After my post graduate training in Internal Medicine [ie MD], I had two options. Either to work as a primary/secondary care General Physician or go for a sub- specialisation [or as it is called in India, Super specialisation,ie DM]. I chose the first option. Why? Do I regret it?
Why I chose not to study more? Primary reason was I had become fed up with studies . I had spent almost 26 years of my life studying by then[including KG].
Also I was married and had just become a proud father. Wanted to earn something for myself and my budding family.
Another factor that made my decision easy was the appointment letter from the Government, posting me as a Physician in a small town not very far from my home.
There was also another big reason. I hated confining myself to one organ or organ system. Internal medicine had all the thrills. The wide variety of illnesses that an internist manage made it an exciting profession.
At that time, I had some noble ideals too [young and romantic?]. I wanted to help as many patients as possible especially the poor. So rather than being a super specialist in a 5 star hospital looking after the cream of the society, I preferred the Govt job as an internist in a small, run down Taluk hospital.
Do I regret it?
Yes, some times.
Especially when patients ask, 'Sir enthinde specialista?'[ in what subject are u specialised in?]or when they ask 'do you feel I should see a specialist?'
Some times it is the relatives who ask the same question.
I reply to them trying to make them feel I am an all rounder, knowing about all diseases.
Also, I regret it some times when I realise that the sub specialist's consultation fee is twice or thrice that of mine.
But most of the time I don't regret it. Looking back I feel my decision was right.
I enjoy my profession. I like the thrill of finding out the cause of fever in a FUO [fever of unknown origin]. I like the satisfaction I get when I correctly diagnose the cause of breathlessness in a poor patient by just patiently listening to the history and using the stethoscope,without ordering any fancy investigations. I like the way people come to me for advise regarding anything related to medicine. I am happy taking disease prevention classes to house wives or school kids or teachers or Taxi drivers or 'Positive'[HIV] people. I feel I am doing something when I console and give hope to a crying man or woman when they first realise they are 'Positive'.
So as of now I am happy being a Generalist who 'know a lot about a lot of illnesses rather than a super-specialist who 'know more and more about less and less'.
Sunday, October 19, 2008
Monday, October 13, 2008
Sad News
The Type 1 Diabetic patient in 'Strange Interview' and 'Happy News' called me to tell that she had a spontaneous abortion.
Her recent blood sugars were between 80 and 220mg but her frequency of testing was only about once a day or once in 2 days.
Early foetal loss is most commonly due to congenital defects in foetus caused by high blood sugar during first few weeks.
For a diabetic woman who wants to be pregnant, keeping a very good control over her blood sugar is very important.The first 42 days after conception is the most important period, but in most cases the woman will be aware that she is pregnant only after a missed period, which is about 14 to 21 days after conception.
So planning the pregnancy in advance and keeping a tight control on blood sugar is absolutely essential.
The loss of that foetus was a personal failure for me too. I should raise the standard of my care of care of Diabetes in Pregnancies.
I had emphasised all these to her and I hope she will have a successful pregnancy next time.
Her recent blood sugars were between 80 and 220mg but her frequency of testing was only about once a day or once in 2 days.
Early foetal loss is most commonly due to congenital defects in foetus caused by high blood sugar during first few weeks.
For a diabetic woman who wants to be pregnant, keeping a very good control over her blood sugar is very important.The first 42 days after conception is the most important period, but in most cases the woman will be aware that she is pregnant only after a missed period, which is about 14 to 21 days after conception.
So planning the pregnancy in advance and keeping a tight control on blood sugar is absolutely essential.
The loss of that foetus was a personal failure for me too. I should raise the standard of my care of care of Diabetes in Pregnancies.
I had emphasised all these to her and I hope she will have a successful pregnancy next time.
Sunday, October 12, 2008
Thirty versus Forty -- Part 2
Reading my last post again I realised I was too negative. Is it true that at Forty I have lost everything that was good in me? No It is not true. Let me try to enumerate the positive changes in me.
My ability to communicate with patients have improved over time eventhough time available for each patient is less. My ability to find out the correct cause of the each patient's problem have also increased very much. This have helped my patients from undergoing unnecessary investigations and mental trauma.
