Thursday, September 05, 2013

Hacking The Brain-Part One


Hacking the brain sleep exercise from Harsha Doddihal


Sleep is very essential for maintaining our health. Also it is integral for good memory. Learn about brain and also how exercise and learning help brain!

https://docs.google.com/forms/d/1d6SvTattrj-8pMpT_9qL1sXT6A6biRyvaOVzTEHMUZI/viewform

Wednesday, May 22, 2013

Stop Taking Drugs Made By Ranbaxy


Trust a basic essential thing can get eroded and undermine the best of relationship. We function in a society based on the premise of trust.

We trust our government, our doctors, organizations and regulators.

Ranbaxy a pharmaceutical company producing generics has consistently produced drugs with fabricated data and put at risk many lives.

It is still in business under new owner Daiichi Sankyo. The old owners and executives have remained untouched.

When one can get away with fraud, crime, it affects everyone.

Oh! Sorry if i have been ambiguous. Emotions have made me angry and sick! Few things which Ranbaxy has done:

"Last week, Ranbaxy Pharma, which is now owned by Japan's Diiachi Sankyo, pleaded guilty to criminal charges of manufacturing and distributing certain adulterated drugs manufactured at its two Indian facilities of Paonta Sahib and Dewas, while agreeing to a $500-millon settlement."

Disgusting!

If you want to read more...

http://features.blogs.fortune.cnn.com/2013/05/15/ranbaxy-fraud-lipitor/

http://economictimes.indiatimes.com/news/news-by-industry/healthcare/biotech/pharmaceuticals/ranbaxy-episode-to-hit-drugs-carrying-india-label-tough-to-secure-new-contracts/articleshow/20184181.cms

Monday, May 20, 2013

International Clinical Trial Day-May 20

Scottish physician James Lind pioneered the field of clinical research. On May 20th, 1747, Lind began the first-ever clinical trial. The trial produced the then-revolutionary finding that citrus fruits prevented scurvy.

Ask questions, know your rights, know your responsibilities but participate to improve science. 

Friday, May 17, 2013

Anterior Cruciate Ligament Injury-To Get Operated Or Not

Few days back a colleague of mine mentioned that his friend has anterior cruciate ligament injury. He wanted guidance about surgery and which graft to to be taken- patellar or hamstring?

Evidence for surgery in few indications is dicey and individual cases need special consideration. Surgery or no surgery, get physiotherapy done diligently. Strengthen your quadriceps and hamstrings and they will help you the most.

My response as given in mail is below, of course the person called me and grilled me for more than 40 minutes.

"Hi Martha,

Does Praful  have any instability of the knee joint?
Has he diligently done physiotherapy to restore/strengthen his knee joint?

The evidence to get surgery done is minimal or non-existent, but i guess getting a surgery done has a strong placebo effect! Also it may encourage the person to take better care of himself (since he would have invested heavily).

If he does physiotherapy regularly (lifelong-there are simple exercises), he will have better QOL and outcome.

Osteoarthritis is a known complication after 10-15 years irrespective of the mode of treatment chosen.  

If you want to read further or look deeply into evidence, here you go....






Hope this helps!! I know it only adds to the confusion.

A delayed surgery has been tried in some cases with equal results. "

Thursday, May 09, 2013

Tobacco-A Saga

Tobacco is harmful. Tobacco kills. Tobacco reduces the quality of life. Tobacco places a huge burden on the health system.
Guess we have all heard this. But we miss the actual impact of tobacco on lives. We think that it will not be me who will suffer from the ill effects of tobacco like cancer, respiratory problems, hypertension, cardiac diseases. We do not care because we do not have the capability to envision what will happen to us 10-20 years down the line. At times it may take more than 20-30 years and we are made to believe that to live life one needs o indulge in pleasures like tobacco and alcohol.

From behavioral studies we also know that mere statistics or number may not motivate us to act. Millions of children dying because of malnourishment, billions getting killed because of tobacco, road traffic accidents-do not motivate us to behave responsibly.

