Prescription CASCADE

Have you noticed that medical prescriptions hardly ever consist of a single drug but most often comprise a long list of them, even when the symptom that took you to the doctor was just a single one? It is due to a recently recognized phenomenon called Prescription Cascade.

As most drugs have side effects, what the doctor tries to do is to add balancing drugs that would counter them should they occur.

The most common example of this phenomenon is to co prescribe drugs that lower the stomach’s acidity when prescribing pain killers. Most pain killers such as aspirin, ibuprofen, diclofenac, indomethacin or naproxen are plagued by the side effect of causing gastric injury, called gastritis or gastric erosions. Indeed long term use of these agents are associated with the development of ulcers in the stomach or duodenum, that apart from causing stomach ache, can sometimes bleed or perforate  posing a threat to life. Doctors, therefore, often find it more covenient, and perhaps safer to add a drug from the group of PPI (proton pump inhibitor), such as omeprazole, pantoprazole or rabeprazole that would suppress the stomach’s acidity and reduce the chances of gastric erosions or ulcers.

While most of these PPIs are generally innocuous themselves, do add significantly to the cost of therapy. While aspirin for a prologed backache, for example, would cost a mere Rs 2 per day, a PPI would cost around Rs 5. At the end of a month, you would therefore have spent Rs 60/- for your backache, but Rs 300/- to prevent a potential adverse consequence of your primary treatment.

Another example is that of an antibiotic and a probiotic. Antibiotics, prescribed for infections, often cause extensive damage to the numerous “good” healthy bacteria that colonize our intestines and ensure our well being. Hence use of antibiotics is often associated with loose motions, called “antibiotic associated diarrhea”. It has therefore become common place to add a concoction of healthy bacteria, called probiotics, when prescribing antibiotics. These probiotics often cost Rs 30 to Rs 60/- a day, sometime s more than the antibiotics themselves, and often need to be taken for periods longer than the 5 day course of the primary drug, making a big hole in the patient’s pocket.

Several medications  that cause nausea or vomiting, such as anti-amoebic drugs  or anti-cancer drugs are routinely co-prescibed with anti-emetics drugs that counter these effects. The situation often gets complex as these secondary drugs sometimes cause side effects themselves such as abnormal muscular movements (dyskinesia), drowsiness or secretion from the breast, causing more concern than the anticipated problem with the primary drug itself.

 The numerous such examples of the  long prescriptions that we  get from  doctors  has raised a debate as to how much is really too much. While undoubtedly prescription cascades may sometimes help make the primary therapy more tolerable, the additional side effects and the cost multiplier effect needs careful consideration.

Short is usually not bad then, especially when it comes to prescriptions.

As published in HT City( Hindustan Times) dated 19 december, 2010. 

Dyslexia: Are We Being Cruel To Bright Kids?

One of the cruelest acts that we as parents, teachers or colleagues might be inadvertently indulging in is failing to recognize dyslexia, and labelling it as mental weakness.

Dyslexics, comprising 5% of the population, can be spotted from pre-school age. Typically, these kids have bright intelligent eyes, seem to follow what you tell them, react intelligently to situations, are emotionally normal, but seem to get into problems when asked to read or write. They may sit with the book open for long hours without progressing down the page, write poorly with lots of spelling mistakes, confuse “b” with “d” (mirror images) and hence get poor marks in the way tests are “normally” conducted.

They are certainly not mentally weak. In fact studies show that some of the brightest and most successful have had the trait. Albert Einstein the great scientist, John Lennon of Beatles fame, Richard Branson the owner of Virgin Airlines, Tom Cruise the Hollywood star, Thomas Edison who gave us the electric bulb, Winston Churchill the British PM are some examples of immensely successful people with dyslexia.

The problem in dyslexia is not with intelligence but with the wiring in the brain that deals with the way we learn or reproduce the symbols of language, such as alphabets or words, especially the written ones. Language, especially alphabets and words, have been made by man as an instrument for communication, and is therefore not something truely “natural”. Dyslexics have a problem learning symbols of this man-made language and hence struggle in assesments that test the ability to learn and reproduce them.

