Thursday 18 January 2018

A GLORIOUS CENTURY





Today is my mother in law’s 100th birthday! It isn't every day somebody turns a century old. I'm so glad she is one of the lucky few. It's such a blessing to have her in our life. Happy 100th birthday! It is a great occasion for the family and all her children and grand children and great grand children will be around this weekend to celebrate this momentous family occasion. Her family has started arriving in the city from all parts of the country and the world and we are looking forward to a joyous family reunion, an occasion God has most gracefully bestowed upon us! Lucknow is still very cold for an outdoor celebration for a 100 years young lady so the family has decided to postpone the big party for a far gentler spring day in future but this weekend will be an all family affair, at her abode.




I was just wondering what it means to be 100 years old and though life expectancies worldwide are increasing but in 2012, the United Nations estimated that there were 316,600 living centenarians worldwide, but in India there are only 27,000! Japan currently has the greatest number of known centenarians of any nation with 67,824 according to their 2017 census!

She was born in 1917, so what was India like in 1917? We were still 30 years from being an independent nation, one large British colony which was considered the jewel in their crown. In 1917 the Champaran Satyagrah was started in the Champaran district of Bihar against the British Raj. Under Colonial era laws, many tenant farmers were forced to grow some indigo on a portion of their land as a condition of their tenancy. This indigo was used to make dye. The Germans had invented a cheaper artificial dye so the demand for indigo fell. Some tenants paid more rent in return for being let off having to grow indigo. However, during the First World War the German dye ceased to be available and so indigo became profitable again. Thus many tenants were once again forced to grow it on a portion of their land- as was required by their lease. Naturally, this created much anger and resentment and hence the Satyagrah. Gandhi had already been back in India for two years, and two leading statesmen who had guided Gandhi’s politics in his South African life, Gopal Krishna Gokhale and Dadabhai Naroji recently passed away.

It was the era of silent movies with Jamshedji Framji Madan producing Satyawadi Raja Harishchandra, a remake of Phalke's Raja Harishchandra (1913). So, they were making remakes even then! Transportation was by walking, palanquins, bullock carts and horse carriages and ricshaws came after two decades in 1940! Trains were pulled by steam engines and diesel or electric engines came in 1925, though in 1920, electric lighting of signals was introduced between Dadar and Currey Road in Bombay. The trams in Calcutta, Bombay and Chennai were horse drawn but getting electrified and there were trams in Delhi, Kanpur, Nashik, Bhavnagar, Patna and Cochin as well.

And what do you think was happening in the rest of the world in 1917? By this time the Russian Revolution took place in 1917 led by the indomitable Vladamir Ilich Lenin. Many countries were involved in the First World War for three years by then and the same would continue for one more year. But there was a silver lining for the women of the world. They entered the workforce. Many were skeptical about letting women take on roles that traditionally belonged to men, as women were seen fit only to take care of their homes and children. When the men went off to war, the women at home undertook their jobs in addition to running their homes and caring for their children. In this way, the women supported the war effort in numerous ways — and their expectations for themselves shifted as well.

By 1917, there were more than 100 day nurseries across England to provide childcare for those women who had to go off to work. Towards the end of 1917, there were more than 250,000 British women working as farm laborers, working the land, and doing chores, such as milking cows and picking fruit. So with women doing men’s jobs at the same time that they held things together at home, they were no longer considered inferior to men. This started the Suffragist movement, the demand by the women for extension of the "franchise", or the right to vote in public elections. In America too WWI proved beneficial to the women’s suffrage movement, advancing the suffragettes’ cause. Suffragist demonstrations outside Woodrow Wilson’s White House culminated in the “Night of Terror” in November 1917, where many women were arrested for picketing in support of a federal amendment granting women the right to vote. All this did not go in vain as women in Britain over the age of 30, meeting certain property qualifications, were given the right to vote in 1918, and in 1928 suffrage was extended to all women over the age of 21.

Clothings and fashion too saw a sea change in 1917. As more women joined the workforce, however, they needed appropriate clothing. Shirtwaists and tailored suits appeared, and women ditched their cumbersome underskirts.