Individual stories of people who have suffered from tobacco will be presented later. Today let me numb you with numbers. All excerpts from Lancet series.
Base Tongue Cancer


1. According to WHO, tobacco use killed 100 million people in the 20th century and, if trends continue, it will kill 1 billion people in the 21st. Furthermore, by the year 2030, 80% of these deaths will be in low income and middle-income countries.

2.Asia is at the frontline of the tobacco epidemic. Campaigns to curb the epidemic must succeed in this region if the world aspires to be free from tobacco in the 21st century.

3.Tobacco was politicised in the late 1980s, when the Office of the US Trade Representative threatened various Asian jurisdictions with trade sanctions under Section 301 (a) of the Trade Act of 1974.1 With these threats of economic sanctions, Japan, the Republic of Korea, and Taiwan bowed to US pressure and accepted American cigarette imports.

4.The market share of US cigarettes in the four affected jurisdictions in Asia increased substantially after the countries were compelled to import US tobacco products under trade agreements—cigarette consumption per head was almost 10% higher than it would have been if markets had stayed closed to American cigarettes.

5.Research of the economic costs of tobacco has provided compelling data: between 2003 and 2008, 3·2% of total health-care expenditures in China were used to treat tobacco-related illnesses.

6.In 2012, the Asian Development Bank estimated that, in the absence of intervention, smoking will eventually kill about 267 million current and future cigarette smokers who are presently alive in five Asian countries (China, India, Philippines, Thailand, and Vietnam), and increases in tax would reduce the number of smokers and the number of smoking-related deaths, and would generate substantial new revenues.

7.More than half the tobacco consumed in the world is consumed in Asia.

Action:

Quit Smoking, Quit Tobacco

Do not tolerate passive smoking

Avoid Tobacco in any format

If you have never tried tobacco, never try it!

Go to the nearest cancer hospital to see for yourself what one suffers.

It is not just cancer, meet people who have had heart disease, respiratory problems.

References:



Thursday, May 02, 2013

Cardiovascular Risks With Azithromycin

Azithromycin is an important antibiotic used by Pulmonologists, ENT specialists, General Practitioners and other doctors.

Azithromycin has had a recent label change which warrants this writing.

The revised label advises against the use of azithromycin in patients with known risk for QT interval prolongation, hypokalemia, hypomagnesemia, bradycardia. 

This label revision is because of post marketing surveillance findings, an observational study involving Tennessee Medicaid Patients and also Danish national healthcare data.

Excerpts"


For every 21,000 outpatient prescriptions written for azithromycin, one cardiovascular death occurred in excess of those observed with the same number of amoxicillin prescriptions. The excess risk over amoxicillin varied considerably according to cardiovascular risk factors; the researchers estimated that there was one excess cardiovascular death per 4100 prescriptions among patients at high cardiovascular risk but less than one per 100,000 among patients with lower cardiovascular risk.”


The risks and benefits of antibacterial therapy should be considered in prescribing decisions. Pharmacologic and epidemiologic data point to lethal arrhythmias as a potential consequence of QT-interval prolongation with use of azithromycin, other macrolides, and fluoroquinolones. This possibility should give clinicians pause when they're considering prescribing antibacterial drugs, especially for patients with preexisting cardiovascular risk factors or clinical conditions in which antibacterial drug therapy has limited benefits.”


Cardiovascular Risks with Azithromycin and Other Antibacterial Drugs

Andrew D. Mosholder, M.D., M.P.H., Justin Mathew, Pharm.D., John J. Alexander, M.D., M.P.H., Harry Smith, Ph.D., and Sumathi Nambiar, M.D., M.P.H.
N Engl J Med 2013; 368:1665-1668May 2, 2013DOI: 10.1056/NEJMp1302726



Saturday, April 27, 2013

The Doctor

The Doctor by Sir Luke Fildes.

Photo courtesy-  www.tate.org

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249807/

Thursday, April 25, 2013

Plastic And Health

It is the age of plastic. We find and use plastic everywhere. They have made certain things hygienic, for example disposable spoons and plates. They  in innumerable ways touch our life from bags, toys, cellular phones, walls, water bottles and so on....

