Also Read: AbbVie, Teva finalize USD 6.6 billion US opioid settlements

The company's previous sales outlook for Skyrizi and Rinvoq in 2025 was more than $15 billion.

AbbVie also expects peak sales of the drugs to exceed $21 billion in 2027. The two drugs are part of the company's long-term growth strategy to offset Humira's loss of exclusivity.

The drug maker has been in contract negotiations with insurers and pharmacy benefit managers for Humira for this year, and said in October that pricing of its rivals would determine the drug's sales this year.

Also Read: Abbvie RINVOQ gets European Commission nod for treatment of Active Non-Radiographic Axial Spondyloarthritis in adults

The Healthy Caribbean Coalition (HCC) has led the development of this discussion paper in collaboration with a group of like-minded civil society representatives from other Small Island Developing States (SIDS) regions, and with the support of the NCD Alliance (NCDA), a global network of CSOs also dedicated to NCD prevention and control worldwide.

This discussion paper was developed as a contribution to the High-Level Technical Meeting and Ministerial Conference on NCDs and Mental Health in SIDS, which will be convened by the World Health Organization (WHO) in Barbados, in January and June 2023 respectively.

This discussion paper outlines the unique characteristics of SIDS and the challenges they face, particularly related to their size, geography, and small populations; constraints for achieving economies of scale due to their small domestic markets, limited resources, and undiversified economies; and threats from the climate crisis and food and nutrition insecurity. These challenges, among others, have been aggravated by the 2019 coronavirus (COVID-19) pandemic, which has put at further risk SIDS’ efforts to mount efficient and effective responses to their disproportionate burden of NCDs, using approaches that are equity- and rights-based, multisector, and multistakeholder.

Civil society is a critical stakeholder, along with government and the private sector free from conflicts of interest, in the response to the major NCDs—heart disease and stroke, diabetes, cancer, chronic respiratory diseases, and mental, neurological, and substance abuse disorders (MNSDs). CSOs advocate for and contribute to interventions that address NCDs and their risk factors—particularly poor diets, tobacco use, alcohol use, physical inactivity, and air pollution—as well as the determinants of health—social, economic, environmental, commercial, political, legal, and other non-medical factors that strongly influence health outcomes. In producing this discussion paper, HCC, NCDA, and SIDS civil society representatives analysed the NCD situation in SIDS across various regions, built on global and regional frameworks for the reduction of NCDs and their underlying causes, and identified priorities, recommendations, and key asks for inclusion in the report of the January 2023 High-Level Technical Meeting and the outcome document of the June 2023 Ministerial Conference on NCDs and Mental Health in SIDS.

Read or download the discussion paper.

Authors welcome comments on this discussion paper at hcc@healthycaribbean.org until 28 February 2023.

 

The post Noncommunicable Diseases and Mental Health in Small Island Developing States – A Discussion Paper by Civil Society appeared first on Healthy Caribbean Coalition.

The Host

Julie Rovner
KHN

@jrovner

Read Julie's stories.

Julie Rovner is Chief Washington Correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A-Z,” now in its third edition.

Having spent its entire first week choosing a speaker, the Republican-led U.S. House finally got down to legislative business, including passing two bills backed by anti-abortion groups. Neither is likely to become law, because they won’t pass the Senate nor be signed by President Joe Biden. But the move highlights how abortion is sure to remain a high-visibility issue in the nation’s capital.

Meanwhile, as open enrollment for the Affordable Care Act nears its Jan. 15 close, a record number of people have signed up, taking advantage of renewed subsidies and other help with medical costs.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Sarah Karlin-Smith of the Pink Sheet.

Panelists

Sarah Karlin-Smith
Pink Sheet

@SarahKarlin

Read Sarah's stories

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories

Margot Sanger-Katz
The New York Times

@sangerkatz

https://www.nytimes.com/by/margot-sanger-katz

Among the takeaways from this week’s episode:

• The House now has a speaker after 15 rounds of full-chamber roll call votes. That paved the way for members to be sworn in, committee assignments to be made, and new committee chairs to be named. Cathy McMorris Rodgers (R-Wash.) and Jason Smith (R-Mo.) will be taking the helm of major health committees.
• McMorris Rodgers will lead the House Energy and Commerce Committee; Smith will be the chairman of Ways and Means. Unlike McMorris Rodgers, Smith has little background in health issues and has mostly focused on tax issues in his public talking points. But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees.
• One thing is certain: The new GOP-controlled House will do a lot of investigations. Republicans have already reconstituted a committee to investigate covid-19, although, unlike the Democrats’ panel, this one is likely to spend time trying to find the origin of the virus and track where federal dollars may have been misspent.
• The House this week began considering a series of abortion-related bills — “statement” or “messaging” bills — that are unlikely to see the light of day in the Senate. However, some in the caucus question the wisdom of holding votes on issues like these that could make their more moderate members more vulnerable. So far, bills have had mostly unanimous support from the GOP. Divisions are more likely to emerge on topics like a national abortion ban. Meanwhile, the Title X program, which pays for things like contraception and testing for sexually transmitted infections, is becoming a hot topic at the state level and in some lawsuits. A case in Texas would restrict contraception availability for minors through this program.
• It’s increasingly clear that abortion pills are going to become an even bigger part of the abortion debate. On one hand, the FDA has relaxed some of the risk evaluation and mitigation strategies (REMS) from the prescribing rules surrounding abortion pills. The FDA puts these extra restrictions or safeguards in place for certain drugs to add additional protection. Some advocates say these pills simply do not bring that level or risk.
• Anti-abortion groups are planning protests in early February at large pharmacies such as CVS and Walgreens to try to get them to walk back plans to distribute abortion pills in states where they are legal.
• A growing number of states are pressuring the Department of Health and Human Services to allow them to import cheaper prescription drugs from Canada — or, more accurately, importing Canada’s price controls. While this has long been a bipartisan issue, it has also long been controversial. Officials at the FDA remain concerned about breaking the closed supply chain between drugs being manufactured and delivered to approved U.S. buyers. The policy is popular, however, because it promises lower prices on at least some drugs.
• Also in the news from the FDA: The agency granted accelerated approval for Leqembi for the treatment of Alzheimer’s disease. Leqembi is another expensive drug that appears to work, but also carries big risks. However, it is generally viewed as an improvement over the even more controversial Alzheimer’s drug Aduhelm. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug.
• As the Affordable Care Act enrolls a record number of Americans, it is notable that repealing the law has not been mentioned as a priority for the new GOP majority in the House. Rather, the top health issue is likely to be how to reduce the price of Medicare and other health “entitlement” programs.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week that they think you should read, too:

Julie Rovner: The Washington Post’s “Social Security Denies Disability Benefits Based on List With Jobs From 1977,” by Lisa Rein

Margot Sanger-Katz: Roll Call’s “Providers Say Medicare Advantage Hinders New Methadone Benefit,” by Jessie Hellmann

Alice Miranda Ollstein: The New York Times’ “Grant Wahl Was a Loving Husband. I Will Always Protect His Legacy.” By Céline Gounder

Sarah Karlin-Smith: KHN’s “Hospitals’ Use of Volunteer Staff Runs Risk of Skirting Labor Laws, Experts Say,” by Lauren Sausser

Also mentioned in this week’s podcast:

• KHN’s “States Challenge Biden to Lower Drug Prices by Allowing Imports From Canada,” by Phil Galewitz
• Politico’s “Next Frontier in the Abortion Wars: Your Local CVS,” by Alice Miranda Ollstein and Lauren Gardner
• KFF’s “Millions of Uninsured People Can Get Free ACA Plans,” by Jared Ortaliza, Justin Lo, Gary Claxton, Krutika Amin, and Cynthia Cox

TRANSCRIPT

Click here for a transcript of the episode.

KHN’s ‘What the Health?’Episode Title: GOP House Opens With Abortion AgendaEpisode Number: 279Published: Dec. 12, 2023

Tamar Haspel: A lot of us want to eat better for the planet, but we’re not always sure how to do it. I’m Tamar Haspel.

Michael Grunwald: And I’m Michael Grunwald. And this is “Climavores,” a show about eating on a changing planet.

Haspel: We’re here to answer all kinds of questions. Questions like: Is fake meat really a good alternative to beef? Does local food actually matter?

Grunwald: You can follow us or subscribe on Stitcher, Apple Podcasts, Spotify, or wherever you listen.

Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Jan. 12, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Good morning.

Rovner: Margot Sanger-Katz of The New York Times.

Margot Sanger-Katz: Hello.

Rovner: And Sarah Karlin-Smith of the Pink Sheet.

Sarah Karlin-Smith: Hi, everybody.

Rovner: So no interview this week, but lots of news, so we will get right to it. We’re going to start with the new Congress, where the House finally has a speaker after 15 rounds of full-chamber roll calls. Settling the speaker meant that the rest of the House could be sworn in and things like committee chairs elected. Two key health committees, Energy and Commerce and Ways and Means, will both have new chairs, not just new because they’re Republican, but new because they have not chaired the committee previously. Energy and Commerce will be headed by a woman for the first time, Cathy McMorris Rodgers of Washington state, who’s had a longtime interest in health policy and was also in the Republican leadership. Over at Ways and Means, the new chairman is Jason Smith of Missouri, who I confess I had never heard of before this. Does anyone know anything about him? And does he have any interest in health care?

Ollstein: Most of what he said about chairing the committee has been about things other than health care. It’s been a lot on taxes, for instance. The new House majority is very “exorcised” about the IRS funding that the previous Congress approved and trying to get rid of that. But he has shown some interest in some telehealth provisions. And so I think also I’m sure we’re going to discuss some interest in, shall we say, revisiting Medicare’s benefits and funding …

Rovner: Yeah, we’re going to get to that next.

Ollstein: So there could be some things, but it doesn’t seem that he’s been a big health care guy or will be a big health care guy going forward.

Rovner: In the olden days, when I started covering this, the chairman of the Ways and Means Committee frequently did not have either an interest or an expertise in health care. But the chairman of the Ways and Means health subcommittee did. That’s where pretty much everything came from. Do we know yet who is going to chair the Ways and Means health subcommittee …? We do not. So we’ll wait to see that. But yes …. even though I read Chairman Smith’s little introduction about what he’s interested in — and I know he mentioned rural health — but he did not anywhere mention Medicare. And of course, the Ways and Means Committee has jurisdiction over most of Medicare in the House. It is going to come up, as far as we can tell, right?

Sanger-Katz: One imagines so because some of the promises that leadership has made to its members to think about how to balance the budget in the long term, to consider entitlement reform, whatever that may mean. And, you know, Medicare is where the money is. So you would think that the Ways and Means Committee would want to be looking seriously at how to reform the program, if that’s the interest of leadership on this policy area.

Rovner: And they’ve already said that they want to tie any debt ceiling vote, which [is] one of those things that Congress absolutely has to do to reforms, quote-unquote, of the Medicare and Social Security programs. Because, again, as Margot said, that’s where the money goes. So we expect to see Medicare as an issue, regardless of what the Ways and Means Committee does, right?

