JANUARY 2017
THE DOCTOR’S PEOPLE
Volume : 89
Year : 08
New Delhi
Pages : 19
: 125
THE BEST IS YET TO COME.
THE NEW YEAR IS FULL OF THINGS
THAT HAVE NEVER BEEN.
Beautiful li
fe
in stories
om e
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Editor ’s Po
int of view
rites
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Medic
Our regula
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INDEX
TEAM BRIEF
THE DOCTOR'S PEOPLE
Editor
Dr. Mahesh Baldwa
Editorial Assistants
Vijay Arora. (M.B.A. L.L.B)
Yatindra Singh Bisht.
Graphics & Design
Design Accent
Advertising Director
Sanjay K. Mishra.
Operational Support
Monica Gosain.
Circulation Manager
Deepak Chabra.
Anurag Mishra.
Publication Support
Rajan Kumar. & Pradeep Sodhi.
2 Beautiful Life Through Stories
4 Life Is Awesome
6 Medical News Update
Disclaimer for Doctor’s People Magazine
Medical and medico-legal field is always in a dynamic state, with a
continuous influx of new knowledge, practices and judicial pronouncement.
Everyday results of new researches new judicial pronouncements broaden
our understanding of the subject, improve our medical and legal practices
and change our approach and methods. Doctors should use their clinical
acumen, experience, skill and knowledge in evaluating and using any
information written in brochure supplied by drug manufacturers,
techniques, procedures, equipment, but should not experiments without
ICMR and institutional ethics committee approval. In clinically applying such
knowledge or methods they should be careful of their own safety as well as
that of others, including parties for whom they have a professional liability.
When using any drug described herewith, readers are advised to check the
most current information provided by the manufacturer. They should verify
the recommended dose or formula, the method, route and duration of
administration, side effects and contra-indications. The clinician should
assess each patient individually and use their own knowledge, skill and
experience to make a diagnosis and determine the best peri-operative or
procedural anesthetic regime for each patient. Contributors are individually
responsible for their respective opinions, views, information and figures
assimilated in their respective chapters and are hereof individually
responsible for the source of such information.
To the fullest extent of the law, neither the publisher, nor the authors,
contributors nor editors assume any liability for any injury and / or damage
to persons or property as a matter of product liability, negligence or
otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.
Editor’s Point Of View
Dear colleagues,
Greetings for the New Year. Last year there were lots of tussles
regarding the medical council's existence and replacement with
the national medical commission, but as yet MCI appears to be the
winner. This time, let me talk about ethics, morals and related
ethical code. As you all know the medical profession is comprised
of a motley group of practitioners, each subscribing to a different
system of medicine. Allopaths constitute 43.3% of the profession,
homeopaths 16% and practitioners of Indian systems of medicine
(viz. Ashtang Ayurveda, Unani Tibb, Siddha) account for 35.7% of
all trained medical personnel. Most of these professionals conduct
private practice in urban areas and in an individual capacity. The
urban concentration is particularly indicated for allopaths (72.8%
of them were found in towns and cities) and to a lesser extent for
practitioners of the Ayurveda and Unani (42.7% and 61.2% of
whom were in urban areas).
Main ethical aspects: Four cardinal ethical principles of importance
in brief
The word, “ethics” is derived from the Greek word ‘ethos’ which
means customs and habits. It means something in conformity with
moral norms or standard of professional conduct. The word relates
to the precepts which should control moral behaviour. Ethics is that
science of knowledge, which deals with the nature and grounds of
moral obligations, distinguishing what is right from what is wrong.
There are four basic ethical principles underlying good medicoethical practice in western countries. Four pillars of these
principles are autonomy, justice, beneficence and nonmaleficence amongst others. They sound tongue twisters and also
of little help in day to day practice yet we shall discuss the age old
principles in brief to benefit our insight to decode ethics-2002.
The term profession is derived from the original Latin profiteor. For
the medical professional, this public commitment is to the welfare
of patients and for improving the health status of people. This
medical morality, avowal, the public commitment has been behind
it as tradition for many centuries. Since the dawn of the
civilization, by trial and error, it has become established that a
society and more so it’s medical profession, a publicly oriented and
noble profession, cannot survive and thrive without observance
and practice of certain rules of conduct guided by ethical, moral,
legal and social values of the land.
The first principle is autonomy: the right of a fully informed parent
to choose out of the treatment offered to the patient.
Human culture is built upon the foundation of value system formed
on the basis of the society, ethical fabric of honesty, integrity,
respect to each other, pursuit of excellence, happiness by adhering
to civic duties, accountability and loyalty to one and all elements of
society.
Before ethics 2002 code there were other codes also. Few of the
ethical codes are
1.
2.
3.
4.
Hippocratic Oath;
Declaration of Geneva;
Declaration of Helsinki;
International Code of Medical Ethics
The second principle is called justice: the right to receive what is
recommended by RMP. Justice in this concept might be interpreted
as meaning that patients are entitled to be treated fairly and
equally by their doctors. Equitable distribution of medical
resources may be another meaning of justice. Health professionals
should not show preference for patients to enjoy a particular
status, or provide substandard care for patient of whom they
disapprove.
The third principle is beneficence: the obligation of RMP to do good
in a given situation before, during and after the administration of
treatment. This does not necessarily imply to preserve life at all
costs.
The fourth and final principle, we shall discuss is non-maleficence:
the obligation to avoid doing harm while giving treatment (Latin primum non nocere).
With this note of advice about basic four principles of ethics, one
can easily practice safely.
Wishing you a happy New Year and happy medical practice.
“The patient will never care how much you know, until they know
how much you care.”
Dr. (Prof.) Mahesh Baldwa,
M.D, D.C.H, FIAP, MBA:, LL.B, LL.M, PhD (law)
SENIOR PAEDIATRICIAN & SENIOR MEDICO-LEGAL ADVISOR
Beautiful Life in stories
A Little Tiny Thing
OUT in the garden Mary sat hemming a pocket-handkerchief, and there came a little insect running—oh, in such a hurry! —across the small stone table
by her side.
The sewing was not done, for Mary liked doing nothing best, and she thought it would be fun to drop her thimble over the little ant. “Now he is in the
dark,” said she. “Can he mind? He is only such a little tiny thing.”
Mary ran away, for her mother called her, and she forgot all about the ant under the thimble.
There he was, running round and round and round the dark prison, with little horns on his head quivering, little perfect legs bending as beautifully as
those of a race-horse, and he was in quite as big a fright as if he were an elephant.
“Oh,” you would have heard him say, if you had been clever enough, “I can’t get out, I can’t get out! I shall lie down and die.” ” Mary went to bed, and in
the night the rain poured. The handkerchief was soaked as if somebody had been crying very much, when she went out to fetch it as soon as the sun
shone. She remembered who was under the thimble. “I wonder what he is doing,” said Mary. But when she lifted up the thimble the little tiny thing lay
stiff and still.
“Oh, did he die of being under the thimble?” she said aloud. “I am afraid he did mind.”
“Why did you do that, Mary?” said her father, who was close by, and who had guessed the truth. “See! he moves one of his legs. Run to the house and
fetch a wee taste of honey from the breakfast-table for the little thing you starved.”
“I didn’t mean to,” said Mary.