I have established a very good practise with a large number of loyal patients. I read [when I get time] journals and Text Books.Still now I am one of the better informed doctor of my age.
I have a very good relationship with all other doctors I work with.
I have done some good work in training other doctors in HIV/AIDS. I have become a much better speaker in front of general public and even in front of doctors.
The quality of care I give to my patients as a whole have improved.
Lastly and not the least I have a blog of my own which I am able to maintain with frequent posts.
So Forty is not bad at all.
My ability to communicate with patients have improved over time eventhough time available for each patient is less. My ability to find out the correct cause of the each patient's problem have also increased very much. This have helped my patients from undergoing unnecessary investigations and mental trauma.
I have established a very good practise with a large number of loyal patients. I read [when I get time] journals and Text Books.Still now I am one of the better informed doctor of my age.
I have a very good relationship with all other doctors I work with.
I have done some good work in training other doctors in HIV/AIDS. I have become a much better speaker in front of general public and even in front of doctors.
The quality of care I give to my patients as a whole have improved.
Lastly and not the least I have a blog of my own which I am able to maintain with frequent posts.
So Forty is not bad at all.
Wednesday, October 8, 2008
Thirty versus Forty
This year I turned 40.
A milestone in many aspects.
10 years ago when I turned 30 where was I?
It would be interesting to study the contrast.
At 30, I was out of medical college after my postgraduate degree and had just started my career. I was raring to go and was flushed with the initial success of my practise. As I had only few patients to see,I spent considerable amount of time talking to patients, making them understand the disease and how to cope with it. I wondered why the senior doctors in my area are not communicating well with the patients. I was happy to see patients 24hrs a day.
Each difficult case was a challenge to me and I researched and referred books and net till late hours to find a solution to each diagnostic problem. Each new issue of my favourite medical journal was awaited eagerly. I wanted to practise medicine the way it is given in Text Books. I hated when the patient or the relatives said that they are going to a higher medical centre for further evaluation. I looked down in other doctors who referred cases without any reason. My belief in Science was immense. Also I believed very much in my patients and their relative's loyalty to me. I never could imagine one of them going for a malpractice litigation against me. I was ready to teach the staff nurses the finer points of patient care at any time.
I had umpteen number of dreams about my future. Researching and finding out a new breakthrough methodology of treatment for an important disease was one of them. Presenting papers after papers in National and International conferences and publishing them was another.
At medical conferences, I was the baby among the audience. I was up to date in knowledge and was proud about it. I was bombarded with advise from seniors to do that,to do this, and not to do this etc. I was also an early product of technology generation. So, I was the one who showed the senior doctors how to use the Internet and the possibilities of cell phones.
At 40, I am in the middle of my career in practising clinical medicine.The sight of crowded waiting room in my clinic do not excite me, rather it makes me feel tired. I stick to my working hours. Any patient coming outside it, is shown an angry face. Finishing the patient appointments in time is the priority now. Time given for each patient became limited.
I am slow to accept changes in treatment methods. Text Books and journals pile up untouched.
A difficult case is easily referred. Any wish expressed by the patient to go elsewhere, brings up a reference letter from me in a jiffy. My belief in the unknown increased. Each person who enter my clinic is viewed as a possible litigant.
The dream of researching and presenting papers still remain a dream. At medical conferences, I am somewhat a veteran. Young faces are seen all around. Many come to me for advice. I try not to show youngsters my lack of up to date knowledge.
Still I try to maintain the spirit and my standard of practise, may be for another decade.
A milestone in many aspects.
10 years ago when I turned 30 where was I?
It would be interesting to study the contrast.
At 30, I was out of medical college after my postgraduate degree and had just started my career. I was raring to go and was flushed with the initial success of my practise. As I had only few patients to see,I spent considerable amount of time talking to patients, making them understand the disease and how to cope with it. I wondered why the senior doctors in my area are not communicating well with the patients. I was happy to see patients 24hrs a day.
