On 31 August 2023, the 65th Ramon Magsaysay Award, also called the Nobel Prize of Asia, was awarded to the surgical oncologist Dr R. Ravi Kannan of India, along with Korvi Rakshand of Bangladesh, Eugenio Lemos of Timor-Leste and Miriam Coronel-Ferrer of the Philippines. Dr Kannan has been named as a recipient of the Magsaysay Award under the category ‘Hero of Holistic Healthcare’.

Dr Ravi Kannan, a Padma Shri awardee, is the director of the Cachar Cancer Hospital and Research Centre (CCHRC) in Silchar, Assam. Having previously worked as a surgeon at Chennai’s Adyar Cancer Institute, he took over the reins at the CCHRC in 2007.

Under the leadership of Dr Kannan, the CCHRC has become a full-fledged comprehensive cancer care hospital and research centre. He has been instrumental in introducing free treatment, lodging and food for patients. Also, caregivers are provided adhoc employment. When patients are unable to continue treatment due to their inability to travel long distances, homecare is provided. The CCHRC has started clinics in Karimganj, Hailakandi and Dima Hasao. Under his leadership, the follow-up ratio has increased to over 90% from less than 50%.

The CCHRC now has 28 departments ranging from oncology to palliative care. The staff strength has increased from 23 to 451 personnel.

The award citation states that the Ramon Magsaysay Awardees Foundation board of trustees recognizes Dr Kannan’s devotion to the highest ideals of public service in his profession. The combination of skill, compassion and commitment shown by him in pushing the boundaries of cancer care that is pro-poor and people-centric. The award citation also states that Dr Kannan has been a beacon of hope for millions of people living in the state of Assam, without any expectation of reward.

Ramon del Fierro Magsaysay was the seventh President of the Philippines. He was known for his simplicity, humility, human dignity and a passion for justice. He died in a plane crash in 1957. That year the Ramon Magsaysay Award Foundation was created in his memory and to spread his ideals of integrity in public service.

Some notable Indians who have been awarded the Magsaysay Award include Acharya Vinoba Bhave (Community Leadership, 1958), Mother Teresa (Peace and International Understanding, 1962), Dr Verghese Kurien (Community Leadership, 1963), Satyajit Ray (Journalism, Literature, Creative Communication Arts, 1967), M.S. Subbalakshmi (Public Service, 1974), R.K. Laxman (Journalism, Literature, Creative Communication Arts, 1984), Pandit Ravi Shankar (Journalism, Literature, Creative Communication Arts, 1992), and T.N. Seshan (Government Service, 1996).

P.M. NISCHAL, Mangaluru, Karnataka

ORCID iD: 0000-0003-3491-5500

The Ethics and Medical Registration Board (EMRB) of the National Medical Commission (NMC) released the ebook, ‘Professional conduct review: Lessons from case archives, Volume I, 2023’ on 5 October 2023. The NMC has focused on the attributes distinguishing proficient Registered Medical Practitioners (RMPs), emphasizing the important role of compassion, understanding, empathy and compassion in the interactions of RMPs with patients’ families during critical incidents.

The ebook covers nine case archives, exploring diverse situations that are encountered in day-to-day clinical practice such as communication between doctors and patient’s relatives; allegation of wrong diagnosis resulting in treatment delay; specialty practice without adequate qualification/training; clinical drug trials and role of RMPs, elective lower segment caesarean section (LSCS) done by a general surgeon resulting in maternal death, hysterotomy done by a general surgeon; documentation of surgical procedure, misrepresentation of qualification and alleged overcharging by a medical practitioner, and life-threatening events: a dilemma for patient’s family.

For each of these case scenarios, relevant key words, context, abstract, summary, discussions (including decisions by medical councils), lessons learnt, take-home messages, and relevant references have been provided. The ebook also addresses the contemporary real-life situations such as differences in perception regarding illnesses and their outcomes by the patient’s family (who are possibly misinformed by limited knowledge available on the internet and other resources) and the scientific evidence with rigorous implementation of the standard operating procedures and protocols by RMPs and the treating team, among others. Further, the importance of maintaining an uninterrupted channel of compassionate empathetic communication, especially in emergency situations, need for clear communication, as well as meticulous documentation to avoid lawsuits in future is emphasized. The ebook is an attempt to enhance awareness, mitigate professional errors and safeguard patients from potential ethical lapses.

