Blend sense with tradition this Diwali

If you fancy yourself as a good blend of modern sense and customary tradition, upcoming Diwali is the time and opportunity to experiment and demonstrate to neighbours and friends smart new ways of doing old things.

Regular sweets such as barfis, gulab-jamoons and multi-coloured khoya sweets are so predictable, calorie-dense and heavy, that most guests either shun them or reluctantly pick up the smallest piece on the plate when compelled. With diabetes, obesity and heart problems being as common as they are, most of these traditional delicacies do not go down well with those for whom they were intended, but find their way to homes of servants, drivers and junior office staff. 

Should you want your guests to eat, enjoy, take an extra-helping and remember what they had at your house, you need to make them appealing, healthy and different.

Manju never failed to surprise me over the years with her innovative preparations: mouth-watering and memorable, with that right mix of being delightful to the eyes and tongue, healthy and quite out of the ordinary. Here are some of the unique yet simple recipes she has shared.

Fruit “Cream”. Soak dried figs and dates in water for a while and puree them. Cut fruits of your choice and mix with the fig date puree to make a healthy sugar-free fruit cream.

Banana Shrikhand. Strain the water out of yogurt by putting it in a sieve for about an hour. Mix ground sugar and  ground cardamom to the thick yogurt. Add banana slices. Serve chilled.

Dry Healthy Mix. Cut slices of coconut, dates, figs and almonds. Mix them and serve as dessert.

Apple Sandesh. Mash paneer well.. add sugar, powdered cardamom and saffron, and mix well. Cut apple in small thin slices and stew with little sugar. In small bowls, put a thin layer of paneer, then of apple stew, then again paneer….Sprinkle sliced pistachios on top or decorate with dots of saffron paste.

Fig Yogurt.  Set yogurt in tiny glasses, but fill only half the glass. Soak figs and puree three-fourth. Cut the other one-fourth into tiny pieces. Mix the paste and pieces. Slowly cover the yogurt in glasses with the fig mix. Serve cold. As an alternative to figs, you can use any sweet fruit, like deseeded custard apple.

Apple Kheer. Grate apple and stew with sugar or sweetener. Thicken milk a little by boiling; add sugar, ground cardamom and saffron.  Chill the milk and stewed and stewed apple…mix and serve.

Adding and garnishing your preparation with natural sweeteners such as honey, dates, figs and raisins could add originality and make them stand out, apart from making them healthy. 

Further, Manju’s recipes contain less than half the calories that regular sweets contain, do not pose the dilemma “to take or not to take”, and do not cause the weight surge we go through at this time of the year.  Make this Deepawali different.

As published in HT City ( Hindustan Times) dated 27 October, 2013.

Stupid Benefits of Celebrating Festivals

The modern-day sceptic looking through his logical lens at what we do at this festive time of the year, often finds it as meaningless, wasteful old fashioned mass hysteria! Attempts by Indians to reconnect with their families and friends, pray and fast together, perform rituals, wear new clothes, hug each other and rejoice and try to keep their traditions and faiths alive make little practical sense. What is worse is that the food is usually poisonously rich, roads are choked, offices and businesses come to a grinding halt in what appears quite stupid.

And yet the air that gets charged with renewed excitement is what scientists find difficult to measure and analyse. While lifestyle and food are indeed important for good health, studies suggest that human emotions may have a significant, perhaps crucial impact on an individual's well-being. Researchers from University of Kansas found that positive emotions are critical for upkeep of physical health for people worldwide, especially for those who are deeply impoverished.

"We've known for a while now that emotions play a critical role in physical health," said Sarah Pressman, assistant professor of psychology at KU and a Gallup senior research associate. "But until recently, most of this research was conducted only in industrialized countries. So we couldn't know whether feelings like happiness or sadness matter to the health of people who have more pressing concerns - like getting enough to eat or finding shelter. But now we do," she added.

They found that positive emotions such as happiness and enjoyment were unmistakably linked to better health, even when taking into account a lack of basic needs. While negative emotions such as worry and sadness were a reliable predictor of worse health.The association between emotion and physical health was more powerful than the connection between health and basic human physical requirements. Even without shelter or food, positive emotions were shown to boost health.

