I knew it ! Money makes Man stronger

Having money in hand not only gives confidence and makes you feel stronger but also attenuates physical pain. These are the conclusion from studies publised in Nature

Handling or even contemplating money can relieve both physical pain
and the distress of social rejection, according to a study by Chinese
and American psychologists. But remembering cash one has spent intensifies both types of hurt.

findings suggest that the mere thought of having money makes people
feel physically stronger and less dependent on the approval of others
to satisfy their needs. “Money activates a general sense of confidence,
strength, and efficacy,” the researchers propose.

Thoughts of money soothe social rejection : Nature News

You can read the whole article here in Psychological Science

Armchair Apocalypse

The influenza pandemic designated Influenza A (H1N1) has spread to 29 countries with more than 3440 affected individuals.

The spread and mortality has not been as devastating as was feared when the outbreak spread in Mexico. How it evolves in future remains to be seen. But without doubt ‘swine flu’ has been used as fuel for mass hysteria and given bizarre twists by folks with vested interests.

Warren Holstein provides a great reality check and humorous commentary on the going ons in his blog and I quote starting with his comparision and experiences during SARS and the present Influenza pandemic-

First SARS, then Avian Bird Flu, and now the Iddy Biddy Piddy Pandemic. Here we go again, and this time we are at DEFCON 2, apparently. And of course in times of artificially manufactured duress we must remember to not under any circumstances remain calm–it is very important to panic and support a good healthy public hysteria. Do your part. Support the mass media’s fixation on a modern-day Captain Trips narrative. They need the ratings. There hasn’t been a good old-fashioned saucy sexual scandal among the politicos in quite some time, all is quiet on the tsunami/volcano front, and the Craiglist Killer just doesn’t got what it takes (hard to empathize with sinners’, who were utilizing casual encounters, most unfortunate endings when they were financially hawking happy ones). I mean we seriously can’t be expected to sit in front of the boob tube drooling over Arlen Specter’s spectacular defection to the Democratic Party can we? Where are the tantalizing titillation or doom and gloom? Please! I might as well read a book or pursue my dreams or something.

and then he goes on to conclude-

Ultimately, though, the excitement it bound to end and the drama to abate as the world survives another media spin cycle and the perfect storm for virulent virus mutation once again fails to form. Odds are most of us will survive to watch yet another sub-par episode of American Idol thanks to the technologically advanced art of hand-washing we practice. It also doesn’t hurt to have access to stockpiles of Tamiflu or the ability to mass-produce more, this being a first-world country and all. And let’s remember this is a strain of influenza, not AIDS, and the majority of us would probably kick it on a mucus filled Nintendo-Wii-filled sick day vacation from our cubicles.

Read the complete post here

Heart Diseases and Genetics.

As advances in genetics are made the influence of genes on individual’s health is all the more apparent. It is quite well known that people of South Asian origin are inordinately susceptible to heart diseases besides diabetes and associated metabolic syndromes.

Today’s Genetics Nature carries a paper delineating the high incidence of genetic mutation among Indians which is associated with Cardiomyopathy and heart failure.Heart failure is a leading cause of mortality in South Asians. However, its genetic etiology remains largely unknown1. Cardiomyopathies due to sarcomeric mutations are a major monogenic cause for heart failure (MIM600958). Here, we describe a deletion of 25 bp in the gene encoding cardiac myosin binding protein C (MYBPC3) that is associated with heritable cardiomyopathies and an increased risk of heart failure in Indian populations (initial study OR = 5.3 (95% CI = 2.3–13), P = 2 times 10-6; replication study OR = 8.59 (3.19–25.05), P = 3 times 10-8; combined OR = 6.99 (3.68–13.57), P = 4 times-11) and that disrupts cardiomyocyte structure in vitro. Its prevalence was found to be high (approx4%) in populations of Indian subcontinental ancestry. The finding of a common risk factor implicated in South Asian subjects with cardiomyopathy will help in identifying and counseling individuals predisposed to cardiac diseases in this region.

