Dear Editor,

I certainly understand the unethical nature of experimenting an unproven treatment on people without informed consent. The criticisms levied at such an action by a Major city government (or any for that matter) seem wholly valid.

It is not fully clear, however, what the results of the experiment are, unethical as it may have been. Given such a large sample size, do we have a better understanding of the value, if any, in using Ivermectin to treat COVID-19?

Furthermore, the fact that the article was taken down due to public pressure, which is what appears to have been the case according to the article, is somewhat concerning. Surely, the only factor in making such a decision should be the quality of the research. Public pressure, which is not in and of itself considered scientific critique, shouldn't be influencing publishing decisions in scientific journals.

Dear Editor, Well stated and concluded. It is obvious that in times of crisis, such as COVID 19 pandemic in the earlier phases, with high morbidity and unusual mortality, treatment with what is ' probably known ' exemplified by Hydroxy Q , was commenced, soon followed by Ivermectin. This was an act of commission -(therapeutic) , and no serendipity. Awaiting results from an RCT could be a luxury against the passage of crucial time. Clinical observations / observational research acquired an elevated status and importance in the intermediate time gaps, as response and experience demonstrated. Though considered gold standard, limitations against the time frame, need to be accepted and acknowledged, Further, the matching of some results between the RCTs and observational research lends credence to the utility of later in specific situations, with the population component considered. Generating evidence may be time/situation specific and disregarding / underestimating observational findings may turn erroneous and could deprive some of 'legitimate' care. Dr Murar E Yeolekar, Mumbai.

Healthcare Ecosystem in India in Future

Now a days healthcare delivery in India has witnessed a renewed focus on leveraging digital technology during the COVID-19 pandemic and after.

Various healthcare reforms launched before and during the pandemic such as, National Health Digital Mission (NDHM) and teleconsulting guidelines combined with burgeoning health tech start-up ecosystem, have evolved to make healthcare journey better for Indian population.

The new normal in Indian healthcare ecosystem will be about how healthcare delivery will innovate in the coming decade and what it means for both patients and healthcare providers. 

Digitization, technological enablement, and automation are affecting industries today in profound ways. Healthcare is no exception. The paradigm of healthcare delivery in India is changing and is poised for a big leap forward. Healthcare and drug innovation have come into sharp focus as never before in India 
[21/05, 9:34 am] MA: The COVID-19 pandemic has demonstrated that health care organizations become more resilient, agile, and innovative through digitally enabled business models with data at the core. The pandemic added urgency and accelerated the process of change for healthcare to become more digitally enabled.

In India healthcare delivery is moving outside the four walls of traditional health system . Health care providers have realized that products or services alone, no matter how strong they are technically, will not be enough in future. They should look into the future to engage with their users across the health care value chain, whether that be physicians or patients, and deliver to them not just a better care product or care service, but a better care experience. Also, one needs to keep an eye on developments coming from non-core sources like technology companies which could further help in diagnosis or early detection and aid the healthcare ecosystem.

Hence, as health care organizations consider to move ahead, creating the right data environment to support a more human-centered approach to health care is an urgent need.
[21/05, 9:34 am] MA: In India  the explosion of health care data requires a new ecosystem to be built around the needs of an individual enabled by technical standards, open data models and empowered by governance systems that deliver trust.

In our country,rising technologies generating data will need equally powerful tools to organize, interpret and draw insights from them — Artificial  intelligence (AI)is critical in this journey to turn complex information into usable insights, including individualized wellness solutions and show how to efficiently provide care across the ecosystem.

To keep up with the velocity and variety of health data generated today in India, the health information infrastructure must enable providers to connect, combine, analyze, and share health and social data.

Trusted intelligence systems also will emerge to secure confidence and participation of consumers and other stakeholders in India in near future. 
[21/05, 9:35 am] MA: In India clinicians will need to leverage medical, data and behavioral science knowledge and skills in the near future to deliver a personalized care demanded by patients. To support this shift, healthcare entities must decide now where to invest in education, training and recruiting.