And do you know who else was born in 1917 and whom Amma has outlived – former Prime Minister Smt. Indira Gandhi (died in 1984), Mr. M.G. Ramachandran, actor, Chief Minister of Tamil Nadu (died in 1987), Mr. T. Nagi Reddy, communist politician (died in 1976), and the legendary director of television serial ‘Ramayan’, Mr. Ramanand Sagar (died in 2005)!

Thomas T. Perls, the director of the New England Centenarian Study at Boston University feels that Centenarians will often have many friends, strong ties to relatives and high self-esteem. My mother in law fits this description perfectly! In addition, some research suggests that the offspring of centenarians are more likely to age in better cardiovascular health than their peers. So there is good news for my wife Neeta and her siblings as well!!



So Happy Birthday Amma! We all wish you many happy returns of the day! We hope and pray that you live a happy and healthy life to be a supercentenerian, as that is a landmak just a decade away!

Sunday 14 January 2018

SHOULD THE PHARMACEUTICAL INDUSTRY NOT CHANGE ITS PRIORITIES?




If you were of the opinion that drugs cost a hell of a lot in India than they should do and the pharma companies and implant manufacturers are financing dubious "educational activities" of doctors and passing on the cost to the helpless patients, then you will be surprised to know that this is a world wide phenomenon. At its peak, in 2007, the American pharmaceutical industry employed 102,000 sales reps, making constant visits to the country’s approximately 661,400 doctors. Free drug samples were only part of the formula used by the pharmaceutical companies to influence doctors’ medical biases and prescription-writing habits.

In the U.S, away from the office, a sales representative for a major drug company was expected to entertain doctors, often by buying them tickets to expensive sporting events and treating them to dinners at five-star restaurants. In fact, gifts ranged from the mundane – pens and coffee mugs embossed with a new drug’s name, stuffed animals embroidered with a company logo and personalized stethoscopes – to the exotic: tropical vacations disguised as educational seminars. In Australia alone thirty-three drug companies spent $8.6 million dollars sponsoring events for healthcare professionals between November 2016 and April 2017. Slowly these habits reached the developing world.

But the same money can be used and has been put to good use in the U.S when the pharma industry has invested heavily in medical research and education. The U.S.-based pharmaceutical industry maintains its world leadership, principally because of the industry's willingness to invest huge sums of money in research and development (R&D). In India too this is essential, we must cite a favorable public policy environment; a spirit of cooperation; and a collaborative relationship among industry, government, and academia on research projects.

Now, unfortunately, the environment threatens to change—in part, at least, because of a sincere concern for rising health care costs but also because of a poor understanding and simplistic analyses of the economics of the drug development process. As a nation, we must reach a better understanding of the case for public policies that encourage medical research and innovation, which will result in dramatic improvements in health, quality of life, and the economic well-being of our country. This nation can ill afford policies that discourage innovation in the pharmaceutical industry. In fact this can be an invaluable part of our 'Make in India' programme.

The fact of the matter is that the best way to reduce the price of treating a disease is to discover a cure for it. Cancer, stroke, cirrhosis of liver, renal failure, viral diseases are all draining our resources because we do not have a cure for them today, whereas small pox does not cost a paisa today because it's cure has been discovered and it has been eradicated. So drug companies must continue to invest in medical education and medical research along with the government and they should come to an open understanding of each other's role and contribution and not be suspicious of each other. Capping prices of drugs, stents and orthopaedic implants are good for PR but unavailability of the best quality because of knee jerk bans will surely take us back to the dark ages.

At 0.83% of gross domestic product (GDP), India is among the countries with the lowest investment in scientific research and that is the reason we are still a developing country, despite being the fastest growing economy. FDIs do not like to invest in Indian pharma sector because of weak intellectual property protection, lack of data protection for biologics, low investment in R&D and price regulations, all of which contribute to reduced revenue and therefore reduced future investment in biopharmaceuticals.