The chemicals in plastic do get released and have an impact on health. The health of present and future generation is continuously at risk. Judicious and safe use of plastic is need of the hour.

One important tip is do not consume anything stored in plastic which has been exposed to heat for a long time. Plastics leech chemicals when the temperature increases. So water stored in water bottles for a long period are no no. Packing food in plastic bags or containers is hazardous. There may not be any immediate effect but consider that from the time we are in our mother's womb to adulthood we are continuously exposed to chemicals. Prudent to avoid at least in the growing years when our organs are far more susceptible to damage.

Animal models and computational models give us the clue about risk of plastics. Prudence will be to take heed and not wait to take action till concrete evidence of harm is established.
Few highlights:

1. They release estrogenic chemicals. Estrogen is the female hormone. It can have adverse endocrine and other effects.

2. Phthalates in plastic can increase obesity and insulin resistance (promote risk of diabetes).

3. Plastic fumes are injurious to lungs.

Ubiquitous presence of plastics need to challenged by judicious usage.

Reduced usage and better disposal of plastic needs attention from everyone.

Plastic industry should accelerate technology of plastic disposal.

References:

1. Read to understand different types of plastic. http://articles.mercola.com/sites/articles/archive/2013/04/11/plastic-use.aspx

2. An excellent review
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873021/

Animal models and computational models give us the clue about risk of plastics. Prudence will be to take heed and not wait to take action till concrete evidence of harm is established.

Thursday, April 18, 2013

Exclusive Breast Feeding-Just Do It

WHO recommends exclusive breast feeding for first six months. This recommendation is for everyone but unfortunately everyone do not practice it. There are many reasons for that.

To strengtthen the case for exclusive breast feeding there is more evidence from this study

Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations


published Food and Nutrition Research. You can read the full text article here.

Let me highlight the main points:

1. Evidence is convincing about benefit of breastfeeding against overweight and obesity in childhood and adolescence.

2. Benefit against infections, acute otitis media (ear infections), and gastrointestinal and respiratory infections.

3. There is probable evidence that it is beneficial against inflammatory bowel disease, celiac disease, and diabetes.

4. Probable benefit on IQ.

5. Probable small reductive effect on blood pressure and blood cholesterol in adulthood.



 Enough reasons I guess!!

Sunday, April 14, 2013

Mental Health-BRAIN INITIATIVE

Ageing and uncertainties in love, work, economic well being, social acceptance is making us stare at an epidemic of mental health disorders.
Depression leads the problem cutting across different age groups. Dementia, Alzheimer's, brain injury, schizophrenia, autism, epilepsy and Parkinson are other villains affecting our mental health. We are fr away from understanding these disorders and also having implementable effective strategies to combat them.

In this light the initiative of Barrack Obama to give a special focus on mental health through BRAIN INITIATIVE is laudable.
The premise is by understanding the activity of the human brain, by mapping the neural pathways, by imaging it, we will make progress in unraveling the mystery of brain and its afflictions.

There are voices which bring attention to the plight of children and maternal care. By improving health, nutritional, educational and access parameters for infants and children we may probably tackle mental health in a much better way.
To quote from Lancet article, "As many as 200 million children fail to reach their full potential as a result of exposure to risk factors—malnutrition, infection, poor management of pregnancy, birth complications, and lack of stimulation and nurturing—in the first 1000 days of life. Protecting young brains from these threats in developing nations should be part of the BRAIN Initiative to ensure that the project has global impact, he says."

Guess we need to hack at the root as well as take care of the leaves and branches of the problem!

Friday, April 05, 2013

World Health Day-Hypertension

April 7 is celebrated as World Health Day. The theme for this year is Hypertension that is high blood pressure. Its global brief is here.
Hypertension increases the risk of heart attack, strokes and kidney failure. Hypertension is defined as systolic blood pressure equal to or above 140 mm  HG and diastolic blood pressure above 90 mm Hg.
The leading risk factor for global disease burden is high blood pressure. This has been validated in this Lancet publication also.
Hypertension is a leading non communicable disease. It affects people across socioeconomic class. Developed and developing nations-all suffer from this. The African nation has the highest number of adults older than 25 years suffering from hypertension. India, China will also lead this epidemic with increasing elderly population.

