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The Wire
17-07-2025
- Business
- The Wire
'NITI Aayog No Substitute,' Says Ex-Bureaucrat as Govt Moves 9 Flagship Schemes Out of Usual Appraisal System
'By doing away with such an appraisal process, and bringing in NITI Aayog, the government is blocking doors to a professional socio-economic appraisal of schemes – something that is essential.' An illustration on the Ayushman Bharat Digital Mission's official site. New Delhi: Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, and PM Kisan, are among nine of the Narendra Modi government's flagship schemes that the government has decided to keep outside the ambit of the ongoing appraisal process for central sector programmes, Economic Times has reported. Speaking to The Wire, a former secretary in the finance department has called this a move by the government to block doors to a professional socio-economic appraisal of schemes. The report says that in a letter dated July 4, the Department of Expenditure asked the respective ministries and departments to exclude the schemes from the standard appraisal process. This exclusion will remain in place for the next five years, starting April 1, 2026, the report said. These schemes, the letter said, will be evaluated and appraised in detail by the planning think-tank NITI Aayog's Development Monitoring and Evaluation Office. An unnamed senior official quoted by ET noted that this is because some of these schemes will need "some structural changes." "Niti Aayog has been tasked to do the detailed exercise so there is no duplicity of efforts,' the official told ET. The full list of the schemes are: Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, PM Kisan, Ujjwala Yojana, PM Jan Dhan Yojana, PM Stand Up India, PM Jeevan Jyoti Bima Yojana, PM Suraksha Bima Yojana, and a scheme under the Department for Promotion of Industry and Internal Trade to refund central GST and integrated GST to industrial units in northeastern and Himalayan states. In addition, schemes related to the Department of Space and the Department of Atomic Energy and the National e-Vidhan scheme are also outside the ambit of the appraisal process. A former secretary in the finance department told The Wire that the NITI Aayog is no substitute for an established system of appraisal. The former bureaucrat said that the established practice is that a Public Investment Board (PIB) headed by the expenditure secretary appraises all new schemes that involve large investments. The erstwhile Planning Commission – under the Manmohan Singh-led United Progressive Alliance government – used to have a Project Appraisal Division (PAD) that had expertise in evaluating such schemes and projects. The PAD would give inputs to the PIB for appraisal. The PIB's recommendations on the scheme would then be looked at by the Cabinet for a final decision. The former IAS officer, who headed the PAD and PIB, noted that PAD and PIB inputs added value to schemes. "While recommending a scheme to the Cabinet with improvements, I remember setting apart a small percentage of the investment for independent social audits to provide feedback during implementation," he noted. He also added that NITI Aayog "woefully lacks the required expertise, as PAD used to conduct social-cost social-benefit appraisal, which NITI Aayog is not in a position to do." "By doing away with such an appraisal process, and bringing in NITI Aayog, the government is blocking doors to a professional socio-economic appraisal of schemes – something that is essential," he added. The Wire is now on WhatsApp. Follow our channel for sharp analysis and opinions on the latest developments.
