Plastic Bags are a Health Menace

Plastic carry bags that are so liberally doled out by grocers and store-keepers are emerging a major health hazard and killer.

They are made of polythene, a product of petroleum and can be seen littered on roadsides, drains and fields while you travel by car or train. They choke landfills and drains and have even caused floods. They block the intestines of cattle and marine animals when they are ingested mistakenly while grazing, and kill around 10, 00,000 each year by painfully strangulating their intestines or by choking.

Disposing these bags is not easy; their burning releases toxins that are harmful to environment and us. Burying them causes the landfills to choke as polythene does not breakdown and decompose easily, and when they do, release toxins into the soil that find their way into the food chain.

Sometimes plastic bag litter can cause more problems. According to Nobel Peace Prize winner, Professor Wangari Mathaai, discarded bags fill up with rainwater and become perfect breeding grounds for malaria-bearing mosquitoes. Researchers from United Nations Environment Program have recommended banning of plastic bags to check malaria and save lives in several such countries.

Social costs of plastic litter add up as well; countries lacking comprehensive waste management often sprout underground economies of ragpickers — typically children who wander refuse heaps and collect potentially recyclable materials for sale to shady businessmen operating from official dump sites.

The problem with plastic bags is that it has become the victim of its own success. It is cheap, light, impervious and convenient with around 5 trillion produced each year. Their menace can be contained by the 4-Rs — Reduce, Recycle, Re-use, Repair.

Several developed countries have concentrated on re-use. Unfortunately the disposal, collection and recycling of used plastic bags in poor countries pose logistic problems with less than 1% ever been recycled.

It is time that visionary governments impose a ban on plastic bags.

If we take our jute or cotton “jholas” when we go to the grocers, it would reduce the use of plastics. Celebrities could make it a fashion statement and the media can publicise it. Retailer chains could offer an option of jute bag carry aways, at a little extra price; many of us wouldn’t mind it.

And if we could ensure clearing of the littered bags in our vicinity, we could reduce the breeding places of mosquitoes and the harm they cause to cattle. A difference, no matter how small, is urgently worth making, and we can set examples and inspire others to join in.

What does Research say about Happiness?

The secret to happiness may have to do with relatives and friends rather than money and fame, reports a recent scientific study.

The findings of a 75 years long study undertaken by Harvard University researchers to find out what makes people happy and healthy as they go through their lives, was presented by Dr Robert Waldinger, the fourth director of the long research project, in his crisp 12 minute TED talk “What makes a good Life. Lessons from the longest study on Happiness”, recently (http://ted.com/talks/robert_waldinger_what_makes_a_good_life_lessons_from_the_longest_study_on_happiness).

This unique study, the longest ever undertaken to study happiness, tracked the lives of hundreds of young people, rich and poor, starting from their teenage to their nineties.

On expected lines, most youngsters, at the time of initial interview in 1930 when the study started, had mentioned money as the most important thing they thought they needed to make them happy. Some had said they wanted fame, and several others had said that they wanted both money and fame to achieve happiness in life.

Over the 75 years, the participants were interviewed periodically and their perceptions of happiness were recorded each time to see if they changed.

By the time they were 50 years old, two types of people could be identified: those with lots of “relationships”, that is close bonds with relatives, friends and people, and another who were loners.

When followed up further till their 80s and 90s, the researchers evaluated how happy the participants were and had been in their lives, and tried to see a pattern in their lives that could correlate with their state of mind and health.

In the TED talk, Dr. Waldinger says that the research failed to show any correlation of the wealth or fame they had achieved, with their health and happiness.

What the researchers noted however was that the happy nonagenarians were far more likely to have had more relationships, often with many relatives and large families, or larger number of friends.

On trying to look back at the lives of participants, the researchers note that those who had many good strong relationships at age 50 were far more likely to be happy and healthy in their nineties.

Dr. Waldinger therefore goes on to conclude, that in order to be happy in life, investing time in relationships seem to be more important than acquiring money or fame. Building close warm bonds with relatives and friends seem to pay rich dividends later on.

Ever since I heard this talk, I am working to change my schedule to make more time for those seemingly unimportant occasions such as a cousin’s grandchild’s birthday, or a friend’s son’s marriage. Meeting people and spending time interacting with relatives and friends seem to be what we need to rediscover and get back in our increasingly busy lives.

I strongly urge you to listen to the talk and make up your minds.