She touched the honey in the spoon with a blade of grass, and tenderly put a drop of it before the little ant. He put out a fairy tongue to lick up the sweet
stuff. He grew well, and stood upon his pretty little jointed feet. He tried to run.
“Where is he in such a hurry to go, do you think?” said father.
“I don’t know,” said Mary softly. She felt ashamed.
“He wants to run home,” said father. “I know where he lives. In a little round world of ants, under the apple tree.”
“Oh! Has such a little tiny thing a real home of his own? I should have thought he lived just anywhere about.”
“Why, he would not like that at all. At home, he has a fine palace, with passages and rooms more than you could count; he and the others dug them out,
that they might all live together like little people in a little town.”
“And has he got a wife and children—a lot of little ants at home?”
“The baby ants are born as eggs; they are little helpless things, and must be carried about by their big relations. There are father ants and mother ants,
and lots of other ants who are nurses to the little ones. Nobody knows his own children, but all the grown-up ones are kind to all the babies. This is a little
nurse ant. See how she hurries off! Her babies at home must have their faces washed.”
“O father!” cried Mary; “now that is a fairy story.”
“Not a bit of it,” said father. “Ants really do clean their young ones by licking them. On sunny days they carry their babies out, and let them lie in the sun.
On cold days they take them downstairs, away from the cold wind and the rain. The worker ants are the nurses. Though the little ones are not theirs, they
love them and care for them as dearly as if they were.”
“Why, that’s just, like Aunt Jenny who lives with us, and mends our things, and puts baby to bed, and goes out for walks with us.”
“Just the same,” said father, laughing.
“Is that the reason we say Ant Jenny?”
“You little dunce! Who taught you to spell? But it is not a bad idea, all the same. It would be a good thing if there were as many ‘ant’ Jennys in this big
round world of ours as there are in the ants’ little round world—folk who care for all, no matter whose children they are.”
While they were talking, the little ant crept to the edge of the table, and down the side, and was soon lost among the blades of grass.
“He will never find his way,” said Mary.
“Let him alone for that,” said father. “The ants have paths leading from their hill. They never lose their way. But they meet with sad accidents sometimes.
What do you think I saw the other day? One of these small chaps—it may have been this very one—was carrying home a scrap of something in his jaws
for the youngsters at home. As he ran along, a bird dropped an ivy berry on him. Poor mite of a thing! This was worse than if a cannon ball were to fall
from the sky on one of us. He lay under it, not able to move. By-and-by one of his brother ants, who was taking a stroll, caught sight of him under the
berry.
“What did he do?” said Mary.
“First, he tried to push the berry off his friend’s body, but it was too heavy. Next he caught hold of one of his friend’s legs with his jaws, and tugged till I
thought it would come off. Then he rushed about in a frantic state, as if he were saying to himself, ‘What shall I do? what shall I do?’ And then he ran off up
the path. In another minute he came hurrying back with three other ants.”
“Is it quite true, father?”
“Quite. The four ants talked together by gentle touches of their horns. They looked as if they were telling one another what a dreadful accident, it was,
and how nobody knew whose turn would come next. After this they set to work with a will. Two of them pushed the berry as hard as they could, while the
other two pulled their friend out by the hind legs. When at last he was free, they crowded round as if petting and kissing him. You see these little ant folk
have found out that ‘’Tis love, love, love, that makes the world go round.’ I shouldn’t wonder if that ant you teased so thoughtlessly is gone off to tell the
news at home that there is a drop of honey to be had here.”
“Oh, he couldn’t, father!”
“Wait and see,” said father.
In a little while back came the ant with a troop of friends.
“He has been home and told them the good news about the honey,” said father. “Do you think that all children are as kind as that?”
Mary said, “No, they’re not. I don’t run to call all the others when I find a good place for blackberries.”
“Then,” said father, “don’t be unkind to the ant, who is kinder than you, though he is only a little tiny thing.”
A Pair of Silk Stockings
By Kate Chopin
Little Mrs. Sommers one day found herself the unexpected possessor of fifteen dollars. It seemed to her a very large amount of money, and the way in
which it stuffed and bulged her worn old Porte-monnaie gave her a feeling of importance such as she had not enjoyed for years.
The question of investment was one that occupied her greatly. For a day or two she walked about apparently in a dreamy state, but really absorbed in
speculation and calculation. She did not wish to act hastily, to do anything she might afterward regret. But it was during the still hours of the night when
she lay awake revolving plans in her mind that she seemed to see her way clearly toward a proper and judicious use of the money.
A dollar or two should be added to the price usually paid for Janie's shoes, which would insure their lasting an appreciable time longer than they usually
did. She would buy so and so many yards of percale for new shirt waists for the boys and Janie and Mag. She had intended to make the old ones do by
skilful patching. Mag should have another gown. She had seen some beautiful patterns, veritable bargains in the shop windows. And still there would be
left enough for new stockings--two pairs apiece--and what darning that would save for a while! She would get caps for the boys and sailor-hats for the
girls. The vision of her little brood looking fresh and dainty and new for once in their lives excited her and made her restless and wakeful with
anticipation.
The neighbors sometimes talked of certain "better days" that little Mrs. Sommers had known before she had ever thought of being Mrs. Sommers. She
herself indulged in no such morbid retrospection. She had no time--no second of time to devote to the past. The needs of the present absorbed her
every faculty. A vision of the future like some dim, gaunt monster sometimes appalled her, but luckily tomorrow never comes.
Mrs. Sommers was one who knew the value of bargains; who could stand for hours making her way inch by inch toward the desired object that was
selling below cost. She could elbow her way if need be; she had learned to clutch a piece of goods and hold it and stick to it with persistence and
determination till her turn came to be served, no matter when it came.
But that day she was a little faint and tired. She had swallowed a light luncheon--no! When she came to think of it, between getting the children fed and
the place righted, and preparing herself for the shopping bout, she had actually forgotten to eat any luncheon at all!
She sat herself upon a revolving stool before a counter that was comparatively deserted, trying to gather strength and courage to charge through an
eager multitude that was besieging breastworks of shirting and figured lawn. An all-gone limp feeling had come over her and she rested her hand
aimlessly upon the counter. She wore no gloves. By degrees, she grew aware that her hand had encountered something very soothing, very pleasant to
touch. She looked down to see that her hand lay upon a pile of silk stockings. A placard near by announced that they had been reduced in price from two
dollars and fifty cents to one dollar and ninety-eight cents; and a young girl who stood behind the counter asked her if she wished to examine their line of
silk hosiery. She smiled, just as if she had been asked to inspect a tiara of diamonds with the ultimate view of purchasing it. But she went on feeling the
soft, sheeny luxurious things--with both hands now, holding them up to see them glisten, and to feel them glide serpent-like through her fingers.
Two hectic blotches came suddenly into her pale cheeks. She looked up at the girl.
"Do you think there are any eights-and-a-half among these?"
There were any number of eights-and-a-half. In fact, there were more of that size than any other. Here was a light-blue pair; there were some lavender,
some all black and various shades of tan and gray. Mrs. Sommers selected a black pair and looked at them very long and closely. She pretended to be
examining their texture, which the clerk assured her was excellent.
"A dollar and ninety-eight cents," she mused aloud. "Well, I'll take this pair." She handed the girl a five-dollar bill and waited for her change and for her
parcel. What a very small parcel it was! It seemed lost in the depths of her shabby old shopping-bag.