Healthcare delivery in India witnessed a renewed focus on leveraging digital technology during the pandemic. The sector, predominantly recognized for sick care delivery, has looked at building next-gen capabilities that will be a differentiator in the decade ahead. Several reforms launched before and during the pandemic such as National Health Digital Mission (NDHM), teleconsulting guidelines combined with burgeoning health tech start-up ecosystem enabled by innovation, have evolved to make the healthcare journey better for Indian population. It is good that the private equity/ Venture capital funding is also coming to support the health tech start up eco system.
[21/05, 9:36 am] MA: Maximizing the clinical, financial, and operational value of these new digital offerings and services requires biopharma, medtech and other health care stakeholders to reinforce digital as an entirely new business model and ecosystem to deliver better outcomes and drive stakeholder awareness, adoption, engagement, and growth.

Dear Editor

Monkey pox - new outbreak with potentially novel mode of spread

We read with keen interest the BMJ report of seven cases of monkeypox that were confirmed in the UK by the 16 May 2022. Since then, 13 more cases of monkeypox have been identified by The UK Health Security Agency (UKHSA) bringing the total number of monkeypox cases confirmed in the UK to 20 as of 20 May 2022. Why are these cases generating so much interest globally and provoking urgent public health action? It is because there have been some unprecedented events in this outbreak, which have also been reported in several other European countries as well as in the US, Canada, and Australia. Firstly, The World Health Organization (WHO) has announced that many of the cases in the UK and other European countries have occurred in young, gay, bisexual or men who have sex with men (MSM). Secondly, all except the first case detected in the UK on May 7, 2022, have had no recent travel history to central or west Africa where monkeypox is endemic. Thirdly, there have been no proven connections between most of these cases. This has raised the possibility of a novel community spread and sexual contact is now considered a likely route of transmission.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC), and cases of monkeypox have been reported in west Africa or central Africa, with large outbreaks in Nigeria. Monkeypox is an emerging zoonotic disease transmitted by monkeys, Gambian poached rats, dormice and squirrels. The reservoir species are suggested to be rodents. Fever, headache, muscle aches and lymphadenopathy are common symptoms which precede the rash which often begins on the face and then spreads to involve other parts of the body including the genitals. The rashes develop sequentially from macules to papules, vesicles, pustules, and crusts during a 2–3-week period. Monkeypox is usually a mild self-limiting illness and virus entry into humans is thought to occur via the oropharynx, nasopharynx and intradermally. Close contact between infected humans, or contaminated clothes, towels or furniture, and respiratory droplets is the established mode of transmission of monkeypox. However, the current outbreak is exposing gaps in our knowledge of this disease. The case fatality rate, derived largely from African cohorts, is 5% and this is higher in children, immunosuppressed and persons infected with the central African variant of monkey pox virus. Smallpox vaccination provides 85% protection for those at risk and the decline in smallpox vaccine immunity is thought to account for monkeypox outbreaks in 2017-2020.

This unprecedented change in epidemiology of human monkeypox has thrown up several issues. Some of the UK and other European cases have been characterized by a lack of prodromal symptoms and herald skin lesions at point of sexual contact which are both strongly suggestive of sexual transmission. There are concerns that the media’s projection of MSM as the at-risk population for this infection may lead to disproportionate stigmatisation of these groups. Case definitions have had to be rapidly revised to reflect possible cases as not necessarily having a history of travel to West or Central Africa. New clinical guidelines are required to address issues such as appropriate personal protective equipment to be used in sexual health clinics and revision of standard operating procedures in laboratories.
With cases of monkeypox now identified in Europe, North America and Australia, the apprehension about cross-border spread of this disease appear to be well founded. It will be vital to establish robust health surveillance and control measures to address the threat posed by monkeypox.