New Delhi, March 13 - Congress parliament member Sachin Pilot wants a legislation to make it mandatory for all dairy firms in the country to fortify milk with Vitamin A as India is home to 40 percent of the world\'s malnourished children.


Pilot submitted a private member\'s bill to the Lok Sabha and sought amendment to the Prevention of Food Adulteration Act to include fortification of milk with Vitamin A. He Thursday said the government would support the move.

Pilot was speaking at an event organised by the Global Alliance for Improved Nutrition -, a Swiss foundation governed by the UN and funded by the Bill and Milinda Gates Foundation and the US government.

Almost 46 percent of Indian children under the age of three suffer from malnutrition, according to the survey by the health ministry in conjunction with the United Nations Children\'s Education Fund -.

This figure is worse than that of the sub-Saharan countries. If 35 percent of the children in sub-Saharan region suffer from malnutrition, in china the figure is only eight percent.

Seeking support for the bill, the MP from Dausa in Rajasthan said he with other young MPs sought support of Prime Minister Manmohan Singh, Congress president Sonia Gandhi, Health Minister Anbumani Ramadoss and Leader of Opposition L.K. Advani.

\'We have got good and positive response from them. Malnourishment among children cannot go on. Our effort is to raise consciousness. It is a severe problem. Fortification of milk is just a small step in this direction,\' he said.

\'I will present the bill in the current budget session. We want to create awareness in the country, which would match the HIV/AIDS and polio campaigns,\' he added.

When milk is processed and the fat content is reduced, Vitamin A and D are removed with fat. \'Therefore, toned and double toned milk are low in fat and also low in vitamin A,\' he said.

Pilot, a member of the Citizen\'s Alliance consisting of young MPs from all parties and celebrities, said Congress MP Mabel Rebello would move a similar bill in the Rajya Sabha.

The legislation would not cost much to dairy firms, as they only have to add soluble to toned milk to fortify it with Vitamin A,\' he explained.

To discuss the matter a meeting was organised Wednesday, which was attended by most of the Alliance members.

\'This move will have far reaching consequences. All members agreed that it is a positive step. It is a big first step and its early implementation will help the country,\' said Pilot.

Though, the milk would be fortified, it would not mean fat contents would be high, said R. Sankar, senior manger and regional representative South Asia, GAIN.

Ninety percent of the children get less than fifty percent of Vitamin A through food, while 80 percent of women get 50 percent of the vitamin, he added.

Women with breast cancer have more aggressive disease and lower survival rates if they are overweight or obese, according to findings published in the March 15 issue of Clinical Cancer Research, a journal of the American Association for Cancer Research.

“The more obese a patient is, the more aggressive the disease,” said Massimo Cristofanilli, MD, associate professor of medicine in the Department of Breast Medical Oncology at The University of Texas M.D. Anderson Cancer Center. “We are learning that the fat tissue may increase inflammation that leads to more aggressive disease.”

Cristofanilli and colleagues observed 606 women with locally advanced breast cancer. These women were classified by body mass index into the following three groups: normal/underweight (24.9 or below), overweight (at least 25 but less than 30) or obese (more than 30). Body mass index is calculated by dividing a person’s weight by their height.

At five years, overall survival was 56.8 percent among obese women, 56.3 percent among overweight women and 67.4 percent among normal weight women. The 10-year survival rate was 42.7 percent among obese women, 41.8 percent among overweight women and 56.5 percent among normal weight women.

The rate of inflammatory breast cancer, previously shown to have worse outcomes than non-inflammatory breast cancer, among obese women was 45 percent compared with 30 percent in overweight women and only 15 percent in women considered normal weight, researchers found.

Risk of breast cancer recurrence was also higher in obese or overweight women. By five years, 50.8 percent of obese women reported a recurrence compared with 38.5 percent of normal weight women. By 10 years, the rate of recurrence was 58 percent among obese women and 45.4 percent among normal weight women.

“Obesity goes far beyond just how a person looks or any physical strain from carrying around extra weight. Particular attention should be paid to our overweight patients,” Cristofanilli said.

Cristofanilli said physicians need to pay close attention to breast cancer patients because commonly used drugs, such as tamoxifen, tend to increase weight gain during treatment.

“We have actually become quite good at managing acute side effects such as nausea in our chemotherapy patients and it goes away within a couple of days,” Cristofanilli said.

“Following the nausea, our patients tend to overeat, which further increases their risk of weight gain. We need to implement lifestyle modifications interventions and develop better methods to follow these patients closely.”

New Delhi, March 14 - India lags far behind developed countries in managing tuberculosis - because of the social stigma attached to it and health workers are particularly vulnerable to the disease, says a new report.


Titled \'Worlds Apart - Tuberculosis in India and the United States\', the article by US-based doctor Vikram Paralkar has been published in the current online version of the New England Journal of Medicine.

Mumbai-born Paralkar says the \'persistent burden of the disease in developing countries was once due to lack of scientific understanding and now due to lack of infrastructure\'. Over one million TB cases are reported every year in India, as per official figures.

