World Asthma Day: Cutting-Edge Treatments And Management Strategies
7 May 2024
9 mins
World Asthma Day: Cutting-Edge Treatments And Management StrategiesBreath Easily; Live Freely!   While almost everyone is familiar with the appearance and sound of an asthma inhaler, only some are aware of the actual nature and cause of the condition and the fact that there are various types of asthma.  World Asthma Day is an annual global healthcare event held on the first Tuesday of May to raise awareness of asthma globally. The 7th of May (Tuesday) in 2024 is designated as World Asthma Day. Today, many worldwide and local organizations join together to tackle the world's leading non-communicable disease in children and adults. GINA (Global Initiative For Asthma) created World Asthma Day in partnership with the World Health Organisation.   WORLD ASTHMA DAY 2024 THEME    This year's World Asthma Day 2024 theme is “Asthma Education Empowers” which emphasises the need to spread the knowledge about the appropriate management of disease and recognize the right time to seek the doctors help.   Today, GINA seeks to expand and deepen its relationship with local and national policymakers. GINA also pledges to make specific recommendations for environmental sustainability by discussing concerns about global health with a focus on patient safety. GINA works to enhance the lives of people with asthma around the world, and multifaceted collaboration for improvement in all elements of asthma care for patients and the environment is essential. IMPORTANCE OF WORLD ASTHMA DAY    Asthma is the most common chronic disease in both children and adults worldwide. Asthma was identified by the World Health Organisation (WHO) and other regulatory bodies as both a cause and an effect of poverty in low- and middle-income nations. According to the WHO, 26.2 crore people have asthma, [https://www.who.int/news-room/fact-sheets/detail/asthma] with a mortality count (deaths) of 4.55 lakh globally in 2019. According to the Global Burden of Disease Report (GBDR) 2019, India has the world's highest and growing burden of asthma in terms of deaths and disability-adjusted life years, with over 3.4 crore people suffering from the disease, despite accounting for only 13% of the world's asthma population and 42% of global asthma death rates.    HISTORY OF WORLD ASTHMA DAY    The Global Initiative for Asthma (GINA) established World Asthma Day in 1998. The day was designed to raise awareness of asthma as a growing problem. It affects at least 14% of children worldwide [https://www.daysoftheyear.com/days/asthma-day/] and appears to be rising. Asthma was recognized as a serious public health concern by the World Health Organisation (WHO) in 2016. This day aims to enhance asthma care worldwide by educating people about the disease and advocating for better management and preventative techniques.   WHAT IS ASTHMA?    A Fight For Breathable Air!   Most of you must have heard that asthma is an infectious lung disease that can be transmitted from person to person. While the fact is that asthma is a non-communicable inflammatory condition that affects the lungs. Asthma is a chronic lung condition that occurs due to inflammation of the airway that leads to constriction in bronchial tubes or airways. Besides the inflammation, there is also excessive mucus production and muscle stiffening around the bronchial tubes, leading to narrowing airways.   TEN TYPES OF ASTHMA   * Exercise-induced asthma: Not all types of physical activity aggravate asthma symptoms. [https://www.mrmed.in/health-library/respiratory-disorder/all-you-need-to-know-about-asthma] For those prone to asthma attacks, strenuous exercises can worsen the condition leading to severe wheezing. * Occupational asthma: For certain people subjected to chemicals (dyes & rubber) in textile, agricultural, metal, and manufacturing industries, the fumes can irritate their airways and cause asthma attacks. * Nocturnal asthma: A type of asthma that occurs primarily at night and causes sleep disturbances. * Allergic asthma occurs when asthmatics consume allergic foods or expose themselves to external triggers such as dust, mites, molds, etc. * Nonallergic asthma happens when asthmatics are confronted with strong emotions such as stress, exposure to strong odors, etc. Such emotions can flare up asthma attacks. * Intermittent asthma: This type of asthma attack occurs in those people who experience on-and-off asthma symptoms. * Persistent asthma: For some people, asthma symptoms may endure for a chronic period. This type of asthma can be presented with mild or moderate to severe symptoms. * Adult-onset asthma: Asthma symptoms that occur in the late teens. * Childhood asthma: It has been named childhood asthma based on the onset that occurs in infants or toddlers. * Asthma- COPD overlap syndrome: This occurs if an asthma attack occurs along with chronic obstructive pulmonary disease that flares up the shortness of breath that worsens the wheezing.   WHAT ARE THE FACTORS THAT CAUSE ASTHMA?   *  Hereditary: A family history of asthma is likely to contribute as a risk factor, and it is related to having a high risk of causing asthma. * Obesity: In obese people, an excess amount of fat accumulated in the chest and abdomen region leads to difficulty in breathing due to strong constriction of the airways. * External factors include passive smoking or exposure to pollution or chemical fumes that tend to irritate your bronchial pathways and elevate the risk of asthma. In addition, those of you with a history of RSV virus or respiratory syncytial viral infection are more likely to develop asthma.   BREATHING SOLUTIONS: ASTHMA TREATMENT AND MANAGEMENT OPTIONS   Asthma can be treated by the following methods which are given below:   * Quick-relief medicine: They can help you to give immediate relief, prevent or ease the symptoms of asthma. Some of the common relievers which are used in asthma are short-acting beta2-agonists (SABAs), Oral corticosteroids, Short-acting anticholinergics. * Long term medication: Your doctor or healthcare provider may prescribe you controller medicines to prevent and control the asthma attacks and its symptoms. Medicines like corticosteroids, biological medicines, leukotrienes modifiers, long-acting bronchodilators, mast cell stabilizers and allergy shots like subcutaneous immunotherapy (SCIT) are helpful in preventing and controlling the asthma. 5 WAYS TO MANAGE ASTHMA   According to the WHO experts, here are the five tips to manage asthma in a better way:   1. Be aware of your symptoms: Speak with a doctor, if you have symptoms like coughing, wheezing and difficulty breathing. 2. Identify and avoid your triggers: It is recommended to identify your asthma triggers (smoke, fumes, viral infections, pollen and animal fur) that worsen the symptoms of asthma and try to avoid it or keep your inhalers with you before you are exposing it. 3. Know your inhalers: Use an appropriate inhaler which your doctor recommends you for the asthma symptoms. Some might be recommended to use reliever inhalers whereas others are prescribed steroid inhalers. 4. Use a spacer: A spacer is a plastic chamber which connects the inhaler to your mouth through a plastic pipeline. It helps the medicines to be breathed in for more time and improve the effectiveness of the inhaled medicines. 5. Take back control: It is recommended to clarify your doubts with your doctor regarding how to use an inhaler in an emergency situation and it is also necessary that your friends and family members are also aware of the steps that they need to take during the emergency situation.   Watch your breathing breath; every breath matters!   Asthma can affect anyone, irrespective of age and gender. Consider having a skin prick test to avoid the triggers. Maintaining a healthy weight and following an active lifestyle is important to prevent asthma attacks. It is recommended that you discuss with your doctor about the type of asthma you have and know which treatment plan works best for you. On this world asthma day 2024, let's vow to end air pollution and provide our support to asthmatics by creating a healthy environment to breathe clean air.