Mrs. Sommers after that did not move in the direction of the bargain counter. She took the elevator, which carried her to an upper floor into the region of
the ladies' waiting-rooms. Here, in a retired corner, she exchanged her cotton stockings for the new silk ones which she had just bought. She was not
going through any acute mental process or reasoning with herself, nor was she striving to explain to her satisfaction the motive of her action. She was not
thinking at all. She seemed for the time to be taking a rest from that laborious and fatiguing function and to have abandoned herself to some mechanical
impulse that directed her actions and freed her of responsibility.
How good was the touch of the raw silk to her flesh! She felt like lying back in the cushioned chair and revelling for a while in the luxury of it. She did for a
little while. Then she replaced her shoes, rolled the cotton stockings together and thrust them into her bag. After doing this she crossed straight over to
the shoe department and took her seat to be fitted.
She was fastidious. The clerk could not make her out; he could not reconcile her shoes with her stockings, and she was not too easily pleased. She held
back her skirts and turned her feet one way and her head another way as she glanced down at the polished, pointed-tipped boots. Her foot and ankle
looked very pretty. She could not realize that they belonged to her and were a part of herself. She wanted an excellent and stylish fit, she told the young
fellow who served her, and she did not mind the difference of a dollar or two more in the price so long as she got what she desired.
It was a long time since Mrs. Sommers had been fitted with gloves. On rare occasions when she had bought a pair they were always "bargains," so cheap
that it would have been preposterous and unreasonable to have expected them to be fitted to the hand.
Now she rested her elbow on the cushion of the glove counter, and a pretty, pleasant young creature, delicate and deft of touch, drew a long-wristed
"kid" over Mrs. Sommers's hand. She smoothed it down over the wrist and buttoned it neatly, and both lost themselves for a second or two in admiring
contemplation of the little symmetrical gloved hand. But there were other places where money might be spent.
There were books and magazines piled up in the window of a stall a few paces down the street. Mrs. Sommers bought two high-priced magazines such as
she had been accustomed to read in the days when she had been accustomed to other pleasant things. She carried them without wrapping. As well as
she could she lifted her skirts at the crossings. Her stockings and boots and well fitting gloves had worked marvels in her bearing--had given her a feeling
of assurance, a sense of belonging to the well-dressed multitude.
She was very hungry. Another time she would have stilled the cravings for food until reaching her own home, where she would have brewed herself a cup
of tea and taken a snack of anything that was available. But the impulse that was guiding her would not suffer her to entertain any such thought.
There was a restaurant at the corner. She had never entered its doors; from the outside, she had sometimes caught glimpses of spotless damask and
shining crystal, and soft-stepping waiters serving people of fashion.
When she entered her appearance created no surprise, no consternation, as she had half feared it might. She seated herself at a small table alone, and
an attentive waiter at once approached to take her order. She did not want a profusion; she craved a nice and tasty bite--a half dozen blue-points, a
plump chop with cress, a something sweet--a creme-frappee, for instance; a glass of Rhine wine, and after all a small cup of black coffee.
While waiting to be served she removed her gloves very leisurely and laid them beside her. Then she picked up a magazine and glanced through it,
cutting the pages with a blunt edge of her knife. It was all very agreeable. The damask was even more spotless than it had seemed through the window,
and the crystal more sparkling. There were quiet ladies and gentlemen, who did not notice her, lunching at the small tables like her own. A soft, pleasing
strain of music could be heard, and a gentle breeze, was blowing through the window. She tasted a bite, and she read a word or two, and she sipped the
amber wine and wiggled her toes in the silk stockings. The price of it made no difference. She counted the money out to the waiter and left an extra coin
on his tray, whereupon he bowed before her as before a princess of royal blood.
There was still money in her purse, and her next temptation presented itself in the shape of a matinee poster.
It was a little later when she entered the theatre, the play had begun and the house seemed to her to be packed. But there were vacant seats here and
there, and into one of them, she was ushered, between brilliantly dressed women who had gone there to kill time and eat candy and display their gaudy
attire. There were many others who were there solely for the play and acting. It is safe to say there was no one present who bore quite the attitude which
Mrs. Sommers did to her surroundings. She gathered in the whole--stage and players and people in one wide impression, and absorbed it and enjoyed it.
She laughed at the comedy and wept--she and the gaudy woman next to her wept over the tragedy. And they talked a little together over it. And the
gaudy woman wiped her eyes and sniffled on a tiny square of filmy, perfumed lace and passed little Mrs. Sommers her box of candy.
The play was over, the music ceased, the crowd filed out. It was like a dream ended. People scattered in all directions. Mrs. Sommers went to the corner
and waited for the cable car.
A man with keen eyes, who sat opposite to her, seemed to like the study of her small, pale face. It puzzled him to decipher what he saw there. In truth, he
saw nothing-unless he were wizard enough to detect a poignant wish, a powerful longing that the cable car would never stop anywhere, but go on and
on with her forever.
Life Is
Awesome
Toilet paper for smart phones now on offer at Japanese airport
A mobile phone company has installed dispensers for "toilet paper" to be used on smartphones in the conveniences
at Japan's Narita International Airport.
The dispensers have been put in place in 86 toilet cubicles at the airport's arrival terminal, where they will remain
until March 2017.
Provided by NTT Docomo, Japan's largest mobile operator, they will be stocked with paper sheets to be used
to keep phones clean.
The sheets also bear messages welcoming visitors from overseas, and offering information on how to
connect to Docomo's WiFi service.
The company said the service was a response to findings that smartphone screens have been found to carry more than five times the amount of germs of a
toilet seat.
Docomo also published a light-hearted video demonstrating how to use the sheets - along with other information to help visitors get to grips with the hitech public toilets they are likely to encounter in Japan. According to a 2013 study by Ofcom, 11 per cent of Britons admitted to viewing video content on a
phone, tablet or laptop while in the bathroom. The figure was 20 per cent among 18 to 24 year-olds.
Which? Has conducted a number of swab tests on mobile phones that have revealed "hazardous" levels of germs that can cause vomiting and diarrhea and
even infections such as e.coli.
The organisation has urged people to keep their devices clean by using anti-bacterial wipes.
Plane passenger unimpressed by extraordinarily phallic in-flight meal
Airline food doesn't have a great reputation - but this meal, served on a Qantas flight from Sydney to Brisbane, ought
to win some sort of prize for its startling appearance alone.
The passenger who received the meal told news.com.au: “I asked the server what it was ... and he told me that it
was a root vegetable.
“I asked him to pass me my phone so I could take a photo … I never take photos of food but this was too funny
to pass up. “He blushed and was very apologetic, I don’t think he had ever seen anything quite like it … the
lady next to me was cracking up."
The passenger - who declined to give her name - added that she elected against eating the phallic-looking
vegetable, but did polish off the dumplings, which were "delicious".
She later posted the image to Facebook, where one follower commented: “Is that food, or in-flight entertainment?”
The domestic business class menu on Qantas is developed in conjunction with chef Neil Perry from restaurant group Rockpool.
“The cornerstone of good cooking is to source the finest produce,” the site says under its Qantas section.
“Rockpool Consulting endeavours to deliver above and beyond in-flight, bringing restaurant quality to the skies with one eye always casts on consistency,
seasonality and quality of food.”