Diabetes and the Liver

One could wonder why in diabetes, a condition in which the blood sugar concentration in the blood goes up, need we worry about the liver? Or for that matter, even take the blood sugar reports seriously at all.

Doctors have begun to realise that the elevated blood sugar value is only the tip of the iceberg. Patients with type 2 diabetes, the common form of the disease that occurs in adulthood, often go on to develop problems with several other organs of the body, such as kidneys, brain, blood vessels, heart, feet and the liver.

At the root of the problem in Type 2 Diabetes, is the observation that contrary to intuitive logic, the blood levels of insulin in this condition is increased!

Insulin resistance (IR) as its is called brings with it several changes in the body such as thickening of the basement membrane, the floor on which cells of all organs of the body are lined up and pushes up fatty acids in blood circulation, that then gets deposited in the liver and blood vessels.

Fatty liver is seen in two-third of diabetics. It usually has no clear symptoms in the early stages often getting recognised during investigations for abnormal readings on liver function tests (AST, ALT or GGT levels in blood) or during an ultrasound examination.

It is however not an innocuous condition. Research shows that patients with extra fat in their livers die earlier, that is, their lives are shorter than their fat-free counterparts.

What happens to people with Fatty Liver? Some of them go on to develop a state of weakness of the liver called Liver Cirrhosis. In this condition, liver cells die insidiously and are replaced by scar tissue. The organ gradually starts functioning poorly, sometimes causing swelling of feet or retention of water in the abdomen. The veins in the food pipe can get engorged and rupture, causing blood vomiting.

When the liver gets very weak due to Liver Cirrhosis, transplantation of the diseased organ is sometimes required. This condition is getting so common that it makes up around a third of all causes of liver transplantation.

Another recent finding that research has shown up is that patients with diabetes and fatty liver are at increased risk of developing liver cancer. They often come silently or are incidentally picked up on imaging tests, but progress aggressively over few months. Scientists are debating whether all type 2 diabetics with excess fat in their liver should be monitored periodically with CT scans or MRI scans to watch for early liver cancer.

Diabetes therefore is a condition of not merely increased blood levels of sugar. Although it has a genetic basis, its severity and outcome is decided by how we eat, and exercise, and get our periodic checks done to ensure our organs are keeping healthy.

Liver is a large organ with lots of reserve, but it is wise not to ignore it in diabetes. 

Healthcare in Our Country

One recent morning while I was gloating about our country’s claim to be seated among the developed powerful nations of the world, my car stopped at a traffic signal and a dirty starving man begged me for some money to eat a meal. While parting with a tenner, I asked him what made him beg. He said he had been a small farmer in UP, but had lost his land, home, money and living, trying to provide treatment to his son who had been stricken with cancer for two years.

Treatments have improved and many diseases are now curable, but they have come at huge costs that continue to spiral. And when a loved one falls prey to disease, emotions compel us to go to the last post to save his or her life.

Administrators view healthcare sector as a graveyard for government investments. A government hospital does not fetch money on a regular basis, unlike manufacturing industries, housing, liquor or tobacco businesses. And the political benefits of cutting red ribbons of hospitals before elections do not match the grandeur of inaugurating “large buck” projects.

Our planners and politicians, who are handicapped with visions limited to 5 years, have therefore found it prudent to pass the onus of caring for the sick and ailing, to private players. And industrialists, property dealers, liquor barons, brick kiln owners and their likes have responded by building hospitals, with profit in their eyes and philanthropy on their lips!

Business gurus argue that Health Care is after all an industry (why get emotional about it?) growing at 13% pa, and a safe bet to invest in. To meet the demands of this industry, a new breed of “health care professionals”, have come up. If you ask one such honcho what he did before joining a corporate hospital, don’t choke, if he tells you that he sold automobiles or insurance!

The norms that they have brought with them are those of any other industry: impressive-looking infrastructure, elegant ambience, modern equipment, predictable service with smiles, reputed doctors and of course, good publicity.  And they wait eagerly for returns that their investments would bring, called “ROI”.

This breed has created new jargon. Their efforts start with increasing “foot falls” (people visiting the facility), that hopefully lead to increased “conversions” (people undergoing procedures or admissions that really bring in the mullah), and a positive P and L bottom line.

Private hospitals cater to 70% of the country’s health needs and have sometimes done well, wringing in technology and advances ahead of government hospitals (liver transplant and robotic surgery being two examples).

But they come at a price, and occupy the space that our planners have created for them.