Another study affirmed that family rituals (such as birthdays, religious celebrations, and family reunions) are associated with marital satisfaction, adolescents' sense of personal identity, academic achievement, children's health, and stronger family relationships.

Family rituals and symbolic communication reinforce our identity and tell us who we are as a group, providing continuity in meaning across generations. They deliver valuable emotional imprint the individual may replay it in memory to recapture some of the positive experience.

Be it Eid, Navratri, Durga Puja or Diwali, celebrate it with emotional gusto. Never mind what the Westerners would say about our seemingly meaningless ceremonies. They probably envy us for being able to let our hair down and be “stupid” at times, that their excessively rational mind-sets prevent them from doing. What keeps us ahead of them on the Happiness Index despite our impoverished state is our ability to keep logic aside for a while when we celebrate festivals with passion.

Cyclone and health

One of the problems of preparing for natural onslaughts such as the cyclone that hit our east coast last evening is that we are always caught under-prepared despite met warnings and visits of chief ministers to the potential disaster sites to oversee preparations. 

The problems are understandably formidable with very  large number of vulnerable people living in ramshackle homes with scanty food reserves. The scenario is compounded by poor communication, proneness to crime and disinclination to follow instructions.

It is worth looking back at what happened after hurricane Katrina struck America in 2005. Despite the USA being far more resourceful than us, Hurricane Katrina brought with it flood waters, loss of power and livable space, created a breeding ground for mosquitoes and turned into crime havens. It caused molds to grow, endotoxin levels to rise, depleted clean drinking water, spoiled food, allowed diseases to spread. Close to 2000 people died and around 800 went missing after the storm, and the adverse health legacy still lingers on after 7 years.

The immediate concern is from being washed away or drowned by floods, for which staying indoors or preventive evacuation to safer zones is the best method.  Early casualties occur from trees and walls falling on people causing injuries to head and limbs. For this, there needs to be functional hospitals and clinics with easy access (remember roads may have been washed away making it impossible to carry a comatose person on the shoulders across flood waters).

For those who have survived the first strike, the next wave of disease and deaths come from infections:  diarrhoea, cholera, typhoid, skin infections, and pneumonia. Ensuring an adequate store of safe drinking water is an absolute necessity. It can be supplemented with disinfection tablets. With electricity wires snapping and poles falling, homes are likely to be without power; hence one needs to be prepared with alternate methods of cooking and cleaning water. Keeping a stock of antibiotics at home makes practical sense.

It is unpleasant but essential to be think-through and prepare how to deal with dead-bodies of those who die in and dispose bodies of dead animals. It is equally important to make sure that adequate facilities are made for people to defecate and urinate: these should be at a distance from where food is prepared, should be disinfected frequently and should be in adequate numbers. This step is essential to prevent outbreaks of disease amongst huddling survivors.

The effect of such natural disasters on the mind can be significant: it starts with fear, is followed by horror, and then replaced often by a sense of anger or grief. These feelings often interfere with rescue operations, rehabilitation and even survival. Loss of crops, livelihood, home, relatives and sometimes health makes a deadly combination.

For those who survive, life usually never returns to quite normal: anxiety, depression and a sense of permanent loss often persist for the rest of life, much after the TV crew and their cameras have left.

As published in HT City ( Hindustan Times) dated 13 October, 2013.

Dengue prevention for you, the family and locality

The scare of the currently raging Dengue epidemic
in Lucknow is neither a false alarm nor media hype.
Good many people have fallen prey, and few have
already died.

The tragedy is that Dengue assumes an aggressive
form in young healthy adults, who were, till yesterday,
up and about their usual lives, going to school or
college, attending to work, partying or planning a grand Diwali bash.

Attempts at mosquito control seem to have gone away. Many might ask if it had started at all, seeing the heaps of polythene bags by the roads. The striped Aedes mosquitoes are easily seen in homes and offices on their dauntless flights landing on arms, necks and feet for their blood meals and injecting the virus through skin pricks.

What can you do to protect your self and your family?

Involve your neighbours, make a local team, pool some money and arrange people to clear the heaps of polythene bags from the neighbourhood, burning them if necessary. Arrange a fogging machine and organize Malathion spray if possible. Get some kerosene poured on stagnant pools of water in the locality. Dont wait for the government municipality any more.