Qantas described the innuendo-infused meal as:
“Steamed Vegetarian Dumplings with Chilli Black Vinegar and Soy Dressing.
"The dumplings are accompanied with steamed Japanese Eggplant, which is used commonly in Asian meals.
"Based on this picture, we may look at renaming it Dumpling Surprise.”
Diseases That Affect Developing Countries More Than Developed
In the 1950s, the U.S. government declared that malaria was eliminated from the United States. Due to a highly effective vaccine and a high vaccination
rate, the same statement was true for measles in 2000. According to the Centers for Disease Control, for a disease to be eliminated, a region must go 12
or more months without continuous disease transmission.
Despite the eradication of certain health conditions in developed countries like the U.S., Germany and Japan, the same is not true for developing
countries. People in countries like Botswana, Uganda and North Korea lose more healthy years of life to certain diseases that no longer pose a threat to
the developed world. A bevy of issues can impact a developing region's risk of disease, including sanitation disparities between countries, the emergence
of new diseases and poor health care systems.
Because diseases have varying impacts across the world, the data analysts at HealthGrove, a health research site
powered by Graphiq, set out to find the health conditions that affect people in developing countries more than in
developed countries.
The list is ranked in ascending order of diseases that impact developing countries the most. Healthy years of life
lost encompasses both fatal and non-fatal consequences of these diseases. The number of healthy life years lost
is calculated for every 100,000 people.
Many of the conditions on the list — like iodine deficiencies and protein-energy malnutrition — result from
undernutrition. Others — like leishmaniasis
and lymphatic filariasis — occur when parasites enter the body. Unless vaccination efforts, health care
systems, sanitary efforts and education about diseases, improve in developing countries, millions of people will remain more at risk than those in
developed countries for one of these 58 health concerns.
Note: The criteria to determine what is a developing or developed country comes from the Institute for Health Metrics and Evaluation at the University of
Washington. The regions are determined by looking at GDP per capita and educational attainment.
Countries Making the Greatest Strides Against AIDS
In the 1980s, the AIDS epidemic took off in the United States. The disease still cost many lives every year, but the
number of diagnoses and deaths attributed to it have drastically decreased in the past couple decades.
This is true not only in the United States, but in many other nations as well. In order to find the countries that
have made the biggest strides against AIDS, the data analysts at HealthGrove, a health research site powered by
Graphiq, looked at AIDS mortality rates over time. Using data from the Global Health Data Exchange, the team
found the places with the largest decreases in AIDS mortality from 1990 to 2013 (the most recently available
data). Of the countries that provided data, 32 have seen AIDS mortality decreases since 1990. However, it's
important to note that many developing countries on this list still have very high per capita death rates, which
means that many people would benefit from continued AIDS research.
According to the United Nations Programme on HIV/AIDS Global Report, in 2013, AIDS-related deaths
had fallen 30 percent since their peak in 2005. However, more than 35 million people are still living with HIV. Given recent pharmaceutical advancements
and aggressive goal setting by global AIDS groups, these numbers will likely continue to decrease.
In 2014, UNAIDS launched its 90-90-90 plan, which aims for “90 percent of people living with HIV to be diagnosed, 90 percent to be accessing
antiretroviral treatment and 90 percent to achieve viral suppression by 2020.” The approval of Pre-Exposure Prophylaxis as an HIV-prevention drug in
2012 has already begun helping this cause.
Though the nations on this list have already made large strides against AIDS, there is still much work to do and a lot of room for other countries to follow
suit. Perhaps unsurprisingly, Western countries, primarily comprise the top 20, but quite a few African countries also made it into this list.
Ireland
Change From 1990 to 2013: -2.38 percent
Death Rate in 1990: 0.34 per 100K
Death Rate in 2013: 0.33 per 100K
Congo
Change From 1990 to 2013: -2.41 percent
Death Rate in 1990: 149.5 per 100K
Death Rate in 2013: 145.9 per 100K
Honduras
Change From 1990 to 2013: -3.24 percent
Death Rate in 1990: 18.42 per 100K
Death Rate in 2013: 17.82 per 100K
Zambia
Change From 1990 to 2013: -12.76 percent
Death Rate in 1990: 382.56 per 100K
Death Rate in 2013: 333.74 per 100K
Brazil
Change From 1990 to 2013: -17.54 percent
Death Rate in 1990: 5.89 per 100K
Death Rate in 2013: 4.86 per 100K
Central African Republic
Change From 1990 to 2013: -23.87 percent
Death Rate in 1990: 307.91 per 100K
Death Rate in 2013: 234.42 per 100K
India
Change From 1990 to 2013: -24.3 percent
Death Rate in 1990: 8.66 per 100K
Death Rate in 2013: 6.56 per 100K
Norway
Change From 1990 to 2013: -29.36 percent
Death Rate in 1990: 0.37 per 100K
Death Rate in 2013: 0.26 per 100K
Iceland
Change From 1990 to 2013: -38.49 percent
Death Rate in 1990: 0.11 per 100K
Death Rate in 2013: 0.07 per 100K
Japan
Change From 1990 to 2013: -41.62 percent
Death Rate in 1990: 0.07 per 100K
Death Rate in 2013: 0.04 per 100K
United Kingdom
Change From 1990 to 2013: -47.27 percent
Death Rate in 1990: 0.64 per 100K
Death Rate in 2013: 0.34 per 100K
Sweden
Change From 1990 to 2013: -53.98 percent
Death Rate in 1990: 0.41 per 100K
Death Rate in 2013: 0.19 per 100K
Mongolia
Change From 1990 to 2013: -55.83 percent
Death Rate in 1990: 0.08 per 100K
Death Rate in 2013: 0.03 per 100K
Netherlands
Change From 1990 to 2013: -56.74 percent
Death Rate in 1990: 1.06 per 100K
Death Rate in 2013: 0.46 per 100K
Switzerland
Change From 1990 to 2013: -65.01 percent
Death Rate in 1990: 3.18 per 100K
Death Rate in 2013: 1.11 per 100K
Hungary
Change From 1990 to 2013: -65.17 percent
Death Rate in 1990: 1.19 per 100K
Death Rate in 2013: 0.42 per 100K
MEDICAL
News
UPDATES
Just How Safe Is That Baby Teether?
Source : HealthDay News
A chemical that's banned from baby bottles and children's drinking cups is still widely used in baby teethers, a new study finds.
Researchers in the United States who tested five dozen baby teethers found all of them contained bisphenol-A (BPA) and other endocrine-disrupting
chemicals.
Studies in animals have shown that endocrine disruptors interfere with hormones and cause developmental, reproductive and neurological harm,
according to the study authors.
Although most of the teethers were labeled BPA-free or non-toxic, all of them contained BPA, the study found. BPA is banned from children's drinking
utensils in the United States and much of Europe.
The teethers also contained a range of parabens and the antimicrobial agents triclosan and triclocarban, which are also endocrine disruptors, the
researchers said.
"The findings could be used to develop appropriate policies to protect infants from exposure to potentially toxic chemicals found in teethers," said study
author Kurunthachalam Kannan and colleagues from the N.Y. State Department of Health's Wadsworth Center.
Baby teethers are used to soothe babies' gums when their teeth start coming in, at around 3 to 7 months of age.
