A toolkit to evaluate the quality of health stories published in the Indian newspapers and in the electronic media has been launched to help journalists and health correspondents evaluate media stories on new tests, treatments and procedures, on health advice, health policy and public health stories.

The toolkit known as Media Doctor is modeled after a similar pioneering checklist developed in Australia that ran from 2003 to 2013. However, the toolkit has been modified in the Indian context after several consultations with journalists and media academics and now comprises four checklists – one each to look at stories on new tests and treatments, health advice, health policy and public health.

The toolkit was launched at the University of Shantiniketan over the weekend. Dr. Biplab Loho Choudhury was part of the media doctor pilot in India also hosted the launch.

Mr. Kannan Krishnaswamy, our Communications Manager, teamed up with the University of Newcastle, Australia to Indianise the tool and will be helping in facilitating workshops for journalists, media students and faculty members of journalism institutions to familiarize them with these tools and to encourage them to use the same. 

This is the first version of the toolkit that is being made available to journalists and media students. Based on feedback from stakeholders, the version will be fine-tuned and a second improved version will be launched later this year.

Dr. Vivekanand Jha, our Executive Director commended the tool launch. He says:

"Although we we do not need structured tools to evaluate any media story about health in general. but they do prevent us from overlooking important aspects of a story. They also highlight opinions which can be constructively challenged and discussed and provide a method of comparing the quality of stories from various outlets, besides also providing a means of following trends over time,” 

Dr. David Smith of the University of Newcastle, Australia,  played a significant role in the development of the toolkit both in Australia and in India. He says:

“Readers make significant health care decisions based on what they read in newspapers or see in electronic channels. Policy makers are influenced by public opinion, and public opinion is in great part determined by the media.  And at a more philosophical level, if the public has a ‘right to know ‘, it has a right to good quality information,” 

“The quality of health stories in the media often leave much to be desired. Lots of studies have shown that quality can be reduced to two fundamental values of accuracy and completeness. Quality can thus be rated using tools that reemphasize these values of completeness and accuracy. That is what Media Doctor Australia (MDA) and Media doctor India (MDI) are all about.,” .  

All the rating items in the MDI tools relate to the value of completeness or accuracy. In a practical way, a story of high quality as MDI and MDA define quality, will be one that scores well with the application of the appropriate rating tool.

Armed with an innovative  repertoire of health practices, Dr. Gopal Pai, General Manager, George Clinical, represented the George Institute for Global Health  at the Australia  country session as part of the Make in India Week  in Mumbai last week and showcased George’s contribution to medical and pharmaceutical research.
 
He was part of  a  delegation of 50 government and business leaders representing a range of Australian expertise in multiple sectors.
 
Dr. Pai, whose session was entitled  “Make in India: Impacting Health Practices for Indians” highlighted the involvement of the George Institute and George Clinical in high quality academic and in regulated and commercial research.
  
Acting Australian High Commissioner Chris Elstoft said Australia’s engagement in Make in India Week was an important step in helping convert business opportunities into outcomes for the two nations.

“Each of the sectors from Australian business taking part in the event will be crucial to India achieving its ‘Make in India’ dream,” he said.

“As Prime Minister Modi suggested when he visited Australia, in every area of national priority for India, he sees Australia as a natural partner – this delegation embodies that seamless fit between Indian priorities and Australian capability.”

The sectors represented include energy, resources and water, industrial design, infrastructure investment, pharmaceutical research, agribusiness, metals recycling for manufacturing inputs, and agribusiness. 

The Country Session showcased Australian expertise across a number of sectors and profiled its engagement in India by large corporations to small companies.

Rio Tinto and Woodside, two of Australia’s biggest resource companies, were present during the Session, while other participants include industrial design expert Mark Watson speaking on Smart Cities and Yes Bank will discuss the benefits of partnering with Australia.