What complicates the lives of dyslexic children is that parents as well as school teachers are often not aware or trained to pick up dyslexia. The trauma of a lovable bright child starts when he underfperforms in his first written test, gets poor grades and is told that he is dull or inattentive. Parents are then informed in PTMs that their child is mentally weak. Imagine how we would feel if we were told that we are dull just because we could not reproduce or write words or sentences well, but we had wonderfull skills in painting, music or designing that our teachers never tested us at!

That then is the tragedy. Dyslexics are often very creative and artistic and can leave their “scholar”colleagues way behind if only they were tested at what they were gifted with – art, designing, music, creativity etc. They would grow up and make the list of geniuses longer and brighter.

Amir Khan’s “Taare Zameen par” helped bring dyslexia to society’s notice. Now special training modules are available that can help dyslexic children learn language well and rub shoulders with the toppers of his class. Picking these kids with special traits up at an early age, perhaps in preschool, is what we need to strive for. Our dyslexic geniuses will then realize their true potential and lead us forward with their creativity. 

As published in HT City ( Hindustan Times) dated 12 december, 2010.

Music and Health

Are you getting enough of good music to benefit your body and mind?

Research has shown that music has a profound effect on your body and psyche. In fact, there is a growing field of health care known as music therapy, which uses music to heal. Those who practice music therapy are finding benefit in using music to help cancer patients, children with ADD (attention deficit disorder), and even hospitals are beginning to use music to manage pain, fight depression, calm patients and ease muscle tension,

 Airlines and hotel industries were quick to spot the benefit of soft soothing music on customers and started using it in flights and hotel lobbies. Their customers started feeling cheerful and stress-free with patient satisfaction surveys and business turnover showing mprovement.

 Studies have shown that patients waiting for endoscopic or surgical procedures are less stressed and have fewer complications if soothed and prepared with soft music. Further, surgeons undertaking high-risk challenging life-saving surgeries such as liver transplnation, heart or brain surgeries seem to perform better when soft music is played in the operation theatre.

 How does listening to music bring about these changes?

 Music with a strong beat can stimulate brain waves to resonate in sync with the beat, with faster beats bringing sharper concentration and more alert thinking, and a slower tempo promoting a calm meditative state. Young people therefore prefer fast loud “rock” music that provides the pep. The march tunes, such as Colonel Bogey, provide the much needed beat, pride and “valour” sentiments during march pasts.

 Further, with alterations in brainwaves come changes in other bodily functions. Those governed by the autonomic nervous system, such as breathing and heart rate can also be altered by the changes music can bring. This can mean slower breathing, slower heart rate, lowering high blood pressure and an activation of the relaxation response. This is why music and music therapy can help counteract or prevent the damaging effects of chronic stress, greatly promoting not only relaxation, but overall health. The chants such as Gregorian, Gayatri or even fusion ones can indeed wipe much of the frustration, anxiety and restlessness from your system.

 Music can also be used to bring a more positive state of mind, helping to keep depression and anxiety at bay. This can help prevent the stress response from wreaking havoc on the body, and can help keep creativity and optimism levels high.

 Which then is the best music for you? The answer can come only from your own heart. Each one should build and listen to his own collection, consisting of some for general listening (perhaps popular movie songs with beats, rhythm and melody, gazals, Rabindra-sangeet), some to bust stress or to support us in bad times (slow chants, bhajans, spiritual invocations), some for background music when stressed, or in office, hospital, aircraft (Kenny G is very popular, try some piano concertos, Strauss, our own rich Indian classical instrumental collection or jazz) , and some peppy ones when we want to lift our spirits and those of our guests as in parties.

 It’s no surprise that so many are seeing music as an important tool to help the body in staying (or becoming) healthy. Music is the medicine of the soul, so let it play on!

              As published in HT City( Hindustan Times) dated 5 december, 2010.