< General Studies Home Page

Content

• Dementia
• Mitochondrial Disease
• ANti-Microbial Resistance
• Smoking / Drinking Etc
• International Initiatives
• Food Safety
• Making Medicines Affordable

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1) DEMENTIA

• Details
  • What is dementia?
    • It is the loss of cognitive functioning – thinking, remembering, and reasoning – to such an extent that it interferes with a person’s daily life and activities.
    • Dementia is more common as people grow older (about 1/3rd of all the people aged 85 or older may have some form of dementia) but it is not a normal part of aging. Many people live in 90s and beyond without any sign of dementia.
    • There are different forms of dementia including Alzheimer’s disease which is responsible for 70% of the cases.
  • Situation in India:
    • According to a 2020 report published by the Alzheimer’s and Related Disorder Society of India, there are 5 million people in India living with dementia.
  • Cause: When healthy neurons, or nerve cells, in the brain stop working; sometimes genetic mutation may also be responsible.
    • The exact causes of Alzheimer’s are still unknown, but a classical feature of the disease is the build up of two proteins in the brain: beta amyloid and tau.
      • In people with Alzheimer’s, beta-amyloid is usually found in large quantities outside of neurons (brain cells), and tau “tangles” are found inside axons, the long, slender projection of neurons.
    • Three genes have been linked to Alzheimer’s disease in the young: amyloid precursor protein (APP), presenilin 1 (PSEN1) and presenilin 2 (PSEN2).
      • These genes are involved in producing a protein fragment called beta-amyloid peptide, a precursor to the previously mentioned beta-amyloid. If the gene is faulty, it canleadtoanabnormalbuild-up(plaques)ofbeta-amyloidinthebrain–a hallmark of Alzheimer’s disease and a target for treatments such as the recently approved drug lecanemab.
      • People only need one of APP, PSEN1 or PSEN2 to be faulty to develop Alzheimer’s disease.
  • Prevention of Dementia:
    • No proven prevention
    • In general, leading a healthy lifestyle may help reduce the risk factors that have been associated with these diseases.
• A 19-year-old from China is the youngest person to be diagnosed with Alzheimer’s disease – the cause is a mystery (Feb 2023)
  • Nearly, all cases of Alzheimer’s disease in people younger than 30 are due to inherited faulty genes. In fact, the previous youngest case – a 21-year-old – had a genetic cause.
  • But, in this case, genetic cause was ruled out.
• Lecanemab gains FDA approval for early Alzheimer Disease (Jan 2023)
  • This is a treatment that may moderately slow mild cognitive decline and reduce amyloid-B-plaques in the patients with early Alzheimer disease. It gained accelerated approval from the US FDA.

 2) MITOCHONDRIAL DISEASE

• Introduction
  • Mitochondrial disease is a group of disorders caused by dysfunctional mitochondria, the organelles that generate energy for the cell.
  • It is an inherited chronic illness that can be present at birth or develop later in life. It causes debilitating physical, developmental, and cognitive disabilities with symptoms including poor growth; loss of muscle coordination; muscle weakness and pain; seizures; vision and/or hearing loss; gastrointestinal issues; learning disabilities; and organ failures. About 1 in 2000 people have this disease in USA. It’s progressive and there is no cure.
  • There are many forms of mitochondrial disease, and it is inherited in a number of ways.
• What causes Mitochondrial diseases?
  • For many patients, mitochondrial disease is an inherited genetic condition. Some percentage of patients acquire symptoms due to other factors, including mitochondrial toxins.
  • The types of inherited mitochondrial diseases inherited include:
    • DNA inheritance (DNA contained in the nucleus of the cell). Also called autosomal inheritance
    • MtDNA Inheritance (DNA contained in mitochondria)
      • There is 100% chance of trait occurring in other siblings, since all mitochondria are inherited from mother, although symptoms might be more or less severe.
      • Note: Mitochondrial DNA is separate from DNA found in the cell nucleus and does not affect human characteristics such as hair or eye color, appearance or personality traits.
  • Other causes
    • Diseases specifically from deletions of large parts of mitochondrial DNA molecule are usually sporadic without affecting other family members.
    • Medicine or other toxic substances can trigger mitochondrial disease.
• Treatment
  • The goal is to improve symptoms and slow the progression of diseases.
    • Use vitamin therapy.
    • Conserve energy
    • Pace activities
    • Maintain an ambient environmental temperature.
    • Avoid exposure to illness.
    • Ensure adequate nutrition and hydration.
• Three Parent Babies
  • In 2015, Britain became the first country in the world to allow a three-parent baby to prevent some inherited incurable diseases.
  • It is considered only hope for women who carry defective mitochondria to  have healthy children. It is designed to help couples with mitochondrial disease, incurable condition passed down the maternal line that affect around one in 6500 children worldwide.
  • The treatment is known as “three-parent” in vitro fertilization (IVF) because the babies, born from genetically modified embryos, would have DNA from mother, a father and from a female donor.
• In 2018, UK doctors selected first women to have ‘three person babies’.
  • They carried genetic mutations which caused rare genetic disease.