Mr. Elstoft said the Modi Government’s successful ‘Make in India’ program had boosted India’s manufacturing sector, and would provide ongoing impetus to India’s robust economy.

 “With a growth forecast of 7.6 percent for 2015-16, India is one of the fastest growing economies in the world. The level of Australian engagement in Make in India Week is evidence of Australian business confidence in the opportunities for doing business with India,” he said.

By Professor Vivekanand Jha. First published by ETHealthWorld.com

Dialysis is one of the first technological innovations in medicine - and the only treatment that does not involve transplant, and yet allows a patient with end stage organ failure to live long, healthy and productive lives. Currently, about 2.4 million people are alive on dialysis worldwide.

Dialysis removes the “waste” chemicals that accumulate in the blood because the failed kidneys are unable to excrete them. It can be done in two ways: haemodialysis in which the blood is taken out of the body and passed through a machine, and peritoneal dialysis, in which a natural internal membrane lining the abdomen is used to clear the blood. The first one is typically done at dialysis facilities, whereas the second one is done at home. Since the “waste” accumulation is continuous, dialysis must be repeated at regular intervals. This is critical, since the long-term and repetitive nature of this treatment has major health and economic implications.

In India, dialysis is reserved for the very rich, or to those lucky enough to be eligible for full medical reimbursement. Everyone else faces crippling long term expenditure and descent into deep poverty. It is estimated that about 200,000 new patients develop end-stage kidney failure every year in India. Even though about 70-80% of them actually start dialysis, resource limitations force about two-thirds of the starters to withdraw and be condemned to death. Most of these patients are young, in the prime of their lives - family breadwinners or homemakers. Losing them has devastating impact not only on the families but brings down the productivity of entire society and reduces the national income.

As the size of the middle class, and people with “disposable incomes” has grown, the number of people seeking - and staying on - dialysis is increasing. Dialysis centres, till recently the preserve of large cities, are opening regularly even in smaller cities, thus bringing the treatment close to patients' homes. Estimates put the number of patients on dialysis in India currently at about 100,000. India’s demand for dialysis is growing at a rate of 31 percent, compared to 6 percent in the US and 8 percent in the rest of the world. Mathematical modelling using data from comparable countries shows that if access to treatment was not restricted, this number would be approximately 1,100,000, highlighting a large unmet need, and therefore an opportunity.

The quality of treatment across facilities is uneven, and is especially poor in smaller towns. Setting up a dialysis facility requires practically no regulatory approval. Many centres adopt questionable strategies to cut costs and maximize profits, often compromising outcomes. Mom-and-Pop dialysis units run in several instances by non-physicians, get away with practices that would earn opprobrium in mature medical systems. Information asymmetry, cost and geographic limitations force patients to accept whatever they get.

Patients on dialysis have complications related to many other organ systems - the main ones being cardiovascular disease, lack of production of red blood cells, and abnormal bone health. All this requires regular monitoring, ideally by nephrologists, of whom there are only about 1600 in the entire country (just about 1.3 for every million Indians). Similarly, the number of trained dialysis technicians and nurses is woefully small.

A major gap is lack of reliable data to guide practice. All over the world, programs mandatorily collect and report data on the clinical outcomes of dialysis patients, an important activity that helps decide how the programs stand up to international comparisons, and provide valuable information to the public and policy makers.

There are signs, however, that things might be changing. The main drivers of this change are changing reimbursement policies, increasing coverage through insurance schemes, empowered consumers, involvement of professional societies and consolidation of dialysis industry. But there is evidence that an increasing number of individuals are benefitting from these schemes. The Indian Society of Nephrology has published guidelines to empower nephrologist-physicians looking to set up dialysis units and implement quality standards. The entry of dialysis chains, like NephroPlus, DaVita and Sparsh is likely to bring operational as well as clinical improvements, through establishment of quality measures, uniform protocol-driven practices and accountability. There has been a sharp increase in the number of nephroloist training positions, and at this time about 100 seats are available every year. Efforts are being made to scientifically evaluate outcomes of patients on dialysis through systematic studies.