ALLADI MOHAN, Tirupati, Andhra Pradesh

ORCID iD: 0000-0002-3214-9884

The Nobel Assembly of 50 voting members at Karolinska Institute in Stockholm, Sweden announced the Nobel Prize in Physiology or Medicine on 2 October 2023. There were no surprises here—Katalin Karikó and Drew Weissman were jointly awarded the honour for their path-breaking work on nucleoside base modifications, which eventually led to the development of effective mRNA vaccines. These vaccines (manufactured by Pfizer-BioNTech and Moderna) were the main fortification in the Covid-19 pandemic of the early 2020s. Hungarian-American biochemist Katalin Karikó and her American immunologist colleague, Drew Weissman introduced variants of mRNA with chemically modified bases into dendritic cells to study the suppression of inherent inflammatory responses and increased protein production. Their study was published in a series of research papers between 2005 and 2010, and saw vaccines against Zika virus and MERS-CoV as initial prototypes before large-scale successful production of mRNA vaccines with reported 95% effectiveness against Coronavirus was approved as Emergency Use Authorization by the U.S. Food and Drug Administration in December 2020.

Karikó was vice-president and later, senior vice-president at BioNTech RNA Pharmaceuticals from 2013 to 2022. She is currently a Professor at Szeged University, Hungary and an Adjunct Professor at Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA since 2021.

Drew Weissman initially set up his research and started collaborating with Karikó at Perelman School of Medicine at the University of Pennsylvania in 1997 and is, at present, the Roberts Family Professor in Vaccine Research and Director at the Penn Institute for RNA Innovations, Philadelphia, USA.

A fundamental problem with RNA therapy was that the RNA resulted in adverse side-effects such as inflammatory reactions. Karikó and Weissman used synthetic nucleosides instead, and made it non-immunogenic (Karikó K, Buckstein M, Ni H, Weissman D. Suppression of RNA recognition by Toll-like receptors: The impact of nucleoside modification and the evolutionary origin of RNA. Immunity 2005;23:165–75. doi: 10.1016/j.immuni.2005.06.008).

Both have earlier been joint awardees of the Lasker-DeBakey Clinical Medical Research Award (2021) and the Novo Nordisk Prize ( 2022).

Meanwhile, the 33rd Ig Nobel Prizes were awarded in September 2023 to arguably the most outré scientific achievements, in an event sponsored by the Harvard-Radcliffe Science Fiction Association and the Harvard-Radcliffe Society of Physics Students. Notably, 10%–20% of the contenders were self-nominated. Titled ‘A celebration of two acts’, the event was first webcast on 14 September 2023 and then had an in-person award ceremony at the Massachusetts Institute of Technology Museum, Cambridge, Massachusetts, USA on 11 November 2023.

The winners in the Medicine category were Christine Pham, Bobak Hedayati, Kiana Hashemi, Ella Csuka, Tiana Mamaghani, Margit Juhasz, Jamie Wikenheiser, and Natasha Mesinkovska, who evaluated the uniformity of distribution of intranasal hair in each nostril of cadavers, in an attempt to study the origin of partial scalp baldness (Pham CT, Hashemi K, Hedayati B, Csuka E, Babadjouni A, Mamaghani T, et al. Measurement and quantification of cadaveric nasal hairs. Int J Dermatol 2022;61: e456–e457. doi: 10.1111/ijd.15921). Twenty cadavers (10 male and 10 female) from the medical school at the University of California, Irvine were assessed with measuring tapes to conclude the average human has a nose hair count of 120 and 122 hair per nostril. The authors are from University of California, Irvine, CA, USA.

Other notable mentions include Homei Miyashita and Hiromi Nakamura, who won the 2023 Ig Nobel Prize in Nutrition for experimenting with altered taste perceptions after study subjects were made to eat and drink food with electrified chopsticks and drinking straws (Nakamura H, Miyashita H. Augmented gustation using electricity. AH ’11: Proceedings of the 2nd Augmented Human International Conference March 2011 Article No. 34. Pages 1–2. https://doi.org/10.1145/1959826.1959860) and Katy Tam, Cyanea Poon, Victoria Hui, Wijnand van Tilburg, Christy Wong, Vivian Kwong, Gigi Yuen and Christian Chan, the Ig Nobel winners in Education for methodically studying 437 students and 17 of their teachers from two local secondary schools in Hong Kong, to analyse how the boredom of teachers affected the boredom of students and lowered overall motivation to learn and to study (Tam KYY, Poon CYS, Hui VKY, Wong CYF, Kwong VWY, Yuen GWC, Chan CS. Boredom begets boredom: An experience sampling study on the impact of teacher boredom on student boredom and motivation. Br J Educ Psychol 2020;90 Suppl 1:124–37. doi: 10.1111/bjep.12309. Epub 2019 Jul 24). They concluded that presumed boredom of teachers was a direct measure of achieved boredom by students, irrespective of whether the anticipation was true or speculation.