Each difficult case was a challenge to me and I researched and referred books and net till late hours to find a solution to each diagnostic problem. Each new issue of my favourite medical journal was awaited eagerly. I wanted to practise medicine the way it is given in Text Books. I hated when the patient or the relatives said that they are going to a higher medical centre for further evaluation. I looked down in other doctors who referred cases without any reason. My belief in Science was immense. Also I believed very much in my patients and their relative's loyalty to me. I never could imagine one of them going for a malpractice litigation against me. I was ready to teach the staff nurses the finer points of patient care at any time.
I had umpteen number of dreams about my future. Researching and finding out a new breakthrough methodology of treatment for an important disease was one of them. Presenting papers after papers in National and International conferences and publishing them was another.
At medical conferences, I was the baby among the audience. I was up to date in knowledge and was proud about it. I was bombarded with advise from seniors to do that,to do this, and not to do this etc. I was also an early product of technology generation. So, I was the one who showed the senior doctors how to use the Internet and the possibilities of cell phones.
At 40, I am in the middle of my career in practising clinical medicine.The sight of crowded waiting room in my clinic do not excite me, rather it makes me feel tired. I stick to my working hours. Any patient coming outside it, is shown an angry face. Finishing the patient appointments in time is the priority now. Time given for each patient became limited.
I am slow to accept changes in treatment methods. Text Books and journals pile up untouched.
A difficult case is easily referred. Any wish expressed by the patient to go elsewhere, brings up a reference letter from me in a jiffy. My belief in the unknown increased. Each person who enter my clinic is viewed as a possible litigant.
The dream of researching and presenting papers still remain a dream. At medical conferences, I am somewhat a veteran. Young faces are seen all around. Many come to me for advice. I try not to show youngsters my lack of up to date knowledge.
Still I try to maintain the spirit and my standard of practise, may be for another decade.
Read the next part of Thirty versus Forty here
Tuesday, October 7, 2008
Follow up
I had narrated about many people/patients in my postings. This is a post which will tell you about where they stand now.[as far as I know]
The 31 year old newly wed wife who preferred Insulin to tablets is now well controlled on a single tablet. She also started working part time and looking forward to get pregnant.
The 50 year old lady who took money from me [as narrated in patient taking money from doctor]for her bus ticket returned the amount promptly next month. But I have not heard from the other guy whom I helped on the same day for getting Government certificate.
The 65 years old Type 2 Diabetes patient who disturbed my sleep by missing her Insulin injections for a few days was hospitalised for 3 more times, all around 2 am, with hypoglycemia.The doctor on duty managed her all the time with out disturbing my sleep.
The patient in Another sad 'positive' story is doing well with anti Tuberculosis treatment.His CD4 count is also low and may need anti HIV medicines too shortly.
The guy in Craze for specialist consultation was diagnosed to have Hepatitis B. He went to a Gastro-enterologist for better care, but was unhappy with the lack of communication of that particular specialist.He came back to me again and has now recovered well.He is back in Bangalore working.
The 12 year old girl with Diabetes in Type 1 or Type 2 did not keep her follow up appointments. I hope she is getting treatment and monitoring from some where else, may be from Government run clinics as the family was very poor.
The 31 year old newly wed wife who preferred Insulin to tablets is now well controlled on a single tablet. She also started working part time and looking forward to get pregnant.
The 50 year old lady who took money from me [as narrated in patient taking money from doctor]for her bus ticket returned the amount promptly next month. But I have not heard from the other guy whom I helped on the same day for getting Government certificate.
The 65 years old Type 2 Diabetes patient who disturbed my sleep by missing her Insulin injections for a few days was hospitalised for 3 more times, all around 2 am, with hypoglycemia.The doctor on duty managed her all the time with out disturbing my sleep.
The patient in Another sad 'positive' story is doing well with anti Tuberculosis treatment.His CD4 count is also low and may need anti HIV medicines too shortly.
The guy in Craze for specialist consultation was diagnosed to have Hepatitis B. He went to a Gastro-enterologist for better care, but was unhappy with the lack of communication of that particular specialist.He came back to me again and has now recovered well.He is back in Bangalore working.
The 12 year old girl with Diabetes in Type 1 or Type 2 did not keep her follow up appointments. I hope she is getting treatment and monitoring from some where else, may be from Government run clinics as the family was very poor.