Ollstein: That’s right. There were a lot of calls for Democrats to address the debt ceiling issue during their final months in power. They did not do so. That means that it’s going to be a big, messy fight this year. One of the biggest things to watch. This is an instance where the Republican House majority will be able to flex its muscles even though they don’t have the Senate and White House, because they can trigger a budget standoff that puts the faith and credit of the country in jeopardy and demand concessions, including cuts to Medicare. So we’ll see how that goes.

Rovner: Although I will say, Sen. Brian Schatz of Hawaii was on Twitter, and he didn’t ask me anything much to the horror of his communications staff. But one of the questions that somebody asked him was, “Why didn’t you do the debt ceiling?” And he just said: We didn’t have the votes. So that at least answers the question of why didn’t they take care of this before the Republicans took the majority back? Well, one thing we do know is going to happen is that the new Republican-controlled House is going to do a lot of investigations. Indeed, one of the first orders of business in the new Congress was the re-establishment of a committee on the covid pandemic with a new focus on investigating the origins of the virus and the government’s response to it. What are we expecting out of that?

Karlin-Smith: As you said, Julie, I think two of the things is, one, they’re going to do more investigation into the origin of the virus. Republicans have pushed the potential theory that this was borne out of a lab in China, not necessarily something more naturally occurring. And I think a lot of scientists have said this theory has been fairly close to disproven and find that the focus on it distracts from really dealing with the current pandemic. But I think we should expect a lot of that. And that will include, I think, a lot of relitigation of Anthony Fauci and his particular role in the NIH [National Institutes of Health] and funding different types of research on viruses, both in the U.S. and abroad. The second thing I think they’re going to look very closely at is how the U.S. has spent the covid funding that Congress has doled out and appropriated. That’s certainly a lot of money. And I think, again, oversight is always probably … it’s a good thing to see if Congress gives money, are we spending it? … Does it actually get to where it needs to go? Does it go to where it’s supposed to go? I think that … in general, I think most people think that’s a good thing. Sometimes what ends up happening is it gets taken a little bit to …  this disingenuous step forward in Washington, where everything gets questioned or they pick on jurisdictions for not spending the money fast enough when it’s just not realistic. So you have to read between the lines really carefully when you’re looking at some of the findings from that type of work. Because sometimes, again, when you give a state $1,000,000 to do something, they’re not often able to make that change in two months.

Rovner: And then if they do, they get criticized for spending it on the wrong thing, so …

Karlin-Smith: Right.

Sanger-Katz: But I will say, speaking as a journalist, not as a congressional investigator, I do think that the covid funding is really ripe for a lot of investigation. There’s already been very good reporting that a lot of the small-business programs were broadly defrauded. I think there was a real emphasis by Congress and — in a bipartisan way, Republicans obviously voted for these bills as well. But I think there was a real emphasis on just getting money out the door. People were so scared of a catastrophic economic collapse that, unlike a lot of programs that Congress designs that fund various things, there weren’t a lot of initial safeguards, there wasn’t a lot of process or administrative burden associated with getting money. And so that means it really is valuable to look and see where did it go, who may have defrauded the program, what are ways that in the next crisis it might be possible to do these kinds of programs in a way that is more efficient. You know, it occurs to me that in addition to the small-business money, hospitals got a whole lot of money as part of these programs. And again, there’s been some journalism about this, but I do think I’m all for more oversight, trying to learn some real lessons. I agree with Sarah that there is probably some of this that’s going to veer into the disingenuous and kind of “gotcha.” But there may be some useful and interesting findings as a result of this process as well.

Rovner: And as we saw with the Jan. 6 committee, Congress has powers that journalists don’t. As we know, the Justice Department has powers that Congress doesn’t. But Congress has pretty good investigatory powers. They can subpoena things when they need to. So, yes, I imagine we’re going to learn something about the fate of all of those dollars that went out the door.

Ollstein: Just to be fair, Republicans have sort of claimed that the Democrat-led effort to investigate covid didn’t have any financial accountability aspect. That’s not true. It did. They really scrutinized a lot of government contracts — like no-bid government contracts that funneled lots and lots of money to things that did not pan out or help anybody. There has been some of that already. But I agree that there’s definitely more to look at.

Rovner: And there … obviously, there was a Republican and a Democratic administration handling the covid pandemic. So one presumes there are things to investigate on both sides. Well, even while the House committees are gearing up, Republicans are bringing “statement” bills to the floor, bills that we know the Senate won’t take up and the president won’t sign. And despite the fact that abortion rights drove a lot of the midterm elections in the other direction, two of the first bills brought to the floor by the new Republican majority seek to do the bidding of anti-abortion groups. This, apparently, making Republican moderates, particularly those in swing districts, not so happy. Alice, are we looking at pretty much the same split in the Republicans in the House as in a lot of states — the people who think that the Republicans didn’t do well because they should have done more and people who think the Republicans didn’t do well because they should have done less?

Ollstein: Yeah, absolutely. And there’s a split on how to talk about it or whether to talk about it as well. It’s not just the actions, it’s the messaging in addition. And so, yes, there are some in the House who are, like, why are we doing this? Why are we taking these votes that have no chance of becoming law? It just puts our members from swing districts in a more vulnerable position. The things they voted on so far this week have pretty unanimous support on the Republican side, I would say. I think where you could start to see some bigger divides are when they get into votes on an actual national abortion restriction that would put a gestational limit on the procedure, or something like that, which absolutely some members want to do and want to take a vote on. I think that’s where you could start to see some Republicans being, like, wait, wait, wait, wait, why are we doing this? But the things so far are, like you said, they’re “messaging” bills, but they’re ones that have pretty broad support on the conservative side.

Rovner: And we should mention, I mean, one of them was just a sense of Congress that, you know, that bombing pregnancy crisis centers is bad. Or that violence against pregnancy centers …

Sanger-Katz: I’m not going to give credit for this correctly, but I saw a tweet on this topic last week when the list of demands and the list of these bills that we’re going to get a vote on was released where someone asked, Oh, did D-Triple-C [the Democratic Congressional Campaign Committee] co-author this list? Where I do think there is an interesting tension, as Alice said, where the particular message bills that the most conservative members of the House Republican caucus want to vote on are those issues where we see in public opinion polling, where we see in the last election that the majority of Americans are not really with those most conservative Republicans. And I think a lot of moderate Republicans would just prefer not to vote on those issues, particularly because they know that they can’t make them policy. And we were talking about changes to Medicare and Social Security, and I think that also falls very much in that category where there might be a situation in which if Republicans really thought that they could reform these programs, maybe they would want to take the political risk, because I do think it’s an important long-term goal of many Republicans. But I think there’s also a frustration, you know, why would we take all these votes on something that is generally unpopular? Everyone knows that both Social Security and Medicare are really, really popular programs and people are very wary of changes to them. There is a political risk in taking a bunch of votes saying that you want to pull money out of those programs or change them structurally when you can’t even achieve it.

Rovner: Yeah. Well, speaking of that, during Wednesday’s abortion debate on the House floor, Republican moderate Nancy Mace of South Carolina kept saying to any cable outlet that would put a microphone in front of her that Congress should be making birth control more widely available instead of voting on abortion. But we are also seeing the first shots fired in an effort to restrict birth control. Well, last month, a Trump-appointed judge ruled that the Title X family planning program is illegally providing contraception to minors. Now, this is a fight that dates back to even before I started covering it. It was called “the Squeal Rule” in the early 1980s, an effort by the Reagan administration to require parental involvement before teens could use Title X family planning services. It was eventually struck down in federal court, but now it’s back. Is this where we’re headed?

Ollstein: I think it’s really important to watch things in law and policy that are just directed at minors because inevitably it does not stop there. Like, that’s sort of the testing ground. It’s where people are more comfortable with more restrictions and more hoops to jump through. But as we’ve seen with gender-affirming care, it doesn’t stop there. What’s tested out as a policy for minors is inevitably proposed for adults as well, and so …

Sanger-Katz: What’s the adult version of this, Alice? Like who? Like spousal consent?

Rovner: Yes, there had been — I was just going to say — not so much in contraception, although originally it was, but also on abortion that, yeah, if there’s a partner that the partner would have to consent.

Ollstein: But there’s also been spousal consent stuff for more permanent … getting your tubes tied, those kinds of things. That’s been a debate as well. And, I mean, in the abortion space we’ve seen this for, in terms of like traveling across state lines for an abortion. That’s been a restriction for minors that’s also been proposed for adults. So it’s just this phase we should absolutely watch — as well as Title X program continues to be a space for proposed restrictions. It’s a lever that they’re able to hold because it does have federal funding and it does have constraints that other pots of money don’t have.

Rovner: My favorite piece of trivia is that the Title X program has not been reauthorized since 1984 because Congress has never been able to find the votes. You know, when the Democrats were in charge and wanted to do it, the Republicans would have all of these amendments that the Democrats probably couldn’t fight off. The Republicans wanted to do it and put all these stringent rules that the Democrats wouldn’t have. So, literally, this program has been … it gets funded every year, but it’s been marching along for now several decades without Congress having formally reauthorized it.

Ollstein: Yeah, that’s why you keep seeing different presidential administrations trying to put their stamp on it through rulemaking, which, of course, can be rolled back by the subsequent president, as we’ve seen with [Donald] Trump and [Joe] Biden. And so it just keeps going back and forth. And these clinics that are out there getting this funding, which, again, can’t be used for abortion, for contraception, STD testing, fertility stuff, all kinds of stuff, but not abortion. But they keep having to comply with these wildly different rules. It’s really difficult.

Rovner: Yeah, it is. All right. Well, last week we talked about the Biden administration’s effort to make abortion pills more available through both pharmacies and the mail. On the one hand, some abortion rights advocates say that the FDA is still overregulating the abortion pill by requiring extra hoops for both pharmacies and doctors to jump through in order to offer or write prescriptions for a medication that’s proved safe and effective over two decades. On the other hand, we now have the specter of abortion opponents protesting at CVSes or Walgreens near you. And Alice, they’re already planning to do that, right?

Ollstein: Yeah, that’s right. They would have done it sooner, but they didn’t want to step on the March for Life, which is coming up in a couple of weeks. And so they’re planning these protests at CVS and Walgreens around the country for early February, trying to pressure the company to walk back its announcement that they will participate in the distribution of abortion pills in states where they remain legal, which is, by our count, currently 18 can’t do this either because abortion is banned entirely or because there are laws specifically restricting how people get the pills.

Rovner: Sarah, I want you to talk about some of these extra hoops that have to be jumped through because a lot of people think it’s just for this pill and it’s not. This is something that the FDA has for any drug that’s potentially abusable, right?