MAHARRA HUSSAIN, United Arab Emirates

ORCID iD: 0000-0001-7632-0631

Readers of this news-page would recall reading a news item regarding the pilot project of teaching MBBS in Hindi medium, scheduled to begin from the academic session 2022–23 in Madhya Pradesh, the first state to start MBBS in an Indian language (Mohan A. Undergraduate medical education in Hindi medium: An idea whose time has come. Natl Med J India 2022;35:382–3). Close on the heels of this move, another first-of-its-kind announcement has ensued.

Commemorating the celebrations of its 200th year, the UK-based medical journal The Lancet Regional Health-Southeast Asia is scheduled to be published in Hindi as well. On the occasion that coincided with the Hindi Diwas (14 September 2023) the Madhya Pradesh Education Minister announced that experts from the Gandhi Medical College, Bhopal, Madhya Pradesh, and the Madhya Pradesh Directorate of Medical Education will facilitate and coordinate Hindi translation of the journal. The Hindi language version will be published bimonthly and is expected to make science more accessible and inclusive to researchers and students.

Earlier, The Lancet had different local language editions; a Chinese version was published for a short duration but has been discontinued.

ALLADI MOHAN, Tirupati, Andhra Pradesh

ORCID iD: 0000-0002-3214-9884

The Government of India has issued, for the first time, guidelines for admission and discharge of patients from intensive care unit (ICU). The guidelines were developed using the Delphi methodology to generate consensus (defined as achieved for an option when voted 70% or more by experts) by 24 eminent experts, including those from Dubai and Canada. The guidelines can be accessed at https://dghs.gov.in/Uploaddata/Final%20 Guidelines%20for%20ICU%20Admission%20and%20Discharge %20Criteria%2023.12.2023.pdf.

The guidelines, released in December 2023, state that the terms critical care, intensive care/intensive care/intensive therapy unit are synonymous. The definition of an intensivist or critical care specialist is also given. The minimum monitoring while awaiting an ICU bed, for inter-facility transfer of a critically ill patient to a hospital/ICU; minimum stabilization required before a patient is transferred to an ICU are also presented.

These guidelines state that the criteria for admitting a patient to ICU should be based on organ failure and requirement for organ support or in anticipation of deterioration in the medical condition. The guidelines also provide clarity on which patients should not be admitted into an ICU. Critically ill patients cannot be admitted to the ICU if patients/relatives refuse to give permission for admission, or a treatment limitation plan for any disease. Further, terminally ill patients with a medical judgement of futility; patients with a living will or advanced directive against ICU care should not be admitted to the ICU. In a pandemic or disaster situation, where there is a limitation of resources (e.g. beds, workforce, equipment), patients with low priority criteria should not be admitted to the ICU.

The guidelines recommend discharge criteria as well. These include the return of physiological aberrations to near normal or baseline status; reasonable resolution and stability of the acute illness that necessitated ICU admission; and patient/family agreement for ICU discharge for a treatment-limiting decision or palliative care; medical decision of lack of benefit from aggressive care, infection control reasons (ensuring appropriate patient carein non-ICU location); and when rationing is mandated by resource crunch. When prioritization is to be done in the face of a resource crunch, there should be a fair, consistent, reasonable explicit and transparent rationing policy.

ALLADI MOHAN, Tirupati, Andhra Pradesh

ORCID iD: 0000-0002-3214-9884

On 7 December 2023, the Union Minister of State for Health, Dr Bharati Pravin Pawar informed the Rajya Sabha that there were 706 medical colleges in India and the total number of available MBBS seats was 108 848.

Compared to 2013–14, the number of medical colleges had increased by 82% from 387 to 706. Similarly, there was an increase of 112% in the total number of MBBS seats from 51 348 to 108 848 as of 30 September 2023.

A key reason for the increase in the number of new medical colleges and MBBS seats was the provision for establishing new medical colleges that were attached to existing district and referral hospitals under a Central Government Sponsored Scheme. This resulted in the approval in three phases of 157 government medical colleges; of these, 108 medical colleges are now functioning.

Tamil Nadu has the maximum number of medical colleges (74), with a total intake capacity of 11 650. Karnataka has 70 medical colleges with 11 745 MBBS seats. Maharashtra is next, with 68 medical colleges and 10 845 MBBS seats. Uttar Pradesh also has 68 medical colleges, but with an MBBS intake capacity of 9903.