Yahoo
10-07-2025
- Health
- Yahoo
A one minute scan of your foot could help prevent amputation – here's how
Imagine having blocked arteries in your legs and not knowing it. At first, there may be no symptoms at all. Just occasional fatigue, cramping or discomfort – symptoms easy to dismiss as ageing or being out of shape. But as blood flow worsens, a small cut on your foot might not heal. It can turn into an ulcer. In the worst cases, it can lead to amputation. This condition is called peripheral artery disease (PAD) – and it's far more common than many realise. PAD affects around one in five people over the age of 60 in the UK, and is especially prevalent in people with diabetes, high blood pressure or kidney disease. PAD is rarely an isolated issue: it's usually a sign of widespread atherosclerosis, the build-up of fatty deposits that can also narrow arteries in the heart and brain. It also significantly increases the risk of heart attacks, strokes and other conditions linked to poor blood flow to vital organs. Research shows that a large proportion of people diagnosed with PAD will die within five to ten years, most often due to these complications. Early detection is key to reducing the impact of PAD, and I've been working with colleagues to develop a faster, simpler way to diagnose it. Doctors can check circulation in the feet by comparing blood pressure in the toe with that in the arm. The result is known as the toe–brachial index (TBI). The trouble is that the test needs a toe-sized cuff, an optical sensor and a doctor who knows how to use the equipment. Many GP surgeries and foot clinics don't have this kit. And in many people, especially those with diabetes or stiff arteries, the test doesn't always give a clear or reliable, result. Our research team asked a simple question: could we turn a routine ultrasound scan into a quick, reliable way to measure blood flow in the foot? Most hospitals, and many community clinics, already have handheld ultrasound probes, which use Doppler sound to track how blood flows through vessels. This works through the Doppler effect: as blood moves, it changes the pitch of the sound waves. Healthy blood flow creates a strong, steady 'swoosh', while a narrowed or blocked artery produces a faint or disrupted sound. Doctors are trained to hear the difference and use these sound patterns to spot circulation problems, especially in conditions like PAD. But my research team wondered whether a computer could do more than listen: we wanted to know whether it could convert the shape of that Doppler 'wave' into a number that mirrors the TBI. To investigate, we scanned the feet of patients already being treated for PAD – 150 feet in all. For each artery, we used Doppler ultrasound to measure how quickly blood surged with each heartbeat, a pattern known as the acceleration index. We then compared these results to the standard toe–brachial index, the traditional test that measures blood pressure in the toe. The acceleration index alone was able to predict the standard toe–brachial index with 88% accuracy. Using a simple formula, we converted that Doppler reading into an 'estimated TBI' – a number that closely mirrored the conventional result. It needed no toe cuff, no optical sensor and it took under a minute to perform. Even more encouraging, estimated TBI rose in tandem with traditional TBI results after treatment. When patients underwent angioplasty – a procedure to reopen blocked arteries – their estimated TBI increased almost identically to the measured TBI. That means this scan doesn't just help diagnose PAD; it could also be used to track recovery over time. Crucially, our approach works with equipment that's already widely available. We repeated the experiment using a basic pocket Doppler: the kind many GPs and podiatrists have tucked in a drawer. While it wasn't quite as precise as hospital-grade ultrasound, the results were still strong. With some additional software refinement, doctors could soon assess foot circulation quickly and accurately using tools they already own, without adding time to a busy clinic schedule. Because early diagnosis of PAD changes everything. It can mean the difference between losing a foot, keeping your mobility and living longer with a better quality of life. It can shorten hospital stays and reduce the risk of heart attack and stroke. But right now, too many people with PAD aren't diagnosed until they already have chronic limb-threatening ischaemia – the most severe form of the disease. This condition occurs when blood flow to the legs or feet becomes critically low, depriving tissues of oxygen. It can cause constant foot pain (especially at night), wounds that won't heal and, in advanced cases, tissue death (gangrene) and the risk of amputation. Without urgent treatment to restore circulation, chronic limb-threatening ischaemia can be life-threatening. Part of the problem is that the tools used to diagnose PAD are often slow, expensive or too complicated for routine use. That's why a simple, cuff-free Doppler scan that provides a reliable estimate of toe–brachial index is so promising. It uses equipment that many clinics already have, takes less than a minute and delivers immediate results – offering a faster, easier way to spot poor circulation before serious damage is done. We're now looking at ways to automate the measurement so that it can be used even by non-specialists. We're testing it in various clinics with different patient groups and exploring its performance over time. But the evidence so far suggests that this could become a key part of vascular care – not just in hospitals, but in GP surgeries, diabetes clinics and anywhere else early intervention could save a limb. Blocked arteries don't need to stay hidden. With the right tools, we can find them earlier, treat them faster and protect people from the devastating consequences of late diagnosis. This article is republished from The Conversation under a Creative Commons license. Read the original article. Christian Heiss has received funding from Lipton Teas & Infusions, Ageless Science, iThera, the Medical Research Council, the ESRC, European Partnership on Metrology, co-financed from European Union's Horizon Europe Research and Innovation Programme and UK Research and Innovation. He is member of the board of the European Society of Vascular Medicine, president of the Vascular, Lipid and Metabolic Medicine Council of the Royal Society of Medicine, and chairperson-elect of the ESC WG Aorta and Peripheral Vascular Diseases.
