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Ayushman Bharat health scheme to provide free treatment to those aged above 70 years: Prez

June 27,2024 New Delhi: All citizens aged above 70 years will be provided free treatment under the Ayushman Bharat health insurance scheme, President Droupadi Murmu said on Thursday. The opening of 25,000 Jan Aushadhi Kendras in the country is also progressing at a fast pace, she said while addressing the joint sitting of Parliament. Under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), free health services are being provided to 55 crore beneficiaries, Murmu said. “Further, the Government is going to take yet another decision in this area. Now all the elderly above 70 years of age will also be covered and get the benefit of free treatment under Ayushman Bharat Yojana,” the President said. The AB-PMJAY, the largest publicly funded health insurance scheme in the world, aims to provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to 12 crore families. Hospital Empanelment and Management (HEM) guidelines for empanelment of hospitals under AB-PMJAY mandates the State Health Agencies (SHAs) with the responsibility of empanelling hospitals under the scheme. Source: Healthworld

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Norms soon on disposing of expired medicines

June 27,2024 New Delhi: Throwing expired medicines with household trash is not an ideal way to get rid of them. The country’s drug controller is working on a guidance document detailing methods to be followed for safe disposal of unused and expired medicines. “The need was felt for safe and proper disposal of expired/unused medicines/drugs for protecting the environment and public health,” a government official aware of the development told ET. The document is in the final stages of completion. It will include procedures to be followed for disposal, collection, storage and transportation of expired and unused drugs. Improper disposal of medications that have crossed the expiry date mentioned on the label or not used by the individual for whom they were prescribed and purchased may be hazardous to public health, animal health and environment, officials said. The recently notified Schedule M under Drug Rules prescribed the requirements for manufacturers for proper and safe storage of waste material awaiting disposal. The guidance document in works has been prepared to provide the best practices that may be followed for safe and proper disposal of expired/unused drugs, the official cited above said. The document has been prepared keeping in view various international guidelines including those issued by the World Health Organisation (WHO) and the US Food and Drug Administration (USFDA). The Biomedical Waste (Management and Handling) Rules, 2016, have also been considered, officials said. The Central Drugs Standard Control Organisation (CDSCO) had received a letter from researchers, referring to an article regarding a study aimed to assess the extent of exposure of active pharmaceutical compounds (APCs) in the hydrologic cycle in and around New Delhi. The study stated the role of ecological exposure due to the disposal of unused and expired pharmaceutical compounds into landfills and indicated that un-segregated drug disposal could be a reason for the emergence of drug resistance with special reference to antibiotics. Discussions to make sure proper disposal of these medications have been going on for long. The guidance documents will have methods for disposal of expired/unused medicines in landfills. It will also specify ways to dump antineoplastic drugs, officials said. Source: Pharma

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80% of public health facilities are substandard: Govt survey

June 29,2024 New Delhi: Nearly 80 per cent of public health facilities in India do not meet the minimum essential standards for infrastructure, manpower, equipment and other benchmarks set by govt. This shocking detail has emerged from a self-assessment exercise carried out by govt in which public health facilities from states and UTs covered under the National Health Mission (NHM) were asked to fill in details, such as the number of doctors, nurses or basic medical equipment they have. There are more than two lakh public healthcare facilities, including district hospitals, sub-district hospitals, community health centres, primary health centers, and Ayushman Arogya Mandir (erstwhile sub health centres) that are covered under NHM – a flagship scheme of govt. Of them, data shared by govt on the Indian Public Health Standards (IPHS) dashboard shows, 40,451 filled in key statistics about their respective facilities in the Open Data Kit – a digital tool – developed by the health ministry. When the scoring was done based on the statistics shared, it was revealed that only 8,089, approximately 20% of the facilities, scored 80% or higher which is needed to qualify as IPHS compliant. Simply put, these facilities had the required infrastructure, human resources, drugs, diagnostics and equipment available to provide essential services as desired. Total 17,190 (42%) of the facilities that participated in the self-assessment exercise scored less than 50% while the rest, 15,172 facilities, scored anywhere between 50 to 80%. All these details have been put out in public domain on the IPHS dashboard. A senior health ministry official said the self-assessment and its real time monitoring has been started to ensure that the health facilities maintain the required standards of infrastructure, equipment, and human resources, leading to better health outcomes and fostering a healthier and more equitable society. The Centre, an official said, is aiming to make 70,000 health institutions IPHS compliant within the first 100 days of the new govt’s formation. “The aim of this self-assessment exercise is to identify the gaps and push the states/UTs to fill them with full support from the Centre so that quality of services provided to the public improves,” a senior health ministry official said. She added that self-assessment is the first step and the Centre also plans to carry out surprise inspections to verify the claims being made by health facilities against the benchmarks set by IPHS. While the IPHS assesses health facilities for basic services, National Quality Assurance Standards (NQAS) is another higher level of evaluation which rates them on the basis of best practices followed such as availability of essential medicines, equipment, waste management, infection control practices, support services and patient’s rights. The official said that while NQAS assessment for district hospitals, sub-district hospitals, community health centres and primary health centers will continue to be carried out physically, they have introduced a new provision of virtual assessment for the Ayushman Arogya Mandir that constitute the highest number of public health facilities under NHM. The Centre bears 60 per cent of the expenditure in a public health facilities under the NHM while the rest of the expenditure is borne by the state. Source: Healthworld