Sunday, October 5, 2008
Chronic severe Joint pain of Chikungunya
The rainy season due to the South West Monsoon over the Indian sub continent is over.Epidemic of acute severe joint pain and swellings associated with fever due to Chikungunya infection has also subsided.Now I am seeing more and more patients with Chronic severe joint pain of varying duration, a sequel of Chikungunya infection.
Let me tell you a little more about this virus and the illness it causes in humans.
Chikungunya is a re-emerging, mosquito-borne viral infection causing fever, rash and acute or sudden severe joint pains of several joints.Chikungunya (Chick’-en-GUN-yah) in Swahili an African language meaning “that which contorts or bends up” refers to the contorted (stooped) posture of patients who are afflicted with severe joint pains (arthralgia) the most common feature of the disease.
Chikungunya virus is a single-stranded RNA Alphavirus, from the family Togaviridae. Other Alphaviruses also causing fever, rash and arthralgia, include O’nyong-nyong, Mayaro,Barmah Forest, Ross River and Sindbis viruses. Chikungunya virus is most closely related to O’nyong-nyong, but remains genetically distinct.
The disease was first described by Marion Robinson and W.H.R. Lumsden, following an outbreak along the border between Tanzania(erstwhile Tanganyika) and Mozambique, in1952. Since 1953, the virus has caused outbreaks in Africa and South Eastern Asia, including India, Sri Lanka, Myanmar, Thailand, Indonesia, the Philippines and Malaysia, which are well documented. There is historical evidence that Chikungunya virus originated in Africa and subsequently spread to Asia. Phylogenetic studies support this theory, with Chikungunya virus strains falling into three distinct genotypes based on origin from West Africa, Central/East Africa or Asia.
Chikungunya is transmitted by the bite of the infected Aedes mosquito from an infected person to a healthy person. The disease does not get transmitted directly from human to human (i.e. it is not a contagious disease). In a pregnant woman with Chikungunya there is risk of transmitting the disease to her foetus.
The fever starts usually about 2 to 3 days after the entry of virus into the human body. There will be severe chills and shaking of the body at the onset of fever.At the same time the joint pain and swelling starts.The patient will not be able to move with in minutes of onset of illness.The joints of hands mainly the metacarpo phalangeal and proximal inter phalangeal joints become warm swollen and very painful.Wrist and elbow are also affected to a lesser extend.The joints of ankle,feet and to a lesser extend hip are all affected.
Itchy reddish raised rash is typically seen[70%] when the fever subsides, which in most of my patients was by 3 days.Many patients and Physicians confuse it with drug rash due to allergy to the medicines the patient took for fever and joint pain.
Rash is typically seen on the cheeks, nose and outer part of ears.The ear lobe is typically painful to touch. The rash is also seen over the trunk and limbs with severe itching which lasts for only 2 days. There will be painful swelling of ankle and shin with dark red discoloration. Painful oral ulcers are also seen during this time.Last year I had few patients with enlarged cervical lymph nodes, which disappeared in few days.
Although rare, the infection can result in meningo-encephalitis, especially in newborns and those with pre-existing medical conditions. Pregnant women can pass the infection to their foetus. Severe cases of Chikungunya can occur in the elderly, in very young ones (newborns) and in those who are immuno-compromised.
Chikungunya outbreaks typically result in several hundreds or thousands of cases but deaths are rarely encountered.
Differential diagnosis of Chikungunya includes Dengue and Dengue Haemorrhagic Fever,
O’nyong-nyong virus infection and Sindbis virus infection.
It has been reported that attack rates in susceptible populations may be as high as 40-85 per cent and the ratio of symptomatic to asymptomatic patients is about 1.2:1.
Children are less likely to experience joint pain, but may have other features such as febrile fits, vomiting, abdominal pain and constipation.
The discoloration of the nose usually lasts for months.I call it the seal of Chikugunya as I can identify a person who had Chikungunya in the recent past seeing that seal.
Some patients may remain feverish for some more days. The joint pain become less in few days. In about 60 percent of the patients the ilness including the joint pains last only about a week.They become completly all right with only a little bit of tiredness remaining.
