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Getting health care through modern medicine is not without risk

Getting health care through modern medicine is not without risk

Getting health care through modern medicine is not without risk

Dr K K Aggarwal

Padma Shri Awardees

Honorary Secretary General IMA

The Indian Government is envisaging starting  a bridge course of one year and allow Ayush doctors to practice modern medicine. The same will be injurious to the health status of the country.

Also both Joint Commission International and National Accreditation Board of Hospitals, both concerned with quality and safety may never allow that.

At Indian Medical Association we are concerned about this move. It is not public friendly as more people will die then will be saved.

  1.  Ayush and modern medicine teachings and philosophy are different and cannot be equated
  2. Modern Medicine is a continuous learning and the learning curve starts at five and a half years. On an average it takes ten years of learning and practicing in modern medicine to be able to practice quality and safe medicine. During this person a person is often trained under the supervision of seniors.
  3. It is impossible for an AYUSH doctors to learn modern medicine in one year bridge course and start treating patients to provide safe and quality treatment.
  4. It is argued that AYUSH doctors can be given permission to prescribe over the counter drugs but even they are not safe. In the US alone there is an estimated 56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths related to paracetamol associated overdoses per year.
  5. AYUSH doctors can never be trained in one year to decide the exact dose of a drug in a prescription. Today drug overdose is the most common medical injury.  In USA drug overdose was the leading cause of injury death in 2012. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes. The drug overdose death rate has more than doubled from 1999 through 2013. In 2011, drug misuse and abuse caused about 2.5 million emergency department (ED) visits. Of these, more than 1.4 million ED visits were related to pharmaceuticals. Between 2004 and 2005, an estimated 71,000 children (18 or younger) were seen in EDs each year because of medication overdose (excluding self-harm, abuse and recreational drug use). Among children under age 6, pharmaceuticals account for about 40% of all exposures reported to poison centers.

     In 2013, of the 43,982 drug overdose deaths in the United States, 22,767 (51.8%) were related to pharmaceuticals. Of the 22,767 deaths relating to pharmaceutical overdose in 2013, 16,235 (71.3%) involved opioid analgesics (also called opioid pain relievers or prescription painkillers), and 6,973 (30.6%) involved benzodiazepines.

     In 2011, about 1.4 million ED visits involved the nonmedical use of pharmaceuticals. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics.
  6.  Modern medicine practice is risky. In the US, in 1999, the Institute of Medicine published a seminal report titled To Err is Human, which estimated that as many as 98,000  die in hospitals each year as results of medical errors. Medical errors in hospitals kill more people annually than "such feared threats as motor-vehicle wrecks, breast cancer, and AIDS and deaths from medical errors are equivalent to 10 jumbo jets crashing each week.

     A follow-up study published in 2013 argued that the IOM numbers were a vast underestimate, and that medical errors contribute to the deaths of between 210,000 and 440,000 patients. At the lower bound, that's the equivalent of nearly 10 jumbo jets crashing every week or the entire population of Birmingham, Alabama dying every year.

    If a small plane crashes by the airport, that makes news but as people dying in hospitals are happening one at a time and in isolation, and they get less attention.
  7.  Modern Medicine carry risk of hospital acquired and health care associated infections: Also of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one Hospital Acquired Infection. The estimated rate in USA was 4.5% in 2002, corresponding to 9.3 infections per 1000 patient-days and 1.7 million affected patients, with 99.000 deaths annually. The European centre for Disease Prevention and Control reports an average prevalence of 7.1% in European countries. The cumulative incidence of infection an adult high-risk patients is 17.0 episodes per 1000 patient-days. HAI in low- and middle-income countries; at any given time, the prevalence of HAI varies between 5.7% and 19.1%.
  8. In Modern medicine multi drug resistance is a problem:  In 2008, MDR TB caused an estimated 150,000 deaths, as per a 2010 WHO report.
  9. Surgical practice linked to modern medicine is not without risk: As per WHO over seven million people across the globe suffer from preventable surgical injuries every year, a million of them even dying during or immediately after the surgery.

    Number of surgeries taking place every year globally is 234 million. One in every 25 people undergoing it at any given time. China conducts the highest number of surgeries followed by Russia and India. In developing countries, the death rate was nearly 10% for a major surgery. Mortality from general anesthesia affected one in 150 patients while infections were reported in 3% of surgeries with the mortality rate being 0.5%. Nearly 50% of the adverse effects of surgery were preventable.
  10.   Modern medicine carry a risk of medical errors, adverse events and adverse drug events: India is recording a whopping 5.2 million injuries each year due to medical errors and adverse events. Of these, the biggest sources are mishaps from medications, hospital-acquired infections and blood clots that develop in legs from being immobilized in the hospital. Similarly, approximately 3 million years of healthy life are lost in India each year due to these injuries. (Harvard School of Public Health )

    For every 100 hospitalizations, there were approximately 14.2 adverse events in high-income countries and 12.7 in low- and middle-income countries.

    In the US, annually, adverse events are responsible for 180,000 deaths and adverse drug events are the fourth most common cause of death in US accounting for more than 100,000 deaths per year. For India the extrapolated figures would be 400,000 deaths due to adverse drug reactions and 720,000 adverse events per annum. Incidence of serious Adverse drug reaction is 6.7 per cent and of fatal adverse drug reaction is 0.32 per cent. Incidence of adverse events is 4 per cent and of deaths due to adverse events is 14 per cent of adverse events. Adverse drug events prolong hospital stay by 2 days.

    In India of all visits to the medical emergency department 6 per cent are drug-related. Adverse drug reactions account for 45 per cent of all adverse events.