Karlin-Smith: Yeah, I wouldn’t say abusable is the right word, but basically people call this a REMS. It stands for risk evaluation and mitigation strategy. And it’s actually an authority Congress gave the FDA to — we use this term “safe and effective,” but we know all drugs, even when we say that “safe” term, will come with risks. And the idea here is that when the benefit-risk balance would be … so that it would be … FDA might say, OK, this is actually too risky to approve. However, we think we could make it kind of safe enough if we put in a little extra safeguards instead of just letting it go out there. Here’s a drug, doctors, you can prescribe it, follow the normal pathway, which is that the federal government, or at least the FDA, doesn’t really have a lot of say in exactly how the practice of medicine works. That’s left up to states. And, you know, doctors individually. They implement other practices to help ensure that safety balance is there. So one famous example is Accutane, which is an acne drug. It’s incredibly harmful to a developing fetus and birth defects. So women of pregnancy, bearing age are usually required to take regular pregnancy tests and so forth and monitor the status of that. And you’re not supposed to use the drug while pregnant because of the incredible harm you do to a baby. So there’s everything from things like that to just simply more written literature might be provided for certain drugs. Sometimes in the cases of the abortion pill, you know, who could actually dispense it and when was restricted. Sometimes there are particular sorts of trainings doctors have to take to get that extra authority to prescribe the drug. And again, the idea is that just to provide a little extra safeguard. Again, the controversy over the years with this pill is that people feel like it doesn’t meet that standard to have a REMS, that it can be safe and effective through our normal prescribing systems. Actually, Stat this week had an interesting interview with Jane Henney, who was the FDA commissioner when they first approved this drug. And she …

Rovner: Yeah, in the year 2000.

Karlin-Smith: Right. Which is actually …

Rovner: Right at the end of the Clinton administration.

Karlin-Smith: Actually predates this formal REMS authority. But there were others, different authorities that then evolved into REMS. But she said she thought that a lot of these restrictions would be gone by now and that what, at the time, what they were waiting for was more U.S.-specific experience with the drug, because what they were basing the original approval on was a lot of use of the drug in France, which had such a different health system than the U.S., they were a little bit uncomfortable, I guess, opening the floodgates in a way. So I thought that was an interesting historical point that came out this week.

Rovner: But clearly, Alice, I mean, this is going to be the next big fight in abortion, right, is trying to restrict the abortion pill?

Ollstein: Absolutely. I’ve been writing about this since before Roe v. Wade was overturned. The pills were already becoming one of the most popular and now are the most popular way to terminate a pregnancy in the U.S., which makes sense. You can take them in the comfort of your home with the people that you want to be with you, not in a scary medical environment. It’s also a lot cheaper than having a surgical procedure. So but then, of course, with the pandemic, people started using them even more because it was more dangerous to go to a clinical setting. And so this has been a big focus of both sides of this fight for a long time: either how to increase access to the pills or restrict them. Also, now that Roe v. Wade has been overturned, the pills and the ability to order them online from overseas in this legal gray area, that’s been a major way people have been getting around state bans, and the anti-abortion groups know that. And so they want to look at any way they can to crack down on this. And so with the Biden administration opening up a new potential pathway with these local retail pharmacies, they’re of course going to try to crack down on that as well.

Karlin-Smith: I mean, we talked about this before in the podcast, but I think this issue of federal preemption, if it gets teed up, is going to be a big thing that’s beyond just abortion, in terms of when does FDA’s approval of a drug trump state regulations around how it’s going to be used? And, you know, I feel like some people have not been satisfied on the … who want more access to abortion drugs in terms of how FDA has handled the rollback of the REMS. But you also have to wonder if they’re operating in this setting where, again, if you push things too far and you get a legal challenge, given how our courts are, right? And how politically it can backfire. And so it’s a complicated balance there.

Rovner: Well, speaking of drugs that are in gray areas that people order online, my KHN colleague Phil Galewitz reports that four states — Florida, Colorado, New Hampshire, and New Mexico — are now pressuring the Biden administration to allow them to import prescription drugs from Canada in an effort to reduce the cost of drugs for their residents. Now, despite the fact that this has been and remains a very bipartisan ask, the FDA, under both Republican and Democratic commissioners, has strongly objected to it over the years. Somebody remind us why this is so controversial.

Karlin-Smith: I think the big thing FDA has objected to is that when you allow importation in the way states have often asked for it, you basically often give up the supply chain oversight that we have in the U.S. that ensures people are not getting drugs that are counterfeit and have somehow been tampered with as they’ve gotten through the supply chain. And so, actually, I was refreshing my memory, and I can’t believe how long ago it is. When the Trump administration first became the first administration to say, Oh, actually, OK, we are going to agree that we think this could be come safely. Then they put out regulations that tried to … basically like made it so that to do importation, you would almost have to mimic the same supply-chain safety measures we already have for the FDA. So it became this double-edged sword of, sure, you can do the importation, but you’re going to have to jump to this level of hurdles that then makes it unusable. And so I think that’s the key barrier here, is that can a state actually propose a program that would get sign-off? And I think it’s not really surprising to me that the Trump team tried to thread the needle in that way of giving people the win of saying, Oh, we’ll allow it without actually making it feasible.

Sanger-Katz: I think it also highlights what a weird ask this is in some ways because what the states are looking to do is they are not looking to import drugs from other countries because they think that other countries have better manufacturing, have better safety protocols, have different drugs. They just want to import the lower prices that other countries pay for the same drugs. And so this is, in some ways, a very cludgy workaround that the states are basically asking for price regulation of drugs. But that obviously is a very difficult political act. So instead they’re saying, well, can we just import the prices that some other country has negotiated. And then it raises all these other issues about, Well, you know, there is like a reason why, in general, the United States has regulatory control over the drug supply.

Rovner: Also, Canada doesn’t have enough drugs to serve all of these states. I mean, that’s the thing that I’ve never managed to get over. And, in fact, Canada has said that they’re not anxious to do this because they don’t have enough drugs to serve both Canada and the United States. I mean, it also seems just literally impractical.

Sanger-Katz: I mean, we are seeing, of course, like in the Inflation Reduction Act, there were new measures that would allow Medicare, in particular, to start negotiating for lower prices for certain drugs. Obviously, that policy has a fair number of limitations, including that it’s only for Medicare, it’s only for certain drugs, and it’s not going to be instant. But while we did get some new timeline from the Biden administration this week, and it looks like that policy is going to start rolling out. So I think states are asking for this now because they want to import prices from other countries. But also, for the first time, Medicare, or the federal government is starting to take on drug prices directly. And we’re going to see how that looks relatively soon.

Rovner: Yes, this ship turns very slowly, but it does seem to be turning a little bit. Well, as we previewed last week, the FDA has approved another controversial Alzheimer’s disease drug, Leqembi. I think that’s how you say it, which has a Q without a U. Sarah, you’ve been following this. Are we headed down potentially the same road we traveled with Aduhelm? It feels kind of familiar. It’s a drug that we think works, but we don’t really know, and it has some big risks and will be expensive.

Karlin-Smith: Yeah, I mean, similar, but slightly different. And perhaps the analogy that things slowly make their way in a different direction is also right here. This drug, I think most people see it as an improvement on Aduhelm because it has, in one major clinical trial, shown some benefit on people’s cognitive decline slowing a bit. However, the big debate there is that … how meaningful the change that was seen in the trial is. Is it really going to be meaningful in people’s lives and is that worth the price? The company is … actually a similar company is involved here, but they priced it quite a bit lower than the original Aduhelm price, even lower than the price of Aduhelm now. It’s still seen as on the very high end of what a lot of cost-effective watchdogs say is a fair price. And as of right now, CMS [the Centers for Medicare & Medicaid Services] or Medicare is not going to be covering it at all because right now the drug only has what’s known as an accelerated approval. So we’re going to, over the next probably less than a year, in about nine months or so, FDA will have to weigh in on whether it gives the drug a full formal approval. And at that point, we’ll see if Medicare also gives the sign-off that they think this drug might actually be effective for people and are willing to pay for it. I think my bottom line on this drug is, you know, it provides some hope and some improvement for people, but it looks like to be a small clinical benefit for a big trade-off in risks. So I think as more data comes out over time, we’ll see again if that benefit-risk trade-off for most people falls on the right side of the coin.

Rovner: And we’ll watch this whole process go forward again. All right. Finally this week, but not least, there’s also news on the health insurance coverage front. With the end of open enrollment for the Affordable Care Act coverage rapidly approaching in most states, by Jan. 15, officials at the Department of Health and Human Services this week reported that enrollment is already up 13% from last year to almost 16 million people, including about 3.1 million people who are new enrollees. In the meantime, though, my colleagues over the firewall at KFF report that some 5 million more uninsured Americans are actually eligible for free health care coverage under the ACA. It feels ironic because this is not the first year of expanded subsidies and there’s been relatively little media coverage of open enrollment. Is it just that it takes time for knowledge of these offers to trickle down to people? Or that the Biden administration put a lot more effort into outreach this year?

Sanger-Katz: I think it’s all of the above. I think for the first few years of the Obamacare program, there were a lot of complaints that this insurance really wasn’t affordable enough for people. And, obviously, that’s why Congress, first in part of the pandemic stimulus bill and now again in the Inflation Reduction Act, really jacked up the subsidies and made the plans cheaper and, in many cases, have more wraparound benefits so that low-income people could get insurance that was either free or relatively low-premium and also didn’t ask them to pay a lot out-of-pocket for their own care. And we can see also that the Biden administration did a lot of outreach. I mean, it’s definitely the case that they both, through Congress, made the plans cheaper and also, through various administrative actions, made the plans more widely publicized. And I just want to highlight, I think last year was the record year for Obamacare enrollment. And now we’re seeing this huge increase on top of a record year. So these things seem to matter. I think the affordability of plans, the availability of free plans for a lot of uninsured Americans is very appealing. And yet the people who are uninsured and poor, I think, are difficult to reach. There is a lot of long-standing opposition to Obamacare. There are a lot of places where there are a lot of uninsured Americans, where there’s not particularly effective and robust outreach. People don’t know how to find these things, how to sign up. And it is really administratively complex to sign up for these plans. I mean, I don’t know how many of our listeners have tried to do it. It’s not impossible. It is on the internet. You know, anyone can do it. And you don’t have to have someone holding your hand. But I think in many cases you probably do want someone holding your hand if it’s your first time doing it. There are, in many markets, lots of choices. It’s confusing. It’s hard to know what the best option is, sometimes it’s a little bit hard to figure out what it’s going to cost you until you enter in a lot of information about your income. And you might also be scared that if you’re not sure or you put something in wrong, you could get in trouble. So I think this is just an ongoing challenge of getting all these people who are now eligible for these really low-cost plans to actually interact with the system and get insurance.

Rovner: One thing I guess bears mentioning is that with the Republicans just, you know, plan to do all of these things like try to repeal the Inflation Reduction Act because they don’t like the drug price provisions … [but] they are not talking about repealing the Affordable Care Act anymore, right? Have we finally come to the end of that particular fight?

Sanger-Katz: It sure looks that way.

Ollstein: Yeah. The right the writing has been on the wall in terms of the lack of that talk on the campaign trail for a few years now. I was joking with some colleagues that, you know, the “repeal Obamacare” is tired; the “repeal the drug price negotiation provisions” is wired. That’s the new talking point, although that’s not going to happen either, obviously, because of the control of the Senate and because of how insanely expensive it would be to repeal that. But the Republicans definitely have moved on to other targets.