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Never had any intention to lower dignity of SC: IMA chief tenders apology

July 05,2024 New Delhi: Indian Medical Association chief Dr R V Asokan on Thursday issued a public apology for his remarks in an interview regarding an observation made by the Supreme Court during the hearing of a case to which the IMA was a party, saying he regrets his statement and it was never his intention to lower the court’s dignity. . “The IMA National President Dr R V Asokan has released an apology regretting his statement to the press regarding a comment by the Supreme Court while IMA was party to the case,” the statement issued by the doctors’ association said. The Indian Medical Association (IMA) was equally concerned about the issues of malpractice, Dr Asokan said in the statement referring to the April 23 order in which the apex court during the hearing of a matter related to Patanjali Ayurved Ltd’s misleading advertisements case had observed that it was of the opinion that IMA also needs to put its house in order. In an affidavit filed in the top court, Dr Asokan had also tendered an unconditional apology for his statement against the Supreme Court. “IMA has filed a writ petition before the Supreme Court against misleading advertisements and malicious campaigns by some persons and entities against modern medicine professionals. With reference to certain statements made by me during an interview with PTI News, I have expressed regret to the Supreme Court and have also submitted my affidavit to the court for tendering my unconditional apology,” Dr Asokan said. “I never had any intention to lower the majesty or dignity of the Supreme Court,” he added in his apology. “There are several complaints relating to the alleged unethical acts on the part of the members of the Association who are abusing the trust reposed in them by patients and not only prescribing prohibitively expensive medicines, but also recommending avoidable/unnecessary investigations as a part of the line of treatment, for purely extraneous considerations,” the bench had said. Constant updating and dissemination of ethical practices was one of the main activities of the IMA, Dr Asokan said. Recently, the IMA engaged patient groups in a dialogue for addressing the concerns of patients and a joint declaration was released in Bangalore, the statement said. Source: Healthworld

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Expert panel urges drug regulator to approve Lilly’s obesity drug Mounjaro

July 01,2024 Hyderabad: An Indian government-approved expert panel has advised the country’s drug regulator to approve the import and sale of U.S. drugmaker Eli Lilly’s Mounjaro, a blockbuster diabetes drug and a wildly popular obesity treatment, a document on a government website showed on Monday. Lilly’s Mounjaro, chemically known as tirzepatide, and Zepbound and Danish rival Novo Nordisk’s Wegovy and Ozempic belong to a class of therapies known as GLP-1 receptor agonists, developed to control blood sugar in patients with type 2 diabetes. They also slow digestion, helping patients feel full longer, making them a wildly popular choice for weight loss. “After detailed deliberation, the committee recommended for grant of permission for import and marketing” of certain doses of tirzepatide “for chronic weight management subject to the condition that firm should conduct Phase 4 clinical trial (post-marketing surveillance),” the Subject Expert Committee said in a notification dated June 19. The committee advises India’s drug regulator on approvals of drugs and trials. “A recommendation from the subject expert committee is like the penultimate step of the approval,” said Sheetal Sapale, vice president of research firm Pharmarack. Lilly did not immediately respond to a Reuters request for comment. CEO David Ricks had told Reuters a few months back that the company expected to launch Mounjaro in India as early as next year. India has the world’s second-highest number of people with type 2 diabetes and high obesity rates. Around 11% of Indian adults will be obese by 2035, per the World Obesity Federation Atlas. The global weight-loss drugs market is estimated to reach at least $100 billion by the decade’s end. Lilly should also submit the required manufacturing and controls data, the expert panel added. The notification was first reported by a local medical journal, The Indian Practitioner. (Reporting by Rishika Sadam; Editing by Dhanya Skariachan and Savio D’Souza) Source: Pharma