But in about 40% of patients joint pain increases or persists.The chronic joint pain of Chikungunya resembles that of Rheumatoid arthritis. The joints commonly involved are the wrists and the knees.The ankle and smaller joints of feet and hands are also involved.Stiffness of these joints in the morning lasting more than 30 mts is typical. The patient feels better as he/she continues to move the joints.
The joint stiffness and pain lasts for about 3 months in about 30% of patients in my practise. But in an unfortunate 10% it may last indefinitely.
Lab Diagnosis of Chikungunya fever
Virus isolation and PCR techniques are costly and is available in very few centres. Serological diagnosis is possible only after a week of onset by detecting antibodies. As the treatment is mostly symptom specefic diagnosis will not alter patient management much. So the typical triad of fever, acute onset joint pains and rash along with a low white cell count in blood sample is sufficient enough to diagnose Chikungunya fever
Treatment of Chikungunya fever
Paracetamol 10 to 15mg per kg body weight given 3 to 4 times a day reduces the fever.It is needed only in the first 2 to 3 days of illness.
Non Steroidal anti inflammatory agents have to be given liberally to reduce the pain and swelling. This may have to be continued for few weeks in some patients with persistent joint pain. Renal and Gastric safety have to ensured while taking such medicines.
Short course of steroids like Prednisolone also helps in resistant cases.
Other analgesics like Tramadol are also useful.
Disease modifying anti rheumatic agents like Chloroquine have been found useful in some studies.Personally I feel Chloroquine is not of much help as it is a slow acting drug taking almost 3 months to be fully effective.
Most of the patients who turned to alternative systems of medicine for relief came back to me saying there is no relief to pain.Many had to take NSAIDs along with their Ayurvedic and Homeopathic medicines which proved that other systems have nothing much to offer.
In short Chikungunya fever is easy to diagnose but not that easy to treat, but to those who suffer it is pure hell.
Let me tell you a little more about this virus and the illness it causes in humans.
Chikungunya is a re-emerging, mosquito-borne viral infection causing fever, rash and acute or sudden severe joint pains of several joints.Chikungunya (Chick’-en-GUN-yah) in Swahili an African language meaning “that which contorts or bends up” refers to the contorted (stooped) posture of patients who are afflicted with severe joint pains (arthralgia) the most common feature of the disease.
Chikungunya virus is a single-stranded RNA Alphavirus, from the family Togaviridae. Other Alphaviruses also causing fever, rash and arthralgia, include O’nyong-nyong, Mayaro,Barmah Forest, Ross River and Sindbis viruses. Chikungunya virus is most closely related to O’nyong-nyong, but remains genetically distinct.
The disease was first described by Marion Robinson and W.H.R. Lumsden, following an outbreak along the border between Tanzania(erstwhile Tanganyika) and Mozambique, in1952. Since 1953, the virus has caused outbreaks in Africa and South Eastern Asia, including India, Sri Lanka, Myanmar, Thailand, Indonesia, the Philippines and Malaysia, which are well documented. There is historical evidence that Chikungunya virus originated in Africa and subsequently spread to Asia. Phylogenetic studies support this theory, with Chikungunya virus strains falling into three distinct genotypes based on origin from West Africa, Central/East Africa or Asia.
Chikungunya is transmitted by the bite of the infected Aedes mosquito from an infected person to a healthy person. The disease does not get transmitted directly from human to human (i.e. it is not a contagious disease). In a pregnant woman with Chikungunya there is risk of transmitting the disease to her foetus.
The fever starts usually about 2 to 3 days after the entry of virus into the human body. There will be severe chills and shaking of the body at the onset of fever.At the same time the joint pain and swelling starts.The patient will not be able to move with in minutes of onset of illness.The joints of hands mainly the metacarpo phalangeal and proximal inter phalangeal joints become warm swollen and very painful.Wrist and elbow are also affected to a lesser extend.The joints of ankle,feet and to a lesser extend hip are all affected.
