Docs told not to accept gifts from drug cos

The global association of doctors World Medical Association (WMA) has asked physicians to refrain from taking gifts, including hard cash from drugmakers, as an incentive to promote their medicines to the patients. It is part of a resolution passed by WMA outlining the guidelines for doctors to follow while dealing with pharma companies.

The advisory issued during a recent WMA meeting in Delhi comes at a time when the domestic pharma companies and medical bodies are in the process of finalising a detailed marketing code of conduct to curb the practice of pharma companies paying doctors to prescribe their medicines. The Indian government had recently asked the drug industry to self regulate so that the interests of the patients are not compromised.

The Rs 36,000-crore Indian drug retail market is fiercely competitive, with the largest player having a meagre 5% market share. Globally, drugmakers are not allowed to advertise their prescription drugs, or medicines that can only be bought on a doctors prescription. As a result, the success of a medicine largely depends on the recommendation of doctors.

The WMA guidelines has asked doctors to refrain from taking expensive personal gifts designed to influence clinical practice, payments in cash or cash equivalents from companies, payment to cover travelling expenses or room for conference or compensation for their time, and declare financial support they get from companies.

The Indian Medical Association (IMA), representing doctors in the country, and the domestic drugmakers associations say they agree with the WMA resolution in-principle. IMA secretary general Dharam Prakash said: “Once you take a gift or travel at somebody’s expense, you would be obliged to return the favour, which means promoting a company’s brand. The resolution should curtail the practice of drugmakers to unethically promote their drugs.”

“In many areas, the WMA statement is similar to our code of conduct for marketing practices. This is a good step in the right direction,” said Tapan Ray, director general at the Organisation of Pharmaceutical Producers of India, a group that represents the interests of large drugmakers in the country.

Most doctors in the country accept gifts and incentives in various forms to promote a particular company’s products. Industry experts such as CM Gulati, a veteran with medical regulations, feels the resolution will be ineffective and it is an attempt by the medical fraternity and industry bodies to prevent the government from regulating the drugmakers marketing practice.

“Both the doctor and industry are interested parties who benefit from the current practice, the consumers interest is not represented. The industry bodies are toothless and can’t take any punitive action, so the question of self-regulation is a hogwash,” he says.

Changes Recommended in Schedule of Cervical Cancer Screening

Less than a week after a government task force announced controversial recommendations for breast cancer screening, a doctor's group is recommending big changes in cervical cancer screening.

The American College of Obstetricians and Gynecologists (ACOG) now says women should begin cervical cancer screening at age 21, rather than earlier in life.

And the group no longer recommends annual screening for most women.

The new breast cancer recommendations sparked heated debate within the medical community. Even those who support delaying the onset of mammography screening acknowledge that some breast cancers will be missed.

But experts tell WebMD the revised cervical cancer guidelines will not be as controversial.

"The new recommendations for cervical cancer screening really do not miss any cancers," says David E. Soper, MD, who chairs ACOG's Gynecological Practice Bulletin Committee.

"The data are very clear," he tells WebMD. "For women in their 20s, having an annual Pap smear will find no more cancers than screening every two years."

Pap Test Saves Lives

Soper says the call for delayed and less frequent screening does not mean Pap testing is not effective.

Screening is largely responsible for a 50% decline in cervical cancer rates during the past three decades.

"There are still 11,000 new cases of cervical cancer and 4,000 cervical cancer deaths in the United States each year, and most of these could be prevented with adequate screening," Soper says.

ACOG now recommends:

• Screening women with Pap testing between the ages of 21 and 30 every two years instead of annually
• Screening women 30 and older who have had three consecutive normal Pap test results every three years instead of annually
• More frequent screening for women with risk factors for cervical cancer

Screening can be stopped in women who are 65 to 70 and have had three or more consecutive normal test results and no abnormal test results in the past 10 years.

Women who have been vaccinated against human papillomavirus ( HPV) should follow the same screening guidelines as unvaccinated women.

Even if a Pap test isn't due, doctors should let their patients know that annual gynecologic exams may still be appropriate.

The Case Against Screening Teens

ACOG's previous guidelines called for cervical cancer screening to begin three years after a woman becomes sexually active or by age 21, whichever occurs first.

Many women become infected with sexually transmitted HPV, but most women's bodies get rid of the infection naturally. Most women who get infected don't develop cervical cancer, and there are other causes of cervical cancer.

But while active infection can be common in women younger than 21, cervical cancer is remarkably rare.

"It literally occurs in about one in a million women younger than 21," Soper says.

Since about 85% of women who become infected will clear the HPV virus within a few years, delaying screening until age 21 will prevent unnecessary surgical treatment to remove suspicious lesions.

Such treatment has been linked to an increase in premature births.

"Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own," ACOG's Alan G. Waxman, MD, says in a news release.

Ob-gyn Mark H. Einstein, MD, agrees. He directs the division of gynecologic oncology clinical research program at New York's Montefiore Medical Center.

"The vast majority of abnormalities identified though early screening are clinically irrelevant manifestations of [transient] HPV infection," he tells WebMD. "Early screening stigmatizes young women and subjects them to extra testing and unnecessary treatment."

Perspective of American Cancer Society

The American Cancer Society, which was highly critical of the mammography changes, supports the new ACOG cervical cancer guidelines.

Last June, representatives from the American Cancer Society, ACOG, and close to 25 other health groups met to discuss cervical screening and management for adolescents.

According to American Cancer Society Director of Breast and Gynecologic Cancer Debbie Saslow, PhD, there was general agreement that for most women, screening should begin at age 21.

Saslow says in a news release that overscreening has lead to overtreatment of young women. But she also says that underscreening of women who should have regular Pap tests leads to death. "Most women who die from cervical cancer have never been screened or have not been screened in at least five years."

stem cell transplant for thalassemia

Exactly 49 days ago, Harshil Nanda was a severely ill thalassemic patient with B positive blood group. Today, he is a healthy infant with A positive blood group and a confirmed evidence of how stem cell transplant can cure thalassemia. The change in his blood group is in fact proof that Harshil’s procedure, the country’s second stem cell transplant from umbilical cord blood of a stranger child received from a private bank, has worked. Harshil’s rapid recovery has cheered stem cell transplant surgeons at Gujarat Cancer Research Institute (GCRI) where the first such transplant was performed nearly a year ago. “This means that unrelated umbilical stem cell transplant can be termed as an established treatment. As they say, first success could be luck but second is science,” said director of bone marrow transplant department at GCRI Dr Sandip A Shah. The transplant was assisted by Dr Kinnari Patel and Dr Kamlesh Shah. The first success story was of Rishi, a thalassemic major child from Kutch, who was cured by umbilical cord stem cells transplanted from an unrelated donor as he did not have siblings. Harshil is also the only child of his parents. “While it took three months in Rishi for the donor blood cells to completely take over and change his blood group, Harshil has recovered within two months,” said Dr Shah. For children without siblings and suffering from thalassemia, aplastic anaemia and similar blood problems, this is good news. The success rate of such transplants is 70 per cent. Doctors are now poised to perform a third unrelated umbilical cord stem cell transplant. “The third patient is a girl called Zeel, who has got Rs 10 lakh as donation from Bollywood star Ajay Devgan to perform the transplant,” said Dr Shah.

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation

Abstract

Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population.

Methods: The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.

Recommendations: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation)

The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement)

The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)