The article, which is based mostly on Paralkar\'s personal experience of working in a remote village in India and Mumbai\'s King Edwards Memorial Hospital, points out that even among India\'s educated, tuberculosis carries a stigma.

Paralkar, who is currently a resident in internal medicine at the Temple University Hospital in Philadelphia, says life with TB in India seems \'precarious\'.

\'...India has lagged far behind developed countries in the containment and management of the disease,\' the writer says.

\'Many people continue to slip through the net and into jostling crowds, with at the most a thin handkerchief to stifle their incessant coughs.\'

He says: \'Despite the laudable progress that has been made in India in the 60 years since its independence, it remains challenged in fundamental ways\'.

\'Social stigma often discourages people from seeking treatment for months and when they do seek it, treatment is administered on an outpatient basis, since isolating otherwise functional people is rarely feasible.\'

He says the treatment of latent tuberculosis with nine months of single-drug therapy -- the norm in the United States -- is a concept found only in textbooks in India. \'If it were implemented, nearly a 10th of the population would require treatment.\'

Citing his stint in a rural health centre, he said: \'I saw dedicated healthcare volunteers trek miles down narrow, muddy cattle paths to provide free Directly Observed Treatment - to patients in remote areas.\'

\'Unfortunately, I also witnessed unscrupulous medical officers recording fictional patient names in their logbooks in order to meet government quotas,\' he adds.

He says the rate of confirmed infection in the medical fraternity alone is startling.

Citing a finding at a medical school in northern India, he said researchers found an incidence of about 17 new cases of active TB per 1,000 medical residents per year as compared to about two cases in the general population. In the US, the rate is 0.05 per 1,000 in the general population.

\'The prevalence of latent infection among healthcare workers at a rural medical school - was more than 40 percent,\' he said.

He said genotypic analysis of mycobacterium tuberculosis in patients admitted to two different wards in Delhi revealed clusters of genetically similar strains among patients who had had overlapping hospital stays at the same institution - making for compelling circumstantial evidence of nosocomial transmission.

Recalling his time at King Edward Memorial Hospital in Mumbai where he took training, Paralkar says: \'Although they possessed a certain archaic grandeur, the wards housed patients in a communal space that was not designed for the containment of infectious diseases.\'

He says patients suffering from TB were situated in the \'farthest reaches\' and stayed close to those who were being treated for AIDS or cancer.

Incidentally, the huge number of TB cases is also compounding the AIDS situation in India.

The writer says many of his classmates were \'exposed to\' the infectious disease. \'Many more students probably underwent months of treatment without revealing their diagnoses. Even among India\'s educated classes, tuberculosis carries a stigma,\' he said.

The World Health Organization\'s 2007 report on global tuberculosis control has said India\'s Revised National Tuberculosis Control Programme has expanded DOTS \'to the entire country, with 100 percent geographical coverage in March 2006\'.

But Paralkar says: \'Although these steps forward are worthy of celebration, we must remember that statistics are only as good as the village-level data on which they are based.\'

New Delhi, March 16 - Possibly hinting at the cases of medical negligence that have come to light at the All India Institute of Medical Sciences -, Health Minister Anbumani Ramadoss wants the premier referral institute to focus more on patient care and safety.

Ramadoss also believes AIIMS should give high importance to research.

\'Patient safety should be given first priority. Also, the institute should ensure that the medical staff, including nurses, are polite to them. They should behave well with them. They should offer a holistic environment,\' Ramadoss, who is also AIIMS president, told IANS.

He said the World Health Organisation - lays a lot of importance on patient safety.

On Jan 1 this year, a senior doctor was accused of leaving artery forceps in the stomach of a 30-year-old woman who had undergone operation. The forceps were removed in a subsequent operation. She was discharged later.

In October last year, a cardiac surgeon left a screw inside the chest of a heart patient. The patient died a few days after the operation. In another case, a doctor, while taking out stones from a patient\'s stomach, left a towel inside the patient.

Ramadoss said focus on research should also be high on the agenda of AIIMS.

Expressing concern that for the past few years the institute has not been able to come out with any major research breakthroughs, he stressed that research is the key area.

Research is the only way we can reduce the disease burden on the country, he added.

The health ministry last year allotted to the institute Rs.2.8 billion , out of which only Rs.2 billion was spent. \'We also gave them an additional amount of Rs.300 million to Rs.500 million,\' said Ramadoss.

\'If they ask for more money we will give them more. It is our own premier institute,\' he said.

The health minister also said that in another three months the institute would be able to shortlist the name of its new director. \'The process has begun to look for a new director,\' he said.

Ramadoss was in the spotlight last year for his bitter turf war with renowned cardiac surgeon P. Venugopal who was subsequently removed as AIIMS director.

Currently T.D. Dogra is functioning as the acting director. The minister appointed Dogra as he was next in seniority to Venugopal, who was ousted after parliament passed a legislation fixing the retirement age at 65 for the director.

Soon after his removal, Venugopal, 66, approached the Supreme Court challenging his removal as director of AIIMS. The apex court March 12 reserved its verdict on his petition.