Sanger-Katz: Although I will say, you know, once again, the fact that House leadership has committed to proposing cuts to health entitlement programs, the fact that they have committed to proposing a budget that balances in 10 years means that, I think, it will be extremely difficult for them to avoid talking about particular cuts or changes to Affordable Care Act programs. You know, again, it’s just like this is where the dollars are. They can take a lot of dollars out of Medicare, that is very politically unpopular. They can take some dollars out of Medicaid, you know, the largest expansion of which is part of ACA. They can take money out of these subsidies, which, you know, have been supercharged in recent years beyond even what Congress initially passed in 2010. And I do think, as Alice said, you know, this is not a popular talking point. I don’t think Republicans, by and large, want to be talking about repealing Obamacare anymore. And yet I think they are backed into this corner where they’re going to have to make and propose specific modifications and cuts to these programs in order to achieve these high-level philosophical goals that they’ve signed up for. And so I think it will be interesting to see what does it look like, maybe they’re not going to call it Obamacare repeal anymore, but they might still be sucking $1,000,000,000,000 out of Medicaid, like some of the Trump administration budgets did.

Rovner: Yeah. And it’s important to mention, again, I mean, the Republicans talk about all these things they’re going to do and people are thinking, Oh, my God, if they vote for this balanced budget, in 10 years it’s going to happen. They can’t do most of these things without the Senate and/or the president unless they have two-thirds to override, which they don’t. The one place that we do think they could exercise some leverage, obviously, is this debt ceiling vote where the Congress has to vote to raise the debt ceiling or the U.S. will default on things that it has already bought but not paid for — basically paying the credit card bill. And that, certainly, they’re going to try to make some entitlement changes. But all of these other things that they say they’re, quote-unquote, “going to do,” they’re mostly just quote-unquote, “making political statements,” right?

Sanger-Katz: But they’re going to have to talk about them. They’re going to have to write things down. They’re going to have to have specific dollars attached to this. I do think that it will be politically salient and that it will create some visibility into, like, well, how do you balance the budget in 10 years? What does entitlement reform look like? And they’re not saying Obamacare repeal anymore and they don’t want to, they understand that they don’t want to. And yet I think they’re going to be in this position where they’re going to effectively have to lay out something that looks like Obamacare repeal, something that looks like Social Security reform, something that looks like big changes to Medicare. And we will have a political debate about that because Democrats are just salivating to have those conversations. I think they feel like that is very strong political ground on them. They think that voters trust them to protect those very popular programs if they’re under assault. And, you know, which is very similar to the political dynamic we saw when Republicans were really trying in earnest, when they had full control of government and wanted to repeal Obamacare.

Rovner: Yes. And I would say, as we absolutely saw in 2017, when they failed to repeal it, Republicans very much agree on their goals, but they very much disagree on how to get there. There is no unified Republican plan for either reforming, you know, the Affordable Care Act or Medicare or Medicaid, I mean, except for basically cutting money out of it. So I will be interested, as Margot says, to see what they actually put down on paper.

Sanger-Katz: And, sorry, just one more thing on this point, which is, again, I think that the kinds of show votes that the Republican House leadership is going to have to put on these issues are probably not going to be particularly politically productive and may be politically damaging to them. But I do think, setting that aside for the moment, I do think we are entering in an environment of much higher interest rates, of really more accelerating federal debt. You know, there are a lot of conditions right now that are potentially ripe for thinking about government spending and particularly thinking about these big categories of government spending that are our federal health care programs. I think the last few years there’s been this sense that, you know, debt is free and the deficit doesn’t matter. And I think inflation is high, interest rates are rising. I do think that we’re in a moment where there may be a greater sense of a need to confront this problem. And I’m interested in what that conversation looks like, which may be a little bit different than the kind of highly ideological conversation that we’re going to see in the very near term.

Rovner: I was going to say that that would require actually having substantive talks about what might work, which we don’t know is going to happen, but we can cross our fingers and hope. All right. That is the news for this week. Now it is time for our extra-credit segment where we each recommend a story we read this week we think you should read, too. Don’t worry if you miss it; we will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Sarah, why don’t you go first this week?

Karlin-Smith: Sure. I took a look at a story by Kaiser Health News’ Lauren Sausser: “Hospitals’ Use of Volunteer Staff Runs Risk of Skirting Labor Laws, Experts Say.” I thought this was a fascinating story about hospitals’ reliance on volunteers, not for the types of activities I usually associate hospital volunteers with, which would be …

Rovner: Like candy stripers.

Karlin-Smith: Right. Like light … I don’t know, “light” is not the right word, but, you know, visiting people, comforting them in some way, providing added benefit of sorts. And this is really people that are being asked to do medical care and the basics, some of the basic care you need when you are in a hospital. And I think her story cites about $5 billion maybe in the U.S. of free labor through these types of volunteers. And the question becomes, you know, is this violating labor laws? And should these people be getting paid for the work, or should they … are they basically, because they’re using volunteers, taking money and job opportunities away from other people? And I thought it was a fascinating story just because I had no idea of all of this, you know, volunteer labor was being used and the impacts on these hospitals during the pandemic, when they couldn’t have volunteers. And just, I think, important to think about, too, how this impacts the quality of care as well people receive.

Rovner: Hospitals are very clever. Margot.

Sanger-Katz: I wanted to recommend an article from Jessie Hellman at Roll Call called “Providers Say Medicare Advantage Hinders New Methadone Benefit.” And I’ve been doing a lot of reporting on the Medicare Advantage program lately. And so I was a little bit jealous of this story. Congress just recently required Medicare to pay for methadone. You know, a very evidence-based treatment for opioid addiction that it hadn’t been covering before. And what this article found is that these Medicare Advantage plans, or private competitors to the government Medicare program, have been enacting a lot of roadblocks that make it hard for people to get this treatment. So they technically cover it, but they require often what’s called prior authorization, where you have to … doctors and others have to jump through a lot of hoops to prove that the person really needs it. And when I saw this article, I put out a bat signal on my Twitter and I said, Can anyone think of the medical reason why you would want to have … restrict access to methadone treatment? And, you know, this is just a Twitter poll, but no one could come up with the reason. They could think of lots of reasons why the insurance company might not want to cover it, because it’s expensive, because patients who have opioid addiction probably are pretty expensive in general. And so, you know, this could be a way to avoid paying for a complex treatment or a way to discourage patients who have complex health care needs from choosing a Medicare Advantage plan. Anyway, so just a good story and just, you know, another illustration of, you know, even after Congress does something like add a new benefit, there’s always value in doing oversight to see how is that actually working in the real world and is it giving patients the care that was intended?

Rovner: Yes. And we will be talking, I think, much more about Medicare Advantage this year. Alice.

Ollstein: So I have a very sad piece to recommend. It is an op-ed by Céline Gounder, who is a public health expert that we all know well, as well as the widow of Grant Wahl, the soccer journalist who died covering the World Cup. And she wrote about how her husband’s death has been co-opted by anti-vax conspiracy theorists who are trying to draw some connection to what happened to him and being vaccinated for covid. But she really smartly walks through the misinformation playbook because it is a very sort of predictable playbook with very predictable points and, you know, dismantles them one by one. And I think it’s really helpful for the inevitable next time we see this come up to be prepared in advance and be able to refute those points. Very tragic but very helpful thing to know.

Rovner: Yeah. Céline is our colleague now at KHN, in addition to everything else that she does, and I can just say to these trolls: Don’t mess with Céline. It really was a very good piece. Well, my extra credit this week is from The Washington Post, and it’s a great story that ran in the dead week between Christmas and New Year’s. So I … gave it an extra week. It’s called “Social Security Denies Disability Benefits Based on List With Jobs From 1977,” by Lisa Rein. And while I’ve known for a long time that the Social Security disability program has a multiyear backlog, one thing I didn’t know until I read this story is that a lot of otherwise likely eligible people get their benefits denied because they could theoretically do jobs that largely no longer exist. Among the jobs the government says people who are disabled might be able to do are nuts sorter, dowel inspector, or egg processor. That’s because the last time the labor market data used to determine if a disabled person might be able to do a job was last updated 45 years ago. The agency has been working since 2012 to update its listing of jobs that could be done by sedentary individuals. But somehow the new directory of jobs has not made it into use yet. Meanwhile, thousands of people deserving of disability benefits are being steered to jobs that are now largely automated, offshored, or otherwise obsolete, something that clearly needs to be fixed.

OK, that is our show for this week. As always, if you enjoy the podcast, you could subscribe wherever you get your podcasts. We’d appreciate it if you’ve left us a review — that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. As always, you can email us your comments or questions. We’re at whatthehealth — all one word — @kff.org. Or you can tweet me. I’m still at Twitter for now: @jrovner. Sarah?

Karlin-Smith: I’m @SarahKarlin

Rovner: Margot?

Sanger-Katz: @sangerkatz

Rovner: Alice.

Ollstein: @AliceOllstein

Rovner: We will be back in your feed next week. In the meantime, be healthy.

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The Caribbean region is in the middle of the influenza season, typically from November to March.

The Ministry of Health in St Kitts has detailed ways for the people to address the issues around respiratory diseases. The Minister of Health, Dr Terrance Drew, has taken to his social media account to share ways in which people can limit the transmission of these infections.

The Ministry of Health in St Kitts and Nevis has shared the information available to them regarding the infections. The Ministry has stated that Influenza (flu) is an acute and very contagious respiratory tract infection that can be caused by influenza type A (H3N2) and type B viruses.

Currently, the country is facing growing concerns over emerging Influenza, Respiratory Syncytial Virus (RSV), and the new strain of COVID-19.

The Ministry of Health update details that they are monitoring the new omicron subvariant of Covid-19 that is emerging in some areas of the North-Eastern USA. The sources reveal that this is the most transmittable variant of the disease. However, the infection is much less severe in the variant. Meanwhile, the Respiratory Syncytial Virus (RSV) is a respiratory virus which causes cold and cough-like symptoms.

The Ministry of Health further stated that RSV Infection is not severe and individuals can recover from it within a week; however, children younger than four and older are still vulnerable.

The Ministry of Health has laid out some guidelines to combat the situation. The first is using masks for isolated individuals who have tested positive for the Covid-19 virus, RSV or Influenza. If the individuals are tested positive, they are required to remain in isolation.

Covers are also mandatory if visiting the hospital or healthcare centres. The Ministry of Health advises people to see the doctor regularly in case they develop flu-like symptoms or suffer from a persistent cold.

“31 countries have reported outbreaks, more widespread and lethal than normal, and the figure is 50% higher than in previous years,” Tedros Adhanom Ghebreyesus, WHO director-general, warned at a press conference in 2022.

Tedros emphasized that Haiti, Syria, and Malawi are among the most affected countries and that the simultaneous outbreaks have resulted in a vaccine shortage, prompting the international immunization coordination mechanism to reduce the doses administered to each patient. 