Ishwarya R
What is terminal cancer, its life expectancy, and treatment options?
6 May 2024
10 mins
What is terminal cancer, its life expectancy, and treatment options?In the hushed corridors of hospitals and the intimate spaces of homes, there’s a profound struggle playing out. It’s not a battle of armies, but a battle fought quietly, courageously, against cancer. Imagine facing each day with the uncertainty of how many you have left. For those confronting terminal cancer, every breath is a testament to strength, every moment a precious gift. They endure pain, fear, and doubt, yet amid this darkness, there's a flicker of hope—a collective effort to ease their burden, to bring comfort and relief. Today, we journey into their world, to understand their struggles, and to discover the many ways we can make their journey a little less daunting, a little more bearable.   WHAT IS TERMINAL CANCER?   Terminal cancer is otherwise known as end-stage cancer, which cannot be controlled or treated with any other treatment options. It is different from advanced-stage cancer, where there exists an option to control the effect of cancer or to cure it completely. Patients who are affected by advanced cancer have a rapid spread of cancer cells to nearby tissues or other parts of the body. Terminal cancer [https://www.cancer.gov/about-cancer/advanced-cancer#:~:text=Those%20that%20cannot%20be%20controlled,or%20elsewhere%20in%20the%20body] can occur for any type of cancer patient who is in the stage 4 or final stage of the cancer.   WHAT ARE THE END-STAGE CANCER SYMPTOMS?   Terminal cancer patients can experience the symptoms which are given below:   1. Fatigue: Individuals may experience exhaustion or feeling tired without doing any stressful activities. 2. Vomiting: Patients may experience vomiting or forceful throwing up of food from the stomach. 3. Loss of appetite: Individuals may experience a loss of appetite or lose an interest in eating the foods. 4. Weight loss: Patients can experience sudden weight loss due to the eating disorder. 5. Feeling unwell: Individuals may experience uncomfortable feelings or discomfort. 6. Delirium: Patients may experience a serious change in mental ability, which can lead to confused thinking and a lack of awareness of their surroundings. 7. Shortness of breath: Individuals may experience difficulty breathing or discomfort during breathing. 8. Coughing: Individuals may have a continuous cough, which can lead to discomfort. 9. Constipation: Patients may have trouble passing the stool. 10. Trouble swallowing: Individuals may experience trouble in swallowing the foods and liquids which can lead to loss of appetite and weight loss. 11. Myoclonic jerks: Patients may have a sudden muscle jerk that they cannot control. 12. Fever: Individuals may have a rise in body temperature or an abnormal increase in body temperature.   WHAT IS THE LIFE EXPECTANCY OF TERMINAL CANCER PATIENTS?   The Life expectancy of a terminal cancer patient is usually shorter when compared to others who are in different stages of cancer. The life expectancy of an individual is based on various factors,    * Cancer type * The overall health of the individual * Health issues other than cancer.   Some of the methods like Karnofsky performance scale, Palliative prognostic score are helpful in estimating the life expectancy of an individual. However, these estimations are just predictions which help people and doctors to make decisions according to the timelines.   ARE THERE ANY TREATMENT OPTIONS AVAILABLE FOR TERMINAL CANCER?   The fact is that terminal cancer is incurable and does not respond to any type of cancer treatment. But, there are some options in which a person can make [https://www.cancer.gov/about-cancer/advanced-cancer/care-choices] the rest of the lifetime valuable through non-medicine approaches. Some of the options are given below:   1. Palliative care:  Palliative care is a holistic approach to elevate the quality of patients ' lives and their families who are facing struggles with life-threatening illnesses. It starts when the disease is diagnosed and continues even with the treatment. Palliative cancer is essential for patients who choose to stop the cancer treatment due to its lack of improvement and worsening side effects. Palliative can usually include the following processes, which are given below: * It helps to treat or prevent the cancer symptoms and its treatment side effects. * It provides emotional and spiritual support to the patients. * It helps to address both the patients and the family's concerns.   2. Hospice care: Hospice care is a specialised approach in which medical, psychological and spiritual support are given to patients and their families in situations where there is no option in treating the cancer. Hospice can help to provide comforts and care to the patients and the families members.   Here are the 8 major things you need to know about hospice care:   1. Hospice care is not similar to palliative care: You might be confused that both hospice and palliative care are similar due to the comfort and support they provide to the patient. However, this is not the case; palliative care can be started from the diagnosis of cancer till the treatment or after the end of the treatment, whereas hospice care is focused only on relieving the symptoms and providing support at the end stage of a patient. 2. Hospice care is about caring and not meant to cure: The hospice care is mainly focusing on providing relief from pain and symptoms of cancer. It is not meat to cure any disease in the individuals. 