The next morning, I looked around for the destitute at the traffic lights, clutching a Rs 100 note in my hands, to make small amends for having joined the healthcare industry, that had robbed him of all he ever had and made him a beggar!

Food Fetish in Medical Descriptions

Strange as it may sound, doctors have an obsession for food items when describing body parts, organs or even human excrements.
It often starts with the relatively innocuous description of kidneys as bean-shaped organs and the human brain as walnut shaped, that most students of biology are familiar with.
But they soon go on to use “café-au-lait” marks, salmon patches, and cherry red spots to describe different types of skin lesions that tell tales of diseases from a brown nevus or angioma or bleeding spots.
And when doctors, who by the way derive their professional origin from butchers, delve inside the human body while cutting up corpses during autopsy, they resort to food items to describe what they see. If the liver shows alternating red and white stripes as in early cirrhosis the description goes as “nut meg liver”. If the intestine shows a central narrowing due to a cancerous tumour, an “apple core lesion” seems to depict it best.
Familiar fruits are most commonly used to describe the size and shape of tumours and swellings: from “ berry like” small ones, to “lemon” sized bigger ones, to “orange” shaped yet bigger ones and then on to “melon” shaped large tumours. References to our familiar fruits mango and coconut are however conspicuously absent as most writers of modern medicine have been of British or American origin.
When doctors start peeping into the stomach or other organs through the endoscope, this food-based description takes yet another turn. Scattered erosions of the stomach are described as “salt and pepper”, polyps as “pea-like” and a gastric antral vascular ectasia as “water melon stomach".
“Bunch of grapes” is a common descriptive term used for large varices (dilated blood vessels) located in the stomach or rectum, while “cherry red spots” help depict if they are in imminent risk of bleeding. “Curd like” or “cheese like” white patches suggest fungal infections of the food pipe while “cauliflower” lesions depict large cancerous growths in the gut.
When an abscess forms in the liver as often happens in amoebic infection, the reddish brown liquefied content is described as “anchovy sauce”.
Radiologists are not far behind in this race. Apart from the “apple core” lesions of luminal cancers, the swollen pancreas in auto-immune pancreatitis is likened to a “sausage” and shadows in the lungs to seeds of millet to castor, depending on their size.
But the most nauseating description is of human excrements. It is “rice water” stools in cholera, “pea-soup” stools in typhoid and “currant jelly” stools in intussusception.
It could be hazardous to have a doctor over for dinner. If you see him getting too chatty with guests, make sure you keep him well away from this topic the entire evening, should you want your guests to eat well rather than retch and scamper to the wash-room when food is served.

Eclipse of Hepatitis C

A hugely positive note with which 2015 is signing off on the medical front is the revolutionary treatment of Hepatitis C that is set to transform the lives of 12 million Indians and several fold more across the world. Around 1-2% of Indians harbour this chronic viral liver infection, most of them unknowingly and many coming to know of it when they have already developed liver cirrhosis or liver cancer. Treatment over the last 3 decades has been either unusually difficult, with weekly injections of interferon, or impossible (due to weakness or low platelets precluding this form of therapy).
Three oral “miracle” drugs have burst into the world’s therapeutic arena, and what could not have been better is that this treatment is now available in India at less than 1% of the international price!
Sofosbuvir is the prime new anti-viral medicine for treating Hepatitis C that was discovered and launched in USA and Europe by Gilead company at the prohibitive cost of US$ 1000 (Rs 60,000) per tablet to be taken daily for 3 to 6 months, amounting to Rs 1 crore for a full course of treatment. It is now available in India for Rs 400 per tablet.
Sofosbuvir needs to be taken with another supportive drug for better results, called Ledipasvir (for genotype 1, 4 or 6) or Daclatasvir (for genotype 2,3) that also reduce treatment duration to just 3 months. Last week, the latter two drugs also became available in India at affordable prices. The total cost of treatment with these oral regimes is approximately Rs 50,000 over 3 months, with a very high (more than 90% chance of cure) and with hardly any side-effects.
The news has been quick to spread across the world where the treatment cost by original international branded medicines is still upwards of Rs 1 crore. This has led to a huge surge of “medical tourism” with plane loads of patients from across the globe, streaming into India to reap the benefit.
Hepatitis C has been painfully difficult and expensive to treat for 20 years with weekly injections of Peg-Interferon along with a weak anti-viral tablet called Ribavirin given for for 6 to 12 months. Almost every patient who has taken this therapy has felt miserable with adverse effects such as fever, weakness, falling blood counts, anemia and depression.
And in addition to the high cost (Rs 1.5 to 3 lac) and several months of ordeal of treatment, relapses have been frequent: the virus often reappearing quickly on stopping treatment. For specialists, meeting such patients who had invested a lifetime’s savings and endured a year’s tribulation but missed achieving a “cure” has been helplessly humbling.
Hepatitis C had its moment of public recognition when the well-endowed silverscreen celebrity Pamela Anderson of Baywatch fame got diagnosed with it. The sensational manner in which she contracted it made it even more popular: she had shared the needle for a skin tattoo with her boyfriend, Tommy Lee, who had carried the infection. The gossipy tale went further to her litigating against him for concealing the information, but as often happens there, they finally united by wedlock!
All this is soon poised to become history as treatment becomes simple and easy.