Itchy reddish raised rash is typically seen[70%] when the fever subsides, which in most of my patients was by 3 days.Many patients and Physicians confuse it with drug rash due to allergy to the medicines the patient took for fever and joint pain.
Rash is typically seen on the cheeks, nose and outer part of ears.The ear lobe is typically painful to touch. The rash is also seen over the trunk and limbs with severe itching which lasts for only 2 days. There will be painful swelling of ankle and shin with dark red discoloration. Painful oral ulcers are also seen during this time.Last year I had few patients with enlarged cervical lymph nodes, which disappeared in few days.
Although rare, the infection can result in meningo-encephalitis, especially in newborns and those with pre-existing medical conditions. Pregnant women can pass the infection to their foetus. Severe cases of Chikungunya can occur in the elderly, in very young ones (newborns) and in those who are immuno-compromised.
Chikungunya outbreaks typically result in several hundreds or thousands of cases but deaths are rarely encountered.
Differential diagnosis of Chikungunya includes Dengue and Dengue Haemorrhagic Fever,
O’nyong-nyong virus infection and Sindbis virus infection.
It has been reported that attack rates in susceptible populations may be as high as 40-85 per cent and the ratio of symptomatic to asymptomatic patients is about 1.2:1.
Children are less likely to experience joint pain, but may have other features such as febrile fits, vomiting, abdominal pain and constipation.
The discoloration of the nose usually lasts for months.I call it the seal of Chikugunya as I can identify a person who had Chikungunya in the recent past seeing that seal.
Some patients may remain feverish for some more days. The joint pain become less in few days. In about 60 percent of the patients the ilness including the joint pains last only about a week.They become completly all right with only a little bit of tiredness remaining.
But in about 40% of patients joint pain increases or persists.The chronic joint pain of Chikungunya resembles that of Rheumatoid arthritis. The joints commonly involved are the wrists and the knees.The ankle and smaller joints of feet and hands are also involved.Stiffness of these joints in the morning lasting more than 30 mts is typical. The patient feels better as he/she continues to move the joints.
The joint stiffness and pain lasts for about 3 months in about 30% of patients in my practise. But in an unfortunate 10% it may last indefinitely.
Lab Diagnosis of Chikungunya fever
Virus isolation and PCR techniques are costly and is available in very few centres. Serological diagnosis is possible only after a week of onset by detecting antibodies. As the treatment is mostly symptom specefic diagnosis will not alter patient management much. So the typical triad of fever, acute onset joint pains and rash along with a low white cell count in blood sample is sufficient enough to diagnose Chikungunya fever
Treatment of Chikungunya fever
Paracetamol 10 to 15mg per kg body weight given 3 to 4 times a day reduces the fever.It is needed only in the first 2 to 3 days of illness.
Non Steroidal anti inflammatory agents have to be given liberally to reduce the pain and swelling. This may have to be continued for few weeks in some patients with persistent joint pain. Renal and Gastric safety have to ensured while taking such medicines.
Short course of steroids like Prednisolone also helps in resistant cases.
Other analgesics like Tramadol are also useful.
Disease modifying anti rheumatic agents like Chloroquine have been found useful in some studies.Personally I feel Chloroquine is not of much help as it is a slow acting drug taking almost 3 months to be fully effective.
Most of the patients who turned to alternative systems of medicine for relief came back to me saying there is no relief to pain.Many had to take NSAIDs along with their Ayurvedic and Homeopathic medicines which proved that other systems have nothing much to offer.
In short Chikungunya fever is easy to diagnose but not that easy to treat, but to those who suffer it is pure hell.
Thursday, October 2, 2008
Smoking banned in public places from today
India on Thursday once again imposed a countrywide ban on smoking in public spaces in its fight against tobacco use, four years after a largely ignored earlier prohibition saw people continue to puff away in restaurants, clubs and bars.The ban, aimed at the country's 120 million smokers, has received a good response from people across the country,Health Minister Anbumani Ramadoss asserted.
"It is a continuous process, ... and the message will go across through repeated awareness campaigns by the government and the media," Ramadoss, a tireless anti-smoking campaigner, told reporters.