“Despite this unprecedented measure, stocks remain very low and production is at its maximum capacity,” Tedros lamented, urging countries that have recently experienced outbreaks to step up prevention of potential new infections.

 

e, Livestock, and the Environment of the affected countries. “We want to appeal to the public to calm down. We have been actively warning about this situation since March of this year, particularly last September due to the start of bird migrations from North America to South America,” said Andrés González, FAO Livestock, Animal Health, and Biodiversity Officer.

“We have active coordination with international organizations, and we are managing ways to assist recently affected countries,” he added. He also stated that there is no scientific evidence that HPAI is transmitted to humans through the consumption of birds or properly prepared eggs. González explained that the countries’ prevention, early detection, and response plans are being supported in the regional emergency of Highly Pathogenic Avian Influenza with the assistance of national representations, through an incident command group led by the FAO’s Animal Health division, and in close coordination with the regional steering committee of the Global Framework for the Progressive Control of Transboundary Diseases of Animals (GF-TADs).

Latin America and the Caribbean produce 20.4% of the world’s poultry meat and 10% of the world’s eggs, making this a vital sector for the livelihoods of millions of small and medium-sized agricultural producers. As a result, it is critical to activate the region’s emergency protocols as soon as possible.

 

Estrella explained that the ministry maintains house-to-house operations in areas such as La Zurza and Capotillo, where a random survey of 68 samples was conducted, collecting samples from both symptomatic patients and those who did not present themselves at the Hospital. “Of these tests, we have only four positives. Two of them were completely asymptomatic patients, and two were hospitalized patients” (Goico).

According to the doctor, Public Health collaborates with the Corporation of Aqueduct and Sewerage of Santo Domingo (CAASD) and the ministries of Education, Environment, and Public Works to develop disease promotion and prevention efforts. “We’re waiting for permission to build the bridge and move the dredgers and equipment to the area to start dredging a large portion of La Isabela that adjoins the La Zurza sector,” she explained. Similarly, Estrella assured that they are looking for efficient ways to dump solid waste and improve the quality of La Poza’s waters.

“We are watching every area along the river’s banks,” she said again. Concerning the spread of bacteria in areas other than the riverbank, such as Villas Agrcolas and San Carlos, the doctor stated, “the fact that I live in one sector does not mean that I do not move to another.” Eladio Pérez, Vice Minister of Collective Health, recalled that in neighboring Haiti, more than 24,000 cases had already been reported, with over 450 people dying.

“The more the epidemiological curve develops in the neighboring country, the more likely it is that it will occur in ours,” he said.

 

DrNB Medical
Gastroenterology or Doctorate of National Board in Medical Gastroenterology
also known as DrNB in Medical Gastroenterology is a super specialty level
course for doctors in India that is done by them after completion of their
postgraduate medical degree course. The duration of this super specialty course is 3 years, and it focuses
on the study of the human digestive system and the diagnosis and treatment of diseases related to it.

The course
is a full-time course pursued at various accredited institutes/hospitals across
the country. Some of the top accredited institutes/hospitals offering this
course include Amala Institute of Medical
Sciences-Kerala, Apollo
BGS Hospital- Karnataka, Apollo
Hospital
(Unit International Hospitals)- Assam, and more.

Admission to this course is done through the NEET-SS Entrance exam
conducted by the National Board of Examinations, followed by counseling based
on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee
for pursuing DrNB (Medical Gastroenterology) varies from accredited
institutes/hospital to hospital and may range from Rs. 1,25,000 to Rs. 3,00,000
per year.

After completion of their respective course, doctors can either join the
job market or can pursue certificate courses and Fellowship programmes recognized by
NMC and NBE. Candidates can take reputed jobs at positions as Senior residents,
Consultants etc. with an approximate salary range of Rs. 4 Lakh to Rs. 45 Lakh per year.

DNB is equivalent to
MD/MS/DM/MCh degrees awarded respectively in medical and surgical super
specialities. The list of recognized qualifications awarded
by the Board in various broad and super specialties as approved by the
Government of India are included in the first schedule of the Indian Medical
Council Act, 1956.

The Diplomate of National Board in
broad-speciality qualifications and super speciality qualifications when
granted in a medical institution with attached hospital or in a hospital with
the strength of five hundred or more beds, by the National Board of
Examinations, shall be equivalent in all respects to the corresponding
postgraduate qualification and the super-speciality qualification granted under
the Act, but in all other cases, senior residency in a medical college for an
additional period of one year shall be required for such qualification to be
equivalent for the purposes of teaching also.

What is DrNB in Medical Gastroenterology?

Doctorate of National Board in Medical
Gastroenterology, also known as DrNB (Medical Gastroenterology) or DrNB in (Medical
Gastroenterology) is a three-year super specialty programme that candidates can
pursue after completing a postgraduate degree.

Medical Gastroenterology is the branch of
medical science dealing with the study of the human digestive system and the diagnosis and treatment of diseases related to it.

The National
Board of Examinations (NBE) has released a curriculum for DrNB in Medical
Gastroenterology.

The curriculum
governs the education and
training of DrNB in Medical Gastroenterology.

The postgraduate students must gain ample knowledge and
experience in the diagnosis, treatment of patients with acute, serious, and
life-threatening medical and surgical diseases.

PG education intends to create specialists who can
contribute to high-quality health care and advances in science through research
and training.

The required training done by a postgraduate specialist in
the field of Medical Gastroenterology
would help the specialist to recognize the health needs of the community. The
student should be competent to handle medical problems effectively and should
be aware of the recent advances in their speciality.

The candidate is also expected to know the principles of
research methodology and modes of the consulting library. The candidate should
regularly attend conferences, workshops and CMEs to upgrade her/ his knowledge.

Course
Highlights

Here are some of the course highlights of DrNB in Medical Gastroenterology

Name of Course

DrNB in Medical Gastroenterology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

Candidates must have a postgraduate medical Degree in MD/DNB (General Medicine) obtained from any college/university recognized by the MCI (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

Admission Process /
Entrance Process / Entrance Modalities

Entrance Exam
(NEET-SS) 

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

Counseling by DGHS/MCC/State Authorities

Course Fees

Rs. 1,25,000 to Rs. 3,00,000 per year

Average Salary

 Rs. 4 Lakh to Rs. 45 Lakh per year

Eligibility Criteria

The eligibility criteria for DrNB in Medical Gastroenterology are
defined as the set of rules or minimum prerequisites that aspirants must meet
in order to be eligible for admission, which includes:

Name of the super specialty course

Course Type

Prior Eligibility Requirement

Medical Gastroenterology 

DrNB

MD/DNB (General Medicine)

Note:

·
The feeder qualification for DrNB (Medical Gastroenterology) is defined by the NBE
and is subject to changes by the NBE.

·
The feeder qualification mentioned here
is as of 2022.

·
For any changes, please refer to the
NBE website.

• The prior entry qualifications shall be strictly
  in accordance with Post Graduate Medical Education Regulations, 2000 and its
  amendments notified by the NMC and any clarification issued from NMC in this
  regard.
• The candidate must have obtained permanent
  registration with any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off dates
  for the Postgraduate Degree courses shall be as prescribed by the Medical
  Council of India (now NMC).

Admission Process

The admission process contains a few steps to
be followed in order by the candidates for admission to DrNB in Medical Gastroenterology. Candidates can view the complete
admission process for DrNB in Medical
Gastroenterology mentioned below:

• The NEET-SS or
  National Eligibility Entrance Test for Super specialty courses is a
  national-level master's level examination conducted by the NBE for admission to
  DM/MCh/DrNB Courses.
• Qualifying Criteria-Candidates placed at the
  50th percentile or above shall be declared as qualified in the NEET-SS in their
  respective specialty.
• The following Medical institutions are not
  covered under centralized admissions for DM/MCh courses through NEET-SS:

1.
AIIMS, New Delhi and other AIIMS

2.
PGIMER, Chandigarh

3.
JIPMER, Puducherry

4.
NIMHANS, Bengaluru

• Candidates from all eligible feeder specialty
  subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a superspecialty course in any of the super-specialty courses covered in that group.
• A candidate can opt for appearing in the
  question papers of as many groups for which his/her Postgraduate specialty
  qualification is an eligible feeder qualification.
• By appearing in the question paper of a group
  and on qualifying for the examination, a candidate shall be eligible to exercise
  his/her choices in the counseling only for those superspecialty subjects
  covered in the said group for which his/ her broad specialty is an eligible feeder
  qualification.

Fees Structure

The fee structure for DrNB in Medical Gastroenterology varies from accredited institute/hospital to hospital. The fee is
generally less for Government Institutes and more for private institutes. The average fee structure for DrNB in Medical Gastroenterology is around Rs. 1,25,000 to Rs. 3,00,000 per year.

Colleges offering DrNB in Medical Gastroenterology

There are various accredited institutes/hospitals across India that
offer courses for pursuing DrNB in Medical Gastroenterology.

As per the National Board of Examinations website, the following accredited
institutes/hospitals are offering DrNB (Medical Gastroenterology)
courses for the academic year 2022-23.

Hospital/Institute

Specialty

No. of Accredited
Seat(s)
(Broad/Super/Fellowship)

Amala Institute of Medical Sciences
Amala Nagar, THRISSUR
Kerala-680553

Medical Gastroenterology

2

Apollo BGS Hospital
Adichunchanagiri Road, Kuvempunagar, Mysore
Karnataka-570023

Medical Gastroenterology

2

Apollo Hospital
(Unit International Hospitals) Lotus Tower, G S Road, Guwahati
Assam-781005

Medical Gastroenterology

2

Apollo Hospital
21, Greams lane, Off Greams Rd, Thousand Lights, Chennai.
Tamil Nadu-600006

Medical Gastroenterology

2

Apollo Hospital
Parsik Hill Road, Plot no 13, Sector 23,CBD Belapur, Navi
Mumbai
Maharashtra-400614

Medical Gastroenterology

2

Apollo Hospital
Plot No. 251 Sainik School Road Unit-15, Bhubaneshwar
Orissa-751005

Medical Gastroenterology

2

Apollo Hospital
Room No. 306, Office of the Director of Medical Education
Jubilee Hills, Hyderabad
Telangana-500033

Medical Gastroenterology

2

Apollo Hospital International
Plot No. 1A, GIDC Estate Bhat, District - Gandhi Nagar
Gujarat-382428

Medical Gastroenterology

1

Apollo Multispecialty Hospitals
Limited
58, Canal Circular Road, Kolkata
West Bengal-700054

Medical Gastroenterology

6

Army Hospital (R and R)
Delhi Cantt, New Delhi
Delhi-110010

Medical Gastroenterology

2

Artemis Health Institute
Sector 51, Gurgaon
Haryana-122001

Medical Gastroenterology

1

Asian Institute of Gastroenterology
6-3-661, Somajiguda, Hyderabad
Telangana-500082

Medical Gastroenterology

14

Aster CMI Hospital
#43/2, New Airport Road, NH - 7, Sahakara Nagar, Hebbal,
Bangalore
Karnataka-560092