Coping with Midlife Crisis

When a 57 year old well-established doctor suddenly decided to quit his stable government job of 25 years, 8 years ahead of his retirement age, change his career path, move to a new town, buy a swanky car, many were taken by surprise.

When a lady of 52 years, decided to leave her career of 15 years as a school-teacher, to dive into her passion of Hindustani classical music, her friends and family were taken aback.

When a 40 year-old successful industrialist running a health care industry suddenly deciding to leave his corporate life and take to spirituality and social service, his colleagues were stunned.

Many men and women, usually between 35 and 65 years, often show a change of mood, or surprising behaviour, that smack of mid-life crisis. It was described first by Elliot Jacques in 1965, and since then been recognised the world over.

The common symptoms and signs include:
1. Change of job, often giving up one that had been going smoothly for years, and taking up a more challenging one.
2. Making new friends, often younger, and dropping old ones
3. Splashing on a new car, youthful dresses, a luxury trip
4. Mood changes such as snappiness, low feelings or unexpected joviality
5. Asking questions on meaning and purpose of life, looking back and assessing one’s achievements, wondering if life should have been lived differently
6. Picking up new hobbies. Several people take to photography, music, theatre, social work or art at this age.
7. Impulsive decision making such as changing partners, filing for divorce or having an affair.
8. Obsession with health and fitness
9. Increase in alcohol consumption

While researchers recognise that some people demonstrate such strange behaviour during the middle years of their lives, there is much speculation on the reasons behind it. Some people seem to be seeking a break from that monotonous life when their children leave the nest, freeing them of their daily parenting responsibilities. Many, on the other hand, look to fulfilling their dreams and aspirations in the evenings of their lives before the dusk of old age sets in.

Middle age brings with it change in moods and behaviour. Depression is common, manifesting often as those strange questions that keep popping up: “What have I done in life?”, “What am I living for?”, “What did I wish to achieve and where have I reached?”, “What are the things I still want to do before hanging up my boots?”.

These are indeed difficult questions that can make anyone shift uncomfortably in bed, but what is funny, is that they seem to crop up at this age, often making people feel low, or paradoxically in some, emboldening them to do strange things.

Depression and confusion may require a few sessions with a professional or a trusted colleague. Meditation, healthy food and exercise certainly help.

Midlife crisis is however not inherently a bad thing. On the positive side, it helps people to wake up and realise their unexplored potentials and goals before they walk into the sunsets of their lives. For many then, it can serve as a midlife course-correction than a crisis.

Dealing with Pimples

Pimples are those unwelcome pink little bumps that crop up on the cheeks, chins and foreheads of youngsters often spoiling that otherwise perfect party or sometimes shattering self-esteem and scarring their faces for years. True, they are not dangerous, in the sense, they do not kill or shorten life, but their effects can be pretty nasty and long lasting, on the skin and on their personalities.

Also known as acne, spot or comedo, they result from oily secretions getting stuck in skin pores. Inside the pore are sebacious glands that produce sebum. When the outer layers of skin shed (as they do continuously), the dead skin cells left behind may become 'glued' together by the sebum.

Their appearance around adolescence suggests that hormones play a role in their development. Around puberty, the skin tends to get thicker and the sebaceous glands go into overdrive producing more sebum that builds up behind the blockage. Sometimes this sebum gets infected with bacteria such as Propiobacterium acnes, causing infection, soreness, formation of pustules that sometimes cause scars.

Scientists are not quite clear why some people develop acne while others do not, and why they come in some as occasional pimples while in some as huge crops. It is however a by-and-large urban phenomenon.