Nine states and Union Territories have only one medical college each. They are the Andaman and Nicobar Islands with 114 MBBS seats, Arunachal Pradesh with 50 MBBS seats, Chandigarh with 150 MBBS seats, Dadra and Nagar Haveli with 177 MBBS seats, Goa with 180 MBBS seats, Meghalaya with 50 MBBS seats, Mizoram with 100 MBBS seats, Nagaland also with 100 MBBS seats, and Sikkim with 150 MBBS seats.

Seven states and Union Territories have 10 or less medical colleges. They include Delhi (10; 1497 MBBS seats), Tripura (2; 225 MBBS seats), Manipur (4; 525 MBBS seats), Himachal Pradesh (8; 920 MBBS seats), Jharkhand (9; 980 MBBS seats), Puducherry (9; 1830 MBBS seats), and Uttarakhand (8; 1150 MBBS seats).

The break-up for the remaining states and Union Territories is as follows: Andhra Pradesh (37; 6485 MBBS seats), Assam (13; 1550 MBBS seats); Bihar (21; 2765 MBBS seats), Chhattisgarh (14; 2005 MBBS seats), Gujarat (40; 7150 MBBS seats), Haryana (15; 2185 MBBS seats), Jammu and Kashmir (12; 1339 MBBS seats), Kerala (33; 4655 MBBS seats), Madhya Pradesh (27; 4800 MBBS seats), Odisha (17; 2525 MBBS seats), Punjab (12; 1800 MBBS seats), Rajasthan (35; 5575 MBBS seats), Telangana (56; 8490 MBBS seats), and West Bengal (35; 5275 MBBS seats).

It must be noted that in 2013–14, 6 Union Territories and states had zero medical colleges. They were Andaman and Nicobar Islands, Arunachal Pradesh, Dadra and Nagar Haveli, Mizoram, Nagaland and Telangana. The state of Telangana was formed in June 2014. It was earlier a part of Andhra Pradesh.

Between 2014 and 2023, the number of medical colleges have remained the same in the following states and Union Territories: Chandigarh, Goa, Meghalaya, Puducherry, Sikkim and Tripura. However, the seat intake has increased by a slight margin in most of these centres.

P.M. NISCHAL, Mangaluru, Karnataka

ORCID iD: 0000-0003-3491-5500

Universal Health Coverage (UHC), with an aim to provide consistent health benefits to everyone on Earth, from prevention to investigations, and treatment to rehabilitation, was adopted at the United Nations as a target for 2030 Sustainable Development Goals (SDGs) in 2000. It was reiterated in 2015 when a faltering pace of expansion of service coverage between 2008 to 2015 led to increasing catastrophic out-of-pocket expenses in a global pattern seen across all countries.

UHC service coverage index, which had initially increased from 45 to 68 in the decade following 2000, rose only 3 index points between 2015 and 2021 and has remained static after 2019. The programme was further dealt a debilitating blow by the Coronavirus pandemic in 2020–22; 92% of countries reported disruptions of essential services at the height of the pandemic in 2021. Of these, 84% of countries still reported disruptions in 2022.

A pragmatic review of measures being adopted was proposed at the UHC Day on 11 December 2023. Primary healthcare was once again thrust into the forefront of health safety-guard policies and development of resilient health systems to reinforce the effectiveness of primary healthcare centres and policies were strongly advocated as a goal to meet the changing health-related needs and demands of the human population.

An estimated 50% of the world’s population does not have access to essential health services; 344 million people are anticipated to sink into extreme poverty due to rising health costs while a further 1 billion face catastrophic out-of-pocket health expenses; 40% of the world’s population resides in places highly susceptible to climate change; 25% of the world’s population is exposed to poverty and faces lack of access to basic healthcare due to residence in zones of protracted conflict.

Resilient health systems are the cornerstone in delivering and sustaining 90% of essential UHC interventions through primary healthcare approaches, and are estimated to save 60 million lives by 2030, while also adding an increase in average global life expectancy by 3.7 years in the same time-frame. Some of the mediations proposed include development of integrated, people-centred health services, ensuring availability of appropriately skilled and qualified health workers to provide said services and equitable access to, with safe use of, effective, quality-assured and affordable medicines, vaccines and essential health technologies.

MAHARRA HUSSAIN, United Arab Emirates

ORCID iD: 0000-0001-7632-0631