Because babies suck on teethers, the presence of potentially harmful chemicals on the surface is concerning, the researchers said. The study authors
said this is especially true since they found that BPA and other chemicals leached out of the teethers into water.
The 59 teethers analyzed were purchased online in the United States and tested for 26 potential endocrine-disrupting chemicals, the researchers said.
The results were published Dec. 7 in the journal Environmental Science & Technology.
Heart Rate Change When Standing Up Might Predict
Older Adult's Death Risk
Source : HealthDay News
Tracking the change in an older adult's heart rate when they stand up might reveal their risk of death over the next several years, a new study suggests.
As the researchers explained, when people stand up their heart rate initially increases, and then recovers.
The speed of that heart rate recovery in the 20 seconds after standing predicted an older adult's risk of dying within the next four years, according to a
team at Trinity College Dublin, in Ireland.
"The speed of heart rate recovery in response to standing is an important marker of health and vitality that could be assessed quite readily in a clinical
setting such as a hospital," study lead author Dr. Cathal McCrory said in a college news release.
One cardiologist in the United States believes the new test has promise.
"Changes in heart rate during specific activities is a normal response," said Dr. Satjit Bhusri, who's with
Lenox Hill Hospital in New York City.
"Changes in heart rate during specific activities is a normal response," said Dr. Satjit Bhusri, who's with
Lenox Hill Hospital in New York City.
"The authors of this study have established a link with this response as a marker for overall heart health,"
he said. "We now have another tool to help our patients as we predict ... their long-term heart health and
survival."
The new study included nearly 4,500 Irish adults aged 50 and older. The research showed that those with
the slowest heart rate recovery were seven times more likely to die in the next four years compared to those with the fastest heart rate recovery.
Those with the slowest recovery remained 2.3 times more likely to die during the study period even after the researchers accounted for other factors,
such as age, diabetes, lung disease, socio-economic status, smoking, diet and weight.
Another study author, Rose Anne Kenny, explained that "changing from lying or sitting to standing postures is a repeated activity throughout the day and
poses a challenge to the cardiac system to maintain steady blood pressure and heart rate, and thus lower stress on the system."
Kenny added that heart rate recovery can be improved, "possibly by simple strategies such as individualized exercise.”
The study was published online recently in the journal Circulation Research.
Taking Breast Cancer Prevention Drug Beyond
5 Years May Not Raise Survival
Source : HealthDay News
Many breast cancer survivors take anti-estrogen drugs for at least five years to help lessen their risk of recurrence.
Now, new research suggests that taking such a drug for an even longer period might not confer any added benefit -- at least in terms of survival.
The study of thousands of older breast cancer survivors found that taking the aromatase inhibitor drug letrozole (Femara) for more than the
recommended five years did not help them live longer.
However, other benefits were noted, so the decision to extend use of drugs like these is one best made on a case-by-case basis, cancer specialists said.
One oncologist who reviewed the new findings said the study has been "eagerly awaited," since many breast cancer survivors are counseled to take an
aromatase inhibitor.
"For now, this trial reinforces the need to listen to our patients and weigh out the risk of side effects before extending therapy to 10 years," said Dr. Nina
D'Abreo, medical director of the Breast Health Program at Winthrop-University Hospital in Mineola, N.Y.
Many forms of breast cancer may grow in the presence of estrogen, so medicines such as estrogensuppressing aromatase inhibitors are used to help prevent the disease.
But how long should breast cancer survivors be placed on such drugs?
To help find out, researchers tracked outcomes for almost 4,000 postmenopausal women with early stage
hormone receptor-positive breast cancer (meaning the tumors were sensitive to estrogen). The women
took either letrozole or a placebo for an average of about two years after an initial five years of aromatase
inhibitor therapy.
The result: Women who took letrozole for those extra two years did not experience statistically significant
higher rates of either "disease-free" survival or overall survival than those in the placebo group, the study
found.
There were some other benefits, however. For example, women who extended their use of letrozole
showed a 29 percent reduction in breast cancer recurrence, and a 28 percent reduction in a tumors arising
at locations outside the breasts.
The study was led by Dr. Terry Mamounas, medical director of the Comprehensive Breast Program at University of Florida Health Cancer Center in
Orlando. He presented the results Wednesday at the annual San Antonio Breast Cancer Symposium in Texas.
Women who took letrozole for the additional years also experienced a "small increase in the risk of [clotting] events after 2.5 years," Mamounas noted in
a meeting news release. This slight uptick in cardiovascular risk means that older women considering extra time on the drug "will require careful
assessment of potential risks and benefits," he said.
This case-by-case assessment would involve a discussion of various patient factors, such as the patient's age at diagnosis, whether cancer had spread to
lymph nodes, other illnesses the patient might have, her bone mineral density, and the side effects she had experienced from the aromatase inhibitor
drug, Mamounas said.
For her part, D'Abreo agreed that any decision on whether to take an aromatase inhibitor beyond five years is best made on a case-by-case basis.
"For some subgroups of women with 'high risk' disease, this may be worth the side effects," she said. "Hormone-positive cancers may still recur much
later and for our patients who are living longer, healthier lives, there may be benefits of extended therapy beyond the seven-year period of observation
on this trial."
Dr. Ruby Sharma is a medical oncologist at Northwell Health Cancer Institute in Lake Success, N.Y. She agreed that based on the findings, "the decision to
prescribe additional five years of endocrine therapy needs to be individualized for each particular patient depending on individual risk of recurrence and
side effects of treatment."
The study was funded by the U.S. National Cancer Institute and the drug company Novartis, which makes Femara.
Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.
Excess Sweating Can Be a Drenching, Wrenching Burden
Source : HealthDay News
People with hyperhidrosis -- an excessive sweating condition -- also seem to have higher-than-average
rates of anxiety and depression, a new study suggests.
Roughly 21 percent and 27 percent of people with hyperhidrosis screened positive for anxiety or
depression, respectively. That compared with 7.5 percent and just under 10 percent of other patients, the
study revealed.
The findings do not prove that hyperhidrosis caused those mental health issues. In some cases, excessive
sweating may be part of an anxiety disorder, for example.
"It's not clear if this is cause-and-effect," said Dr. Dee Glaser, a professor of dermatology at Saint Louis
University School of Medicine.
So the findings don't necessarily imply that better control of hyperhidrosis would ease people's
depression and anxiety, according to Glaser, who wasn't involved in the study.
"But," she said, "dermatologists should be aware of the higher prevalence of anxiety and depression in these patients."
And if necessary, Glaser added, they can refer patients to a mental health professional.
Hyperhidrosis is a medical condition that causes people to sweat excessively and unpredictably -- including when they're at rest or in cool conditions. It's
estimated that about 3 percent of Americans have hyperhidrosis, according to the International Hyperhidrosis Society.
There are treatments, such as strong antiperspirants, Botox injections for underarm sweating, and electrical stimulation to dial down sweat-gland
activity in the hands and feet.
Still, it's common for people with hyperhidrosis to feel self-conscious and avoid social activities -- or even things as mundane as raising a hand in class,
Glaser said.
"For people who don't have hyperhidrosis, it's easy to think, 'Oh, it's just sweating,'" Glaser noted. "The impact it can have on quality of life has always
been underestimated."
For the new study, Dr. Youwen Zhou and colleagues wanted to get a clearer idea of whether overt depression and anxiety disorders are especially
common among people with hyperhidrosis.