3) ANTI-MICROBIAL RESISTANCE

• Why in news?
  • Genes fuel antibiotic resistance in Yemen Cholera Epidemic (Sep 2023)
    • The Cholera outbreak in Yemen, which began in 2016, is the largest in modern history and anti-biotic resistance has become widespread among V. cholerae bacteria since 2018.
    • A study has found the presence of a new plasmid – a small, circular DNA molecule – in V. cholerae from late 2018 to the bacterial strain behind the epidemic. This plasmid introduced genes encoding resistance to multiple clinically used antibiotics, including macrolides (such as azithromycin).
• Introduction:
  • Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria become “resistant” and continue to multiply in the presence of therapeutic levels of antibiotic.
• Why do bacteria become resistant to antibiotic?
  • Natural Phenomena: Evolution – Selective pressure for the survival of resistant strains of bacteria.
  • Human Action: Current higher levels of antibiotic resistant bacteria are attributed to the overuse and abuse of antibiotics.
• How do bacteria become resistant?
  • Some bacteria are naturally resistant to certain type of antibiotics.
  • However, bacteria may also become resistant in two ways:
    • By Genetic Mutation
    • By acquiring resistance from another bacterium.
• Why Anti-biotic resistance is more prevalent in India: Key Factors
  • India is the largest consumer of anti-microbials globally and the use of last resort anti-microbials like cephalosporins is soaring.
    • Easy availability and overuse of anti-biotics is the most important factor: Over the Counter Availability; Irrational Use; over-prescription by doctors
  • Poor Health Sector -> improper treatment -> Development of anti-biotic resistance
    • Further, exposure to subtherapeutic levels of anti-microbials or non-adherence to prescribed medications has also been cited as a driver of AMR
    • E.g.: in case of TB
  • Increasing and completely unregulated use of antibiotic in Agriculture, live stocks and Poultry sector.
    • Amount of antibiotics used in the farm animal and food industry is three to four times more than those used by humans.
    • For instance, Colistin is extensively used in veterinary practices as a growth promoter. This leads to generation of colistin-resistant bacteria in poultry and fresh water fish.
  • Poor Sanitation conditions -> More diseases -> More use of medicines -> More AMR development
  • Unchecked discharge of effluents by the pharmaceutical industries -> high concentration of pharmaceutical substances are found in surface and ground water systems near production facilities -> anti-biotics cause development of anti-microbial resistance in environment.
• Impact of increasing anti-microbial resistance
  • Damage to Public Health:
    • In 2019, drug-resistant superbugs killed about 1.27 million people globally – a toll more than HIV/AIDs or malaria – and according to the UN estimates, the number could reach 10 million by 2050.
    • Demands complicated treatment pattern, with longer stay in hospitals -> increase in cost of treatment.
    • Stronger antibiotics which are used after the first line of drugs fail generally have toxic side effects
    • Resistance also emerging for second line of drugs (e.g. XDR-TB emerging)
    • Without functional anti-microbials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with the risk of untreatable infections.
    • All this is compounded by the fact that no new class of anti-biotics have made it to the market in the last three decades, largely on account of inadequate incentives for their development and production.
  • Economic damages due to AMR can be equivalent to what 2008-09 economic shocks resulted into: UN Report
  • Environmental Damages
    • Extensive amount of anti-biotics lead to development of AMR in some micro-organisms. It impacts the microbial biodiversity and thus the environmental balance needed.
• Steps that government has taken:
  • National Policy for Containment of Antimicrobial Resistance, 2011
  • Guidelines for appropriate antibiotic usage which have revised Schedule H drugs to make over-the-counter availability of certain antibiotics nearly impossible
  • Programs such as Red Line Campaign
  • Sanitation campaigns such as Swatch Bharat Mission etc.
  • National Surveillance system for AMR (April 2017)
  • National Action Plan on Antimicrobial Resistance (April 2017): Focused on enhancing awareness, strengthening surveillance, improving rational use, promoting research and supporting neighboring countries.