Medscape
03-07-2025
- Health
- Medscape
Semaglutide Has Found Its STRIDE
Key results and new insights from the STRIDE trial and the evolving role of GLP-1 receptor agonist (RA) therapy in type 2 diabetes (T2D) and peripheral arterial disease (PAD) were discussed during a symposium at the American Diabetes Association (ADA) 85th Scientific Sessions in Chicago, which I was fortunate to attend. A Common Comorbidity T2D and PAD are not strangers to one another; patients with T2D are twice as likely to develop PAD compared with the general population. PAD has been shown to be the most common initial manifestation of cardiovascular disease in T2D. Moreover, patients with diabetes foot complications fear amputation and infection more than death. However, PAD is underrecognized in T2D; only around 20% of patients present with the classical symptoms of intermittent claudication (IC). PAD also has insidious onset: Patients experience slow functional decline and leg discomfort, which is often not recognized as PAD by healthcare professionals or patients. T2D and PAD are growing in incidence and share many risk factors, including obesity. A recent systematic literature review exploring the epidemiology and burden of PAD in T2D found that 12.5%-22% of patients with T2D had comorbid PAD. Furthermore, patients with T2D and PAD have a very high risk for major lower-limb complications and major adverse cardiovascular events, including all-cause and cardiovascular mortality. Unsurprisingly, PAD was associated with poor quality of life and significant healthcare use and costs. Notably, the ADA 2025 Standards of Medical Care in Diabetes now recommends screening for PAD using ankle-brachial index (ABI) testing in asymptomatic patients with diabetes aged > 65 years, microvascular disease in any location, or foot complications or any end-organ damage from diabetes if a PAD diagnosis would change management. PAD screening should also be considered in patients with diabetes duration > 10 years and high cardiovascular risk. PAD in T2D is often recalcitrant to surgical intervention because it tends to affect the distal vasculature (that is, the infrapopliteal vessels). These lesions are less amenable to traditional revascularization procedures such as femoropopliteal bypass and stenting. Unfortunately, this circumstance often leaves patients with T2D and PAD with persistent debilitating symptoms and few surgical options. Many international medical guidelines have class I recommendations to consider SGLT2 inhibitors and GLP-1 RAs for patients with T2D and atherosclerotic cardiovascular disease, though not specifically PAD. The only class I recommendation in PAD is for cilostazol for improving claudication symptoms. Cilostazol is a phosphodiesterase 3 inhibitor that promotes vasodilation and increased blood flow, which can improve symptoms of IC (but not cardiovascular outcomes). A recent Cochrane review found that cilostazol resulted in only a 40 m improvement in absolute claudication distance. From my clinical experience, cilostazol is often poorly tolerated (headache and diarrhea are common). It is contraindicated in heart failure, which frequently occurs with PAD. STRIDE Results The randomized controlled STRIDE trial was published in the Lancet in May 2025 and explored the impact of subcutaneous semaglutide (1 mg weekly) plus standard of care, compared with placebo, on walking capacity in patients with symptomatic PAD and T2D. In essence, STRIDE has laid the foundation for a paradigm shift in how we use GLP-1 RAs for symptomatic PAD. The trial recruited 792 patients with T2D and Fontaine stage IIa PAD. Fontaine stage IIa is early-stage symptomatic PAD, in which patients experience symptoms of IC after walking more than 200 m. Mean ABI was ≤ 0.9 in all participants; a normal ABI is typically 0.90-1.30 and indicates normal blood flow to the lower limbs. One-quarter of participants were female, and median age was 68 years. Obesity was not a criterion for study enrollment; 35% of participants had a BMI < 27. The primary outcome of the study was maximum walking distance after 52 weeks compared with baseline. STRIDE achieved its primary outcome. Subcutaneous semaglutide was associated with a significantly increased maximum walking distance (40 m improvement on a 12% incline, which is equivalent to 80 m improvement on a flat surface). This improvement is double that associated with cilostazol and, importantly, was confirmed to be clinically meaningful. The researchers also observed significantly improved symptoms and quality of life, as evidenced by improvements in the VascuQoL questionnaire. Notably, the reported improvements in ABI and disease progression confirm the vascular benefits of semaglutide. Encouragingly, clinical benefits persisted even 5 