Medical Gastroenterology

2

Aster Medcity
Kuttisahib Road, Near Kothad Bridge, South Chittoor P. O.,
Cheranalloor, Kochi
Kerala-682027

Medical Gastroenterology

3

Baby Memorial Hospital
Indira Gandhi Road, Kozhikode
Kerala-673004

Medical Gastroenterology

2

Batra Hospital and Medical Research
Centre
1, Tuglakabad Institutional Area, M.B. Road,
Delhi-110062

Medical Gastroenterology

1

Believers Church Medical College
Hospital
St. Thomas Nagar, Kuttapuzha P O, Thiruvalla
Kerala-689103

Medical Gastroenterology

3

BGS Global Hospital
67, Uttrahalli Road, Kengeri, Bangalore
Karnataka-560060

Medical Gastroenterology

2

BIG Apollo Spectra Hospitals
Sheetla Mandir Road, Agam Kuan, Patna
Bihar-800030

Medical Gastroenterology

2

Choithram Hospital and Research Centre
Manik Bagh Road, INDORE
Madhya Pradesh-452014

Medical Gastroenterology

3

Continental Hospital
Plot No. 3, Road No. 2, IT and Financial District,
Nanakramguda, Gachibowli, Hyderabad
Telangana-500032

Medical Gastroenterology

2

Cygnus Institute of Gastroenterology
Plot No 34 and 35, Nizampet X Road, Opp More Supermarket,
Sardar Patel Nagar, Hyderabad
Telangana-500072

Medical Gastroenterology

2

Deenanath Mangeshkar Hospital and
Research Centre.
8+13/2, Erandwane, Near Mhatre Bridge, Pune
Maharashtra-411004

Medical Gastroenterology

1

Dr. B L Kapur Memorial Hospital
Pusa Road, New Delhi
Delhi-110005

Medical Gastroenterology

3

Fortis Escorts Heart Institute
Okhla Road, New Delhi
Delhi-110025

Medical Gastroenterology

2

Fortis Escorts Hospital
Jawahar Lal Nehru Marg, Malviya Nagar, Jaipur
Rajasthan-302017

Medical Gastroenterology

1

Fortis Hospital
A- Block, Shalimar Bagh
Delhi-110088

Medical Gastroenterology

1

Fortis Hospital
Mundian Kalan, Chandigarh Road, Ludhiana
Punjab-141015

Medical Gastroenterology

2

Fortis Hospital
Sector-62, Phase-VIII, Mohali
Punjab-160062

Medical Gastroenterology

2

Fortis Memorial Research Institute
Sector-44, Opposite HUDA CITY centre Metro Station, Gurgaon,
Haryana-122002

Medical Gastroenterology

1

GCS Medical College, Hospital And
Research Centre
Opp. Drm Office, Near Chamunda Bridge, Naroda Road, Ahmedabad
Gujarat-380025

Medical Gastroenterology

2

GEM Hospital
Thiruvengadam Nagar, Perungudi, Chennai
Tamil Nadu-600096

Medical Gastroenterology

1

GEM Hospital and Research Centre
45-A, Pankaja Mill Road, Ramanathapuram, COIMBATORE
Tamil Nadu-641045

Medical Gastroenterology

2

Gleneagles Global Hospital
6-1-1070/1 to 4, Lakdi-Ka-Pool, Hyderabad
Telangana-4

Medical Gastroenterology

2

Global Hospital - Super Specialty and
Transplant Centre
35, Dr. E Borges Road, Hospital Avenue, Opp Shirodkar High
School, Parel, Mumbai
Maharashtra-400012

Medical Gastroenterology

2

Global Hospital and Health City
(A unit of Ravindernath GE Medical Associate Pvt Ltd) No-439,
Cheran Nagar, Perumbakkam, Chennai
Tamil Nadu-600100

Medical Gastroenterology

2

Government Medical College
Karan- Nagar, Srinagar
Jammu and Kashmir-190010

Medical Gastroenterology

4

Indian Institute Of Liver and
Digestive Sciences
Sitala(east), Malipukuria, jagadispur, Sonarpur, South 24
Parganas.
West Bengal-700150

Medical Gastroenterology

2

Indraprastha Apollo Hospital
Delhi-Mathura Road, Sarita Vihar, New Delhi
Delhi-110076

Medical Gastroenterology

6

J.L.N. Main Hospital and Research
Centre
Bhilai Steel Plant, Sector-9, BHILAI
Chhattisgarh-490009

Medical Gastroenterology

1

Jaslok Hospital and Research Centre
15, Dr. Gopalrao Deshmukh Marg, Mumbai
Maharashtra-400026

Medical Gastroenterology

1

Kasturba Medical College Hospital
(KMC Hospital)
Dr. B R Ambedkar Circle, Jyothi Balmatta Road, Mangalore
Karnataka-575001

Medical Gastroenterology

4

Kerala Institute of Medical Sciences
P B No.1, Anayara P O, Trivandrum
Kerala-695029

Medical Gastroenterology

1

Kokilaben Dhirubhai Ambani Hospital
and Medical Research Institute
Achyutrao Patwardhan Marg, 4 Bunglows, Andheri (W), Mumbai
Maharashtra-400053

Medical Gastroenterology

1

Kozhikode District Co-Operative
Hospital
Eranhipalam
Kerala-673006

Medical Gastroenterology

1

Krishna Institute of Medical Sciences
1-8-31/1, Minister Road, Secunderabad
Telangana-500003

Medical Gastroenterology

2

Lakeshore Hospital and Research
Centre Ltd.
Maradu, Nettoor P.O. Kochi, Ernakulam, Kerala
Kerala-682040

Medical Gastroenterology

2

Lisie Medical Institution
P.O. Box 3053, KOCHI-18 Kerala
Kerala-682018

Medical Gastroenterology

3

M.I.O.T. Hospital
4/112, Mt-Poonamallee Rd, Nanapakkam, CHENNAI
Tamil Nadu-600089

Medical Gastroenterology

1

Madras Medical Mission Hospital
4A Dr Jayalalitha Ngr, Mogappair CHENNAI
Tamil Nadu-600037

Medical Gastroenterology

2

Malabar Institute of Medical Sciences
Mini Bye Pass, Govindapuram, Calicut
Kerala-673016

Medical Gastroenterology

1

Manipal Hospital
No. 98, Rustum Bagh, Old Airport Road, Bangalore
Karnataka-560017

Medical Gastroenterology

3

Max Super Specialty Hospital
(A unit of Balaji Medical and Diagnostic Research Centre)
108A, Opp Sanchar Apartments, IP Extension, Patparganj,New Delhi
Delhi-110092

Medical Gastroenterology

2

Max Super Specialty Hospital
(Formerly- Pushpanjali Crosslay Hospital) W-3, Sector-1,
Vaishali, Ghaziabad
Uttar Pradesh-201012

Medical Gastroenterology

2

Max Super Specialty Hospital
1,2, Press Enclave Road, Saket,
Delhi-110017

Medical Gastroenterology

5

Max Super Specialty Hospital
A Unit of Hometrail Buildtech Pvt Ltd. Civil Hospital Premises
Phase - VI, Mohali
Punjab-160055

Medical Gastroenterology

2

Max Super Specialty Hospital
FC-50, C and D Block, Shalimar Bagh, New Delhi
Delhi-110088

Medical Gastroenterology

1

Medanta The Medicity
Sector-38, Gurgaon
Haryana-122001

Medical Gastroenterology

4

Medica Superspecialty Hospital
127 Mukundapur, E M Bypass, Kolkata
West Bengal-700099

Medical Gastroenterology

2

Medical Trust Hospital
M G Road, Kochi
Kerala-682016

Medical Gastroenterology

2

Meenakshi Mission Hospital and
Research Centre
Lake Area, Melur Road, MADURAI
Tamil Nadu-625107

Medical Gastroenterology

2

Meitra Hospital
KARAPARAMBA-KUNDUPARAMBA MINI BYPASS ROAD, EDAKKAD POST,
CALICUT
Kerala-673005

Medical Gastroenterology

1

Narayana Hrudayalaya Hospital
(NH-Narayana Health City, Bangalore) #258/A, Bommasandra
Industrial Area, Anekal Taluk, Bangalore
Karnataka-560099

Medical Gastroenterology

2

Nizam`s Institute of Medical Sciences
Punjagutta, Hyderabad
Telangana-500082

Medical Gastroenterology

2

P.D. Hinduja National Hospital and
Medical Research Centre
Veer Savarkar Marg, Mahim, Mumbai
Maharashtra-400016

Medical Gastroenterology

1

Pace Hospitals
Plot Number 23, HUDA Techno Enclave, Patrika Nagar, Madhapur,
Hyderabad,
Telangana-500081

Medical Gastroenterology

2

Paras Hospital
C-1, Shushant Lok Phase-I, Gurgaon
Haryana-122002

Medical Gastroenterology

1

Peerless Hospital and B K Roy
Research Centre
360, Panchasayar, KOLKATA
West Bengal-700094

Medical Gastroenterology

4

Pondicherry Inst. of Med. Scs.
Ganapathichettikulam, Kalapet, Pondicherry
Pondicherry-605014

Medical Gastroenterology

2

Pushpagiri Institute of Medical
Sciences and Research Centre
Pushpagiri Medical College Hospital, Tiruvalla
Kerala-689101

Medical Gastroenterology

2

Pushpawati Singhania Hospital
Press Enclave, Sheikh Sarai Ph-II,
Delhi-110017

Medical Gastroenterology

2

Rabindranath Tagore International
Institute of Cardiac Sciences
Premises No.1489, 124, Mukundapur, E M Bypass, Near
Santhoshpur Connector, KOLKATA
West Bengal-700099

Medical Gastroenterology

2

Rajagiri Hospital
Chunangamveli Aluva Ernakulam District
Kerala-683112

Medical Gastroenterology

2

Ramkrishna Care Hospital
Aurobindo Enclave, Pachpedhi Naka, Dhamtari Road, N. H. 43,
Raipur
Chhattisgarh-492001

Medical Gastroenterology

1

S R Kalla Memorial Gastro and General
Hospital
78-79 Dhuleshwar Garden Sardar Patel Marg Behind Hsbc Bank
C-Scheme Jaipur
Rajasthan-302001

Medical Gastroenterology

2

Sakra World Hospital
(A Unit of Takshasila Hospitals Operating Private Limited) No.
52/2, 52/3, Devarabeesanahalli, Varthur Hobli, Bangalore
Karnataka-560103

Medical Gastroenterology

2

Santokbha Durlabhji Memorial Hospital
Cum Medical Research Institute
Bhawani Singh Marg, JAIPUR
Rajasthan-302015

Medical Gastroenterology

2

Sarvodaya Hospital and Research Centre
YMCA Road, Sector-08, Faridabad
Haryana-121006