The demand for dialysis is only going to go up, and the society urgently needs to explore cost-effective and scalable solutions over a relatively short time frame. One option is promoting peritoneal dialysis, which is cheaper, does not have infrastructure and manpower requirements, and has been adopted as the preferred modality by many countries - Thailand being the latest example.

Industry also needs to come to the fore - with indigenous manufacturing of dialysis machines and disposables, which will reduce the cost. There is a global drive to find cheaper dialysis solutions, only then will Indian patients be able to get the full benefit of this lifesaving therapy.

Professor Vivekanand Jha is the Executive Director of The George Institute, India, and Professor of Nephrology and James Martin Professorial Fellow at the University of Oxford.

India, China buck the global trend when it comes to injuries due to road crashes and self-harm  

Prevention measures and improved access to better quality care after an injury have brought about a significant decline in the burden of injury in high income regions. However emerging economies such as India, Brazil, Russia, China and South Africa continue to experience disproportionately high rates of injury and few of the declines.

As part of a global collaboration, researchers mined the latest GBD update in 2013 to assess the impact of 26 causes of injury and 47 types of injury, dating back to 1990, for 188 countries in 21 regions of the world. They used data on the number of injuries, deaths from injuries, and a measure known as disability-adjusted life years, or DALYs for short. The DALY is calculated by adding together years of life lost to death and years of life lived with a disability.

The researchers, who published the findings in the journal Injury Prevention recently, calculated that in 2013 almost 1 billion people (973 million) sustained injuries that required medical attention/treatment, accounting for 10% of the global toll of disease.

Major causes included road injury, which made up 29% of the total, followed by self-harm (17.6%); falls (11.6%); and violence (8.5%).

With good prevention measures since the 1970s countries like Australia and Sweden have significantly reduced road traffic fatalities.  However, when it comes to low and middle income countries, the numbers are increasing significantly. 

“It is to be noted that many of the low and middle income countries do not have comprehensive road safety laws that cover all five major risk factors for road traffic injuries. And the problem is further accentuated by poor enforcement where the laws exist,” said Professor Rebecca Ivers, Head of the Injury Division at the George Institute for Global Health.

“Good laws accompanied with education and enforcement, are the key to reduce road injury mortality,” she added.

Self-harm is the second leading cause of death from injury and it is a main contributor to injury DALYs. Over the period 1950–1995 the global self-harm death rates were reported by WHO to have increased, although the authors noted that the figures should be interpreted with caution because the 1950 estimates were based on data from 11 countries. 

More than half of all self-harm DALYs occur in East and South Asia. The trends in these regions are in opposite directions, decreasing significantly and by a great margin in East Asia but rising, though not significantly, in South Asia between 1990 and 2013.

“Over the past two decades China and India have experienced rapid economic growth and urbanization and therefore the opposing trends would need to be explained by other factors, such as the distribution of increasing wealth, cultural shifts, ease of access to mental health treatment, ease of access to the main means for self-harm, and other factors,” reported the paper’s authors.  

Coverage of vital registration is low or absent in large parts of the world and there are issues in standardization of data, completeness and validity. “For these regions where robust data is unavailable, best estimates can only be made using models, relying on covariates and verbal autopsy,” pointed out Prof Ivers. 

Besides hospital data collection systems hospital-based trauma registries have become well established in high-income countries and are emerging in some low-income and middle-income countries. “Such registries are critical to help understand the burden of trauma, plan clinical care and evaluate effectiveness of prevention and treatment programs” Prof Ivers said.

“Injuries continue to be a major cause of death and disability in both high and low income settings. Given increases that are still seen in many countries and population groups, we must not be complacent about either prevention, or care. There remains a huge need for Governments and donors to provide universal access to health care, and invest in prevention programs, particularly in the developing economies of the world,” she added.