Soumyadeep Bhaumik’s review of Indian medical papers—18 June 2013

soumyadeepbhaumikOne of the most enthralling articles that caught my attention last month was one entitled “Knowledge and practice of clinical ethics among healthcare providers in a government hospital, Chennai” published in the Indian Journal of Medical Ethics. It revealed that 30% of the responders did not give a definition of healthcare ethics (and I am inclined to think they did not know what it is), and 40% did not name a single ethical principle (again, I suspect they did not know of any). What I found more alarming was the fact that, “25 out of 51 physicians stated that they did not have time to listen to their patients.” 25 out of 51 physician responders also did not respond to the part of the questionnaire that asked them to name the principles of the Hippocratic Oath. All this makes me think that medical ethics in India is not well known, or adhered to strictly enough.

However, the good news is that India does plan to introduce medical ethics in the medical curriculum. Whether a single dose of ethics will be sufficient, or whether students will need a continuous infusion to dramatically change the scenario in the long run is open to debate, but it is a good start nevertheless.

Another issue that needs to be addressed in India is GP prescribing practices. A paper in the Indian Journal of Pharmacology reveals that nearly half of rural GPs, and 25% of urban GPs do not sign their prescriptions. What is more alarming and incredibly scary is that, “Details regarding the drug strength and dosage schedule were present only in 0.7% of the rural GP’s prescriptions, and in 11% of the urban GP’s prescriptions.” Coupled with the fact that most pharmacies in India do not employ pharmacists, this can only mean that it is a random world out there.

Toxic epidermal necrolysis is a disease with mortality rates as high as 30%, and there is no real evidence with regards to the use of the most commonly used current treatments i.e. systemic steroids, cyclosporine A, and intravenous immunoglobulins. The last issue of  Indian Journal of  Dermatology Venereology Leprology compared low dose intravenous immunoglobulins and steroids with only steroids in toxic epidermal necrolysis. But then again the study was not randomised. It seems there is still a lot to go for this high mortality condition.

Heard about honeymoon asthma? Well a case report from Salem, India published in the May issue of American Journal of Medical Sciences mentions it and a subsequent literature review led me to (what I believe is ) the first similar report by Specken in 1958. In fact in all such cases of post-coital asthma, the trigger might not be just sexual excitement (or honeymoon). It might be condom induced due to latex allergy, or in females due to what is known as human seminal plasma allergy. So it might not exactly be a “honeymoon” to diagnose honeymoon asthma.

Soumyadeep Bhaumik is a medical doctor and independent medical researcher from Kolkata, India. He freelances for various national and international medical journals.

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare that I have served a paid editor position in an Indian medical journal before and freelances for various national and international medical journals. No other relevant conflicts of interests.