Senior Doctors write scathing open letter protesting IMA's Yoga based workshop for medicos

' Shameful and appalling initiative '

Vartha Bharati | 04-07-2018 | 19:27:00 IST

Bengaluru, July 04: A group of senior medical practitioners from Karnataka have written a scathing open letter to the president of the Indian Medical Association protesting its decision to hold a 'Yoga based workshop for young medicos. In their letter to the IMA president  Dr. Ravi Wankhedkar, which they have released to the media, these senior doctors have slammed the IMA for  'organising such a workshop in association with self styled 'yoga' teaching centres'. They have alleged that  'IMA is promoting these dubious methods as stress busters, thereby denying the well proven methods in modern scientific medicine to treat and prevent stress, depression, anxiety etc.'

These doctors have  urged the IMA to immediately dismantle this initiative and stop the Doctor Know Thyself Workshop, failing which they have threatened to 'openly oppose such misadventures.'

Here is the full text of the letter :

From

Dr B Srinivas Kakkilaya, Consultant Physician, Mangaluru, Karnataka,

Dr KS Madhava Rao, Senior Neuropsychiatrist, Mangaluru, Karnataka,

Dr Shashidhar Bilagi, Senior Neuropsychiatrist, Bengaluru, Karnataka,

Dr. P Venkataraya Bhandary, Senior Neuropsychiatrist, Udupi, Karnataka,

Dr Ravichandra Karkal, Consultant Neuropsychiatrist, Mangaluru, Karnataka,

Dr Santosh Prabhu, Consultant Neuropsychiatrist, Mangaluru, Karnataka,

Dr Yogananda Reddy, Consultant Paediatrician, Ballary, Karnataka,

Dr Rakshit Kedambady, Consultant Neurologist, Mangaluru, Karnataka,

Dr Prakash C Rao, Senior Family Physician, Bengaluru, Karnataka.

To,

Dr. Ravi Wankhedkar,

President,

Indian Medical Association,

New Delhi

Dear Dr. Ravi Wankhedkar,

Sub: Decision of the IMA to organise Yoga based workshop for medical students – protest reg

It has been brought to our notice that the Indian Medical Association has decided to start IMA Initiative for Emotional Health & Emotional Well-Being of Medical Students and Doctors in India, ostensibly considering the increased rate of mental illness and in some cases even suicides, especially in young medicos, and under its auspices, a workshop is being organised at IMA House, Bengaluru on Sunday, 8th July, 2018, comprising of presentations and orations by Isha Yoga Foundation, Banjara Academy, Laughter Yoga, and Art of Living Foundation.

It is indeed shameful and appalling that IMA is organising such a workshop in association with self styled 'yoga' teaching centres. It's also shameful that IMA is promoting these dubious methods as stress busters, thereby denying the well proven methods in modern scientific medicine to treat and prevent stress, depression, anxiety etc.

We hereby bring to your notice the studies on depression, anxiety and stress among medical students that have comprehensively detailed the causes for such problems and have also suggested remedial measures based on such causes; none of these studies have even mentioned yoga and such other unproven methods as remedial or preventive measures for medical students suffering from depression or anxiety. The possible causes of depressive and suicidal symptomatology in medical students revealed in these studies include stress and anxiety secondary to the competitiveness of medical school; inability to cope with the vast curriculum; repeated examinations; high expectations of the parents, teachers, and patients, and time constraints for pursuing their alternate interests etc. Remedial measures suggested in these reports include restructuring of medical school curricula and student evaluations, reducing barriers to mental health services, including addressing the stigma of depression, having a dedicated psychological help clinic in the campus or having alternate means of communication through a helpline or E‑mail, peer mentorship programs, consultation by psychiatrists and clinical psychologists, life skills counsellingetc. [1-4]