Medical Gastroenterology

2

Satguru Partap Singh Hospital
Sherpur Chowk, G T Road, Ludhiana
Punjab-141003

Medical Gastroenterology

1

Shri Balaji Action Medical Institute
FC-34, A-4, Paschim Vihar, New Delhi
Delhi-110063

Medical Gastroenterology

2

SIDS Hospital and Research Center
JJ Desai Empire, Vijay Nagar, Gate No. 3, Opp. Gandhi College,
Majura Gate, Ring Road, Surat
Gujarat-395001

Medical Gastroenterology

1

Sir Ganga Ram Hospital
Rajinder Nagar, New Delhi
Delhi-110060

Medical Gastroenterology

4

Sir Hurkisondas Nurrotumdas Hospital
and Research Centre
Raja Ram Mohan Roy Road, Gordhan Bapa Chowk, Prathana Samaj,
Mumbai
Maharashtra-40004

Medical Gastroenterology

2

Sree Gokulam Medical College Research
Foundation
Venjaramoodu P.O., Thiruvananthapuram
Kerala-695607

Medical Gastroenterology

2

SRM Institutes for Medical Sciences
No. 1, Jawaharlal Nehru Salai, 100 ft Road, Vadapalani, Chennai
Tamil Nadu-600026

Medical Gastroenterology

1

Suyash Hospital (Suyash Institute of
Medical Science)
Gudhiyari Road, Behind Hotel Piccadily, Kota, Raipur,
Chhattisgarh
Chhattisgarh-492001

Medical Gastroenterology

2

VGM Gastrocentre
2100,Trichy Road, Rajalakshmi Mills Stop, Coimbatore
Tamil Nadu-641005

Medical Gastroenterology

2

Yashoda Hospital
Behind Hari Hara Kala Bhawan, S.P. Road, Secunderabad
Telangana-500003

Medical Gastroenterology

2

Yashoda Super Speciality Hospital
Nalgonda X Road, Malakpet, Hyderabad
Telangana-500036

Medical Gastroenterology

2

Yashoda Super Speciality Hospital
Raj Bhavan Road, Somajiguda, Hyderabad
Telangana-500082

Medical Gastroenterology

1

Syllabus

A DrNB
in Medical Gastroenterology is a three years specialization course
that provides training in the stream of
Medical Gastroenterology.

The course
content for DrNB in Medical Gastroenterology is given in the NBE
Curriculum released by the National Board of Examinations, which can be assessed
through the link mentioned below:

DrNB Medical Gastroenterology In India: Check Out NBE Released Curriculum

Broad guidelines

1. For a broad sub specialty like Medical Gastroenterology it is difficult to decode limits of syllabus .

2. Science is very progressive and ever advancing so every candidate getting trained is advised to keep following the developments closely

3. The objective of the syllabus is an outline of scope of available theory.

i) Basic Sciences

Anatomy and Physiology

• Immune system of the gastrointestinal tract (GIT) and its importance in various GI disorders

• Molecular biology in relation to GIT

• Genetic diseases of the GIT and the liver

• Gene therapy

• GI tumors and tumor biology

• Gastrointestinal hormones in health and diseases

• Embryology of the gut, liver, pancreas and congenital anomalies

• Enteric microbiota

ii) Symptoms, Syndromes, and Scenarios

• Heartburn and noncardiac chest pain Dysphagia and odynophagia

• Chronic or recurrent abdominal pain,

Dyspepsia: ulcer and non-ulcer/bloating and early satiety/belching and rumination

 Nausea and vomiting

• Disorders of defecation

• Diarrhea

• Fecal incontinence

• Rectal bleeding

• Anorectal pain and pruritus ani

• Functional gastrointestinal disease,

• Anorexia nervosa and bulimia nervosa, Weight loss, Gastrointestinal causes of anemia and occult bleeding,

• Intestinal gas

• Upper and lower gastro-intestinal bleeding

• Gastrointestinal tuberculosis

iii) Esophagus

• Basic anatomy, histology and physiology

• Congenital anomalies

• Motility of the esophagus and motor disorders Mechanism of deglutition and dysphagia

• Approach to a patient with dysphagia

• Gastro-esophageal reflux disease

• Tumors of the esophagus

• Esophageal webs, membranes and diverticulum

• Management of benign and malignant esophageal strictures

• Esophagus and systemic diseases

• Infectious diseases of the esophagus

• Foreign bodies in the esophagus and stomach

• Esophageal perforation

• Drug induced esophagitis

• EUS: Techniques, diagnosis, therapy

iv) Stomac

• Anatomy, histology, functions

• Physiology of acid and bicarbonate secretion in health and diseases

• Defence mechanisms against acid and pepsin

• Gastroduodenal motor function in health and diseases.

• Gastritis (nonspecific and specific)

• Helicobacter pylori infection

• Peptic ulcer

• Dyspepsia

• Stress and stomach

• Gastric hypersecretory states including Zollinger Ellison syndrome

• Ulcer complications and their management

• Surgery for peptic ulcer

• Post gastrectomy complication

• Bezoars

• Tumors of the stomach

• Diverticuli and hernia of the stomach

• UGI Endoscopy: technique, diagnosis, therapy

v) Small Intestine

• Anatomy, blood supply, histology

• Motility of the small intestine

• Congenital anomalies

• Normal absorption of the nutrients

• Intestinal electrolyte absorption and secretion

• Malabsorption syndromes Pathophysiology, manifestations and approach

• Celiac sprue

• Infection related diseases a. Intestinal microflora in health and diseases

b.Tropical sprue

c. Whipple's disease

d. Infectious diarrhoea and food poisoning

e. Parasitic diseases

• Small intestinal ulcers

• Short bowel syndrome and intestinal transplantation.

• Eosinophilic gastroenteritis

• Food allergies

• Intestinal obstruction and pseudo-obstruction

• Short bowel syndrome

• Acute appendicitis

• Malrotation of the gut

• Bezoars

• Management of diarrhea

• GI lymphomas

• Small intestinal tumors

• Small intestinal transplantation

• Enteroscopy: Technique, diagnosis, therapy

vi) Colon

• Basic anatomy blood supply, histology and functions

• Motility of the colon and disorders of motility

• Congenital anomalies

• Megacolon

• Constipation

• Colonic pseudo-obstruction

• Fecal incontinence

• Antibiotic associated diarrhea

• Inflammatory bowel disease a. Ulcerative colitis

b. Crohn's disease

c.Indeterminate colitis

d. Ileostomies and its management

• Diverticular disease of the colon

• Radiation entero-colitis

• Colonic polyps and polyposis syndromes

• Malignant diseases of the colon

• Other inflammatory diseases of colon including a. Solitary rectal ulcer syndrome

b. Diversion colitis

c. Collagenous and microscopic colitis

d. Non specific ulcerations of the colon

e. Malakoplakia

f. Pneumatoses cystoids intestinalis

• Hemorrhoids

• Diseases of the anorectum

• Tubercosis of g.i. tract peritoneum

• Colonoscopy and iloscopy: Technique, Diagnosis, therapy

vii) Pancreas

• Anatomy, physiology, blood supply, developmental anomalies

• Physiology of the pancreatic secretion

• Pancreatic function tests

• Acute pancreatitis

• Recurrent acute pancreatitis

• Chronic pancreatitis

• Malignancies of the pancreas(Exocrine and endocrine)

• Cystic fibrosis and other childhood disorders of the pancreas

• Hereditary pancreatitis

• Pancreatic transplantation

• Pancreatic ERCP: Techniques, Diagnosis, therapy

viii) Biliary Tree

• Anatomy, Physiology

• Physiology of bile formation and excretion

• Enterohepatic circulation

• Bilirubin metabolism.

• Approach to a patients with jaundice

• Gallstones, its complications, and management

• Acute acalculous cholecystitis

• Miscellaneous disorders of the gallbladder

• Acute cholangitis

• Benign biliary structure

• Benign and malignant neoplasms of the biliary system.

• Endoscopic management of biliary obstruction.

• Motility and dysmotility of the biliary system and sphincter of Oddidysfunction

• Congenital diseases of the biliary systems

• Biliary ERCP and cholangioscopy: Diagnosis and therapy

ix) Liver

• Anatomy, physiology, blood supply

• Functions of the liver

• Microcirculation of liver

• Liver function tests

• Portal hypertension i. Extrahepatic portosplenic vein obstruction ii. Non cirrhotic portal fibrosis iii. Cirrhosis

• Acute viral hepatitis

• Chronic hepatitis

• Fulminant hepatic failure

• Subacute hepatic failure

• Cirrhosis of liver

• Ascites

• Hepatorenal syndrome

• Autoimmune liver disease

• Metabolic liver disease

• Sclerosing cholangitis- primary and secondary

• Primary biliary cirrhosis

• Hepatic venous outflow tract obstruction

• Fibrocystic diseases of the liver

• Wilson's disease

• Hemochromatosis

• Liver in porphyria

• Hepatic tumors

• Infections of the liver

• Liver in pregnancy

• Liver in congestive heart failure ,Liver diseases and pregnancy,

• Liver biopsy

• Liver transplantation and artificial liver support Liver transplantation

• Liver transplantation: indications and selection of candidates and immediate complications

x) Peritorium and Retroperitoneum

• Ascites

• Chronic peritonitis

• Budd-Chiari syndrome

• Malignant ascites

• Diseases of the retroperitoneum

xi) Diseases of Multiple Organ Systems

• Oral Disease and Oral-Cutaneous Manifestations of Gastrointestinal and Liver Disease

• Disorders of Mouth and Tongue,

• Mucocutaneous Candidasis, Mucocutaneous Features of HIV Infection,

• Mucocutaneous Ulcerative Disease,

• Eosinophilic disorder

• Vesiculobullous Diseases,

• Cutaneous Manifestations of Intestinal Disease

• Collagen vascular and vasculitic disorders

• AIDS and the gut,

• Graft-versus-host disease,

• Radiation and other physicochemical injury

• Systemic amyloidosis,

• Foreign bodies

• Porphyria

• Cutaneous manifestations of GI diseases

xii) Psychosocial factors

• A Biopsychosocial Understanding of Gastrointestinal Illness and Disease Case Study:

• A Typical Patient in a Gastroenterology Practice,

• The Biomedical Model,

• The Biopsychosocial Model

xiii) Nutrition

• Normal nutritional requirements

• Assessment of nutritional status

• Protein energy malnutrition

• Manifestations and management of nutritional deficiency and excess

• Nutritional support in various GI disorders (malabsorption, acute

and chronic pancreatitis, inflammatory bowel disease) Vascular Diseases of the GI Tract

xiv) Paediatric Gastroenterology

• Congenital disorders of gastrointestinal system, liver, biliary tract and pancreas

• Age related physiological and psychological variables of children

• Unique aspects of disease in paediatric age group as compared to adult

xv) Geriatric Gastroenterology

• General Issues:

o Impact of age on presentation, diagnosis and treatment of importantgastrointestinal conditions.

o Impact of depression and dementia on presentation and treatment.

o Pathophysiology of aging

o Social and ethical issues Geriatric gastroenterology

• Changes of G.I. function with aging, (e.g.) slowing of colonic motility and rectaldysfunction

• Changes in drug metabolism

• Effect of aging on nutrition

• GI problems in institutionalized and bedridden patients (e.g) fecal impaction asrisk factor for urine incontinence.

xvi) Womens Health Issues in Digestive Diseases

1. General women health issues

• Doctor-patient relationships

• Cultural and religious issues

• oPsycho-social issues

• Lab values and diagnostic tests - Gender differences as well as changes during pregnancy in normal lab values

2. Specific women health issues

 Health and disease states – gender difference in demographics,

epidemiology, pathophysiology, clinical presentation.