Certain types of diet seem to bring them on in people who are prone. Studies suggest that high consumption of simple sugars, fats and carbohydrates could be harmful. Indeed, people with bad crops of acne often benefit from periods of fat and sugar free, high fibre diets of veggies and fruits.

Treatment consists of keeping the skin pores often and clean, removing the debris and oily secretions with frequest washes. Soaps are not bad and alcohol based skin cleaners can be of help in many with difficulty resistant acne.

Treatment in earlier times often consisted of long courses of antibiotics such as doxycycline or tetracycline. These kill the germs that infected the blocked glands. A better approach is to allow the glands draining well by keeping the pores or mouths open with frequent skin cleansing.

Vitamin A has been found to be helpful in people with difficult pimples. Tretinoin or one of its compounds is often a favourite with modern dermatologists. One needs to be careful though that high doses can be heavy on the liver.

Pimples don’t kill, but they sometimes maim and change the course of events in a young person’s life. Help is at hand. Do not let them dictate your future!

Environment and Human Health

With leaders of over 190 countries discussing global climate in Paris this month, unprecedented floods wrecking havoc in Chennai since last week, smog engulfing the Chinese capital Beijing right now, and air quality charts of Delhi showing that the air we are breathing is choking our lungs and hearts, I would have to be quite an ostrich to write about any other health issue this week.

The health consequences of the Chennai floods that have killed over 200 people is just the tip; what is of greater concern is the wave of infections especially diarrrhoeal diseases, typhoid, pneumonias, malaria, dengue, skin infections and stress that are to follow. Further the floods have devastated the lives of several million and sent shivers down our spines by reminding us that some freak natural disaster could usurp our lives just as it did to Uttarakhand a couple of years ago.

One of the core issues is the amount of green-house gases emitted in to the atmosphere due to the use of fossil fuels such as coal, diesel, kerosene, petrol and CNG. This topic makes headlines and forms the top item in the agenda for inter-governmental discussions. These gases comprising carbon dioxide and methane, warm up the climate, making ice caps melt, that in turn push up sea levels and unusual weathers causing untimely heavy rains and floods.

Another issue is air-pollution and the effect it has on our lungs and hearts. “People think the talks are about protecting the environment, plants, animals,” explained Dr Maria Neira, Director of Public Health and the Environment Department at the World Health Organisation, during a sessions in Paris recently. “But it’s as much about human health”

Some of the effects of climate change that can affect our health are strikingly apparent. During the recent Beijing smog for instance, the air quality index that measures small particulate matter was 611 (a value above 300 means that the entire exposed population is at risk of ‘serious’ health effects) forcing the Chinese government to shut schools and some of its factories. And the air in Delhi has been reported to be 5 times worse at 2000 and we are still going about our lives in our “bindaas” ways!

Particles in the air we breathe enter our lungs and cause chest congestion, cough, asthma and breathlessness. In the long term they can also cause lung cancers, often seen in women who use fossil fuels for their ‘chulhas” or stoves in closed kitchens.
Particles that are smaller than 2.5 microns are called “small particles” and can be even more dangerous. They can enter the bloodstream from the the respiratory tracts and reach all parts of our body. They can damage small blood vessels causing injury to heart and brain, and can also cause a variety of cancers.

The number of health issues linked to climate change are too many to enumerate.
And while global climate has indeed changed through the earth's history, what is making the present crisis unique is that it is our “behaviour” that is causing the trouble this time.

Importance of Emergency Medical Care

 Among the many issues that grabbed media headlines in the aftermath of the Paris carnage recently, the story of how the French medical emergency services responded to the unexpected challenge holds many lessons for us.

Within just TEN minutes of the blasts and shootings, information reached the Emergency Medical Services and its crisis cell called Assistance Publique-Hopitaux de Paris (APHP) got activated. This cell mobilised 100,000 health-care professionals, 22,000 hospital beds and 200 operation theatres across 40 public hospitals in preparedness, all within an hour. A crisis WHITE PLAN that had been worked out and rehearsed for several years was activated, making this the most coordinated medical rescue and support mission in Europe in its history.

The tasks of gathering information, networking and coordinating transport was managed by a cell of 15 people. Forty five well-equipped emergency ambulances with doctors, nurses and technicians were pressed into service, each knowing where to take whom, and each hospital being prepared with prior information to receive the patients being brought there.