The researchers had just over 2,000 patients at two dermatology clinics -- one in Canada and one in China -- answer standard questionnaires that screen
for depression and generalized anxiety disorder.
It turned out that both conditions were more common among hyperhidrosis patients, and the risk was higher when their sweating problems were more
severe, the findings showed.
"This study suggests that hyperhidrosis is tightly linked to depression and anxiety," said Zhou, who directs the Vancouver Hyperhidrosis Clinic at the
University of British Columbia, in Vancouver, Canada.
But like Glaser, he said the findings do not necessarily mean that hyperhidrosis is the cause.
In fact, Zhou said, it may be "more likely" that some other underlying factors contribute to both hyperhidrosis and depression and anxiety. "More
research is needed to uncover this mechanism," he said.
For now, both Zhou and Glaser suggested that hyperhidrosis patients talk to their doctors about any mental health symptoms.
"Don't feel like you have to just live with it," Glaser said.
The findings are published in the December issue of the Journal of the American Academy of Dermatology.
Breast Cancer Cells May Change When They
Spread to Brain: Study
Source : HealthDay News
When breast cancer spreads to the brain, important molecular changes may occur in the cancer, a small study found.
The discovery of these changes could lead to improved diagnosis and treatment, the researchers said.
About 20 percent of breast cancers are a type known as HER2-positive, which typically respond to targeted therapies. However, HER2-negative breast
cancer that has spread to the brain doesn't respond to the same therapies.
In this study, researchers analyzed tumors from 20 patients in the United States and Ireland. They found that primary breast cancer identified as HER2negative switched to HER2-positive when it spread to the brain.
The findings show that treatments should target not only the original breast cancer, but also brain tumors, said study author Adrian Lee, director of the
Institute for Precision Medicine, part of the University of Pittsburgh Medical Center.
“The brain is a common and catastrophic site of metastasis for breast cancer patients," Lee said in a
medical center news release. Metastasis is the medical term for cancer spreading to other organs.
"Our study showed that despite the large degree of similarity between the initial breast tumor and the
brain metastatic tumor, there were enough alterations to support comprehensive profiling of metastases
to potentially alter the course of treatment," he said.
The findings mean "we can screen for presence of HER2 so that we can change and target the therapy to
improve outcomes for our patients," Lee said.
The study was scheduled to be presented Wednesday at the San Antonio Breast Cancer Symposium and
will be published in the journal JAMA Oncology.
Even Small Rise in Blood Pressure Can Harm Black Patients
Source : HealthDay News
Even small increases in blood pressure can be dangerous for black people, a new study suggests.
A rise of as little as 10 mm Hg in systolic blood pressure in blacks raised the risk of dying during the study by
12 percent. The risk was even greater for black people under 60 -- each additional 10 mm Hg increased the
risk of dying early by 26 percent, compared with a 9 percent increase for those over 60, the study showed.
"These findings should urge doctors and patients to consider all the available data and weigh the risks and
benefits prior to selecting a blood pressure goal in African-American patients," said lead researcher Dr.
Tiffany Randolph. She's a cardiologist with the Cone Health Medical Group HeartCare in Greensboro, N.C.
Blood pressure is made up of two numbers. The top number is called systolic pressure. This measures the
pressure in the arteries when blood is being pumped from the heart. The bottom number -- diastolic
pressure -- measures the pressure between heartbeats. Blood pressure is expressed in millimeters of
mercury (mm Hg).
The 2014 blood pressure guidelines from the U.S. National Institutes of Health Eighth Joint National
Committee changed blood pressure goals for patients over 60 without diabetes or kidney disease. The goal
was changed to a target of less than 150/90 mm Hg. Previously the goal had been 140/90 mm Hg, Randolph said.
Although the recommendations were based on clinical trials, the trials didn't include many black people, she said.
"Our data suggest that increases in blood pressure are associated with greater risk of death among all ages of African-Americans, even people over age
60," Randolph said.
Only about 50 percent of all people with high blood pressure reach these goals. And because black people are more likely to have high blood pressure
and suffer from its consequences, such as stroke, heart attack and kidney failure, "there is concern that raising the recommended blood pressure goals in
this population may have unintended consequences," Randolph said.
Moreover, even though the increased risk of death from high blood pressure was smaller among people 60 or older, they may actually benefit most by
having well-controlled blood pressure, as their overall risk of death is higher than those under 60, she said.
Dr. Gregg Fonarow is a professor of cardiology at the University of California, Los Angeles and a spokesman for the American Heart Association. He said,
"These findings provide further evidence of the potential harms in terms of increased risk of heart attacks, strokes, heart failure and premature deaths
that resulted from any physician or patient that followed the Joint National Committee blood pressure guidelines.”
These guidelines have been controversial, Fonarow added. Rather than tightening blood pressure goals to be consistent with all clinical trial evidence in
adults 60 and over, they actually loosened the goal. Major professional societies, such as the American Heart Association and others, have refused to
endorse these guidelines, he said.
The new study included more than 5,200 people enrolled in the Jackson Heart Study between 2000 and 2011 in Jackson, Miss.
All of the study participants were black and their average age was 56. Nearly two-thirds were women. Participants were followed for an average of seven
to nine years.
At the beginning of the study, 60 percent of the participants had high blood pressure, Randolph said. The median blood pressure at the start was 125/79
mm Hg.
"We found that every 10 mm Hg increase in systolic blood pressure was associated with a 12 percent increase in the risk of death and a 7 percent increase
in the risk of being hospitalized for heart failure," she said.
Fonarow recommended these target numbers for optimal health: "The ideal for heart and brain health is a systolic blood pressure of less than 120 mm
Hg and diastolic blood pressure less than 80 mm Hg," he said.
Recently, the Systolic Blood Pressure Intervention Trial (SPRINT), of which 30 percent of patients were black, showed that aiming for a systolic pressure
of less than 120 mm Hg saved lives, reducing deaths from any cause by 27 percent, Fonarow said.
Dr. Stacey Rosen is vice president of women's health at Northwell Health's Katz Institute for Women's Health in New Hyde Park, N.Y. "This study
highlights the need to do more work on where treatment goals should be," she said.
"We cannot underestimate the importance of pushing blood pressure lower in order to minimize cardiovascular risk," Rosen said.
High blood pressure is manageable with a heart-healthy lifestyle, including maintaining a healthy weight, eating a healthy diet, being physically active,
not smoking and, for some, taking blood pressure-lowering medication, the researchers said.
The report was published online Dec. 7 in the Journal of the American Heart Association.
Optimism May Propel Women to a Longer Life
Source : HealthDay News
Women who generally believe that good things will happen may live longer.
That's the suggestion of a new study that seems to affirm the power of positive thinking.
"This study shows that optimism is associated with reduced risk of death from stroke, respiratory disease, infection and cancer," said Eric Kim, co-lead
author of the investigation.
"Optimistic people tend to act in healthier ways. Studies show that optimistic people exercise more, eat healthier diets and have higher quality sleep,"
said Kim, a research fellow in the department of social and behavioral sciences at Harvard T.H. Chan School of Public Health in Boston.
Kim added that an upbeat outlook also may directly affect biological function. Research has demonstrated that higher optimism is linked with lower
inflammation, healthier lipid levels (fats in the blood), and higher antioxidants (substances that protect cells from damage), Kim said.