We also bring to your notice the evidence that exists to disprove the utility of yoga or such methods in preventing or treating depression, anxiety or stress. A systematic review of yoga in neuro-psychiatry concluded that the available research is limited by small sample size, few randomized studies, inadequate control, diversely modified yoga practices, limited assessments and lack of safety data that preclude any firm conclusions on efficacy of yoga on the various psychiatric and neurological disorders. The authors advocated requirement of more research to decisively assess the validity of applying yoga as a mainstream therapeutic treatment for neuro-psychiatric disorders.[5] A systematic review of yoga for neuropsychiatric disorders included 16 of the 124 trials that met rigorous criteria. It found Grade B evidence (sparse high grade data or substantial amount of low grade data) for a potential acute benefit in depression (four RCTs), and Grade C evidence (low grade data without the volume) in sleep complaints (three RCTs). The authors concluded that biomarker and neuroimaging studies, those comparing yoga with standard pharmaco- and psychotherapies, and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health.[6] A Cochrane review on meditation therapy for anxiety disorders included two RCTs of moderate quality that used active control comparisons. The overall dropout rate in both studies was high (33-44%). Neither study reported on adverse effects of meditation. The authors concluded that the small number of studies included in the review do not permit any conclusions to be drawn on the effectiveness of meditation therapy for anxiety disorders and suggested that more trials are needed. [7] Another review found the risk of selection bias to be unclear for most RCTs and the effects were robust against potential methodological bias and no effects were found for patients with anxiety disorders diagnosed by Diagnostic and Statistical Manual criteria, only for patients diagnosed by other methods, and for individuals with elevated levels of anxiety without a formal diagnosis. [8] Yet another review of CAM for anxious patients concluded that only few controlled studies evaluated yoga for anxiety disorders, and all have significant methodologic limitations and/or poor methodology reporting; the diagnostic conditions treated and both yoga interventions and control conditions varied; there is little information regarding safety or contraindications of yoga; the reported attrition rates were high in most studies, which may raise concerns about patient motivation and compliance.[9] A systematic review and meta-analysis of yoga for depression included 12 RCTs with 619 participants. There was moderate evidence for short-term effects of yoga compared to usual care and limited evidence compared to relaxation and aerobic exercise. Limited evidence was found for short-term effects of yoga on anxiety compared to relaxation. Due to the paucity and heterogeneity of the RCTs, no meta-analyses on long-term effects were possible. No RCT reported safety data.[10] Another systematic review and meta analysis of Mindfulness Based Cognitive Therapy for psychiatric disorders concluded that several methodological shortcomings including small sample sizes, non-randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non-specific effects of such practice underscore the necessity for further research.[11]

On the other hand, there are innumerable resources regarding suicidal risk, its identification and management, including emergency care. There is enough evidence regarding the effectiveness of dialectical behavioural therapy and cognitive behavioural therapy in preventing suicides. A recent systematic review and meta analysis of cognitive behavioural therapy for suicidal behaviour, that included ten trials, concluded that cognitive behavioural therapy reduces not only repeated self-harm but also repeated suicide attempts by half and therefore was recommended as the preferred treatment for all patients with depression.[12] There are several other reports and resources as well regarding CBT and DBT in the management of depression and suicidal behaviour. [13-19] None of these guidelines mention yoga or meditation or any such unproven methods. It is in fact dangerous to promote yoga and such methods for anyone with suicidal ideation, and will deny the evidence based critical interventions required for such people. It will also make the Department of Psychiatry, psychiatrists and psychologists in all the medical colleges redundant and unnecessary, and send a very wrong message to the students of modern scientific medicine. Already in India, there is a treatment gap of 87.2-95.7 for depression in community-based studies; therefore, promotion of methods such as yoga will create further confusion and denial of care for the needy.[20]

Therefore, it is amply clear that the proposed initiative does not have any support of evidence, will possibly do more harm than good, and is therefore totally reckless and unnecessary. If any of the committee members or office bearers of the IMA have any personal experience with yoga or such other methods, they can keep the practice to themselves and they should desist from promoting baseless methods to others. IMA should instead focus on scientific analysis of the causes for increasing psychological problems among medical students and practitioners and find remedial measures based on such analysis and promote such scientifically proven methods. We also point out the fact that none of the most proven and life saving methods of modern medicine are ever supported or promoted by the so called alternative therapists, who instead always scorn and discredit these modern scientific methods so as to promote their own fakery. That being the reality, the acts of IMA or any other organisation or individual representing the modern scientific medicine supporting and promoting the unproven, unscientific claims of the so called alternative therapists will only offer credibility and honour to such dubious methods at the cost of defeating and demeaning our own evidence based medical practice, and by doing so, we are certainly playing into their hands, and providing the boost that they seek from us, only to misuse for their own propaganda and fund raising.