Society collectively needs to aim at preventing itself from the ills of hypertension.

The following measures need to be considered.

1. Reduction in salt intake.

2. Avoid smoking and those who smoke need to quit.

3.Creating a culture for physical activity. Providing incentives for outcomes of physical activity.

4. Avoiding harmful use of alcohol.

5. Poor Sleep

Hypertension is asymptomatic in early stages. It is insidious and has ice berg phenomenon. Routine blood pressure check up can give an early diagnosis to hypertension and pre-hypertension stage. Life style modifications and preventive measures will keep one away from this disease and its complications.

Let us all fight Hypertension.

Intend to do a free blood pressure check up in two places on Sunday. Will post about it.

References:

1. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60780-1/fulltext?elsca1=ETOC-LANCET&elsca2=email&elsca3=E24A35F

2. http://www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/

3. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61766-8/fulltext

4. http://www.who.int/world-health-day/en/


Friday, March 29, 2013

Bacteria-The Good Ones


At the same time there are some bacteria which have made a pact with us and live symbiotically. They are called as commensals. They are on our skin as well as mucosa. The mucosa extends from mouth to the anus. Commensals or the good bacteria play many roles. They help us in getting our daily dose of vitamin, especially B complex. They help to keep the growth of fungi in check. When we take antibiotics the commensals can also get killed increasing the risk for fungal infection, B complex deficiency to happen and at times lead to infection from Clostridium difficile, a more serious kind of bacterial infection.

Long back had mentioned in a post about bonding with bacteria about bacteria being harnessed for mutiple benefits including cancer cure. This was about the research of Ananda M Chakrabarty. You can read it here. Will have to write to him to know the current status of his research.

Apparently there are many other myriad, intriguing ways in which the good bacteria help us. Highlighting below some of the recent research findings.

1. Recently had written about gastric bypass surgery also called Bariatric surgery being a potential cure for diabetes in some patients. You can read that post here. When this gastric bypass surgery is done there is change in the gut microbial population. This change in gut micorbiota is considered to be responsible for weight loss! This has been proven in mice by transferring the gut microbiota  to other obese mice which resulted in weight loss and decrease in adiposity.
There is also a strong link between gut microbiota with cardiovascular disease and type 2 diabetes.

References and further reading:

a) Functional Interactions Between The Gut Microbiota And Host Metabolism.

b) Obesity, Gut Microbiota, Weight Loss, Gastric Bypass Surgery. News article for same can be read hereherehere.

c) Open Access Review Article by Kristina Harris, Amira Kassis, Genevieve Major, Chieh J. Chou.

2. Fecal Transplant? Really? Yes, transferring the donor feces into is more effective for treating recurrent C.difficile infection!

Reference: NEJMMedscape2010

It does seem that nature has far greater mechanism for balance and sustenance of energy! (for lack of better term). There are more than 100 trillion archaeal and bacterial cells in our gut and they represent 1000 different species.

The more we learn the more we know that we do not know!!

I have a personal hypothesis and treatment for gastritis which i will cover in a future post. Also how helminths (worms) have a  good role to play in auto-immune diseases, irritable bowel syndrome, Crohns disease and Ulcerative colitis.

Have a healthy life!!

Wednesday, March 27, 2013

Pain and Health


Our behavior is determined either by pursuit of pleasure or avoidance of pain. We seek multiple avenues to avoid pain both physical and emotional. The success or failure determines our future behavior and experience.
Physical pain, especially acute, is to guide us to stay healthy. It forces us to rest that part of the body in pain till healing has happened. It at times brings our attention to the pathology and forces us to seek medical help. Back pain, neck pain, tooth ache, sprains, muscular pains belong to this class which supposedly should alter our behavior to become healthy.
Sometimes we voluntarily endure pain to gain benefit. While exercising if one wants to increase muscle strength and endurance,one needs to exercise till the edge of one's capability. It is when you think that you cannot do one more bench press or pull up that you get the benefit. Even during this endeavor one needs to be alert not to hurt oneself. Muscle, ligament tears can result because of exercising in the wrong way! Also one should not exercise when one has fever, gastroenteritis or other ailment as the reserve ability of the body is less.
This piece of writing is prompted by the severe malaise and body ache i had yesterday on account of fever and bowel disturbance. But more than that it is the account of pain by Dan Ariely.