4) SMOKING / DRINKING ETC.

1) SPURIOUS LIQUOR/ HOOCH TRAGEDIES/ METHYL ALCOHOL

• Why do spurious drinks become poisonous sometime?
  • Excess Methanol: Illicit brewing is unscientific, hooch brewers inadvertently mix excessive amounts of methanol in their liquor every once in a while, leading to mass death.
  • Why is Methyl Alcohol (Methanol) used?
    • It is similar in appearance and test to Ethyl Alcohol
    • It is easily available.
      • In Industry it is used as antifreeze, solvent, fuel, and ethanol denaturant.
  • The potential lethal dose of methanol is variable, adverse effects has reportedly occurred at 30 ml. The toxicity of methyl alcohol manifests as permanent blindness or ultimately death due to respiratory failure.
  • Why is Methanol poisonous?
    • Due to accumulation of formic acid, a metabolite of methanol metabolism.
• Why do people go for this kind of drink?
  • Cheap Price:
  • Availability
  • Strong effect
• Other reasons Spurious liquor prosper-> Corruption

5) INTERNATIONAL INITIATIVES

1) THE LANCET

• Details about the Lancet:
  • The Lancet is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also world’s highest-impact academic journal. It was founded in 1823.
  • It publishes original research articles, review articles, editorials, book reviews etc.
  • The journal has editorial offices in London, New York City, and Beijing.
• The Lancet announced a new commission on Dec 15, 2022, to address public health threats.
  • The scope of work by The Lancet Commission on 21st-Century Global Health Threats includes demographic changes and inverted population pyramids, high body mass index, anti-microbial resistance, eroding sexual and reproductive rights for women, food security, and fraying multilateralism.
  • In 2024, the body will release its report after detailed study of 2 years.

6) FOOD SAFETY

1) LAWS AND INSTITUTIONS

A) FOOD SAFETY AND STANDARDS ACT, 2006

• Came into force in 2011.
• Key Provisions
  1. Consolidation of existing mechanisms
     • The FSS Act consolidated a number of food legislations, rules, orders etc and established a single law for all matters relating to food safety and standards.
     • It subsumes acts like Prevention of Food Adulteration Act, 1954, The Fruit Product Order, 1955 etc.
  2. Classification into standardized and non-standardized
     • Standardized Food products – Standards are prescribed and do not require product approval prior to manufacture, sale distribution, or import. The first time manufacturer or importer only requires an FSSAI license to begin a food business.
     • Non-standardized food products – don’t have standards as their safety parameters are either not known or either not yet ascertained.
  3. Statutory Authority: Food Safety and Standards Authority of India (FSSAI) and State Food Safety Authorities
     • FSSAI is the apex body for food quality regulation in the country. It is responsible for setting standards and regulate, manufacture, storage, distribution, sale and import of food items to ensure food safety.
  4. Commissioner of Food Safety of state
     • Appointed by respective state governments.
     • For efficient implementation of the Food Safety Act and various rules and regulations regarding food safety
     • Commissioner also responsible for appointing Food Safety Officers for various local areas
  5. Graded Punishment and penalties for contravention of the Act
  6. Adjudicating and Appellate Tribunal