1. Call the carpenter and make sure that your windows and doors are netted to prevent mosquitoes from entering.
2. Spray insecticides in and around the home daily
3. Put away your half sleeved shirts, shorts, and T shirts. Start wearing full sleeves, trousers and socks from today. The Aedes mosquito has a short snout and cant sting through a layer of cloth.
4. Request the principal to allow your child to wear full sleeves and trousers. Girls should wear pants or long skirts with leggings underneath.
5. Use mosquito repellents on exposed parts of the body (back of hands, neck, and face) on most times.
6. If fever occurs and stays for more than 2 days, get the blood tests done as advised by your doctor.
7. Take only paracetamol for fever. Avoid ibuprofen, acetaminophen, nimesulide (banned in most countries) and other painkillers. They increase the risk of bleeding and can damage organs
8. The main risks from Dengue are shock and bleeding. To prevent shock, drink lots of liquids and make sure you are passing good amounts of urine. If nausea and vomiting are cumbersome, IV fluids infused timely can help.

Dengue prevention requires all of us to work together if we have to succeed. Women’s groups in Thailand and the Phillipines have solved the problem by forming local groups and taking the initiative. Lucknow should be able to rise to the challenge too.

The greatest marvel of human nature is believed to be that seeing others die around him man refuses to believe that he too shall die. With Dengue raging in Lucknow, our complacence suggests that we feel quite that way!

As published in HT City ( Hindustan Times) dated 15 September, 2013.

Tobacco – A status report

Despite the image enhancement that tobacco companies try to achieve by diversifying into other forms of businesses, sponsoring sports events or music, and doling out prizes and awards for gallantry, their practice of manufacturing and selling tobacco products continues to cause great harm to society.  And they continue to market and bank on tobacco sales for their profit.

Two thousand people will die today in India due to tobacco. India has 250 million tobacco users with around 900,000 succumbing to tobacco-related diseases every year.  We ranks 1st in the world for incidence of oral cancer, caused almost entirely by tobacco use. One of our senior ministers had to be operated in USA for cancer of the cheek due to his Gutka habit. Although his face reveals a lack of symmetry, it is a matter of satisfaction that he is cured of cancer, and has turned a major anti-Gutka campaigner in Maharashtra.

Tobacco has no nutritive value or health benefit. While smoking, one inhales 43 cancer causing substances, 15 harmful chemicals and 400 poisons, all in a single puff.  Tobacco contains nicotine that provides that little kick that people get of it. It is however addictive and habit forming.

The habit usually starts at a young age, usually in school or college, under “peer pressure”, when seniors get their juniors initiated. It usually starts with a spirit of adolescent experimentation or rebellion, and helps a young person enjoy a feeling of having “grown up”. The occasional fag then becomes a way of life, a fashion or personality statement and then very soon, a habit that gets increasingly difficult to kick. Smoking rates in India are growing at an alarming 7% annually.

The harmful effects of smoking are well known to even those who smoke: lack of stamina, chronic cough, heart disease, stroke and stomach ulcers. Smokers are at high risk of cancers, not just of lungs, but of the mouth, pancreas and bladder too. Contrary to the popular “macho” image projected by the tobacco industry, smoking reduces potency in men and causes infertility and birth defects in women.

Smokers tend to be self centered, with scant regard for the welfare of their families and those around.  Innocent children ad spouses exposed to 2nd hand smoking because of an uncaring man, are often harmed this way. They often develop asthma and bronchitis. Sudden infant deaths occur more commonly in homes where someone smokes. Spouses of smokers are at increased risk of developing premature heart disease and cancers. Further, children growing up in a “smoking home” are more likely to take to it in life.

One often finally kicks the habit after a major health problem like a heart attack. By then much narrowing of the arteries have already occurred. One wishes it was much earlier.

Use of tobacco remains a classical example of how irrational some of us can be despite belonging to the human race that claims rationality as its USP.

As published in HT City ( Hindustan Times) dated 6 October, 2013.

Are you a Type A Personality?

The family and friends of Mr KM, a successful manager of a private bank, who recently suffered a heart attack at the age of 40, could have foreseen it coming if they had recognized what his “personality type” was driving him up to.