3. Going for hospice care doesn't mean that you have given up hope: Hopsire care can help you provide hope for a good quality of life for the remaining period where you're going to live. 4. Hospice care can be given in any place: Hospice care can be given in the patient's home. But, it can also be given in hospitals and nursing homes, which generally consist of medical and nursing services, medical supplies and equipment, medicines for managing cancer-related symptoms and pain, inpatient care (short term), volunteers for substituting the caregiver [https://www.mrmed.in/health-library/cancer-care/self-care-for-cancer-caregivers], counseling and spiritual care, social work services, grief counseling and support team. 5. Hospice is full of trained people: Hospice consist of trained professionals and volunteers like doctors, nurses, home health aides, social workers, clergy or other counsellors, speech, physical and occupational therapists. 6. Hospice can give support for months: If you want to start hospice care, you can't wait for the last day or week of life. Hospice can provide support even before one month of your last life expectancy. 7. You need to get a certificate: You can receive hospice care if you are registered with insurance (such as Medicare), which requires a statement from your healthcare provider and the hospice medical director indicating that you have a life expectancy of a month or less. This statement initiates hospice care, which can be continued even after six months if your doctor provides recertification for it. 8. You can stop hospice care if you want: Hospice care can be terminated at any time if a patient feels that he/she doesn't want to continue it or is switching over to cancer treatment again.   3. Clinical trial:   Another option people can choose during their end-stage cancer is clinical trials. Clinical trials are procedures that are conducted to find the appropriate dose and to ensure the safety of a medicine before it is approved or entering into the market. Terminal cancer patients who are eligible for clinical trials are joined due to the hope that the new medicine can aid in treating them, or they want to participate to benefit the patient in the end stage of their life.   FINAL NOTES!   Patients who are in the stage of terminal cancer need appropriate guidance that will help them lead a comfortable and fulfilled life in the last period of their lifetime. Let's give care and hope to those super souls who are counting their days.
Ishwarya R
World Day for Safety and Health at Work
29 Apr 2024
10 mins
Elevating Healthy Work Culture: World Day for Safety and Health at WorkEvery year, on April 28th, the International Labour Organization (ILO) organizes World Day for Safety and Health at Work. This day highlights the importance of creating safe workplaces and spreading awareness about the real impact of work-related accidents and diseases. It was organized in 2003 to urge us to consider how occupational safety and health can be prioritized in global and local policy-making. It is a call to action to bolster our national systems and align them with top international standards for labor safety.   A FUNDAMENTAL RIGHT   A safe and healthy workplace is the fifth Fundamental Principle and Right at Work. On April 28, 2023, some special implements were made during the World Day for Safety and Health at Work, which every worker must be aware of. The International Labour Organization (ILO) celebrated a big decision during the 110th International Labour Conference. They decided that having a safe and healthy workplace is super important—it is actually a basic right for all workers around the world!   Not just that, but two specific rules about keeping workers safe—Conventions Nos. 155 and 187 [https://webapps.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_874743.pdf]—got a special status—they are now called Fundamental Conventions, making them extra important. It means that wherever you work, you should feel safe and healthy while you are there. It has now become a fundamental right at work.   WHY DOES WORKPLACE SAFETY MATTER?   Why is it essential to consider workplace safety as a fundamental right? Well, get ready to uncover some eye-opening facts and figures that emphasize just how critical this matter truly is. Nearly 60% of people worldwide spend a big chunk of their time working. So, it is pretty huge that everyone deserves a safe and healthy workplace, right? Think about it—since we spend so much time at work, it is like a second home. And just like we want our homes to be safe, we should expect the same from our workplaces.   This is not just about physical safety, though. It is also about our mental and social well-being. We want to go to work feeling good, both physically and mentally. But sometimes, workplaces can have hazards—things that can make us sick or hurt us. These risk factors can lead to serious health problems, making it hard for us to keep working.   STUNNING STATS   According to a report by the WHO and ILO, most of the deaths related to work were respiratory and cardiovascular diseases [https://www.mrmed.in/health-library/heart-care/diagnosis-of-cardiovascular-disease]. * The biggest reasons for these deaths were lung problems like chronic obstructive pulmonary disease [https://www.mrmed.in/health-library/respiratory-disorder/all-about-chronic-obstructive-pulmonary-disease] (which caused around 450,000 deaths), strokes [https://www.mrmed.in/health-library/heart-care/stroke-causes-types-symptoms-treatment] (which caused about 400,000 deaths), and heart issues like ischaemic heart disease (which caused around 350,000 deaths). * Also, some deaths happened because of injuries at work, which made up about 19% of all work-related deaths. In total, around 360,000 people died because of these injuries. * In 2016 alone, nearly 2 million people worldwide died because of work-related diseases [https://www.who.int/news/item/17-09-2021-who-ilo-almost-2-million-people-die-from-work-related-causes-each-year] and injuries! That is a huge number. These risks at work are also a big environmental concern. * Recent 2023 stats estimated an annual 36,700 fatalities, 1,83,00,000 injuries, and 18,50,000 diseases [https://oem.bmj.com/content/75/Suppl_2/A144.1] related to occupational hazards in India.    