into large global corporations.

There is a role to be played by trade too - with the margins it makes and the relative absence of competition compared with developed countries, it can invest in quality infrastructure to ensure safe drugs till the end of the delivery cycle.

On its part, given the enormous power it wields, the government can be more proactive than unidirectional in its policy making process.

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