When the blasts and shooting were going on, the state could not be sure as to how many more casualties may occur. It therefore took extra care of putting 2 other major university hospitals at the periphery of the city on alert.

A fleet of 10 helicopters was pressed into service for evacuation of casualties and monitoring medical rescue efforts. Thirty-five psychiatrists and a large number of counsellors were immediately brought in to meet with and provide support to panic stricken victims or shocked relatives.

Hospitals were kept out of bounds for the press and public. We did not get to see familiar visuals of bleeding patients, grieving relatives or corpses on television. Photo-ops of politicians visiting patients were also not seen. We did not see pretty young TV reporters thrusting microphones at grieving relatives and asking them about their feelings at such times!

Steps taken by Russia when its flight carrying over 200 holiday-goers crashed in Egypt was also educative. The flight’s destination was St Petersburg. On receiving information of the crash, one of the first steps taken by Russian authorities was to get 65 psychiatrists and counsellors to the airport hotel in that city where shocked and grieving relatives were expected to gather, anticipating human responses in such tragic occasions.

France and Russia, and for that matter most developed countries spend around 7 to 16% of their GDP on health. India, in contrast, spends a measly 1%. It is little surprise therefore that we deal so differently with our victims of floods, stampedes, blasts and earthquakes.
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A developed country is also known by the health care it provides to its citizen. We are a nation growing in might and aspiring for a place in the security council of the United Nations, but we have miles to go before we can match our “developed” counterparts in medical emergencies.

Traditional Medicine Finally Gets Nobel Nod

Traditional medicine has got its biggest stamp of approval from the scientific community up until now, with one of its practitioners finally getting the Nobel Prize for medicine in 2015.
Dr. Tu Youyou, the 84 years old lady scientist from China who introduced the anti-malarial properties of extracts of a plant (sweet wormwood) to modern medicine, is the recipient of this year's prestigious prize. Artemisinin, the compound that she extracted and discovered, is currently the most favored and safest anti-malarial drug used worldwide, and has saved millions of lives from malaria.
The story of Dr Tu’s discovery is an interesting one. In 1967, Communist leader Mao Zedong decided there was an urgent national need to find a cure for malaria when it was spread by mosquitoes and killing Chinese soldiers fighting Americans in the jungles of northern Vietnam.
A secret research unit was formed to find a cure. Tu Youyou was appointed head of Mission 523 and dispatched to southern China where malaria was rampant. For six months, she stayed there, leaving her four-year-old daughter at a local nursery.
When she started her search for an anti-malarial drug, over 240,000 compounds around the world had already been tested, without any success.
Finally, the team found a brief reference to one substance, sweet wormwood, which had been used to treat malaria in China around 400 AD. The team isolated one active compound in wormwood, artemisinin, which appeared to kill malaria parasites.
How the original Chinese texts helped is the story that should inspire our traditional practitioners: when the team tested extracts of the compound, nothing proved effective in killing malaria initially until Tu Youyou returned to the original ancient text. After another careful reading, she tweaked the drug recipe one final time, ensuring not to boil the extract, that then destroyed the anti-malarial property, but to extract it at lower heating temperatures or through use of solvents.
What should further inspire our practitioners of CAM (Complimentary and Alternative Medicine) is that Dr Tu did not have a medical degree, no doctorate, and had never worked overseas, the three pre-requisites we often consider essential for medical discovery. She was however observant, questioning and persevering in what she pursued.
Traditional medicine is a huge market today of US $ 60 billion. Chinese traditional medicine accounts for $14 billion. Indian traditional medicine also occupies a slice of the pie.
But it is that final proof that makes a compound or extract get global scientific acceptance. And that is where our Indian traditional practitioners should do well to work hard and leave their stamp.