KM had a classical “Type A” personality; he was fiercely ambitious, charged and aggressive.  Friends recall how he was always setting high targets and then restlessly struggling to achieve them. And instead of relaxing for a while when done, he would promptly set another much higher target that he would start to pursue.

He had to be more successful than others, finding it hard to be one of many. Not surprisingly, he had come to achieve an important position at such a young age.  And not surprisingly, he had a heart attack now despite being a non-smoker and regular gym goer.

The constantly charged state of such people generates frequent surges of stress hormones called adrenaline and corticosteroids. The health price they often pay for their achievements is high blood pressure, diabetes, heart disease, stroke and peptic ulcer.  Training such people to take their toes off the accelerator can help them live healthier and longer.

Type B personality is the opposite of type A. They are laid back, cooperative and not easily provoked to anger. They are peace loving by nature, and make good companions, friends or team members. They have larger amounts of the “calming” hormone called endorphins, in their system.Their restful nature protects them from the stress related health disorders often seen in people with Type A personality.

The typical Type C person is a martyr. He is compliant, eager to please and hence often prone to hopelessness and depression. He gives up easily. Studies have shown people with Type C to be vulnerable to cancers and malfunctions of the immune system.

People with Type D personality are notable for negative thinking, worrying, suppressed anger and a tendency to respond to stress by withdrawal or denial. They simmer and blame themselves and others. They rarely voice strong emotions like anger but fare badly in overcoming a stressful situation such as a major illness or hospitalization. While a person with a type A will fight and come out of a difficult situation, a type D will succumb easily. Their blood carries higher levels of inflammatory mediators, generated by their constant internal conflicts.

While these are the 4 major personality types, every person may not always be a straight- fit, but may show predominance of one. Some may have “overlap” personalities. And based on our personalities we react and perform differently in the classroom, boardroom, bed room or on the playfield. 

Learning to recognize these personality types may help us not only to adjust better to our careers, goals, bosses, colleagues, partners and children, but to understand our proneness to disease, and to take the appropriate steps to remain healthy.

As published in HT City ( Hindustan Times) dated 29 September, 2013.

Try Happiness Therapy for Good Health

Recent research is turning the relationship of health and happiness on its head; healthy people are of course happier, but more startling is the observation that those who are happy and satisfied with their lives are a lot healthier. Moreover, the benefit comes with a quick turn around time, with greater happiness boosting health in as little as 3 years.

In a scientific study, 10,000 adults were assessed how happy and satisfied they had been by their response to 2 simple questions: “During the past 4 weeks, have you been a happy person?” and “All things considered, how satisfied are you with your life?” The answers were correlated with physical health parameters in 2001 and then 3 years later in 2004. “We found strong evidence that both happiness and satisfaction have an impact on our indicators of health”, says Dr Siahpush, from the University of Nebraska Medical Center, Omaha, USA. They were associated with excellent or very good physical health, absence of long-term limiting illnesses, and higher levels of physical health 3 years later!

That material wealth and happiness do not go hand in hand is now well known. Bhutan’s King Jigme Singye Wangchuck first coined the concept of Gross National Happiness (GNH), an attempt to define quality of life in more holistic and psychological terms than the Gross National Product (GNP), in 1972. He convincingly argued that spiritual development was as important as economic growth and proposed sustainable development, promotion of cultural values, conservation of natural environment and establishment of good governance as the 4 pillars of GNH.

A German scientist Dr. Grossarth-Maticek showed that a person’s prospects for good health and long life were remarkably dependent upon his mental habits learned in childhood. These attitudes caused emotional reactions which strongly affect the immune system, circulatory system and even risk of accidents. The strength of this correlation between attitudes and health, he felt, had been grossly underestimated by the medical profession.

He devised a simple 5 minute test by which you may assess your happiness and satisfaction levels. Try it at http://www.attitudefactor.com/. The next step could be to set a goal to change some of your negative attitudes to positive ones.  A study conducted by the German team showed that those who did that had a thirty times higher chance of being alive and healthy 21 years later than those who persisted with their self-destructive attitudes.