       If the IMA has no reason to promote modern scientific methods and instead finds it necessary to promote unproven methods, for whatever reasons, let the IMA state its policy openly that it no longer cares about evidence based medical practice and is ever available to promote any kind of hoax, fake claims, alternative therapies and unproven methods of diagnosis and treatment. Lending support and cooperation to unscientific and baseless claims of alternative therapists, and promoting unproven methods such as yoga, will not only be detrimental to the interests of the IMA and the medical fraternity, but also to the health and safety of the people at large. It is indeed saddening to note that the position of the IMA has seen such a U-Turn, after its open challenge and opposition in 2008 to the false claims of Baba Ramdev. Therefore, we urge the IMA toimmediately dismantle this initiative and stop the Doctor Know Thyself Workshop, failing which we shall openly oppose such misadventures.

References:

1.Rotenstein LS et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA.2016;316(21):2214-2236. doi:10.1001/jama.2016.17324.

2.Sarkar S, Gupta R, Menon V. A systematic review of depression, anxiety, and stress among medical students in India. J Mental Health Hum Behav 2017;22:88-96.

3. Datar MC, Shetty JV, Naphade NM. Stress and coping styles in postgraduate medical students: A medical college-based study. Indian J Soc Psychiatry 2017;33:370-4.

4.Garg K, Agarwal M, Dalal PK. Stress among medical students: A cross-sectional study from a North Indian Medical University. Indian J Psychiatry 2017;59:502-4.

5. Anand KS, Verma R. Yoga in Neuro-Psychiatry. J Yoga Phys Ther. 2014;5:e119.
6. Balasubramaniam M, Telles S, Doraiswamy SM. Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front. Psychiatry. 2013 Jan 25;3:117.

7.Krisanaprakornkit T, Sriraj W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews. 2006, Issue 1. Art. No.: CD004998. DOI: 10.1002/14651858.CD004998.pub2.

8. Cramer H et al. Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2018 Apr 26. doi: 10.1002/da.22762.
9.  Antonacci DJ et al. CAM for your anxious patient: What the evidence says. Current Psychiatry Oct 2010;9(10):43.

10.Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for Depression: A Systematic Review and Meta-Analysis. Depression and Anxiety 11/2013;30(11).

11.  Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis. Psychiatry Research. 2011;187(3):441–453.
12.  Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. Journal of the Royal Society of Medicine. 2017;110(10):404-410. doi:10.1177/0141076817731904.
13.  Linehan MM et al. Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Arch Gen Psychiatry. 2006;63(7):757-766. doi:10.1001/archpsyc.63.7.757
14.  Fleischhaker C et al. Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up. Child and Adolescent Psychiatry and Mental Health. 2011;5:3.
15.  Linehan MM et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry. 2015 May;72(5):475-82. doi: 10.1001/jamapsychiatry.2014.3039.
16.  Wenzel A, Brown GK, Beck AT. Cognitive therapy for suicidal patients: Scientific and clinical applications. 2009. Washington, DC, US: American Psychological Association
17.  Wenzel A, Jager-Hyman S. Cognitive Therapy for Suicidal Patients: Current Status. The Behavior therapist / AABT. 2012;35(7):121-130.
18. Stanley B, Brown G, Brent D, et al. Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility and Acceptability. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(10):1005-1013. doi:10.1097/CHI.0b013e3181b5dbfe
19.  Mewton L, Andrews G. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes. Psychology Research and Behavior Management. 2016;9:21-29. doi:10.2147/PRBM.S84589.
20.  Chisholm D et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016;3:415-24.

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Not having memorial for Manmohan Singh deliberate insult to India's 1st Sikh PM: Jairam Ramesh

27-12-2024 ¦ 27-12-2024 IST

Congress general secretary Jairam Ramesh | PC: PTI

New Delhi, Dec 27: The Congress on Friday said that not finding a location for the cremation and memorial for Manmohan Singh is a deliberate insult to the country's first Sikh prime minister.

The Congress raked up the issue after the Union home ministry said in a statement that Singh's last rites will be held at New Delhi's Nigambodh Ghat at 11:45 AM on Saturday with full state honours.

Congress general secretary Jairam Ramesh said party president Mallikarjun Kharge wrote to Prime Minister Narendra Modi, urging him to conduct Singh's last rites at a location where a memorial could be built to honour his legacy.

"The people of our country are simply unable to understand why the Government of India could not find a location for his cremation and memorial that is befitting of his global stature, record of outstanding achievements, and exemplary service to the nation for decades," Ramesh said in a post on X.

"This is nothing but a deliberate insult to the first Sikh Prime Minister of India, Dr. Manmohan Singh," the Congress leader said.

Kharge wrote the letter after speaking to Modi about setting up a memorial for Singh, who was a two-term prime minister revered by the people of the country.