"Optimistic people also use healthier coping styles," he said. "A summary of over 50 studies showed that when confronted with life challenges, optimists
use healthier coping methods like acceptance of circumstances that cannot be changed, planning for further challenges, creating contingency plans,
and seeking support from others when needed.”
For this investigation, scientists reviewed records on 70,000 women who participated in a long-running health study that surveyed them every two years
between 2004 and 2012. The study authors examined optimism levels and other factors that might affect the results, such as race, high blood pressure,
diet and physical activity.
Overall, the risk of dying from any disease analyzed in this study was almost 30 percent less among the most optimistic women compared to the least
optimistic women.
For the most optimistic women, for instance, the risk of dying from cancer was 16 percent lower; the risk of dying from heart disease, stroke or
respiratory disease was almost 40 percent lower; and the risk of dying from infection was 52 percent lower, the study found.
Levels of optimism were determined from responses to statements such as "In uncertain times, I usually expect the best," according to Kim.
While the study uncovered an association between optimism and life span, it did not prove cause and effect.
Dr. Sarah Samaan, a cardiologist at the Heart Hospital at Baylor in Plano, Texas, said healthy behaviors may help fuel optimism.
"It's easier to feel optimistic when you feel healthy and energetic," said Samaan, who was not involved in the research. "By choosing a healthy lifestyle,
you may open yourself up to greater gratitude and create more energy for deeper relationships and professional satisfaction.”
She added that for people with depression and anxiety, medication may help to improve mental outlook and thus overall health, although this study did
not address that specific issue.
The study authors noted that individual actions can promote optimism. The simple act of writing down best possible outcomes for careers, friendships
and other areas of life could generate optimism and healthier futures, they suggested.
Kim described a two-week exercise where people were asked to write acts of kindness they performed that day. Another activity involved writing down
things they were grateful for every day. Both these exercises were shown to increase optimism, he said.
The study was published online Dec. 7 in the American Journal of Epidemiology.
"ROLE OF EXPERT WITNESS
IN MEDICAL NEGLIGENCE CASES”
By
1.
2.
3.
4.
Dr. (Prof.) Mahesh Baldwa, M.D, D.C.H, FIAP, MBA, LL.B, LL.M, PhD (law) SENIOR PEDIATRICIAN & MEDICOLEGAL ADVISOR
Dr Sushila Baldwa, MBBS, MD,DGO, senior gynecologist, Baldwa Hospital, Sumer Nagar, S.V. Road, Borivali (West) Mumbai 400 092
Dr Namita Padvi, MBBS, MD,DNB, PGDML, Fellowship in Pediatric Anesthesiology, Assistant Professor of Pediatric medical s at T.N.
Pediatric Medical College and Nair Hospital, Mumbai-400008
Dr Varsha Gupta, MBBS, MD, PGDML, Medical officer in department of pathology, Bhagwati hospital, Mumbai
Medical Expert not defined in India
In India the term 'expert' or 'expert opinion' is not directly defined anywhere in the Indian Evidence Act or in any other Statute leave aside
medical expert.
Judicial interpretation paved way for interpreting medical expert under s. 45
In 1959, as a stepping-stone, Patna High Court got an opportunity to interpret Section 45 of the Indian Evidence Act in Basudeo Gir v. State. The
question before the court was whether footprint evidence could be made admissible under Section 45 of the Indian Evidence Act. In 1999, State
of Himachal Pradesh v. Jailal followed Balakrishana Das v. Radha Devi and the court made an attempt to spell out the characteristics of a person
to be called as an expert according to law. They are summarized as follows
1.
2.
3.
An expert is a person who has made the subject upon which he speaks a matter of particular study, practice or observation and
thereby has a special knowledge of the subject;
He is not a witness of fact and his evidence is really of an advisory character.
He must have devoted sufficient time and study to the subject. In India, qualification is necessary to admit an expert's evidence. A
vague statement without any particulars of training or type of service does not make any person an expert. The Law does not permit
any assumption without evidence on a material point of competence. Therefore, it is the burden of the expert to prove his
competence. If the examination in chief clearly shows no competency the opinion given by the witness will be excluded. The regular
practice is that the expert will be allowed to give his evidence and his competency can be challenged in cross-examination.
Thus now s. 45 to 51 are applicable to medical experts
Thus indirectly expert evidence is covered under Ss.45-51 of Indian Evidence Act. S.45 of the Indian Evidence Act allows that when the subject
matter of enquiry partakes of medical science as to require the course of previous habit or study and in regard to which inexperienced persons
are unlikely to form correct judgments. In India, there is no separate provision in the Indian Evidence Act regarding the admissibility of lay
opinion testimony. In order to admit a particular piece of opinion, it should come under Section 45 of the Act. But from the language of Section
47 to 50. Lay opinion testimony relating to handwriting, existence of right or custom, usages, tenets and relationship may be admitted. In all
other cases it should satisfy the requirements under Section 45. Section 45 specifically provides that in order to admit a particular piece of
opinion, the person stating that opinion must prove that he is an expert. Section 47 of the Evidence Act reads as follows-When the court has to
form an opinion as to the person by whom any document was written or signed, the opinion of any person acquainted with the handwriting of
the person by whom it is supposed to be written or signed that it was or was not written or signed by that person, is a relevant fact.
From the construction of the provision itself, it is clear that "any person" may give testimony regarding the handwriting or signature and it is not
restricted to experts only.
S. 46 of the Indian Evidence Act. Facts otherwise are not relevant and become are relevant if supported by expert witness.
S.47 of the Indian Evidence Act exclusively deals with the opinion as to the handwriting.
S. 48 of Indian Evidence Act accepts opinions in conformity and relation to customs and usage read with Section 13 of Indian Evidence Act and
S.32 (4) Indian Evidence Act.
S.48 of the Indian Evidence Act deals with the evidence of a living witness, who stood before the Court sworn to depose and subject to cross
examination. The only condition Courts insist is that while deposing about custom it is to be established by unambiguous evidence.
S.49 of Indian Evidence Act is about the opinions regarding tenets and S.50 is about the opinion on relationships read with S.32 (5) of Indian
Evidence Act saying about the admissibility of opinions in relation to relationships.
This principle is envisaged in S. 51 of the Indian Evidence Act that mere opinions of the witnesses are entitled to little or no regard unless they are
supported by good reasons.
History of medical Expert witness Testimony
The need for professionals to testify in medical litigation has its origins in English common law. In the 1767 English case of Slater v. Baker and
Stapleton, the concept of professional standard was established; physicians and surgeons were to be judged by “the usage and law of surgeons
at that time. The then rule was that profession as testified to by surgeons themselves”[Faden RR, Beauchamp TL, King NMP. A History and Theory
of Informed Consent. New York, NY: Oxford University Press; 1986:116]
The Slater case involved the conduct of two physicians who were hired by a patient to remove bandages from his partially healed fracture.
Instead, the physicians re-fractured the leg and placed it in an unorthodox device with the goal of achieving proper limb alignment. The patient
sued, and in support of his case, produced expert testimony from another physician-witnesses who testified that the device used was
inconsistent with standard medical practice.