If food security and education could be served on a platter as rights, I wonder why “happiness” should be left behind? Or should we take it upon ourselves to retain, perhaps regain under present times, a dose of happiness that governments and circumstances may try hard to deny us, for our own health and longevity.

As published in HT City ( Hindustan Times) dated 22 September, 2013.

Rationalism and Life’s Lessons

I felt a tinge of pride on learning that the recently murdered rationalist in Pune, Narendra Badholkar, was a medical man. This 67 year old doctor held a medical degree, and had practiced medicine till 16 years ago before turning a full-time activist of Indian Rationalist movement to fight superstition, black magic and faith healing.

A doctor indeed finds himself so closely nestled between the overlapping spheres of the body, mind, emotions and faith that he comes face to face with irrational practices and social issues almost every day.

Progress in science has been the single strongest factor to dispel in a step-wise manner what we have held as “supernatural”. As a child, I remember hearing stories of how a “possessed” woman could walk in sleep or go through phases of abnormal behaviour. These conditions are probably still treated in villages by witch-doctors through black-magic, animal sacrifices and wearing of stones. As a medical student, I realized that sleep-walking or somnambulism is a common disorder that can be set right by restoring the balance between REM (rapid eye movement) and NREM sleep, while phases of hallucinatory abnormal behaviour was a manifestation of parietal lobe epilepsy that can be very effectively treated by simple anti-epilepsy tablets!

Most illnesses and remedies do follow scientific principles. Anti-malarial therapy for instance, is far more effective in killing the Plasmodium parasite and curing malaria than prayers, surgical removal of a brain tumour in relieving headaches than wearing precious stones, and endoscopic removal of polyps from the colon that cause intestinal bleeding than sacrificial killing of animals!

Life’s lessons sometimes however have the nasty trait of bringing even the most rational people to their knees. Mr Bhargava’s (name changed) was one such happy family of an elderly couple of high financial and political standing, their 4 children all successful businessmen in their 20s to 40s, and their 6 pretty grandchildren. Their lives had been smooth and rich and not required the attention or intervention of gods, god-men, stars and fate.

When the 3rd son Punit, 27 then, developed myeloid leukaemia, (blood cancer) 5 years ago, they rallied together, got him the best treatment possible including a bone-marrow transplantation at a premiere centre in USA, and emerged victorious. Three years later, when he strangely developed anew cancer of the tongue, they were baffled. His tongue had to be removed by a specialist surgeon, leaving him voice-less. Six months ago, when he developed yet another problem – a cancer of the lung this time, the mother started wondering if the family needed to seek answers beyond the boundaries of science.

Although science and medicine has made considerable progress and provided many answers to a multitude of questions, large empty spaces still exist in our understanding of why things sometimes defy expectations and happen the way they do. It is this void that makes us vulnerable to superstition and blind faith, when life begins to beat down on us or our loved ones.

As published in HT City ( Hindustan Times) dated 1 September, 2013.

How Safe is Your Doctor?

Patients planning to undergo major complicated procedures such as heart surgery, organ transplantation or joint replacement are often anxious to know about the success rates and risks, before making up their minds or choosing the doctor.

Conventionally it has been the word of mouth. “ We heard Mr Sharma, our neighbour’s friend, came home well after a heart surgery in X hospital by Y surgeon. He must therefore be good” is the usual formula.

Another method has been to assess a doctor’s competence by seeing the crowd outside his chamber. I remember one Mr Jaiswal who had come to consult me at SGPGI in our opening days in 1987 telling me candidly, “ Most successful doctors in the city have crowds  waiting outside their clinics and they spend 2 minutes per patient, while you spent 30 minutes on me and don’t seem to have any one else waiting outside!”.  He therefore did not think me competent and could not muster up enough confidence to undergo an endoscopy by me at that time.

In these days of computers and internet, the commonest thing smart people do is search the net. This approach however has its own set of problems.

We are led to believe that more hits on Google are more likely to be valuable. It is therefore hardly surprising that corporate hospitals and private doctors have an overwhelmingly larger presence on the net than highly skilled specialists in academic and government institutions, who did not make the effort to promote themselves.

Effort is on in some countries to encourage hospitals and departments to put up data on the internet, stating for instance, how many open heart surgeries have been done, how many have been successful and how many succumbed. It is hoped that this kind of transparency will help patient make better informed choices.