Sensitivity: Key to Healthy Society

When I was a child and encountered the first death in the colony of an elderly neighbourhood-uncle, my grandfather taught me an important lesson.
The news of Mr Khan’s sudden death ushered in hushed discussions amongst elders, puzzled questions from kids, and a quick large gathering of friends and relatives at the neighbour's home three houses down the lane in our colony.
That evening when we were ready in our sports gear and prepared to go down the same road to the play-field, my grandfather dissuaded us with “when neighbours grieve, it is unkind and insensitive to rejoice and play in front of them”. He had not used authority, nor quoted laws and rights, but had left it to us to decide how sensitive neighbours ought to behave. And we had hung up our shoes and sacrificed our pleasure of that day in an act of solidarity!
When I became a doctor and earned my first stipend, I had taken a bunch of friends (Ali, Bhaskar, Mohan and Shyam Sunder Kothari) to a restaurant to dine. One had ordered grilled pomfret, another a beef-steak, yet another some sausage, but when the dishes arrived, we realised our mistake: Shyam Sunder became nauseous at the sight of the fish, Ali sat at a far corner of the table far from the pork, and Mohan looked uncomfortable with Bhaskar biting into the beef.
We realised that evening that the value of each other’s company far exceeded the pleasures of what we ate as individuals. We decided to refrain from ordering pork if Ali was with us, beef if Mohan was present, and go veg if Shyam was in company. Since that day we remained the best of friends for decades! And when Ali got married, he made his wife Afroz learn to cook vegetarian dishes to entertain Shyam whenever he would come to their home for dinner, even for Eid.
Providence, in its generous efforts to over-compensate me for having lost my mother at five, provided me with five foster-mothers (and five mothers-in-law for my poor wife!), one of who was my most affectionate ammi, Mrs Rafiq. On her insistence I had to visit her every Eid not just with my family but also with my colleagues and their families to join her14 biological children and their families, for feasting.
She soon realised that some of my colleagues being vegetarian, felt uncomfortable amidst the gosht and kebabs, while her children felt equally uneasy trying to entertain vegetarian guests on Eid! She soon switched to celebrating a special Eid on a separate day for us, with her maid (Munni) taking a go at vegetarian dishes in the kitchen her ancestral haveli.
While individual rights of what we eat or do are important, sensitivity towards how others in the neighbourhood feel is essential for harmonious healthy living. And no matter what politicians and lawyers say, my grandfather’s lesson and my ammi’s example still remain relevant to this day!

UNDERSTANDING and MANAGING ADDICTION

Scientists seem to have found the underlying defect that explains why some people get addicted, be it to substances (alcohol, tobacco or drugs), sex, the internet, gadgets or shopping, with the discovery that addiction drives up levels of a chemical substance called Dopamine in a part of the brain called the “Pleasure Centre”.
In an article published in the journal Nature Neuroscience in June 2014, researchers from USA looked at addiction related role of nerve-to-nerve communication in the brain, and concluded that activity in the neural circuit that provides the feeling of pleasure gets unduly strengthened in addicts, to the extent that it then starts obstructing other circuits dealing with reasoning and self-control.
Addiction is therefore proving to be a brain disease of a chronic relapsing nature that cause compulsive seeking of pleasure-providing substances or acts that the addict finds helpless in controlling by will power or logical reasoning.
Anyone who has observed an alcohol addict could not have missed noticing his helplessness – in saner mood in the morning he seems to realise and admit that what he is doing is wrong and harmful, often expressing remorse and promising to stop. But come evening and there he goes compulsively after the bottle!
In a recent national conference on alcohol addiction (ALDACON 2015) in Delhi, organised by HOPE Initiative, neuro-psychiatrists drew attention to how society often mistakenly assumes that abusers lack moral principles or willpower, believing that the solution of stopping alcohol or drugs simply lies with their choosing to change their behaviour.
In reality, addiction is a complex disease and quitting takes more than just good intentions and strong will. And because drugs or alcohol change the brain by activating and strengthening the ‘Pleasure Pathway’ with surplus amounts of Dopamine, the cognitive or reasoning pathway is rendered weak and ineffective.
No doubt the first step to addiction begins with a voluntary exploration or seeking of pleasure under temptation or peer pressure. The brain quickly recognises the feeling and perpetuates it repeatedly so that the person then feels compelled to take the drug or perform the habit to maintain the high.
This new understanding is bringing about a profound change in the way de-addiction centres are dealing with addicts. Effective therapy often needs a combination of medicines that reduce craving, substitution of the pleasure seeking substance with less harmful mimics, as well as treatment of the associated anxiety or depression that some forms of addiction such as to alcohol is often associated with. Motivation of course still remains pivotal, but with good family and social support, getting off the hook is getting easier.
In our present permissive times of easy access to pleasurable substances and habits, addictions are getting frightfully common, but a deeper understanding and availability of targeted therapies should help to bring many of them back to normalcy.