 Effect of menstrual cycle and menopause on digestive disease

 Pharmacokinetics of medications – differences in absorption, metabolism and therapeutic response.

3. Pregnancy and child bearing

 GI and liver changes / disorders in normal pregnancy

 Effect of pre-existing GI and liver disorders on pregnancy and fertility.

 Impact of pregnancy on gastrointestinal & liver disease

 GI and liver disorders unique to pregnancy

 Maternal-fetal transmission of infections and appropriate management of mother and infant

 Pharmacokinetics and interactions of medications during pregnancy and breast feeding - potential harm to fetus.

 Nutritional requirements Post-partum issues Rectal prolapse, hemorrhoids, urinary / fecal incontinence

xvii) Research

 Basic knowledge of clinical research methods, biostatistics, epidemiology and ethics.

 Basic knowledge of cell biology, molecular biology, molecular genetics and immunology

 Critical analysis of current literature, ability to formulate research questions,make a study design, calculate sample size, data management, ways to avoid bias etc

 Preparation of proposals for funding and evaluation by institutional review boards

 Presentation of work in written/oral form at Conferences 6. Help mentors in peer review of articles submitted for publications.

xviii) Primer of Diagnostic Methods: Endoscopic

 Upper gastrointestinal endoscopy and mucosal biopsy

 Lower gastrointestinal endoscopy and biopsy

 Endoscopic ultrasonography,

 Diagnostic and interventional endoscopic retrogradecholangiopancreatography

 Enteroscopy (single or double-balloon)

 Capsule endoscopy

 Percutaneous ultrasound

 Barium radiology

 Computed tomography

 Magnetic resonance imaging,

 Magnetic resonance cholangiopancreatography,

 Positron emission tomography

 Non-invasive liver assessment

 Functional testing

 Gastrointestinal motility testing

 Measurement of portal pressure

 Liver biopsy

xix) Primer of Treatments

 Medical treatments of various GI diseases

 Drug prescription in liver disease,

 Nutritional assessment and support

 Therapeutic endoscopy

 Non-variceal upper gastrointestinal bleeding control

 Variceal ligation, glue injection for varices and other lesions

 Snare polypectomy and foreign body removal from GI Tract

 Percutaneous endoscopic gastrostomy

 Endoscopic techniques of removing early gastrointestinal neoplams,

 Dilation and stenting of the gastrointestinal tract,

 The transjugular intrahepatic portosystemic shunt (TIPS Interventional radiology) (Observation only)

 Paracentesis

xx) Miscellaneous

 Biostatistics & clinical epidemiology

 Preventive Gastroenterology and Hepatology

 Management of GI emergencies like upper and lower GI bleed, Acute pancreatitis, hepatic encephalopathy and cholangitis

 Psychological factors in GI diseases

 Medicine relevant to Gastroenterology

 Bio ethics, ethical issue in transplantation, including 'Human Organ Transplant Act'

xxi) Laboratory Methods

The candidate is expected to perform routine stool examination and ultrasonography. In addition he/she must familiarize himself/herself with the following investigations:

 Liver function tests

 Auto analyzer functioning

 Gastro and Liver pathology interpretation including immuno-fluoresence andelectron microscopy.

 Electrolyte and acid base analysis

 Digital subtraction angiography.

 Selective Gastrointestinal angiography and interventional angioplasty andstenting

 Doppler studies

 CT imaging

 Magnetic resonance imaging including MRCP

 Percutaneous Trans hepatic Biliary Drainage (PTBD)

 Various gastro-intestinal isotope imaging and functional technique Microbiology:

 Viral, Bacterial and fungal cultures, Serological and PCR techniques andImmunological test:

 ANA, anti SMA, Anti-LKM, AMA and ANCA, TTG, Anti-endomysial antibody

 Research: The candidate will present at least two paper in the national conference and publish at least one paper in a journal. Practical work:

 Radiology: Reading and interpreting the common x-ray films including X- ray films of the abdomen

 Barium studies

 Ultrasound examination, CT scans

 MR scans and angiography and ERCP films

 GI Pathology Reading and interpreting histological slides of commongastrointestinal and liver disease.

xxii) Gastroenterology and Enviroment Impact on Gastroenterology and Liver physiology due to environmental changes including Air, pollution, Climate change and Heat wave such as

 Effect of air quality on g.i. microbiome

 Effect of heat wave on GI infections and Inflammatory Bowel Diseases

 Effect of air pollution in GI Endoscopy unit

 Relationship of air pollution and peptic ulcer bleeding etc.

 Effect of water contamination on GI health

xxiii) Others

 Ethics

 Medico legal aspects relevant to the discipline

 Health Policy issues as may be applicable to the discipline

ROTATION

During the Training Period.

The resident would be required to rotate through clinical gastroenterology, hepatology, diagnostic and therapeutic endoscopy. In addition, he/she will spend some time in rotations through allied specialities (pathology, radiology, laboratory medicine etc.) Extramural rotations (Institutions outside the primary centre) or rotation at affiliated centres for a maximum period of 3 months may be allowed during after the 1st year of training.

Posting in Gastroenterology

1) Clinical Gastroenterology and Hepatology

2) Diagnostic and Therapeutic Endoscopy

3) Radiology / Pathology

4) OPD consultation

5) Critical care and Emergency

The pattern of training in each of the semester would be as follows :

1st year

Clinical ward posting including ICU, Initiating Research process, Human Rights information Awareness about right to information, Development of communication skills both in the vernacular and English language, Ethical training, Defining brain death, Counseling for organ transplantation, Computer orientation.

2nd year

Change of posting to a busier ward with greater responsibility Independent OPD and Oesophagogastro duodenoscopy under supervision, Organising CME,workshops and seminars

3rd year

Change of posting – Independent charge of the wards, Independent Oesophagogastro duodenoscopy and based procedures Teaching (Inter and intradepartmental) Organising CME, workshops and seminars.

Schedule of Posting

The residents should be posted in the gastroenterology ward, emergency (casualty) and gastroenterology intensive care unit during the three year course. They should also undergo rotation in allied specialties. The following should be the training program in the department

1. Gastroenterology Ward - 2 years

2. Endoscopy Lab - 4 months

3. Gastroenterology ICU/ Emergency- 6 months

4. Pathology- 2 weeks.

5. Microbiology- 2 weeks.

6. Radiology - 1 month

Career Options

After completing a DrNB in Medical Gastroenterology,
candidates will get employment opportunities in Government as well as in the
Private sector.

In the Government sector,
candidates have various options to choose from which include Registrar, Senior
Resident, Demonstrator, Tutor etc.

While in the Private sector the
options include Resident Doctor, Consultant, Visiting Consultant (Medical
Gastroenterology), Junior Consultant, Senior Consultant (Medical
Gastroenterology), etc.

Courses After DrNB
in Medical Gastroenterology Course

DrNB in Medical Gastroenterology is a specialisation course that
can be pursued after finishing a Postgraduate medical course. After pursuing
specialisation in DrNB in Medical
Gastroenterology, a candidate could also pursue certificate courses and
Fellowship programmes recognized by NMC and NBE, where DrNB in Medical Gastroenterology is a feeder qualification.

Frequently Asked Questions (FAQs) – DrNB
in Medical Gastroenterology
Course

Question: What is the full form of DrNB?

Answer: The full form of DrNB is Doctorate of National
Board.

Question: What is a DrNB in Medical Gastroenterology?

Answer: DrNB Medical
Gastroenterology or Doctorate
of National Board in Medical Gastroenterology also known as
DrNB in Medical Gastroenterology is
a super specialty level course for doctors in India that is done by them after
completion of their postgraduate medical degree course.

Question: What is the duration of a DrNB in Medical
Gastroenterology?

Answer: DrNB in Medical Gastroenterology is a super specialty programme of three years.

Question: What is the eligibility of a DrNB in Medical Gastroenterology?

Answer: Candidates must have a postgraduate medical Degree in MD/DNB (General Medicine) obtained from any college/university recognized by the MCI (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

Question:
What is the scope of a DrNB in Medical
Gastroenterology?

Answer:
DrNB in Medical Gastroenterology
offers candidates various employment opportunities and career prospects.

Question:
What is the average salary for a DrNB in
Medical Gastroenterology candidate?

Answer:
The DrNB in the candidate's average salary is between Rs. 4 Lakh to Rs. 45 Lakh per year depending on the experience.

Question: Can you teach after completing DrNB Course?

Answer: Yes, the candidate can teach in a medical
college/hospital after completing DrNB course.

Dr Ram Manohar Lohia Hospital, formerly known as Willingdon Hospital, was established by the British for their staff and had only 54 beds. After independence, its control was shifted to New Delhi Municipal Committee. In 1954, its control was again transferred to the Central Government of Independent India.

RML Hospital Vacancy Details:

Total no of vacancies: 08

The Vacancies are in the department of - Pediatric Surgery.

The date of Walk In Interview is 17th January 2023.

Venue and Timing of Interview:- Hospital Administration Section-II, Academic Block, Ground Floor, ABVIMS, Dr.RML Hospital, New Delhi-110001 from 09.30 A.M. to 10.00 A.M.

For more details about Qualifications, Age, Pay Allowance, and much more, click on the given link:

https://medicaljob.in/jobs.php?post_type=&job_tags=RML+Hopital+Vacancies&location=&job_sector=all

Eligible Candidates (How to Apply)?

Interested & eligible candidates should present themselves for the registration skill test/interview on the date of walk in interview.

The candidates must bring the filled application form (as per Annexure A) and the following original certificates at the time of registration (with one set of self-attested copies of all documents) [The documents should be serially page numbered):

1. Class 10th Pass certificate for age proof.

2. Mark Sheet of MBBS (Part I, II, and Final Year)

3. MBBS Degree

4. MS (PG), DNB/M.Ch (Pediatric Surgery) degree Certificate from University.

5. Proof of publication/presenting paper in indexed PUBMED Journal only, if any.

6. Caste/Community Certificate. OBC Certificate with required validity as mentioned above.

7. NOC from present employer (if employed).

8. Registration Certificates for eligibility as per point 1 of Eligibility Criteria.

All information regarding the result, offer letter, joining, etc. will be uploaded on the hospital website (www.rmlh.nic.in) only. Dr. RML Hospital will not be made individual communication to any candidates.

The crucial date of determination of eligibility will be the date of the Interview.

Also Read:Walk In interview for SR Post Vacancies At Maulana Azad Medical College Delhi, Check All Details Here