It is seriously shocking to see so many people literally being killed by their jobs. This is a wake-up call to all countries to protect the health and safety of their workers.   WHAT ARE THE PRIMARY OCCUPATIONAL RISKS IN WORKPLACES?   Workers are exposed to some occupational risks as part of their professional activities. These risk factors are a major public health issue and are responsible for work-related deaths. A recent European observational study estimated the following occupational risk factors from 20,000 workers [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967294/#app1-ijerph-20-03632] at their workplaces.   Occupational Risk Factors Physical factors 1. Noise 2. Working in bad weather 3. Vibrating machines and tools 4. Ultrasound 5. Extreme Temperatures (hot or cold) 6. Non-ionizing radiation 7. Ionizing radiation Ergonomic risk factors 1. Inappropriate working postures 2. Poor handling of loads Biological factors 1. Work in contact with products of human origin 2. Waste disposal and management works 3. Food industry 4. Work in contact with animals or animal products Chemical agents exposure [https://www.mrmed.in/health-library/cancer-care/cancer-causing-chemicals] 1. Handling chemicals or cosmetics 2. Exposure to fumes, gases, and/or dust 3. Fiber (asbestos, refractory ceramic, insulation wool, etc.) Atypical working hours 1. Weekend work 2. Working irregular hours 3. Work in alternating shifts 4. Night shifts Psychosocial factors 1. Emotional demands of the job 2. Work requirements 3. Autonomy of organization 4. Socioeconomic fears 5. Support at work (colleagues, employer, supervisor) 6. Recognition at work (colleagues, employer, supervisor) 7. Conflict at work   * Climate The impact of climate change on occupational health has also recently emerged as a concern. Climate-related hazards, particularly extreme weather events, limit work output and duration and pose risks to workers’ health and safety.    * Informal Jobs Now, here is another concern: some people work in what we call "informal" jobs. That means they don't have all the protections and benefits that other workers might have. For them, staying safe at work can be even tougher. They might not have the right equipment or training, and they are more likely to get hurt or sick because of it.   * Mental Health Health and safety also go beyond physical concerns. The COVID-19 pandemic has alarmed us to address mental health issues in the workplace. A safe and healthy working place supports mental health, and good mental health, of course, enables people to work productively. Issues such as depression and anxiety are pervasive in workplaces, impacting productivity and performance. When left untreated, the economic cost is estimated at US$1 trillion annually.    Fact Box Occupational Risk FactorsDeaths Linked to Each Factor: WHO report (2000-16)Long Working HoursApproximately 750,000 deathsExposure to air pollutants (particulate matter, gases, and fumes)Approximately 450,000 deaths.   WHAT CAN BE DONE? A CALL-TO-ACTION   The above risk factors are clearly becoming major health concerns worldwide. So, what can be done? Here are six proactive steps that every workplace in every country can take to promote workers' well-being and safety.   1. Clear Rules and Procedures: It is super important for your workplace to have clear rules in place to keep you safe and healthy. Make sure you know what they are and follow them! 2. Regular Health Check-ups: Regular check-ups and follow-ups with your doctor are a great way to catch any health issues early on. Your employer should help out by providing some basic health screenings for everyone once a year. 3. Working Together: We are all working on this together! Governments, employers, and workers need to team up to ensure a safe and healthy work environment for everyone. Let us encourage collaboration between health and labor ministries to tackle workplace health issues head-on. 4. Support for Everyone: No one should be left out. Everyone deserves access to support systems, especially if they work in informal jobs. Let us push for policies that ensure everyone gets fair treatment and support if they get sick or injured at work. 5. Making Health a Priority: Taking care of our health at work is not just good for us; it is good for society, too! Governments and organizations should invest in workers' well-being. That way, we can all grow and be resilient, even in the face of challenges like climate change. 6. Positive Workplaces: Let us create workplaces where everyone feels happy and healthy. When we cultivate well-being, it not only benefits us individually but also enhances the effectiveness and success of our workplaces.   THE BOTTOM LINE   It is super important to ensure that every worker, no matter where they work or what they do, has a safe and healthy workplace. It is not just about keeping us safe—it is about looking out for each other and making sure everyone can work without worrying about occupational hazards.