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Wegovy, Ozempic linked with sight-threatening eye disorder in study

July 04,2024 London: Patients using Novo Nordisk’s wildly popular weigh-loss drug Wegovy and its similar medicines for type 2 diabetes may be at increased risk for a sight-threatening eye condition, according to data from a study published on Wednesday. Wegovy and Novo’s diabetes drugs Ozempic and Rybelsus all contain the same active ingredient, semaglutide, and belong to a class of medications known as GLP1 receptor agonists. The rate of the eye problem known as nonarteritic anterior ischemic optic neuropathy, or NAION, was 8.9% for those taking semaglutide for type 2 diabetes, compared with 1.8% for patients taking non-GLP-1 diabetes medications, researchers reported in JAMA Ophthalmology. Among those prescribed semaglutide for overweight or obesity, the rate of the eye condition was 6.7%, versus 0.8% for those receiving other types of medications for weight reduction. The 36-month observational study involved 710 adults with type 2 diabetes and 979 taking medications for weight loss. NAION develops from insufficient blood flow to the optic nerve and causes sudden painless vision loss in one eye. It is the second most common cause of blindness due to optic nerve damage, after glaucoma. After taking patients’ other risk factors for the condition into account, such as high blood pressure and obstructive sleep apnea, use of semaglutide was associated with a more than four times higher risk of NAION in those receiving it for diabetes and a more than seven times higher risk in patients taking it for obesity. Novo Nordisk in an emailed statement noted several limitations of the study design, which was not a randomized controlled trial. “Overall, the data published in the study is not sufficient to establish a causal association between GLP-1 receptor agonist use and NAION,” the Danish drugmaker said, adding that the condition “is not an adverse drug reaction for the marketed formulations of semaglutide.” NAION more often affects older individuals. In the overall U.S. population, the estimated annual incidence is 0.54 per 100,000 people, rising to 2.3 to 10.2 per 100,000 in adults above age 50, according to the American Academy of Ophthalmology. The prognosis for visual recovery is better for younger patients, the AAO says. Mean ages in the study were 46 among patients using semaglutide for obesity and 57 among those using it for diabetes. “This work has been carried out to a high level of quality and… does suggest an association between semaglutide treatment and one form of sight-threatening optic neuropathy, but this would ideally be tested in larger studies,” Graham McGeown of Queen’s University Belfast, who studies diabetic eye disease but was not involved in the new research, said in a statement. “Given the rapid increase in semaglutide use and its possible licensing for a range of problems other than obesity and type-2 diabetes, this issue deserves further study, but possible drug side effects always need to be balanced against likely benefits,” McGeown said. The researchers involved in the study were not immediately available to comment on their findings. Source: Healthworld

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DCGI inspection brings curtains down on 36% of 400 pharma units; plans for new digital projects