weeks after stopping semaglutide therapy. The treatment's safety profile was consistent with previous semaglutide trials, and no unexpected safety findings emerged. New data presented and simultaneously published in Diabetes Care confirmed that the effect of semaglutide on maximum walking distance was consistent, irrespective of T2D characteristics; benefits were independent of baseline diabetes duration, BMI, HbA1c, or concomitant use of sodium/glucose cotransporter 2 inhibitors or insulin. Functional benefits did not appear to correlate with weight loss or glycemic improvement, again highlighting the vascular benefits of semaglutide in reducing atherosclerosis, possibly through an anti-inflammatory effect. In conclusion, STRIDE increases the suite of recognized cardiometabolic and renal benefits of semaglutide by adding improved walking capacity, quality of life, and disease progression for patients with T2D and PAD. During my resident year as a junior doctor, my vascular consultant always reminded me of the core management of PAD in five words: 'stop smoking and keep walking.' While this remains the cornerstone of management 25 years later, semaglutide is now well positioned as a foundational therapy to improve quality and quantity of life in patients with T2D and PAD.
Bangkok Post
01-07-2025
- Politics
- Bangkok Post
Protest a worrying sign
The protest at Victory Monument on Saturday brought back memories of the last two street demonstrations which rocked the capital in recent years -- the protest organised by the People's Alliance for Democracy (PAD) against then-prime minister Thaksin Shinawatra, and the rallies held by the People's Democratic Reform Committee (PDRC) against his sister, Yingluck. Both protests ultimately failed to remove the leaders from power. However, they paved the way for two military coups to happen -- the first was led by Gen Sonthi Boonyaratglin, and the latest by Gen Prayut Chan-o-cha. On Saturday, Thai politics seemed to have come full circle, with old faces from the PDRC and PAD back to protesting on the streets, this time under the banner of the "Ruam Palang Paen Din Pok Pong Athipatai", or the United Power of the Land to Protect Sovereignty, group. Despite the heavy rain over the weekend, at least 10,000 people reportedly showed up to the peaceful rally to back the push to remove yet another prime minister from the Shinawatra family from office -- this time, Thaksin's daughter, Paetongtarn. The embattled PM is at the centre of the political crisis, which stemmed from the leaked recording of her conversation with former Cambodian prime minister Hun Sen, in which she could be heard promising to do what he wanted to de-escalate the situation along the border. If history is any indication, then this protest movement is destined to fail. Indeed, all street protests over the past two decades -- including those staged by the red shirts and the Democracy Restoration Group (DRG) -- failed to achieve their goal of booting the prime minister from office. However, the latest protest is a cause for concern. During the demonstration, veteran protest leader Sondhi Limthongkul told the crowds which gathered on Saturday that he wouldn't object "if the military does something". Equally worrying is the ultranationalist rhetoric which accompanied his coup-friendly attitude. At the protest, he encouraged the government to reclaim areas along the border which now belong to Cambodia. Such hardline rhetoric truly has no place in today's society. His comments faced a backlash from both the ruling coalition and the opposition, forcing the group to issue a statement to reassure the public that the group isn't calling for a military coup. This, however, isn't enough. To ensure peace, a political campaign or protest must be geared towards promoting democracy through inclusive dialogue and educating the public about the need for a democratic solution and just policies. In fact, Mr Sondhi's remarks spoiled the group's political momentum. The Pheu Thai Party and People's Party have officially blasted the group, accusing it of trying to overthrow the government and undermine democracy by calling for a military putsch. The war of words which followed Saturday's protest suggests Thai politics is about to reach a dead end once more. Street protests and political rhetoric will not bring about real change and improvement. The leaders of all protest movements must remember that people -- regardless of their political inclinations -- turn to street protest because they lack trust in their elected lawmakers. To prevent violent street protests or even a military coup, lawmakers and political parties must work to show that they exist to protect public interests, not their own political goals. Without trust, the centre will not hold.