B) FOOD SAFETY AND IPC

• Section 272 of IPC prescribed punishment for adulteration of food or drink intended for sale.
• Section 273 of IPC punishes sale of noxious food or drink.
  • These two sections provides for imprisonment (upto six months) and/or fine (upto 1,000 rupees)

C) STATE FOOD SAFETY INDEX (FSI)

• Details
  • SFSI is an index developed by FSSAI. It aims to measure the performance of states and UTs on selected parameters of food safety.
  • It is aimed at encouraging states and Uts to improve their performance and work towards establishing a proper od safety ecosystem in their jurisdiction.
  • It is an annual report which has been released since 2018-19.
  • Key Parameters used:
    • Human Resources and Institutional Data (20%)
    • Compliance (30%)
    • Food Testing – Infrastructure and Surveillance (20%)
    • Training and Capacity Building (10%)
    • Consumer Empowerment (20%)

7) MAKING MEDICINES AFFORDABLE

1) GENERIC MEDICINES:

• Why in news recently?
  • On Aug 2023, the National Medical Council (NMC) directed all doctors to prescribe only generic names and not brand names which led to protest. Following the Indian Medical Association’s protest, the NMC has withdrawn the order on ‘generic prescribing’ since Aug 23, 2023.
    • Why the protest?
      • Doctors trust certain brands
      • The control over which brands to take will go to chemist shops.
• What is a generic drug?
  • Generic drug is a low cost version of pharmaceutical drug that is equivalent to a brand-name product in dosage, strength, route of administration, quality, performance and intended use.
  • They usually enter market after patent protection of the original drug expires.
• Note: Broadly Medicines can be of three types:
  • Branded: These are still on patent
  • Branded Generic: Off-Patent and Generic, but nonetheless produced by a reputed company, with a brand.
  • Generic: Off Patent, and unbranded.
• Advantages
  1. Affordable healthcare
  2. Breaks the doctor-pharma nexus
     • Reduce unnecessary prescription
  3. Promotes domestic pharma companies.
  4. Difficult for quacks to function
• Limitations
  1. Quality concerns
  2. Erode doctor-patient relationship
  3. Low profit margins for retailers
  4. Shortage
  5. Difficult for common person to understand, especially the multiple salt names in a FDC.
  6. May discourage big pharma companies to launch their new medicines in India

2) JAN AUSHADHI KENDRAS

• Intro:
  • Pradhan Mantri Bhartiya Janaushadhi Pariyojna (PMBJP) was launched by Department of Pharmaceuticals, Ministry of Chemical and Fertilizers, Government of India as a direct market intervention scheme in 2008.
• It aims to make quality generic medicines available to all at affordable prices through Jan Aushadhi Stores (JAS) opened in each district of the states.
  • First Jan Aushadhi Store (JAS) was opened at Amritsar Civil Hospital in 2008.
• Other key focus of the scheme is to create awareness and demand for generic medicine.
• Incentives given:
  • The scheme provides an excellent opportunity of self-employment with suitable and regular earnings.
  • An incentive of Rs 5,00,000 is provided to the Jan Aushadhi Kendras as financial assistance and one-time additional incentive of Rs 1 lakh (as reimbursement for IT and infra expenditure) is provided to Jan Aushadhi Kendra opened in North-Eastern India, Himalayan state, island territories, and backward areas identified by NITI Aayog as aspirational districts or if opened by women entrepreneurship, Ex-Serviceman, Divyangs, SCs and STs.
• As of Jan 2023, 9,000 Jan Aushadhi Kendras are functional across the country.
  • The government has set up a target to increase the number of Jan Aushadhi Kendras to 10,000 by March 2024.
    • It offers 1759 medicines, and 280 surgical devices covering all major therapeutic groups.