"Apropos our telephonic conversation today morning, wherein I made a request to hold Dr Manmohan Singh's last rites, which will take place tomorrow i.e. 28th December 2024, at his final resting place that would be a sacrosanct venue for memorial of the great son of India.

"This is in keeping with such tradition of having memorials of statesmen and former Prime Ministers at the very place of their funerals," Kharge said in his two-page letter.

The Congress chief said Dr Manmohan Singh holds a highly revered place in the psyche of the country and the people of this nation, and his contributions and achievements were phenomenal.

He also said that Dr Singh's erudition on economic and fiscal matters came from his vast experience as the governor of the Reserve Bank of India, chief economic advisor to the government of India and in various other capacities in several organisations, and the respect and regard that world leaders had for him bears testimony to this fact.

Kharge said Singh's wise counsel, leadership and contribution in mitigating the global economic financial crisis is well-acknowledged. He also recalled President Obama's words when as the US president, he mentioned that "whenever the Indian prime minister speaks, the whole world listens to him".

He also said that when the nation was in the throes of a grave economic crisis, it was Dr Manmohan Singh, along with former prime minister P V Narasimha Rao, who took India out of the crisis and also led the country towards economic prosperity and stability.

The nation today reaps the benefits of the robust economic foundations built by them, Kharge noted.

"Coming from a humble background and having experienced the pains and sufferings of the Partition, it is through his sheer grit and determination that he rose to become one of the leading statesmen of the world. I hope and trust that befitting stature of Dr Manmohan Singh, request to have the funeral of Dr Singh at a place where his memorial can be built, will be acceded," Kharge said in the letter.

Congress Legislature Party leader in Punjab assembly Pratap Singh Bajwa also separately urged Prime Minister Modi to have Manmohan Singh's funeral at a place where a memorial could be built later in his honour.

"I urge Prime Minister @narendramodi to honour Dr Manmohan Singh, one of the most towering Sikhs of modern times, with a memorial befitting his immense contributions to our nation. Rising from humble beginnings in a historic state, representing a community that has always stood steadfast for India's unity and progress, Dr Singh's life is a testament to intellect, integrity, and selfless service," he posted on X.

Bajwa said Punjabis across faiths and political lines unite in their heartfelt plea to recognise this son of Punjab, who played an instrumental role in shaping India's destiny, with the respect he deserves.

Shiromani Akali Dal leader Sukhbir Singh Badal claimed the Centre has "declined" the request of Manmohan Singh's family for performing the funeral and last rites at a place where an appropriate memorial may be built.

There is no official word from the government on Kharge's request.

However, Badal took to X to post, "Shocking and unbelievable! It is condemnable in the extreme that Union Govt has declined the request of Dr Manmohan Singh Ji's family for performing the funeral and last rites of the highly distinguished leader at a place where an appropriate and historic memorial may be built to commemorate his unparalleled services to the nation."

He further said this place should be Raj Ghat.

"This will be in keeping with the settled practice and tradition followed in the past," Badal said.

He said it is "inexplicable" why the government is "showing such disrespect to the great leader who was the only member of the Sikh community to rise to become the Prime Minister".

"As of now, the cremation is slated to be performed at the common cremation ground at Nigambodh ghat. I am unable to believe that the BJP govt's bias would go to such extremes in utter disregard of the towering global stature which Dr Manmohan Singh ji enjoyed and will always enjoy," Badal further said in his post.

He said Singh took the country to great international heights.

"Our political differences with the Congress apart, we have always held Dr Manmohan Singh in the highest esteem as he transcends politics and political affiliations. He belongs to the entire nation.

"Dr Sahib showed great sensitivity and compassion in his dealings with Shiromani Akali Dal over Sikh and Punjab issues," said Badal urging Modi to "intervene personally to change this deplorable decision of the government".

Singh passed away on Thursday night at Delhi's All India Institute of Medical Sciences (AIIMS) at the age of 92.

आज सुबह कांग्रेस अध्यक्ष ने प्रधानमंत्री को पत्र लिखकर प्रस्ताव दिया था कि पूर्व प्रधानमंत्री डॉ. मनमोहन सिंह का अंतिम संस्कार ऐसे स्थान पर किया जाए जहां उनकी विरासत का सम्मान करने के लिए एक स्मारक बनाया जा सके।

हमारे देश के लोग यह नहीं समझ पा रहे हैं कि भारत सरकार उनके वैश्विक…

— Jairam Ramesh (@Jairam_Ramesh) December 27, 2024