June 27,2024 Mumbai: The Drug Controller General of India (DCGI) Rajeev Raghuvanshi on Thursday revealed that the Central Drugs Standard Control Organization (CDSCO) has conducted risk-based inspections of over 400 pharmaceutical manufacturing units over the past year and a half, resulting in the closure of 36% of these facilities. “We have been successfully doing risk-based inspections and inspected about 400 manufacturing units and I am not very happy to say that more than 36% of them had to be closed because there was a reason to close them,” Raghuvanshi said at an Indian Pharmaceutical Alliance (IPA) event. “These MSMEs had to shut down as they realised that they cannot meet the expectations of the regulators.” As the quality assurance of drugs manufactured in the country continues to be a cause of concern, CDSCO is about to start four key projects that will help the Indian pharmaceutical industry to continue improving and maintaining the quality of the drugs coming out of India, the ‘pharmacy capital of the world’. One of the four projects, the regulatory body CDSCO will be coming out with is a digital platform—Digital Drug Regulatory System, he said. “So four big-ticket projects are in the pipeline and one of them we are coming out with is our digital platform, which would cover the complete regulatory value chain in this country,” said Raghuvanshi. The organisation plans to structure the platform in a way that brings aboard all the stakeholders involved in the industry from regulatory bodies to manufacturers and retailers. “Each and every stakeholder, government, private, semi-government, whoever has any stake in the regulatory value chain would be brought onto that platform. And so, you have solutions to all kinds of quality issues. We are waiting on the final approval from the government but to design this we have already floated the RFP and the final tender is yet to be done,” he added. Raghuvanshi then disclosed the second project the organisation is working on – the regulatory rationalisation initiative, under which CDSCO has hired two internationally renowned consultancy organisations. One of the two consultancy firms is tasked to look at CDSCOs’ internal process, while the second one will take a look at The Drugs and Cosmetics Act, 1940 and rules to rationalise while removing the redundancies and simplifying the whole regulation. The first one he disclosed will start its working from 1 July while the second one will begin its work in a couple of weeks time. “Third being, increasing the internal scientific cadre at CDSCO. Unfortunately today there is not a single scientific cadre to do an internal review of the files, which the stakeholders are not comfortable with. So we are initiating a process to get the internal scientific cadre at CDSCO so that more than 50-60% of the activities of the final review can happen internally,” he continued. Finally the fourth project, Raghuvanshi added, is not part of the CDSCO but for the Indian Pharmacopoeia Commission (IPC) to set up the Digital IP. IPC is an autonomous institution of the Ministry of Health and Family Welfare committed to ensuring quality and safety of drugs. “The product is in its final stages and will be in use by the next month as it is under final testing,” he added. Raghuvanshi is also the secretary-cum-scientific director of IPC. Source: Livemint

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52 drug samples fail regulatory body’s quality test

June 26,2024 New Delhi: India’s apex drugs regulatory body has found the samples of around 50 drugs, including that of widely-used paracetamol, pantoprazole and some antibiotics for treating bacterial infections, as not of standard quality. Of these sub-standard drugs, 22 are manufactured in Himachal Pradesh, according to the alert issued by the Central Drugs Standard Control Organisation (CDSCO) for the month of May. Besides Himachal Pradesh, the samples were collected from Jaipur, Hyderabad, Waghodia and Vadodara in Gujarat , Andhra Pradesh and Indore, among other places. A total of 52 samples have failed the quality test conducted by the CDSCO, according to the drug alert issued on June 20. Sources said state drug regulators have reportedly sent notices to the pharmaceutical companies concerned and the failed samples would be recalled from the market. The list of the sub-standard drugs contains Clonazepam tablets that are used to treat seizures and anxiety disorders, pain reliever Diclofenac, anti-hypertension drug Telmisartan, Ambroxol, which is used in the treatment of respiratory diseases, Fluconazole, an antifungal, and some multivitamin and calcium tablets. The samples of around 120 drugs manufactured in Himachal Pradesh had failed the test parameters last year. Source: Pharma

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Edu Tap fined Rs 3 lakh for misleading RBI Grade B exam ads

June 13,2024 The Central Consumer Protection Authority (CCPA) has slapped a penalty of Rs 3 lakh on edtech firm Edu Tap Learning Solutions for misleading advertisements claiming 144 students were selected for the RBI Grade B exam in 2023 after taking its courses. In an order issued on June 12, the CCPA directed Edu Tap to immediately discontinue the “impugned advertisement” from all electronic and print media. The company has been given 15 days to submit a compliance report. The consumer watchdog found that Edu Tap’s advertisements on its YouTube and Telegram channels showcased the names and pictures of 144 candidates selected for the coveted RBI exam. However, it concealed crucial details about which specific courses these candidates had taken from the platform. As per CCPA’s findings, 57 out of the 144 candidates had taken only the ‘Interview Guidance Course’ offered free of cost by Edu Tap. This course comes into play after a candidate has cleared the RBI Grade B exam’s preliminary and main stages. The CCPA order noted that Edu Tap had “deliberately concealed important information” about the type and duration of courses opted by the successful students in a bid to “mislead consumers as a class.” The regulator took objection to Edu Tap using the RBI’s emblem in the advertisements without permission to lend them an “air of authenticity.” With around 2 to 2.5 lakh candidates appearing for the RBI Grade B exam annually, the CCPA underlined that the “vulnerability of the class of persons likely to be adversely affected by such misleading advertisements is huge.” Edu Tap has a sizeable presence with 3.59 lakh subscribers on YouTube and around 15,000 paid users across platforms. The company did not offer an immediate comment on the CCPA order when contacted. Source: Economic Times