The new order bars smoking in hotels, eateries, cafes, pubs, bars, discotheques, offices, airports, railway stations, bus stops, shopping malls and parks. People can continue to smoke in private homes and open spaces.The new ban has directed establishments to appoint anti-smoking officers who will be liable if people smoke.
Britain, France, Ireland and Thailand are among the countries that already have similar bans in place.
The fine for violating India's order is 200 rupees (4.29 dollars), but health authorities said higher fines of up to 25 dollars were being contemplated.
The new Smoking in Public Places Rules 2008 came into force on the anniversary of the birth of Mahatma Gandhi the Father of Nation, who was known for his ascetic habits.
Citing a survey that found that 52 per cent of children took up smoking after watching film stars lighting up on the screen, Ramadoss appealed to Bollywood celebrities not to encourage smoking.
"People look up to celebrities and follow them," the minister said. "Our popular film star Rajnikanth has stopped smoking in movies. Other stars should also set an example."
Besides the police, government officers; inspectors of central excise, sales tax, transport and health departments; and principals of schools have been given powers to fine violators on their respective premises.
Officials acknowledged that enforcement might not be easy.
India is the third-largest tobacco producer and consumer in the world after China and the United States.
According to a Health Ministry release, more than 2,200 Indians die every day from tobacco use. They are at risk from cardiovascular diseases like heart attacks, strokes and cancer.
A recent study by a team of doctors showed that tobacco smoking would kill 1 million people annually beginning in 2010.
Saying India is in the midst of a "catastrophic epidemic of smoking deaths," the doctors warned that nearly 70 per cent of the million deaths would take place among smokers in their prime.
In this large, nationally representative case–control study, it was found that in both rural and urban India, among men between the ages of 30 and 69 years, the rate of death from any medical cause in smokers was 1.7 times that in nonsmokers of similar age, educational level, and alcohol status (use or nonuse). Among female smokers, mortality from any medical cause was double that among their nonsmoking counterparts.
If you are still not convinced about quitting smoking read this and decide.
"It is a continuous process, ... and the message will go across through repeated awareness campaigns by the government and the media," Ramadoss, a tireless anti-smoking campaigner, told reporters.
The new order bars smoking in hotels, eateries, cafes, pubs, bars, discotheques, offices, airports, railway stations, bus stops, shopping malls and parks. People can continue to smoke in private homes and open spaces.The new ban has directed establishments to appoint anti-smoking officers who will be liable if people smoke.
Britain, France, Ireland and Thailand are among the countries that already have similar bans in place.
The fine for violating India's order is 200 rupees (4.29 dollars), but health authorities said higher fines of up to 25 dollars were being contemplated.
The new Smoking in Public Places Rules 2008 came into force on the anniversary of the birth of Mahatma Gandhi the Father of Nation, who was known for his ascetic habits.
Citing a survey that found that 52 per cent of children took up smoking after watching film stars lighting up on the screen, Ramadoss appealed to Bollywood celebrities not to encourage smoking.
"People look up to celebrities and follow them," the minister said. "Our popular film star Rajnikanth has stopped smoking in movies. Other stars should also set an example."
Besides the police, government officers; inspectors of central excise, sales tax, transport and health departments; and principals of schools have been given powers to fine violators on their respective premises.
Officials acknowledged that enforcement might not be easy.
India is the third-largest tobacco producer and consumer in the world after China and the United States.
According to a Health Ministry release, more than 2,200 Indians die every day from tobacco use. They are at risk from cardiovascular diseases like heart attacks, strokes and cancer.
A recent study by a team of doctors showed that tobacco smoking would kill 1 million people annually beginning in 2010.
Saying India is in the midst of a "catastrophic epidemic of smoking deaths," the doctors warned that nearly 70 per cent of the million deaths would take place among smokers in their prime.
In this large, nationally representative case–control study, it was found that in both rural and urban India, among men between the ages of 30 and 69 years, the rate of death from any medical cause in smokers was 1.7 times that in nonsmokers of similar age, educational level, and alcohol status (use or nonuse). Among female smokers, mortality from any medical cause was double that among their nonsmoking counterparts.
If you are still not convinced about quitting smoking read this and decide.
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