Dr. Vijayalakshmi
Transforming Elderly Care: Digital Dispensaries Revolutionize Healthcare For Seniors In India
29 Apr 2024
8 mins
Transforming Elderly Care: Digital Dispensaries Revolutionize Healthcare For Seniors In IndiaGrowing older is just a natural part of life's journey, isn't it? But here's the thing: as we age, our bodies start throwing us a few curveballs, making us rely more on others for the little things. And let's be real, it's not a big deal for some, but for many seniors out there, it's a whole new ball game. With families getting smaller and folks finding it trickier to access healthcare on their own, elderly patients often find difficulty in managing their daily tasks! That's where technology steps in, like the superhero of the story. Now picture this: digital dispensaries swooping in to save the day! These aren't your regular pharmacies—they're like the future of elder care, right in your pocket. Wanna know more about the revolutionizing elderly healthcare in India? Continue to read for more information.   WHAT ARE DIGITAL DISPENSARIES?   A digital dispensary is an innovative online platform that implements technology to provide convenient and accessible medical services to patients. Moreover, it plays a crucial role in improving the accessibility, affordability, efficiency, and quality of healthcare services.   WHY DO THE ELDERLY NEED DIGITAL DISPENSARIES?   According to a World Health Organization report [https://www.who.int/news-room/fact-sheets/detail/ageing-and-health], the percentage of people who are older than 60 years is expected to double between 2015-2050. This shows that there will be an increased need for elderly care, which needs to be addressed as soon as possible. Moreover, digital dispensaries can help address both the needs and demands of elderly caretakers. Here are some of the points that explain the need for digital dispensaries for elders.   1. Easily accessibility: Elderly patients who live in a remote place are often struggling to reach healthcare due to the unavailability of the transport facilities and health conditions. These conditions can be simplified by digital dispensaries, which make healthcare accessible to everyone's comfort. 2. Convenience: Digital dispensaries can offer an alternative for elderly individuals who are unable to walk or travel long distances to visit the doctor for consultations. It can help to get a doctor's appointment, consultations, and early diagnosis of the disease anywhere in the world. 3. Improve health: Digital dispensaries can help provide timely diagnosis and treatment for elderly patients, which can improve their health. 4. Lower the cost of healthcare: It can also help to lower the cost of healthcare in treating disease by cutting down the traveling expense of the elderly patient in visiting the doctor or clinics. 5. Technology for elders: It helps to advance technology for elders in the aspect of healthcare requirements. In fact, after covid-19 break, it is estimated that the use of technology in elderly patients for healthcare has increased. 6. Reduce the caregiver burden: It helps to reduce the workload of caregiver by reducing the visiting times of caregivers to elderly homes [https://www.mrmed.in/health-library/cancer-care/self-care-for-cancer-caregivers].   EXPLORING THE DIGITAL DISPENSARY REVOLUTION: ENHANCING ELDERLY CARE IN INDIA   1. NITI Aayog: NITI Aayog [https://www.niti.gov.in/sites/default/files/2024-02/Senior%20Care%20Reforms%20in%20India%20FINAL%20FOR%20WEBSITE_compressed.pdf], is a government organization dedicated to improving the lives of people in India. They recently released a paper called 'Senior Care Reforms in India - Reimagining the Senior Care Paradigm: A Position Paper.' This paper helps us to understand the policies and programs that support senior care. It also addresses the challenges and gaps in current efforts to meet the healthcare needs of our elderly population. 2. In India, the telemedicine market [https://www.mrmed.in/health-library/health-care/telemedicine-in-india] has seen tremendous growth and is expected to reach 44,280 crore in 2025. 3. In Odisha, the state government of Bhuvneshwar has signed an agreement with the global healthcare system to create and manage 102 digital dispensaries across 23 districts out there, followed by 25 locations in Nabarangpur and 5 districts in Keonjhar. 4. In West Bengal, a new initiative has been launched in the name of a G1 digital dispensary to improve the accessibility of healthcare for the rural population in India. 5. The Ministry of Health & Family Welfare has launched a program (National Programme for Health Care of the Elderly) in 2010 to provide separate and specialized health care for senior citizens in India. 6. The government of Jharkhand has launched a public-private partnership, bringing together public authorities (state or local) and private businesses to offer easily accessible medical services through digital dispensaries and has launched 79,000 digital dispensaries for the rural people in Jharkhand. 7. Government Initiatives like Ayushman Bharat Digital Mission, CoWIN App, Aarogya Setu, e-Sanjeevani, and e-Hospital have made healthcare more accessible and can help to reach those elderly patients who find difficulty in traveling to physical healthcare.   HOW CAN WE MAKE THESE ELDERLY DIGITAL DISPENSARIES MORE RELIABLE?   The Australian government has followed seven guidelines for standards and regulations of digital healthcare, which we can also incorporate in India. These guidelines includes:   1. User-centric: It should meet the demands of both patients and healthcare providers. 2. Security and privacy protection: The patient's health information should be securely maintained with the user's permission. 3. Supporting agile collaboration: It is crucial to maintain an effective team and collaboration that addresses the needs of users and stakeholders. 4. Promoting a culture of quality and safety: It should provide secure and excellent digital health products and services. 5. Enhancing equity of access: It should improve the accessibility of the people who are facing obstacles in reaching healthcare. 6. Leveraging the existing resources and talents: It should improve the provision of digitally enabled healthcare across the countries. 7. Prudent spending of taxpayers' money: It should reduce the wastage for taxpayers and ensure that the investments are delivered in the best healthcare outcomes.   SUMMING UP!   Healthcare needs to bring more innovations that move towards digitalization to reduce the burden for elderly patients around us. When we grow older, we become small kids who need support and care to lead daily activities. Similarly, we need to ensure that every elderly patient is comfortable in running their daily task, especially in healthcare needs. For that, Our world needs more innovation and improvement like digital dispensaries to ease the accessibility to healthcare. Let’s make healthcare more accessible to every elderly patient.