The genesis of this initiative dates back3 decades when a whistle blower drew attention to an alarmingly high rate of deaths in children undergoing heart surgery in a hospital in England. Now known as the Bristol Heart Case, it was revealed that 29 of 53 children who had undergone a type of heart surgery at the Bristol Royal Infirmary during a particular period had died, the mortality rate (55%) being much higher than had been the experience of other similar centres.

As a consequence of this revelation by the inquiry conducted by the National Health Services of UK, the names of Dr James Wisheart, Dr John Roylance and Dr Janardhan Dhasmana were struck off from the council list and they were debarred from operating.

Indeed, if authentic data about a doctor’s experience, success rates and complications were made available, decision making for patients would become far easier. But with corporate hospitals out there to do business, ensuring authenticity of data could be a real challenge.

The word of mouthor neighbour’s advice may still have a place and be very valuable!

As published in HT City ( Hindustan Times) dated 25 August, 2013.

TB is invading our homes

When Mr Randeep (name changed), a 55 year old industrialist and politician, who came to see me for crampy abdominal pain and weight loss over 6 months, was found to have an ulcer in the intestine due to tuberculosis, he reacted with shock and disbelief.  To him, TB was an infection that happened to remote “others” in slums and villages.

With 2.6 million Indians estimated to be suffering from TB, we account for one of every 5 across the world. And with 3.87 lac people acquiring the infection every year, India is emerging as an epidemic bed of TB, claiming a life every 2 minutes.

The disease is now invading our homes, with people from the middle and upper classes no longer being able to remain immune from it. In fact a large number of people coming to me from well-off homes with the infection are surprised how they contracted it.

The infection gets into our body though the air we breathe. The germ, Mycobacterium tuberculosis, spreads through droplets that a person with TB of the lungs coughs or spits, and sprays into the air. Further, once coughed out, the germ tends to hover around in the air for long periods, allowing us to inhale them unknowingly.

Most infections therefore occur in public places: buses, metros, trains, railway stations, crowded classes and offices. Family members of an infected person are more likely to inhale droplets at home,the chances increasing with crowding and poor ventilation.

Tuberculosis of the lungs is easily diagnosed in a person who has been coughing for over a month, running a low grade temperature especially in the evenings and losing weight that a chest X-ray and sputum test help confirm.

The problem however is that most patients do not necessarily present in this classical manner. A person may be running low grade fever for weeks and losing weight for instance, but his chest x-ray may be normal, a situation that happens with infection of other organs. How does one diagnose extra-pulmonary TB?

Blood tests for diagnosis of TB, such as ELISA, are extremely unreliable and have therefore been banned by the government. A skin test called PPD, also tells about a past exposure to the germ that most of us have had, and does not tell about an active disease. Scans such as ultrasound or CT scan may show glands and shadows but does not tell their nature, adding to the diagnostic challenges faced by the clinician.

Another cause for concern is that the germ is showing resistance to commonly used drugs. In fact it has metamorphosed from being resistance to a single drug, to MDR (Multi-drug resistance) and now to a one called TDR (total drug resistance), posing a major threat to all of us.

The germ that was discovered by Robert Koch in 1882 has indeed given mankind a long run, and does not seem to be in a relenting mood in coming times either. TB is indeed lurking around.

As published in HT City ( Hindustan Times) dated 18 August, 2013.

Clinical Trials, Industry and Doctors

Despite general agreement on the pivotal role and necessity of “clinical trials” to usher in better treatments and to keep pushing the boundaries of what medical science can achieve, the term continues to evoke suspicion and cynicism in the minds of the public.

The history of clinical trials has been both epoch making as well as shameful.

During my recent discussions with an international pharmaceutical organization that has developed some promising new molecules for Hepatitis B and C and was trying to identify reliable hospitals and clinical investigators in India, I was told that clinical trials are banned in some states in the country.

Some investigator-doctors here had obviously flouted safety and research norms and jeopardised the lives of innocent patients.  But why did they do it? The possible reasons: there is often unusual eagerness to recruit patients in a trial as successes in the eyes of industry sponsors as well as financial remuneration are linked with the number of patients that a doctor recruits. Once recruited, many busy doctors often do not find time to closely monitor them for side effects. And if a patient does complain of unusual symptoms while on the trial therapy, the investigator-doctor is often reluctant to withdraw the patient from the drug as he fears his numbers might crumble.