The basic concept embodied in Slater, ie, that expert testimony can be admitted to support a claim against a professional, has been retained in
English law as well as in the Indian Evidence act as section 45 to 51.
witness is just an informant of facts
As a general rule, the opinions, inferences, beliefs and mere speculations of witnesses are inadmissible before a Court of law. It means that such
types of evidence do not merit consideration. Hence, they are excluded as inadmissible in the law of Evidence. Witnesses are considered as fact
reporting agents of the legal machinery and their role in the adjudicating process is to inform the court of facts. 'Facts' means only facts and not
opinions or inferences. Witness must testify only what he had perceived with one of his five senses. Therefore, it is worthwhile to know the
meaning of the opinion and its distinction from fact.
Distinction between fact and opinion
However, in some situations it will be difficult to distinguish between fact and opinion because there are borderline cases in which the evidence
of the fact is mingled with evidence of opinion. For example, statements relating to the alleged medical negligence related to diagnosis,
investigations, treatment and complications causing death, disability or mental or physical trauma. In such cases, the law permits witnesses to
state their opinion, without which the fact finder cannot come to a correct conclusion. In some other cases, the line, which differentiates the
facts from opinion, may be delicate. Ordinary lay witness cannot identify certain facts with his prudence. Such facts may be obscure or invisible to
him. But a witness having a particular skill or training may be able to perceive such facts.
Testimony by Experts
The evolution of the concept of 'expertise' is one of the path-breaking achievements of the legal system. Expertisation involves an interaction
between different subjects." Through this interaction what law aims is to acquire Knowledge which is outside the ambit of non-expert fact
finders. Courts are expected to hear and determine all the cases that come before them. They cannot escape from their duty by saying that the
case cannot be disposed of due to the non-existence of judicial techniques Therefore, the judges in their everyday life depend on the expert's
testimony generally and more specifically. Moreover, as a consequence of advances in science and technology, there has been an increasing
necessary for the courts of law to rely on expert testimony.
Expert provides the relevancy of opinion by third persons or non parties to case
Sec. 45 to Sec.51 under Chapter-II of the Indian Evidence Act provide relevancy of opinion of third persons, which is commonly called in our day
to day practice as expert’s opinion. These provisions are exceptional in nature to the general rule that evidence is to be given of the facts only
which are within the knowledge of a witness. The exception is based on the principle that the court can’t form an opinion on the matters, which
are technically complicated and professionally sophisticated, without the assistance of the persons who have acquired special knowledge and
skill on those matters. Conditions for admitting an expert opinion are following:a)
b)
That the dispute can't be resolved without expert opinion and
That the witness expressing the opinion is really an expert.
Why doctors are afraid of becoming expert witness role
In our practice it has been seen that the doctors are generally afraid to testify in the courts. This is mainly because of two reasons: one that they
are not familiar of the legal procedures and two because they are afraid to be grilled in the court by the lawyers. As a result, many a times the
attitude of the doctor while testifying in the court is to finish the testimony and go back, irrespective of the outcome. The beneficiaries in such
cases are the litigants who win in the absence of properly recorded medical evidence coming out to understand the intricacies of the case in light
of knowledge, skill, education, experience and training of testifying doctor.
Scene in the court and repeated dates for the hearing
Inside court room the presiding officer or the judge/s sit/s in a high chair at a higher platform; besides him on his sides at a lower level were the
reader and the clerk. There is a square known as witness box. The court staff includes head clerk (mukhya sahaik), administrative clerk (Nazir),
readers (peshkars), stenographers (stenos), record keepers (almads) and orderlies (peons). Clients/litigants (muvakkils) are present with their
lawyer (vakil) accompanied by his scribe (Munshi) in the courts (kacheri). There is an atmosphere of silence with the chanting of my lord,
mylordship, your honour. Mobiles are in switched off mode. There are police constables (Havaldars) seen lurking around. We doctors are not
used to such set up and repeated dates for hearing and grilling on each adjournment. Expert or eye Witness (Gavah) accompanies litigants if
called by the court. Cases are called out loudly one by one heard briefly if lawyers and litigants present themselves and usually after exchange of
papers or a few sentences uttered by lawyers are more often than not given next dates. Entire team related to case viz; lawyers, litigants and their
witnesses quietly leave the court room, bowing to judge saying obliged my lord.
Procedure of Presentation of evidence is time consuming and laborious to any commoner
After receiving a summons or subpoena the expert witness must appear before the court at the appointed time with the relevant documents.
The evidence is probed for areas of uncertainty, inconsistency or any factors which may make the evidence appear unreliable.
Evidence is presented in a systematic order
1.
Oath administered (s. 51 Indian Penal Code)
2.
Examination-in-chief (direct examination, no leading questions allowed, s. 137 Indian
Evidence Act)
Cross-examination (leading questions permitted, s. 141-146 Indian Evidence Act)
Re-examination (Re-direct examination, s. 138 Indian Evidence Act)
Court questions (questions by judge, s. 165, Indian Evidence Act, s. 311 Criminal Procedure Code)
3.
4.
5.
Signing of evidence
The recorded deposition of a witness is handed over for reading, which one carefully goes through, and signs at the bottom of each page, and on
the last page immediately below the last paragraph; and initials any corrections (s. 278 Criminal Procedure Code). The witness shall not leave the
court without the permission of the judge.
What is the law today related to expert witness ?
The Apex Court of India in Kishan Rao v. Nikhil Super Speciality Hospital & Another, (SC) 2010 (2) RCR (Civil) 929 has held that 'Medical Negligence
Claim of petitioner cannot be rejected only on the ground that the expert witness was not examined to prove negligence of Doctor. It is not
required to have expert evidence in all cases of Medical negligence.’
This does not so far supersede substantive laws. 45 of Indian evidence act. Hence the importance of the role of expert witness in medical
negligence cases continues to still remain. Law of evidence allows any person – who is a witness to state the facts related to issues which are
relevant fact, but not an inference drawn by witness. It applies to both criminal law and civil law. But both eye and expert witness are crucial to
criminal law.
Difference between evidence of an expert and evidence of an ordinary witness:-
Evidence of an expert
Evidence of an ordinary witness
1.
Expert gives his opinion regarding handwriting,
finger impression, nature of injury etc.
1.
An ordinary witness states the fact relating to the
incident.
2.
It is advisory in character.
2.
Witness states the facts. Opinion of a witness is not
admissible.
3.
Court can’t pass an order of conviction on the basis of
expert opinion, as because it is not conclusive.
3.
Court may pass an order of conviction on the basis of
evidence of ocular witness (eye witness).
4.
Expert gives his opinion on the basis of his
experience, special knowledge or skill in the field.
4.
A witness gives actual facts connected with the
incident what he had seen or heard or perceived.
Medical expert opinion:The value of Medical evidence is only corroborative. A doctor acquires special knowledge of medicine and surgery and as such he is an expert.
Opinions of a medical officer, physician, or surgeon may be admitted in evidence to showa)
b)
c)
d)
e)
f)
Medical negligence cases usually involve more complicated errors, such as misdiagnosis or prescribing incorrect treatments.
Complications caused by drug, disease or surgery in case of medical negligence
Cause of disability or death of a person due to medical negligence
Nature and effect of the disease or injuries on body or mind in case of medical negligence
Nature and effect of the disease with respect to complications in case of medical negligence
Probable future consequences of bodily injury, etc. in case of medical negligence.
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