This article was further reported in Medical News Today

The Worst Luck In The World? The Heart Disease Mutation Carried By 60 Million

Heart disease is the number one killer in the world and India carries more than its share of this burden. Moreover, the problem is set to rise: it is predicted that by 2010 India’s population will suffer approximately 60% of the world’s heart disease. Today, an international team of 25 scientists from four countries provides a clue to why this is so: 1% of the world’s population carries a mutation almost guaranteed to lead to heart problems and most of these come from the Indian subcontinent, where the mutation reaches a frequency of 4%.

Considering that the mutation is so dangerous; how come it is so common? Well-

The combination of such a large risk with such a high frequency is, fortunately, unique. “How can such a harmful mutation be so common?” asks Chris Tyler-Smith from The Wellcome Trust Sanger Institute, Hinxton, UK. “We might expect such a deleterious change to have ‘died out’.

“We think that the mutation arose around 30,000 years ago in India, and has been able to spread because its effects usually develop only after people have had their children. A case of chance genetic drift: simply terribly bad luck for the carriers.”

The original advanced online paper is here( in pdf)

Image: topher76

Doctors influenced by Rest and Fluids Industry

This physician enjoyed an all-expenses-paid trip to Aspen, just for telling his patients to “relax.”

I have noticed that medical satire from theonion.com is awfully good. Hats off to the writers(?writer). In keeping with the current flaying of pharma-physican backslapping ties; The Onion investigates and finds ulterior motive in prescription of just fluids and rest for common cold rather than antibiotics ;-0

The investigation—the full details of which will be disclosed in this newspaper over the coming months—documented thousands of instances in which sick patients were repeatedly instructed, often verbatim, to “lie down and drink plenty of liquids.” This treatment, recommended a staggering 4 out of 5 times on average, was in each case prescribed by a physician known to have recently enjoyed a golf vacation courtesy of Big Rest and Fluids.

“You have no idea how deep this goes,” said Dr. X, a physician who wished to remain anonymous. “They’ve got everyone, from the pediatricians and family doctors, right on down to the school nurses. We’ve had the cure for the common cold for nearly 40 years, but it’s still ‘rest and fluids, rest and fluids.’ Why? Because these guys are getting paid through the nose, that’s why.”

The ending of the article is pretty good too…


The complete article from The OnionTechnorati Tags: ,

Spot the helmet

In news from Nigeria is something quite familiar to Indians. People are refusing to wear helmets while riding two wheelers which was made compulsory from the first of January this year.

Police in Nigeria have arrested scores of motorcycle taxi riders with dried fruit shells, paint pots or pieces of rubber tire tied to their heads with string to avoid a new law requiring them to wear helmets.

The regulations have caused chaos around Africa’s most populous nation, with motorcyclists complaining helmets are too expensive and some passengers refusing to wear them fearing they will catch skin disease or be put under a black magic spell.

Reuters reports . Nothing new there excepts for the outlandish explanations. I don’t wear helmets as it musses my hair!

End (Edge) of life issues –

Sometime back, when I was a trainee, we used to get patients at the end of their life. They would come to us tired and dejected (and angry) after  treatment from premier hospitals all over the country; having tried various form of alternative therapies and charlatans. And we would evaluate them and send them back to their homes. Some saw the futility and accepted while some fought to be admitted and die in the ICU. Overall there was (is) singular lack of knowledge and guidelines for the patients, their relatives and also among the physicians and health care workers.

I looked around and found there were no institute or place for such people and their families for guidance. The few places that existed were religion affiliated and their outlook was not what was needed. After so many years; even today no such places exist.

In recent time this area of end of life issues and hospice care has seen advancement especially in United States. A great series of articles was published in the Dallas News which I would recommend to everybody. Excerpts

Nobody wants to die a slow, lingering death. But many Texans do. Half die in hospitals. One in five passes away in intensive care. Often, their last months of life are expensive, painful exercises in medical futility.

Health care reformers in Dallas and around the nation are pushing for a better way to help people at the edge of life.

Practitioners of “palliative care” combine traditional medicine with pain relief, spiritual counseling, and practical advice for patients and families.

