Drug Pusher or Healer – What are you?...

Few years, after the inspiring  Alma Ata Declaration that proposed the goal  of Health for All by 2000AD, the Indian  Council of Social  Sciences Research and  the Indian Council of Medical Research  set up a  joint study group to review  the health care  systems  in the country and recommend a strategy  to achieve  the Health for All goal. One of the most  intriguing and provocative  observation in this report, which has kept me  wondering all these years was  a call  to vigilance against  the over medicalization of the system since Health  is ‘well being’ and not just ‘disease control’. The committee consisting  of some of the senior most   medical and social science  professionals  in the country observed that “ Eternal  vigilance  is required to  ensure  that the health care  system  does not  get medicalized, that  the doctor drug producer  axis  does not  exploit  the people and the abundance of drugs  does not become a vested  interest  in ill health” As a young  faculty  member of a well known  medical college, I found this call to ‘vigilance’ against  making ill health and drug prescribing  a vested  interest  – a  rude shock considering that doctors often thought of themselves as a noble profession concerned only about the wellbeing of their patients. This  stimulated  a life-long  learning effort  at understanding  the doctor – drug – producer  axis  in reality, identified  by the report  as the major villain and the prescribing  practices  of the doctors  as the key culprit. Two more  observations  of this expert  group based  on extensive  review of current  data and trends  were equally  disconcerting. These were : “One of the most distressing aspects of the present health situation in India is the habit of doctors to over prescribe  glamorous and costly drugs with limited...

EVOLUTION

The retrospect-o-scope is one of the finest instruments of knowledge. We understand that each developing civilization evolved its own perspective on Health and Disease. The cross-currents across these human settlements being few and far between, healing expressed itself as localized approaches isolated in their repertories that addressed local problems tackled with local resources. The simplest were “remedies” drawn from the knowledge of the shepherd and the largely unrecognized “home” bank, the chief possessor, implementer and propagator of such treasure being the woman, usually the mother. The grandmother is the wiser version of this trove, with the needed checks, balances, validation and such stuff. It is even so till date.“Therapies” derived from them were prolonged and involved, requiring more experience and understanding of the human organism and responses to disease and interventions employed. The ingredients for such interventions were mainly plant and animal (also mineral, where the other two were scarce, or this resource in abundance) with different modes of processing and differing effects being taken into account. The same stuff was given raw, crushed, dried, roasted, boiled, fried, pickled and so on – good research indeed. The philosophers and religious enter the picture now and adopt (is it co-opt?) these “peoples’ practices” into their world view. The intellectual domination begins, with a framework laid down to explain the how, why, which of what’s observed and the grounds for further development – the cons and pros (so to say) of the evolutionary path taken. The rituals, taboos, dos and don’ts get incorporated and have their say in the matter. The simple, subjective understanding of “hot” and “cold” is characteristic of explanations involving home, herbal and tribal remedies. What happens when you (manage to) consume six eggs in one meal – that’s hot (specific dynamic action...

