The Jan Aushadhi Campaign
A brave new initiative began this July in the country
– The Jan Aushadhi Campaign. The idea was long overdue. India’s
large generic drug industry supplies affordable medicines to more than
100 countries. While it has earned the sobriquet of ‘pharmacy of the
world’, it is preposterous that the common man in India’s major health
expenditure is on drugs.
This campaign launched by the Department of
Pharmaceuticals will provide quality medicines at rock bottom prices to
the masses. The trick is to remove the various intermediaries between
the drug maker and the consumer. The first Jan Aushadhi store
began in Amritsar 6 years ago, and there are a 100 odd stores currently
functioning mainly in Northern India. However, over the years the
program foundered in the murky waters of shortage, stockouts and an
inefficient supply chain management. This year, the country aims to
resurrect the scheme and launch over 1000 Jan Aushadhi shops
across the country. Based on sales of various drugs, the government has
identified 504 drugs including antibiotics, painkillers, vitamins and
some drugs used in specialties such as cardiology, neurology and
gastroenterology. The Medical Council of India and Indian Medical
Association have also been consulted to enable more cooperation from
doctors to prescribe generic names. A mobile application has been
developed to help consumers get the generic name of a particular drug.
Once the brand is rolled out, the government also plans to make it
mandatory for public hospitals to prescribe it wherever possible. There
are concerns on whether the government will be able to maintain and
monitor quality of all such products sold since they will be procured
from different firms. But officials are optimistic that procurement
norms and sampling will help to control quality. (The Hindu 18 June
2015)
Non-invasive Screening for Down Syndrome
A large study of pregnant mothers from Great Ormond
Street Hospital has shown that Non-invasive Prenatal Testing (NIPT) for
Down syndrome is 99.2% accurate. In the NIPT, the maternal blood is
tested for trisomies in fragments of fetal blood around the tenth week
of pregnancy. Cell-free DNA from the mother’s blood is analyzed for
maternal and placental DNA. After sequencing, these DNA fragments are
compared to a reference genome, usually from the mother’s white blood
cells.
Worldwide, the test has contributed to about 50-70%
reduction in invasive procedures such as amniocentesis. False positives
– though low – can result from a twin that died in the womb, abnormal or
mosaic cells from the placenta, or a health condition in the mother,
such as cancer. It is interesting that the NIPT can also pick up
pre-symptomatic cancer in pregnant women. In a review of three case
reports published online on June 5 in JAMA Oncology, researchers
sequenced maternal cell-free DNA from 4000 pregnant women. Three women
had abnormal genome profiles that did not appear to belong to the mother
or fetus, raising suspicion for maternal cancer. The women underwent
whole-body scanning with MRI, which revealed cancer in all three.
Pathologic and genetic tests confirmed the diagnoses. Genetic analyses
of the tumor biopsy specimens confirmed that they matched the genome
results found in the NIPT plasma. The UK’s National Screening Committee
is now planning to assess whether the NHS should offer the test to all
pregnant women this year.
(Medscape Medical News 11 June 2015)
Cholera Vaccine
An oral, cheap cholera vaccine "Shanchol" from
Shantha has been found to be effective in reducing rates of cholera
in Bangladesh. In this real-life cluster randomized open label trial,
two doses of the vaccine were given 14 days apart to participants above
1 year in the urban slums of Dhaka, and compared it with ‘vaccination
plus behavioral changes like hand washing’, and with no intervention.
Overall vaccine coverage was around 65%. Total effectiveness was 53% in
the vaccination group and 58% in the ‘vaccination plus behavioral
change’ group. Even with moderate vaccine coverage, the incidence of
life-threatening cholera in children below 5 years went down by 40%. (The
Lancet 8 July 2015)
American Academy of Pediatrics Opposes Telemedicine
in Unknown Patients
A policy statement by the American Academy of
Pediatrics (AAP) has condemned virtual visits by physicians for patients
whom they have not previously seen. In an article by the Committee on
Pediatric Workforce published in the journal Pediatrics, they
have come down strongly on "ask-a-doc" services. The AAP believes that
the primary care physician must be responsible for the patients, and
guide them through the health care system. "The use of telemedicine care
by virtual health care providers, such as those linked to retail-based
clinics, entrepreneurs, or insurers whose business model is to provide
health care services to patients via smart phone, laptop, or
video-consult kiosk without a previous physician-patient relationship,
previous medical history, or hands-on physical examination (other than
what can be accessed via the technology), can undermine the basic
principles of the patient-centered medical home model," the committee
commented. Many other State Medical Associations and specialty services
also feel the same.
However, the AAP strongly supports the use of telemedicine in the
context of established physician–patient relationships. It calls for an
expansion in the use of the technology to increase patient access to
care, to enable pediatricians to care for more patients, and to allow
them to learn from subspecialists during remote consults. Virtual visits
can also reduce missed appointments, increase adherence to care plans,
enhance disease management, reduce patient travel, and can result in
fewer missed work school days. (Pediatrics. 2015;136:202-9).