These articles derive from the experiences of palliative care team at the Baylor University Medical Center in Texas.

Unlike hospice, palliative care can continue alongside aggressive, life-sustaining treatments. Palliative doctors, nurses and other clinicians guide patients and families through searingly painful choices, including decisions to avoid overly invasive care. They aim to help patients live as well as possible for as long as possible, and to help grieving families prepare for the inevitable.

Research indicates that such “comfort care” sometimes can prolong life more effectively than aggressive surgical, chemical or radiation therapies. It also can reduce medical expenses; Medicare spends 28 percent of its annual budget on care given in the last year of life.

She describes the families and their emotions so well, highly recommended reading includes video clips.

Mr. Bourque tried telling Michelle that her mom might not make it. The little girl set stuffed animals and a purple-and-orange squirt gun on her mother’s emergency-room gurney like talismans.

The Bourques were medical people. Mr. Bourque, 44, was a pediatric ICU technician starting nursing school; Mrs. Bourque, 45, was a pediatric respiratory therapist. They couldn’t kid themselves, but it wasn’t clear how much their daughter understood.

They’d tried to spare her, and sensed that Michelle was trying to protect them, too. They all needed help to get through what was coming. But nothing else could happen as long as Mrs. Bourque was trapped in agonizing pain.

In this era when nothing is ever enough and the machines can breathe for you; pump your heart; feed you forever; but cannot think for you: read here the series by Lee Hancock.Technorati Tags: ,

Drug marketing and dichotomy

When I began my practice following residency I became aware of the cesspool that medical and associated profession have become. Each day was (is) a learning experience. Not that one is completely unaware of the ground realities- but first hand experience is humbling.

I was reading a blog post by Jim Sabin wherein he comments on an article on “Drug promotional practices in Mumbai: a qualitative study” in the Indian Journal of Medical Ethics (April-June 2007 issue) and surmises

All of the issues described in Mumbai are present in the U.S., but in India the pharmaceutical practices are more brazen. Federal and state regulatory capacity is significantly less in India than in the U.S. Perhaps more important, organizations – medical schools, hospitals, medical societies, and more – currently have less capacity to push back against commercial forces than comparable institutions in the U.S.

But the Indian media is sinking its teeth into the issue of commercial corruption of medical decision making (see, for example, “Are your drugs boosting your doctor’s lifestyle?” in yesterday’s Times of India here). The same ethical drama is playing out globally, just with different timing.

the ground reality and the extent is so so much worse that it is mind boggling. and to be frank the medics/doctors are ending up being bit players.

Pic from offside.com
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I was reading

I just finished Grisham’s latest novel The Appeal. His latest book is much better than his last few offerings which I found a bit dull. The story reolves around desperate measures to influence the legal procedure, tort reforms and a mega corp willing to bend any rule for profit.

Set in the state of Mississippi,U.S. having a supposedly tort friendly judiciary a mega corp is accused and convicted of dumping carcinogenic waste into the environment. In order to overturn the verdict and avoid paying the huge compensation awarded the billionaire owner plots to influence the appeal process and the judges involved (I wont go into the details of the plot as you may want to read the book). The novel has interesting side forays into difficulties of being trial lawyers, false & misleading advertising campaigns, medical malpractice and injuries from aluminium baseball bats. Do we have cricket bats made of aluminium or are they banned by ICC?
Just as I finished reading this book I came across this piece of news

The family of a boy who suffered brain damage after he was struck by a line drive off an aluminum baseball bat sued the bat’s maker and others on Monday, saying they should have known it was dangerous.

coincidence or author’s inspiration?

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On Generics and Drug affordibility in India.

I had previously written about compulsory licensing of expensive anti cancer drugs in India and the expected benefits to the patients. Just after this news came out, there was reaction from the Govt. sources  stating that no they had no plans for such measures as cancer was not an “epidemic or national emergency”.
There is an interesting interview with Ranjit Sahani, country president of Novartis in India  who is arguing for better IP protection and pointing out that generics do not solve the issues as they remains out of bound to most of the patients.