Without building a robust innovation and research platform, a top-notch educational and learning environment, and state-of-the-art research facilities, price control on medicines and devices could lead to serious concerns like delayed or absent access to innovative technology, continued rise in the cost of therapies and quality concerns across the spectrum of healthcare. So government, pharma companies and doctors all three should get their act together!

Wednesday 10 January 2018

A DEARTH OF POSTGRADUATE TEACHERS IN MEDICAL COLLEGES




It is a fact that it is not very easy to find quality teachers for post doctoral courses in particular, and even for postgraduate teaching in Medical Colleges. Good physicians and surgeons, after their M.Ch and DM are gobbled up by corporate hospitals leaving very few for teaching hospitals. There can be many reasons for this scarcity – poor remunerations, strange accountabilities, and fanciful rules of perks and promotions! But students are not to be blamed for that. So how do we maintain a high standard of education? What are the solutions?

I am sure that if you apply your mind you can substantially add on to my list, which is as follows:

1. Affiliate good corporate hospitals to teaching institutions. This will be a very bold step, but a very useful one. Not only M Ch and DM students but even MD and MS students can be benefited because the corporate hospitals are better equipped with both facilities and manpower. Why should a candidate going for MD Radiodiagnosis continue working in a teaching hospital which does not have a MRI unit? Why should he/she not be allowed rotation in a private/corporate hospital which has one?

2. Allow senior consultants in private sector to be part time teachers. This is a contentious issue as these guys will not be automatically welcomed by the full time teachers as they would say that the private guys will be enjoying the best of both the worlds. Yes, they will, but they will be invaluable in filling the void in the teaching staff.

3. At some stage E-medicine has to take a firm hold in medical education. Didactic lectures, case presentations, ward rounds and planning sessions can be arranged at a fixed time in each hospital and it can be beamed to hand held devices of MD, MS, DM, DNB and MCh students. Seminars and Journal clubs can similarly be organized every day by one hospital or the other and beamed to all students.

4. Each department has a MCI approved syllabus. Text books are there to assist but students do not know how to utilize the knowledge resource and how to apply this knowledge in clinical practice. This is what a medical teacher is supposed to do - help the students in achieving this goal. If departments cannot employ teachers in flesh and blood then they should at least have a list of E-teachers with whom the students can interact by software like Skype and discuss their subject or their patients. The students can also send a feedback about the quality of their interaction to the department / institution head so that the list and the hierarchy of the E-teachers can keep on changing continuously.

5. In surgical specialties every department cannot perform every type of surgery.  In Plastic Surgery today we are expected to teach Paediatric Plastic Surgery, Reconstructive Surgery, Burns, Hand Surgery, Micro-vascular Surgery, Cranio-maxillofacial Surgery, Uro-plastic Surgery, Onco-plastic Surgery, Aesthetic Surgery and Regenerative Surgery. No department can have specialist of each discipline. So it would be prudent to let the trainee do a rotation in different Plastic Surgery units and pick up the pearls of wisdom from multiple sources. No amount of newer faculty appointment can match this simple modification of the training programme.

6. If good people have to be attracted to teaching jobs, these jobs will have to be made more attractive. Research facilities will have to be added to clinical departments and research should be liberally funded. Research should be meticulously monitored, carelessness reprimanded and outstanding contributions applauded. Publication, citations and patents should be duly rewarded. Podium and poster presentations in state, national and international conferences should be valued and encouraged and these should be the factors in deciding future perks and promotions. Remember, if you pay peanuts.....you will only attract monkeys!


7. Today retirement is linked with age and a few state governments, when they failed to find teachers to fill the vacant positions increased the retirement age to 65 years and some private medical colleges went a step ahead and took it up to 70! Now retirement cannot be linked to age alone. Physical fitness, mental agility, surgical skills and up to date knowledge of the subject are all required to deem someone fit to continue in high and responsible positions. Some of the older teachers are priceless and invaluable and should be requested to continue but by law allowing everybody to be around is mindless. New talent brings new ideas and retaining deadwood stops the flow of the stream of knowledge.