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An interesting news in today newspapers  about government of india through National  Pharmaceuticals Pricing Authority capping the prices of knee implants. As had been done in cases of cardiac  stents there had been reports of profiteering in the implants and panel had been working to streamline the process. Since last evening, when this news came in I received numerous calls from orthopaedic colleagues  and patients about likely impact of this announcement. 

By reducing  the cost of the implants, the treatment of painful arthritis will be cheaper and affordable. It should encourage people to go ahead and get rid of their painful arthritic knees which they were carrying on for long. Health services have to be affordable and in universal reach for them to be meaningful.

As a knee surgeon, I am very happy for my patient as cost should come down. It should also instill trust in medical care as the fear of profiteering in the medical implants is being eliminated. This will help in restoring the patient doctor relationship of trust, which is under severe strain nowadays. Patient will feel reassured they are not fleeced on knee replacement implant costing.

But as had been seen in cases of cardiac stent I donot want new prices to be deterrent for Impalnt companies to bring their latest implants in Indian markets. We cannot be in a situation where we are deprived of the best of the implants as company finds them economically unviable. For that the prices which are fixed yesterday will be reviewed periodically and a robust mechanism should be there to ensure our patients are not denied world class quality implants.

To conclude this is a very positive step, with the noble intention of  keeping patients well being  supreme. But this is not one time action and a constant review is important to keep pace with time and ever changing medical technology. 

The incidence of spontaneous developement of clot formation in leg muscles called as Deep Vein Thrombosis (DVT) and then migrating to lungs is called as Pulmonary Embolism (PE), is not uncommon and stands out as 1 in 1000.  Though anyone can develope this condition there are certain risk factors associated. The risk factors are immobility caused by trauma, surgery, increasing age or even prolonged journey, obesity, pregnancy, cancer or hormones like oral contraceptives.  Thrombosis can be potentially fatal. PE is said to be cause in up to 30% of sudden unexplained deaths. 

This condition can present either as swelling and pain in the muscles of the legs. The diagnosis at this stage isn’t doppler scan or rarely angiography. In case of thrombosis going into lungs a person can feel breathless or get collapsed. The diagnosis in this case is by CT angio.

Thrombosis is generally caused due to stagnation of blood in the leg muscles causing clots or when blood clots abnormally. So one has to prevent prolonged immobilisation like sitting in flight over long periods. More than 4 hours of journey doubles the risk of thrombosis, also called as economic travel syndrome though it can also happen in car or train journey.

So the prophylaxis for this condition in journey is having regular walks and stretches along with keeping self well hydrated by drinking lots of water and avoiding alcoholic drinks.

As this condition mainly affects after surgery it is very important to start early mobilisation to prevent thrombosis. Now a days patient specially those with cancer or with fractures or undergoing joint replacements in hospital are put on calf pumps to prevent clotting of the blood in leg muscles while they are in the bed. More and more techniques are used which ensure early mobilisation of the patients. Doctors also prescribe blood thinner swherever needed to prevent same. The treatment with blood thinners is generally given under close watch.

One should be very particular about checking on a hospitalised patient if thrombosis prevention is being implemented. A good understanding  and avoiding the risk factors for this potentially fatal condition can go long way in improving the clinical outcomes. 

Generic medicines are those which are sold by the names of the actual medicine salt they contain( the one which you see in the ingredient lists of the tablet strip or syrup bottle).

The concern had been that big pharma companies manufacturing these under their brand name make huge profits. There are expectation, by letting patient buy generic rather than brand, a better price will be ensured . But will this actually happen in today’s situation? Will quality be ensured? The plain and simple honest answer is NO.

Why??

Let’s start will a simple scenario.  You buy a soap by asking for a “soap” or you trust a company brand name. The answer is we shortlist one  company name after deciding about its quality and authenticity by media or personal experience. So  can we leave all important decision of buying medicines on shopkeeper, in this case chemists?

There is widespread doubt that doctors write medicine with some motive. The answer is yes, there is a motive behind. As an expert professional, doctors go through the research  and manufacturing standards of that medicine. They study various scientific studies and patient outcomes. They discuss their clinical experience in the peer groups. They write a prescription   with a simple motive of providing a good quality medicine as they are held responsible for clinical outcome. They donot act as brand ambassadors for that product like people endorsing a product brand in TVs after taking a hefty fees (which people donot mind). Tell me what motivates s a famous actor to endorse a product ? Fees or a scientific study of that product but we donot crib about that and happily follow their endorsement.

Problem is if a doctor writes a generic name of Medicine, in present situation it will shift the privilege of deciding which medicines patient will be getting, to chemists. Now what  is guarantee that chemist decision will not be influenced by profit margins. There are almost no generic available in Indian markets and when we say generic is actually a brand generic!!

Confused !! Rightly so.

So if a doctor writes a generic name, then chemist will decide which brand he or she will be dispensing. So decision will shift from doctor to chemist. Is it a comfortable thought?

That’s why the doctors association are asking government, first to take out all loopholes so that patient get generic medicine with cost benefit without compromising on quality. So all branded should be gradually phased out and all medicines with same constituents  will be available on same price for all manufactures following same quality standards. This will be like a situation where buying milk there will be only MILK  written ( Not Amul, mother dairy or any other brand) as prices and standards will be same. Till then let’s donot do anything in haste which can badly backfire.

 Let’s start trusting doctors. 

Today woke up again to read the threat of dengue and Chinky returning this year. Last year I saw so many patient who were crying in pain and debilitated by these diseases. Prevention is most important followed by seeking medical help timely. Stay safe. Wish civic agencies get their act together and citizens donot have to suffer.