But here, generics alone do not solve the issue. Generic versions of Glivec are far too expensive for the poor in India. Furthermore, generic-makers in India have yet to come forward with an access program for generic imatinib mesylate (Gleevec’s generic name). For example, in India the cost of a one-year treatment with generic imatinib is $2,100, or 4.5 times the average annual income. Even our critics recognize that generic versions of Gleevec are not the solution for the poor in India. This is why approximately 99% of patients on Gleevec receive it free. There is no market for Gleevec in India…

You can read the whole article here. (via Pharmalot).

He also discusses the issue of epidemic and national emergency as regards to HIV and Diabetes

There continues to be some ambiguity around what constitutes an epidemic situation. In 2007, India reported 2.5 million HIV infections, a prevalence rate of 0.36%, with less than 15% of HIV-positive people receiving [antiretroviral] treatment. That said, India has about 60 million diabetic patients [30 million diagnosed and another 30 million undiagnosed]. By sheer volume, wouldn’t that constitute an emergency? If examined carefully, limited cases would qualify as a national emergency, an epidemic, for example. HIV and cancer by the very nature of these illnesses are an emotive issue, which is why they get the volume of publicity.

Most Indian practitioners are aware of the huge disease burden in our country and the dismal situation here but the figures he quotes is sobering.

He also talks of differential pricing of drugs but I think it will be hard to put in practice or prevent misuse. Another point he makes ( naturally being a pharmaceutical seller) that the price of drug is fraction of the total cost of treatment.

Despite a significantly higher cost for the private sector, an analysis of the cost structure shows that the amount spent on medicine is a fraction of that spent on diagnosis and doctors’ fees.

I feel that were it not so, the number of patients completing their treatment/ patient compliance will go down even more. The fact is physician compensation/procedure costs are also rock bottom. For example where in world you get a cholecystectomy for Rs 3000/- or an abdominal ultrasound for Rs 300? Unless the economic condition improves the return on medicines will remain around the present levels.

Interesting read over all.

Patients Overcrowding in ER? Lets hangout in Hallways!! few are in cafeteria-

(Image from dailylife .com)

I came across this article while surfing which made me read it again carefully. The health blog in the wall street journal describes a novel way of managing Emergency overcrowding

Here’s one way to ease overcrowding in the emergency room: Move patients to the hallway.

Some hospitals are giving it a try, putting patients in hallways when they’re ready to be admitted, the Associated Press reports

The bizarre ideas germinating in managerial cubicles would put Dilbert’s Pointy headed Boss in throes of delight. The practice was justified by

Peter Viccellio, clinical director of the emergency department at Stony Brook University Medical Center in Stony Brook, N.Y., was involved with a study that found that the practice didn’t do any harm. And before the hospital went this route, on busy days “things would grind to a halt and people would wait to be seen,” he told the AP. Worse, infectious patients would wait in the ER hallways for isolation rooms to open up elsewhere.

I wonder if the said observations were deduced from the hopelessness of the situation. The statement which struck me the most came from one of the proponents of the idea

Nurses, meanwhile, tend not to like the practice. But Carolyn Santora, who heads patient safety efforts at Stony Brook, told the AP that’s fine with her. “I want them to hate it,” she said. “I want them to do everything to expedite flow to get the patient out of the hallway.”

This attitude is typical of the adversarial roles the clinicians (including doctors, nurses, paramedics,cleaners etc as a team) have to face as a team from the managers and the public in general as ‘the problem‘. It is like shooting the messenger-

The reason the nurses are uncomfortable is because they know how dangerous the practice is; they know the enormous stupidity of the move and because they care about the patients despite perceptions otherwise.

Just give them time to accept and acclimatize to the new rules and they will no longer be so uncomfortable!! After all they are powerless and the strings are in someone else’s hands.

The rules and circumstances are so different in India but the end result is all the same. I used to send people with minor lacerations for tea just to have space to deal with the real sick.

Photocredit: Dailylife.com taken out of context here.