I have tried to make my own little mark in this world. My career as a Medical Educator and Clinician in Gastroenterology (see www.gastroindia.net) and my flirtations with Health Promotion, especially amongst school children (see www.hope.org.in) are shown elsewhere.This blog contains my attempts at creative writing, most being write-ups for Health Adda column of HT City of Hindustan Times (also see www.healthaddaindia.blogspot.com) as well as a few others, and some reflections and thoughts that have struck me from time to time on my life journey.Please leave your footprint on this blog with your comment.


Monday, March 14, 2016

Uberification of Health Care


The imaginative concept of matching transportation demands of people with cab facilities using a smartphone platform that Uber is credited to having created is now beginning to be applied to health care as well.

At the outset, let me share with you what I understand of Uber. It is an on-line transportation company that develops, markets and operates the Uber mobile app, which allows consumers with smartphones to connect with Uber drivers through a software platform for taxi service. Uber itself does not own any assets such as cars, or hire the drivers.

Uber was founded by Tavis Kalanick and Garrett Camp as recently as 2009 in San Francisco, but the impact and success of this “start up” has reverberated across the world, being now valued at US $ 62.5 billion.

Fresh successful ideas in one domain often tickle the minds of entrepreneurs in other fields. Healthcare experts are now trying to explore if they can bring about a revolution in their sector as well.

The proposition seems to be as follows: there are several people who need medical help, just as there are several doctors who can deliver them, but connecting them quickly is the real challenge. Our traditional rigid system of “going to a hospital” that is located at a distance, is rigid, and has multiple layers of hurdles is not easy for someone in urgent need.

This was sought to be short-circuited with the development of telemedicine services, by which a patient could get medical advice through an internet based software service or telephone. This format however works only for simple ailments, as there is not much scope for to-and-fro discussion, physical examining the patient, or getting prescription medicines.

The next major step, which enabled a patient to see the doctor and discuss his problems, came with skype based consultations. One could see the doctor on the screen and a to-and-fro discussion was possible. The only shortcoming Skype consults however is the lack of physical feel that is sometime important in clinical medicine. For follow ups, say for instance to tweak insulin doses in a diabetic, physical examination may not always be necessary, and Skype consult can be very convenient for patients.

The new concept of Uberification goes a step further. Can there be smart phone based app that helps patients in emergencies, such as an outbreak of allergy or high blood pressure or acute diarrhea, to get quick medical help from a nearby doctor who is available to visit his home?

This new strategy could be important for several reasons. Ailments which require the physical presence of a doctor would be possible, home care could get its long needed boost, and medical emergencies needing prompt responses would be easy to deliver.

“Unlike cabs, the main challenge in India would be to ensure a uniform and high quality of care by different doctors”, says Dr Dilpreet Brar. Upper class citizen have already started signing up on MediCube that she has launched in Indian metro-cities recently.

Tuesday, March 8, 2016

Plasma therapy for Baldness to Joint Diseases


Excessive hair loss, or alopecia as it is medically called, now has a promising new therapy. Doctors are using platelets from the patient’s own blood to stimulate hair growth.

Platelets are small little particles present in blood that play an important role in plugging leaking arteries and in clotting. They also contain a large number of “stimulating factors” that stimulate degenerating tissues to grow again.

There are several of them such as platelet derived growth factor (PDGF), growth stimulating factor (GSF), epidermal growth factor (EGF), vascular epidermal growth factor (VEGF) and mediators like Interleukin 8 which stimulate growth of hair follicles and cells of several tissues such as nerve cells, bones, cartilage and muscles. This newly discovered property has suddenly catapulted plasma into centre stage.

Plasma rich platelet (PRP) therapy as it is called, involves drawing a sample of autologous (patient’s own) blood, mixing it with an anti-coagulant that prevents it from clotting, spinning it in a test-tube, and taking out the platelet rich portion of the plasma. It is then injected into the scalp or other tissues with a very fine needle, like the insulin needle. Typically 2 to 4 mL are injected in each session, that are then repeated 2 weekly 4 to 6 times.

Several studies have shown this therapy to work in reducing hair loss and improving hair growth, either alone or in combination with other treatments such as minoxidil or hair transplantation. Safety issues around transmitting infections are hardly any as it is the patient’s own blood that is used. It is also cheap and simple.

There is however still some concern about how effective it really is. Some trials have shown impressive success while others have not. Experts believe this difference could be due to the variation in skill and expertise for separating and concentrating platelets.

PRP therapy now has a wide range of evolving applications: plastic surgeons are using it to treat scars and skin grafts while orthopaedic surgeons are treating degenerative joint disorders like osteoarthritis with it. It has become particularly popular in sports-medicine for treatment of injuries of tendons, ligaments and joints. Even neurologists are using it to stimulate regeneration of nerves.

Interestingly, the first use of PRP was in 1997 in Italy for treatment of dead and degenerating heart muscles. Perhaps the fascination of cardiologists with stem cells for the same purpose, made PRP recede to the background over the last 2 decades.

If it delivers on its present promise and proves to be effective, PRP could be a much simpler, safer and cheaper therapy to help stimulate growth of a variety of degenerating tissues, from sleeping hair follicles in balding scalps to the tired muscles of broken hearts.