Bangkok Post
30-06-2025
- Politics
- Bangkok Post
New anti-Paetongtarn group draws scrutiny
Political observers are closely watching the trajectory of the "United Front to Defend Thai Sovereignty", a new group that has emerged as a vocal critic of Prime Minister Paetongtarn Shinawatra. Its future remains uncertain following a large protest at Bangkok's Victory Monument on Saturday, which exceeded expectations in turnout. The peaceful demonstration demanded Ms Paetongtarn's resignation amid growing dissatisfaction with her leadership, prompting speculation about whether further protests will follow. The rally took place amid rising political tensions, with the ruling coalition facing internal rifts and a decline in public confidence. Panitan Wattanayagorn, a political and security analyst, said the protest was notable for uniting figures from former rival groups, including red shirts, the People's Alliance for Democracy (PAD), aka yellow shirts, and the People's Democratic Reform Committee (PDRC), as well as academics and some senators. "It was the largest such convergence in years," he said, particularly surprising given the red shirts' traditional alignment with the ruling party. However, Mr Panitan noted the protest's unity was superficial, as only a few prominent figures from each group took part, and ideological divisions remained. He estimated around 10,000 attendees, a significant number given the lack of political party backing. Opposition parties have so far kept their distance. Mr Panitan stressed the importance of monitoring unaffiliated citizens and online platforms, which have played a major role in spreading the protest's message. He also pointed to the potential influence of upcoming judicial rulings on the PM's status, expected after July 1, in shaping public sentiment. The political and security analyst advised Ms Paetongtarn to engage more actively with undecided citizens rather than relying on vague affirmations of protest rights. "Acknowledging the right to protest isn't a strategy. It doesn't address the causes of dissatisfaction," Mr Panitan said. Olarn Thinbangtieo, deputy dean of Burapha University's Faculty of Political Science and Law, said the rally's scale surprised the government, police, and ruling Pheu Thai Party. Authorities had expected fewer than 3,000 attendees. He attributed the protest's momentum to widespread discontent over the cabinet formation process, legal double standards, especially Thaksin Shinawatra's treatment while detained, and a lack of transparency in public institutions. The audio clip of a conversation between Ms Paetongtarn and Cambodian Senate President Hun Sen, as well as the border dispute and illegal casinos, added to the outrage. Mr Olarn criticised some of the protest's main stands for appearing to seek personal political redemption, mistaking the crowd's presence as support for them. He pointed to PAD leader Sondhi Limthongkul's on-stage remarks suggesting a coup as especially damaging. "Such rhetoric risks alienating the crowd and discrediting the protest," he warned, adding that many participants are wary of any move that could justify military intervention. Mr Sondhi's comments, Mr Olarn argued, created a vulnerability the government could exploit. By invoking the possibility of a coup, Mr Sondhi inadvertently positioned Pheu Thai as a defender of constitutional governance. Even groups critical of the government may back it temporarily to prevent another military takeover. "It was a strategic error," Mr Olarn concluded. Another legal scholar, Komsan Pohkong, emphasised that the demonstration reflected informed civic engagement. "This wasn't mob rule. These participants were concerned, largely middle-class citizens expressing political dissatisfaction in an organised way." He warned against dismissing their concerns, particularly around national sovereignty. "People may tolerate poor governance, but not perceived concessions on sovereignty." Mr Komsan said the rally's scale resembles early stages of past movements, like the PDRC and 2010 red-shirt protests, suggesting the potential for further escalation. "If ignored, this could become a much larger movement." He also noted the lingering controversy over the Shinawatra family's influence.