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How to prevent Big Tech dominance, protect privacy and ensure fair competition

June 13,2024 In 2008, YouTube ran an animation video in which a man who signed up for a free service called ‘Google Toilet’ is seen sitting on a commode, while the smart pot projects ads on the wall in front of him by detecting his food preferences from his excreta and displays his social media status based on his toxicology report. Ultimately, paramilitary forces storm the lavatory and arrest him because the government has taken exception to his deviant food habits. When he protests against this invasion of his privacy and invokes the Bill of Rights, confirming that the scene is set in the US, he is told that he has nobody to blame but himself because by signing up for a free smart commode, he joined the Google Toilet network embedded with secondary disclosure agreements. Counter-arguments, on the other hand, presented by SSDEs (systemically significant digital enterprises) – Alphabet, Meta, Amazon, et al – opposing the Bill are not particularly credible. These include the following notions: That removing self-preferencing – an online platform’s ability to promote its own products, or those of a related party, above that of others – creates customer dissatisfaction. This may have warranted due consideration if SSDEs were in the business of selling shaving foam. But the dominance of online platforms like Meta and Google in India is such that ex ante regulations become necessary to curb the existential threat posed by Big Tech with regard to the non-dominant and nascent digital ecosystem. Self-preferencing and exclusive tie-ups with shell entities improve user engagement and retention, but act as an addictive content loop the user cannot escape. This creates a restrictive trade practice that is difficult to reverse over time. That explicit user-verification measures drive consent fatigue and adversely impacts innovation. This argument favouring innovation over authorisation is outrageous. Current opt-in permissions don’t work. Studies show that, at 250 words per min, it would take at least 30 days each year to peruse end-user licence agreements. Thus, users provide consent without understanding future data utilisation objectives, while digital platforms continue to synchronously harvest personal data. This has forged many unfortunate, and irreversible, outcomes. Recently, New York City filed a lawsuit against Meta, Snapchat, TikTok and YouTube, claiming that their platforms were addicting and endangering children, and promoting unsafe behaviours. Litigation against Meta in 40 other US states allege the same. The magnitude, scale and speed at which such platforms operate demand ex ante regulation, if the real interests of consumers are to be protected. This argument is also without merit. Section 4 of the Competition Act suggests that actions are anti-competitive only if carried out by ‘a dominant entity in its relevant market’. Since the onus of proving dominance and identifying the relevant market rests with the regulator, enforcement proceedings are invariably delayed. In one instance, filed before CCI in 2018, involving abuse of dominance ‘by a licensable operating system (‘OS’) for smart mobile devices’, the case is yet to reach the Supreme Court. In another, the case has been in limbo for 11 years. In such cases, ex post redressal is untenable. And if these reality checks on what constitutes efficient ‘customer satisfaction’ and ‘customer convenience’ are not convincing enough, something more fundamental could make ex ante regulation necessary. As sole providers of public digital infrastructure, SSDE dominance can cause chaos through a single disruption. Meta’s deleterious effect in this regard is well known: its intentional blocking of social media in Australia, and disrupting fire services, health services and vaccine rollouts during the pandemic; its disruption of newsfeeds in 2018 in Bolivia, Slovakia, Sri Lanka, Serbia, Guatemala and Cambodia; and its part in precipitating the exodus of 70,000 Rohingya people, tantamount to subverting the machinery of law and order. As recently as April 2024, Google received authorisation to work with US intelligence and defence agencies, enabling them to use Google’s air-gapped cloud platform ‘to process top- secret workloads’. Given Google’s status as a foreign defence contractor that manages millions of records of sensitive data, can India really afford to oversee SSDEs by initiating the process of discovery and action after the fact? Protecting the welfare of citizens is the essence of national security. Protecting public interest, that of national sovereignty. Often at the expense of accelerated short-term growth. The Digital Competition Bill, which aims to contain matsyanyaya – a law, or absence thereof, which allows big fish to eat little fish – is the first step in this direction. Ultimately, GoI will need to decide if a billion ‘free smart toilets’ are worth any sort of compromise. Source: Economic Times

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