All these failings of doctors are compounded in great measure by illiteracy and poverty of our patients. Speculations begin with how truly informed the ‘’informed consent” usually is for a patient who cannot read the 4 page document that he is expected to put his thumb impression on. Further, in a paternalistic medical climate ‘’where doctor always know best’’, does a poor patient who has surrendered himself completely and suffered a complication of a trial-treatment really has a voice to be heard?

Despite all these ugly tales, successful stories that have benefitted mankind can be found around each medicine that we prescribe or every procedure that we perform today. The discovery of the first antibiotic, penicillin, serves as a milestone. When two doctors, Chain and Florey embarked upon a clinical trial to test Dr Alexander Fleming’s new antimicrobial, patients and the public must have been just as sceptical. Severely infected patients were treated either with the potions of the day or with the experimental drug obtained from the penicilliummould. A few weeks later the researchers noted that while most who received the “standard of care treatment” of the day died, most receiving the ‘’experimental one” pulled through!

Perhaps the greatest challenge of our present times is to bask in the belief that we have reached the pinnacle and need not try out newer treatments any more. We should learn from the other systems of medicine that have all had their days in the sun but have stagnated due to lack of on-going research and now live on as withered wisdom in moth-eaten books.

Medicine needs to move ahead to survive, but it surely needs to find a safer path.

As published in HT City ( Hindustan Times) dated 11 August, 2013.

Crohn’s Disease and Biologicals

Anjali (name changed), a 38 year old bank executive, who had been troubled by recurrent bouts of loose stools over a year and had lost 4 kg weight,and for which she had been prescribed several courses of antibiotics, without lasting relief, had begun to get a “gut feeling” that something was not quite right. She had also started experiencing severe backaches and stiffness of the joints that was interfering with her work.

Exhausted, and at her wit’s end, she underwent a colonoscopy, by which we inspected her large intestine, and discovered that she had patchy ulcers and swellings. The biopsy report indicated Crohn’s Disease.

Crohn’s Disease(CD) is an auto-immune disease, in which the defence forces of the body misguidedly attack its own parts, the intestines in this case. Immune cells called lymphocytes pile up in the intestinal walls and pour out cytokines that imprudently attack and destroy the intestinal cells instead of invading germs. Once considered rare, CD is being increasingly diagnosed in India almost as commonly as in the west.

We were then confronted with choosing the best treatment. The common therapy prescribed on such occasions is cortico-steroids,which suppress the inflammation. They however have a long list of side effects: proneness to infections and diabetes, increase in blood pressure, brittleness of bones, and most importantly for a good-looking young lady like Anjali, development of moon-like swelling of the face.

An alternative was to use a relatively new but expensive group of drugs called “biologicals”, which selectively block the immune-attack occurring in the walls of the intestines. As the main ammunition in CD and Rheumatoid arthritis comes in the form of Tumor Necrosis factor-alpha (TNF-a), scientists have been able to produce blocking anti-bodies that can neutralize them, thus effecting a temporary cure. The medicine, called infliximab, comes as a liquid and has to be given as periodic intravenous infusions.

After detailed consultations with her husband and several specialist doctors, Anjali opted for Infliximab therapy consisting of 3 induction doses within 2 months. She fortunately had enough insurance to cover the cost of Rs 75,000/- for each infusion.

Within a week of the very 1st dose she took in April, she felt 90% well, much better than she had ever felt in the last one year. Her stools returned from 6-10 loose ones a day to a singlewell-formed one. Her back ache, another manifestation of CD, disappeared as she gained 6 kg of weight and began bubbling with energy and strength once again.

Biologicals, while often working as miracle drugs, have their share of problems too. Being proteins in nature, they often instigate the body to develop anti-bodies to them, which neutralize and reduce their effect with time.

Despite this major advance in medical science, the main hurdle remains their exorbitant cost that keeps them beyond the reach of most Indians. We hope Indian firms will be able to produce them in good quality at affordable prices.

As published in HT City ( Hindustan Times) dated 4 August, 2013.