Medicine and Movies Nov30

Medicine and Movies

“Medicine and movies ?”, you may well ask. The traditional stereotype of a doctor is one of a nerdy individual with thick soda glasses who is far removed from anything that Vidya Balan may refer to as “ Entertainment, Entertainment, Entertainment !” Boring, bookish and bland. None of the doctors I know come even close to this cliché. Some are singers, yet others are classical dancers; some are smart and sassy and still others are downright funny. So who creates these stereotypes ? Is there peer pressure to fulfil them ? I still remember my father giving one of my senior medical colleagues the once over and declaring with a disdainful sniff “ He doesn’t even LOOK like a doctor “. Doctors have to look, dress and behave in a prescribed manner ? Doctors are like regular people – they practice medicine and deal with ill people. But as human beings they are not from another planet.I thought I would have a look at doctors and the practice of medicine in movies and see if these stereotypes arose from cinema which usually gets blamed for all society’s ills. A lot of medicine in movies is poorly researched and superficial. Jargon and myths abound. Social beliefs and misconceptions are reinforced. New diseases are trivialized or demonized. One bout of projectile vomiting and the nubile young lass is pregnant. Diagnosed with alacrity by the village dai who perfunctorily measures her pulse. The said young lady climbs a stool to reach an object, and a miscarriage is waiting round the corner. A drizzle begins and labour will proceed among torrential rains to climax in the lusty wails of an Apgar score 2 infant. Sex is never mentioned in the good Indian movie. Children arrive on the scene because the heroine falls in icy cold water and the hero finds no other way to warm the hypothermic young lady ( Refer : Aa Gale Lag Ja with Sharmila Tagore and Shashi Kapoor or Roop Tera Mastan in Aradhana). The Mahesh Bhatt school of unbridled passion and Ekta Kapoor’s rare case of Love, Sex Aur Dhokha is a recent advance in the Journal of Movie Medicine Vol 420, pg. 1- 69. Diseases are either generic like the ubiquitous “ blood cancer “ or become super specific like “ lymphosarcoma of the intestine “ which was immortalized by Rajesh Khanna in Anand. Frank Capra’s famous observation” Tragedy is not when the actor cries; tragedy is when the audience cries ,” perfectly fits Hrishikesh Mukherjee’s Anand that milks a terminally ill patient’s story for every tear in the lacrimal gland. . It is a film that keeps its protagonists dry-eyed but makes the stoniest member of the audience blink with emotion. Disease has been used to give a character colour, content , motivation or meaning. Sanjay Leela Bhansali exploring a blind –mute character in Blackor a paraplegic’s dilemma in Guzaarish are two recent examples. Asperger’s syndrome helped to create My Name Is Khan and dyslexia made a quiet entry into the Indian living room with Taare Zameen Par as did progeria with Pa. International Cinema has been doing this successfully for years. Daniel Day Lewis used just his Left Foot to bring cerebral palsy worldwide attention. Way back in 1967 Satyen Bose showcased schizophrenia in Raat Aur Din with Nargis Dutt’s award winning performance as Varuna/ Peggy. Shankar carried this to melodramatic heights with Anniyan where the multiple personalities even get their hair permed and straightened in seconds. NIMHANS figures in this movie and depends on the psychiatrist for diagnosis and unravelling of mystery.   Doctors are usually portrayed as kind, caring, quiet, morose or intellectual individuals. Way back in 1946 V. Shantaram portrayed the story of a doctor who travelled to China in Dr. Kotnis Ki Amar Kahani based on Khwaja Ahmad Abbas ‘ story ‘And One Did Not Come Back’. The hospital has eerie...

Monthly Investments

There once lived a man in ancient Babylon. He was the richest man in the city. His friends used to wonder how he became so rich while they stayed poor, having started out at the same place at the same time. They decided to ask him the secret of his riches. The richest man in Babylon then shared his big secrets with his friends. His first secret was a lesson he learnt at a very young age from a wealthy merchant. He said, the merchant asked me how many coins are there in my pocket on pay day. I said ten. Then he asked, what remains at the end of the month. I said none. He told me to keep one coin in my pocket and live on the rest nine. I did so for a year. At the end of the year I realised I could live on nine coins and without any pain. I had managed to make my purse full of twelve coins, when earlier it used to be empty. That was my first lesson and I have not forgotten it as I learnt more lessons about money in my life. The same story can work for you too. It pays to save and invest your money wisely as early as possible. Let us look at some simple numbers and how they can change your life for better. Say you are about in the 25-30 year age group. You are more likely to be at the beginning of your career. Earning cycles are at the lower end. It will be a few years before you will actually see higher income levels. So does that mean you wait till you can actually earn enough to have a so called decent surplus? Like...

Dr.Y.Subbarao Oct15

Dr.Y.Subbarao

Our number one contender probably came as a surprise to many of you, who would have been sitting and trying to figure out which of your favorite Indian docs stole number 1 over the previous four. (Note: Sorry, we don’t consider Deepak Chopra as a proper doctor, not that a wellbeing center would have landed him on this list anyway). Graduating from Madras Medical College and Harvard University,Dr. YellapradaSubbarao is the only one on the list who’s been mentioned in a book written by another on this list, as Siddhartha Mukherjee points out: “Any one of these achievements should have been enough to guarantee him a professorship at Harvard. But Subbarao was a foreigner, a reclusive, nocturnal, heavily accented vegetarian who lived in a one-room apartment downtown, befriended only by other nocturnal recluses.”   These achievements include the discovery of one of the first anti-cancer agents, aminopterin (the precursor of the drug that haunts all pharmacology students – methotrexate) for which he was mentioned in Mukherjee’s novel; along with the discovery of the importance of one of the most critical compounds to living beings – ATP (Yes, an Indian discovered the first super long scientific word you learned). In one of the most cited scientific papers of all time, he was mentioned by his colleague- the legendary Sidney Farber, as a key member in the early fight against cancer. (Do read the chapter in “The Emperor of All Maladies” on Subbarao and Farber. Heck, just read the entire book.)   At a time when it is every Indian’s dream to pursue higher education in America, it’s also been one of the toughest decades since Subbarao’s time for achieving that objective. In the face of stricter immigration and the hounding problem of racial selectivity, we...