Ishwarya R
Counterfeit Medicines
3 May 2024
10 mins
Can Technology Lead the Charge Against Counterfeit Medicines?Did you hear about India's recent counterfeit medicine scandal? In August 2023, Sun Pharma uncovered fake drugs being sold from unauthorized vendors. The Indian government quickly seized counterfeit products worth Rs. 2 Crores. This incident sparked global concern over India’s pharmaceutical integrity.   However, there is promising news! Technologies like blockchain and AI are emerging as powerful tools to tackle these issues, potentially transforming the industry and restoring trust in India's pharmaceutical market.   HOW DO COUNTERFEIT MEDICINES APPEAR, AND WHERE DO THEY ORIGINATE?   Counterfeit medicines are falsified drugs that closely resemble generic medicines, to the extent that even healthcare professionals struggle to distinguish them. They are manufactured by unlicensed groups other than the original manufacturers. This is a serious concern that should not be overlooked.   Research to identify counterfeits in India found that drugs coming directly from the manufacturer's facility are trustworthy. However, the risk of fake or spurious drugs [https://www.mrmed.in/health-library/health-care/hidden-dangers-counterfeit-medicines] arises when products are transferred between the various layers of the complex supply chain, like wholesalers, distributors, or sub-distributors. At each transfer point from the manufacturing factory to the patient, drugs can be stolen, adulterated, or replaced. The consequence of such malpractice leads to financial loss for drug makers and, more importantly, poses a significant risk to patient safety.   HOW SERIOUS ARE COUNTERFEITS?   Did you know that India is the leading source of counterfeit medicines? In recent years, India has become a key player in manufacturing brand-name prescription drugs and conducting clinical trials at a much lower cost than the US. While this showcases the growing capabilities of India's pharmaceutical industry, counterfeit medicines are also a significant challenge. It is estimated that India contributes to about 75% of all falsified medicines [https://www.scielo.br/j/bjps/a/bMLbQwpKyXPnBdmmgBTMt6y/?format=pdf&lang=en] worldwide.    These counterfeit drugs are widespread in sectors where there is potential for huge profits. In fact, three-quarters of counterfeit medicines globally originate from India, making it the number one source. This has resulted in thousands of deaths each year, either due to harmful ingredients in counterfeit drugs or because these fake medicines don't effectively treat patients.   Isn't it worse for people to die from counterfeit drugs rather than the diseases themselves? This issue certainly requires urgent attention in India.   WHAT ARE ANTI-COUNTERFEITING TECHNOLOGIES USED IN THE INDUSTRY TODAY?   WHO suggests the following: * Overt technology * Covert technology * Forensic techniques * Serialization/track and trace technologies * Emerging technologies like Blockchain with AI/IoT Let us decode them in detail one by one.   HOW CAN TECHNOLOGIES HELP TO FIGHT COUNTERFEIT MEDICINES?   Below mentioned are a few product identification technologies used to identify counterfeit medicines.   1. Labeling   The traditional approach to ensuring the integrity of medicinal products involves labeling with a batch number and expiry date. However, this labeling can be easily duplicated. To overcome this, several overt or covert technologies are used to eliminate counterfeits.   2. Overt technologies (visible features)   These features are visible and can be seen transparent in the product itself. A few examples include: * Holograms. * Optically Variable Devices (OVD). * Color-shifting security inks and films. * Security graphics. * Sequential product numbering. * On-product marking. Let us examine one example, holograms, which are more commonly seen.   Holograms This technology provides visual authentication that can be difficult to replicate for counterfeit medicines. Also, this technology is not easily automated; it requires an authenticated label or an accurate image for visual comparison. Unfortunately, there are instances of fake holograms which have been found in many spurious antimalarial drugs in India.    3. Covert technologies (hidden markers)    These require specific detection devices. Examples are invisible printing, embedded images, digital watermarks, hidden marks and printing, anti-scan design, laser coding, substrates, and odor.   4. Forensic techniques    These involve specific markers such as chemical taggants, biological taggants, DNA taggants, isotope ratios, and micro-tagants. These forensic markers serve as identifiers that aid in detecting counterfeit pharmaceuticals. They cannot be seen without special equipment and are incorporated into the packaging of pharmaceutical products during manufacturing. Each batch of products possesses its unique set of markers, enabling verification of product authenticity by comparing the marker on the packaging with the corresponding entry in the manufacturer's database.   5. Serialization/track and trace technologies   Serialization involves assigning each unit of a product a unique code. This code helps track and confirm its authenticity as it moves through the supply chain. Examples of serialization include barcoding and RFID technologies.   i. Barcoding: The simplest and least expensive technology for tracking counterfeits in a supply chain. It is widely adopted in many pharmaceutical industries, not just limited to them. The retail sector of India has made barcoding a standard technology to track all inventory and sales. While this technology already exists and is used to identify batches or large quantities of products, it can and should be deployed at the pharmacy level.    For instance, pharmacies could scan barcodes on medicine packs to check their authenticity and details like batch numbers and expiry dates. By linking these scans to e-prescription systems, they ensure every patient gets the correct medicine while automatically weeding out expired or counterfeit drugs. Adding a unique random number to each box could further prevent the distribution of fakes.   ii. Radiofrequency identification (RFID): This RFID tag uses a radio-frequency transponder chip, which is programmed with a permanent unique identification code and also programmed to contain the batch number and expiration date. This combination of a unique code and product information provides a high level of security against counterfeiting.    It utilizes radio waves to identify and track products in real time. This technology can be overt or covert, i.e., either visible on the product itself or hidden in the packaging. Its advantage over traditional barcoding is its ability to detect several items simultaneously, unlike barcoding, where each tag must be visible and requires a separate device for reading. However, until this RFID technology matures and becomes more widespread across India, it will remain more expensive than traditional barcoding.   