EATING SLOW can help SLIM DOWN

The slim and shapely figures of the overwhelming majority of natives I saw on the streets and trains of China during my visit to that country last week made me stand out amidst them with my Desi central bulge. And as this “ I-am –the-paunchy-one among-them” feeling is not something I feel while in Delhi, Punjab, or Gujarat, I tossed the question ‘What makes the Chinese remain slim?’
I had earlier put it to their genes. True most people with Mongolian traits (Chink eyed ones) like the Tibetans, Chinese, Koreans, Japanese look slim and short with smooth skins stretched over their bones and muscles. But catch them in USA after five years of devouring burgers and pizzas with bare hands, and notice the difference.
Or is it their diet? Most are rice eaters, but if rice was the secret to their shape, I couldn’t fathom why Bongs (Bengalis, a community to which I belong by genes and taste buds) queuing up for a table in front of “Oh Calcutta” get that paunch?
And if it is not rice, and if it is not WHAT they ate, what else could the Chinks have in common?
When my Chinese hosts took me to a traditional restaurant for dinner in Beijing, had me seated at the head of the table with a lavish spread of gourmet dishes, and then handed a pair of chopsticks, I realised I could not devour all that as quickly as I wished!
Fortunately I was not a total stranger to chopsticks, having had to use them as my survival tool during a long training trip in Japan many years ago. I remember that it had taken me a week to get the grip, grasp and movements tuned, and had started eating my full meal with just them, but at a very slow pace.
Old memories wafted in while I sipped the soup and watched how my hosts dealt with the dishes of boiled corn, pumpkins, egg, fish, chicken and even rice with just two thin sticks in between their fingers, nibbling at the food like restless ants.
What eating with chopsticks do is restrict the size of morsels. One can barely take a few grains of rice each time, unlike the large morsels that we Bongs scoop with bare hands and put in our mouths before gulping it down. And nibbling small amounts with chopsticks slows eating and stretches the meal time.
During eating, the food gets absorbed from the intestines and sends signals to the brain that then tells us to stop. If we eat slowly the signal reaches on time stopping us from consuming too much. When we eat quickly and gulp, we often miss the “Enough, Now stop” signal.
Eating slow can be a very effective way to slim down. And chopsticks ensure that you do just that. I have decided to take to chopsticks to get into shape.

Murderers: Are they Born or Made?

Most people would find it hard to commit murder, but in the backdrop of several high profile homicides in recent times, people are asking loudly what makes some people go ahead and do it.
Neurobiologists identify two types of murderers: those who are hot-headed, aggressive and easily provoked to anger, and another that are cold, calculating, and “psychopathic”, and the two groups seem to differ considerably in the ways their brains function.
The story of taking a peep into the brains of murderers started in the early 1990s when the women of a crime-prone family in the Netherlands approached a neuro-geneticist to look into the brains of their men-folk who had had repeated bookings for violence, arson, rape and murder, to see if there was an evil gene in the family.
And not surprisingly, doctor Hans Brunner who undertook the investigation found that these aggressive men had an abnormal gene located on their X chromosome that encoded for an abnormal subtype of a brain enzyme called MAOA-L (Mono-Amine Oxidase inhibitor of the type A, and the subtype L, for long acting variety) located in the pre-frontal areas of their cortex.
This gene soon came to be called the Warrior Gene as it provided an answer to what made people aggressive and hot headed by causing a change in the metabolism of neuro-transmitters in the front region of the brain.
But this gene left unanswered why some criminals committed murder, not in anger but in cold blood, and did not seem to show excitement or aggression, perhaps like Indrani Mukherjea. Neuro-psychologists realised Warrior Gene could not explain the behaviour of the “cold blooded” psychopaths.
The lead to solving their mystery interestingly came from the brain autopsy of a psychopath who had gone on an unprovoked shooting spree of 30 innocent children in the USA before being gunned down by the police. When his brain was examined post-mortem, pathologists found a “tumorous” vascular swelling in a under-surface region of his brain called the Amygdala.
Neurobiologists soon jumped in on this cue and looked closely at the brains of hardened criminals using functional PET scans They found that convicts who had been charged with heinous crimes such as cold-blooded multiple murders indeed showed abnormalities in the serotonin uptake in Amygdala portion of their brains.
The brain scan pattern of cold-blooded psychopaths show increased activity in the Amygdala region with scant or no activity in the prefrontal cortex, suggesting that the part of the brain that evokes emotion and says “ No. Don’t do it. It is wrong” is suppressed.
The vexing question that now still hangs in the air, is the role of upbringing and childhood experiences in the making of a killer. Scientists feel that while genes load the gun and make some prone to crime, it is the rearing, environment and circumstances that finally help pull the trigger!