EMERGING TECHNOLOGIES TO COMBAT COUNTERFEIT MEDICINES   While the technologies mentioned above offer some hope, eliminating counterfeits entirely is still challenging. Counterfeiters capitalize on information gaps and the need for more transparency in the supply chain. As a result, patients might unknowingly consume substandard or even dangerous products. To overcome this, one technology on the rise offers hope: blockchain.   BLOCKCHAIN TECHNOLOGY   Blockchain is a digital ledger that synchronizes records of even a single transaction and product information in a highly secure manner, spread throughout the entire supply chain. It works as a chain of interconnected nodes or blocks, where each block contains data linked to the previous one. This means the data is irreversible or unchangeable and forms a chronological record.    KEY FEATURES OF BLOCKCHAIN:   1. Decentralization: Unlike traditional centralized servers, which are susceptible to breaches, blockchain works decentralized, where the data or records are distributed throughout the supply chain participants. This means any person from manufacturers, distributors, online pharmacies, and customers can check every transaction and product information, providing an advanced level of security against counterfeits.   2. Immutability: No single entity in the supply chain can manipulate the data on a blockchain. Each block contains a reference to the previous one, and altering it would require changing subsequent blocks of the network – something nearly impossible to achieve.   3. Transparency: Consumers of every medicinal product get access to the same information. All transactions are visible to everyone, making it easy to detect fraudulent activities.   4. Data security: Blockchain uses cryptographic techniques to secure data, enhancing protection against unauthorized access. This is crucial in the pharmaceutical industry to safeguard sensitive patient information and intellectual property.   5. Traceability: Due to the chronological and unalterable nature of blockchain records, it is possible to trace and alter a product's information throughout its process in the supply chain. In pharma, this means tracking the origin of raw materials, manufacturing processes, distribution, and even patient usage is hardly possible.   This transparency in the supply chain makes it far more challenging for counterfeiters to infiltrate the system, as each medicinal product is identified and verified throughout the supply chain. Hence, blockchain technology is a big boon in helping the accountability and trustworthiness of the entire pharmaceutical realm.   WHAT IS THE CURRENT STATUS OF BLOCKCHAIN TECHNOLOGY ADOPTION IN INDIA?   The Indian government is showing great interest in blockchain technology and is planning strategies for using it in public services. In December 2021, they released the "National Strategy on Blockchain" to outline their plans. They want to use blockchain in areas like healthcare and other sectors. India is working on creating a national framework for it.    The goal is to have Indian-made blockchain technology used worldwide by 2027, and they aim for it to work well with other technologies like IoT (Internet of Things), cloud, and AI (Artificial Intelligence).   As part of this plan, they have developed a Drug Authentication and Verification Application (DAVA [https://www.niti.gov.in/sites/default/files/2020-01/Blockchain_The_India_Strategy_Part_I.pdf]) system to track medicines using barcodes. This will help ensure that drugs made in India are safe and can be tracked in real-time. The system will be rolled out in phases and eventually include all medicine manufacturers in India.  While DAVA is a good start, unlike blockchain, it has limited features; however, it will be implemented soon. With blockchain, AI, and IoT, India can achieve even more in tracking medicines and ensuring their safety.   In addition to blockchain, the Indian government is revolutionizing elderly care through initiatives like the Ayushman Bharat Digital Mission and the launch of digital dispensaries [https://www.mrmed.in/health-library/health-care/digital-dispensaries-india], which are significantly improving healthcare accessibility for seniors, especially in rural areas.     THE BOTTOM LINE   As the technologies mature and continuously adopt these authenticated technologies, we can assure authenticity in different aspects of the supply chain. These advanced technologies make product counterfeiting more difficult and expensive, ensuring safer medicines for everyone.
Dr. Vijayalakshmi
Telemedicine in India
26 Apr 2024
10 mins
Telemedicine in India: Can Virtual Care Lead the Way?Virtual care has become a key player in helping India work towards providing healthcare for everyone. The COVID-19 pandemic really pushed both doctors and patients to start using telemedicine in India more often. There have been some recent positive changes in policy, advancements in technology, and improvements in infrastructure that put India in a good position to skip ahead and possibly do better than some Western healthcare systems. This blog talks about what we can learn from moving to virtual care, the emergence of telemedicine in India and suggests ways that India could use virtual healthcare to ensure all its citizens can access the healthcare they need, even with limited public health resources.   WHAT IS TELEMEDICINE?   Telemedicine involves using technology like computers and smartphones to get medical care from a distance. This means you can talk to your doctors and get help without having to visit them in person. You can get diagnosed, monitor your health, discuss your concerns, and even receive prescriptions—all online. Telemedicine in India has grown significantly in recent years.   COVID-19'S IMPACT ON VIRTUAL HEALTHCARE IN INDIA   When India had to go into a COVID-19 lockdown on March 23, 2020, it really shook up the regular way healthcare was delivered. Many hospitals had to switch things around, moving patients from being admitted to the hospital to getting care while they stayed at home. Because of this, the number of people seeing their doctors in person dropped by 32% [https://yourstory.com/2020/12/india-recorded-3x-increase-online-consultations-practo-report], but the number of online doctor visits jumped by 300%. In fact, the online consultation market grew a lot, reaching $163 million in March 2021. Thus, this pandemic has been the time when telemedicine in India has peeked up.   INDIA'S HEALTHCARE CHALLENGES: A CLOSER LOOK   India faces a big challenge with its healthcare system.  * GDP on Healthcare: The country spends only 1.28% of its total GDP (Gross Domestic Product) on healthcare, which is one of the lowest rates in the world. * Access to healthcare: In India, people living in rural areas or homegrown cities often have less access to healthcare compared to those in cities. * Out-Pocket-Expenses: Personal payments for healthcare cover nearly 62.6% of the total health spending in India [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10041239/], which is one of the highest rates in the world. Not surprisingly, the cost of healthcare is a big reason why many people in India remain poor. * Universal Healthcare: To really help lift its large population out of poverty, India needs to include steps to provide healthcare for everyone, no matter where they live or how much money they have. This is known as Universal Healthcare (UHC), and it is crucial for improving the lives of millions of Indians. And this can be greatly achieved through implementing telemedicine in India.   IS INDIA EQUIPPED FOR VIRTUAL CARE?   India is in a great position to start using virtual healthcare widely due to the fast-growing digital market. * Digital landscape: With over half a billion people already using the internet, the country is ready to embrace online health services. * Regulatory Frameworks: In terms of rules and regulations, the government took a big step in March 2020 by introducing the Telemedicine Practice Guidelines. These guidelines help clear up any confusion about whether online medical services are allowed and provide a detailed set of rules for both patients and doctors to follow. This ensures that everyone is legally protected when using virtual care. * Technical Infrastructure: On the technical side, the launch of the Ayushman Bharat Digital Mission (ABDM) [https://abdm.gov.in/] in 2021 really helped set up a strong foundation for virtual healthcare. This mission created a digital network that lets patients and healthcare providers easily share important health information like medical history, test results, and prescriptions. The system also includes a comprehensive list of healthcare organizations and professionals all over the country, making it easier to connect and coordinate care.  * Digital Dispensaries: India is enhancing elderly care with digital health initiatives [https://www.mrmed.in/health-library/health-care/digital-dispensaries-india], increasing access for seniors through programs like Ayushman Bharat and widespread digital dispensaries.   HOW IS VIRTUAL HEALTHCARE PRACTICED IN INDIA?   India set up a unique free telemedicine service called eSanjeevani [https://esanjeevani.mohfw.gov.in/#/] in 2020, which is the first of its kind in the world. It has two main parts: eSanjeevani Ayushman Bharat–Health and Wellness Centre (AB–HWC) and eSanjeevaniOPD (Outpatient Department).   eSanjeevani AB–HWC works like this: There are two main parts to eSanjeevani: 1. eSanjeevani Ayushman Bharat-Health and Wellness Centre (AB-HWC) (Doctor-Doctor): This is a service where doctors at small health centers in rural areas can connect with specialists at bigger hospitals to help patients. It is like a virtual link between the junior doctors and the specialist. 2. eSanjeevaniOPD (patient-doctor): This allows people to have doctor appointments from their homes using their phones. It's like having a regular doctor visit, but online.   By 2022, it had reached a massive milestone of completing 3 crore consultations [https://pib.gov.in/PressReleasePage.aspx?PRID=1809569#:~:text=Doctor%2Dto%2DDoctor%20telemedicine%20service%20is%20based%20on%20a%20Hub,%2Fhospital%2Fmedical%20college).]. On one busy day, it even managed to do 1.7 lakh consultations. The top 10 states using eSanjeevani the most are Andhra Pradesh, Karnataka, West Bengal, Tamil Nadu, Uttar Pradesh, Bihar, Maharashtra, Madhya Pradesh, Gujarat, and Assam. These are just the beginning steps, but they show a lot of promise for how telemedicine can change healthcare in India.   FUTURE TRENDS IN INDIAN TELEMEDICINE: VR AND AI   The telemedicine market in India was worth $1.9 billion in 2022, and it is expected to grow to $10.7 billion by 2028 [https://www.financialexpress.com/business/digital-transformation-new-trends-in-telemedicine-technology-in-2024-3310901/]. New, embraced technologies like virtual reality (VR) and artificial intelligence (AI) are making telemedicine even better. With VR, patients can feel like they are in the same room as their doctors, even if they're far away. AI helps doctors give personalized treatments [https://www.mrmed.in/health-library/health-care/personalized-medicine-india] and analyze patient data more effectively. In the end of 2024, we will see more e-clinics, which are like regular clinics but online.    WHAT IS REQUIRED FOR INDIA TO SUCCEED IN VIRTUAL HEALTHCARE?   To make virtual healthcare work well in India, there are some important things that need to be considered.   i. First, Regulations There need to be new rules and ways of managing things to deal with issues like keeping people's information safe and making sure everyone gives permission for their data to be used. When new health apps or systems are created, they need to be checked to make sure they're worth the money and actually help patients.   ii. Second, Education Everyone needs to learn how to use virtual healthcare, especially in places where it is not common yet, like villages and city slums. This means teaching people about it in schools and setting up places in communities where people can learn more about it.   iii. Third, Guidelines Doctors and other healthcare workers need to figure out which parts of healthcare can be done online and come up with clear guidelines for how to do it safely and effectively. They also need to learn how to use new technology to provide care in different ways.   iv. Lastly, Training  There need to be more healthcare workers who understand how to use technology to provide care, not just doctors and nurses. This includes training more paramedics and other health workers. For example, having more trained midwives could help save a lot of lives by providing better care for pregnant women and newborn babies.   A PATH TO UHC (UNIVERSAL HEALTH COVERAGE)   Telemedicine is changing the way healthcare works, making it easier for people to get quality care no matter where they live. And as technology keeps improving, telemedicine will continue to grow and help more people in the future. Some key investments from the government side will be a big help in making virtual care even better, faster, and more helpful on the path towards universal healthcare. And who knows? India's progress in this area might inspire other developing countries to follow suit. So, while there have been bumps in the road, the future of healthcare in India looks promising.
Dr. Vijayalakshmi