I started by mentioning how acute pain is there to help us! But are all acute pains helpful? How does acute pain experienced by burns patient helpful?

To read the account of Dan Ariely's encounter with pain click here.

In his account he does mention that the memory of social\emotional pain is stronger than physical pain.

Intend to research more on the topic of pain-all forms and varieties. On a day to day basis see the way  my father endures pain caused by Parkinson disease, both chronic and acute. Multiple medications at times relieve his pain or are overwhelmed. I would say pain relief is both an art and science!
My mother who suffers from osteoarthritis has almost ceased to complain pain from that disease after dad started his journey of Parkinson. Her ability to tolerate pain has increased or is that she considers it futile to complain!!

As i research and ponder more will share my thoughts. Will like to end for now with few points:

1.Our ability to tolerate pain is limited.

2. Our will power supply everyday is limited. So we need to prioritize its use.

3. Our ability to empathize and sympathize is also limited!

Are they capabilities which can be increased? Can we measure them?

I personally believe that one can increase those capabilities!! For this belief i will have to research methods to measure it and do some experiment!

Friday, March 22, 2013

Health and Freedom

We all want to be healthy. Some of us are fortunate and are healthy even when we do not make any particular effort to be healthy. Some of us stay healthy when we strive to be healthy. Some of us are unfortunate and health eludes us. This is especially true in old age.

What is health? WHO defines it as achieving a state of complete physical, mental, and social wellbeing. What is that we gain by staying healthy?

This may sound as a dumb question but as i ponder on it, i have more than one answer. The simplest would be health is required to indulge in pleasurable activities. An hedonistic approach which brings us face to face with the fact that most pleasurable activities when overdone result in ill-health!


Being healthy gives us economic liberty. This is government and societies view. Society benefits from healthy individuals who contribute economically. 


Being a human what is the greatest benefit of being healthy. Good health gives us freedom. The freedom to do the things one wants to do. This is only realized when one sees people in sickness from close quarters.  Paradigm changing events are at times related to surviving a life threatening disease. Because this enables one to choose rightly with the freedom one has.


The onus of staying healthy lies with the individual. It is individuals responsibility to stay healthy. But what can governments do to aid its citizens to stay healthy? How can societies promote healthy living?


Maternal health, sanitation, nutrition are some of the basic aspects which needs to ensured for all citizens. Health of children is another aspect. These are the foundation and must.


But what about health of adults and elderly? Can we create right incentives for them to stay healthy?


The question of freedom comes up again!!


I should have the freedom to smoke......


I should have the freedom to drink soda.......


I should have the freedom to eat junk food..........


The question of freedom, informed choice brings us to a conflict. 


Personally i do not believe in banning anything. At the same time i accept that human beings are not as rational as they appear. The choices we make may be detrimental to us and the society. Our ability to analyze information into knowledge and convert that into wisdom is restricted and limited. 


When such is our ability can we trick ourselves to lead healthy life. Guess so. Peer pressure, incentives from society, companies and government can probably modify our behavior.  


Reference:


1. Offline: Why governments should take health more seriously


2.What Big Soda Learned From the Marlboro Man

3. http://www.hdassoc.org/site/files/351/105796/364911/499774/Active_Policy_Attention.pdf

Wednesday, March 13, 2013

DVT, Cancer & Exercise

Deep Vein Thrombosis (DVT) is a serious complication in many diseases. It is a common post-surgical complication which with the righ prophylaxis is taken care of.

Deep vein thrombosis is clot in the deep vein and when this gets dislodged and move can cause stroke, pulmonary embolism and also damage to heart.

DVT is seen in upto 50% of cancer patients but unfortunately is underdiagnosed. DVT in cancer patients can be because of various reasons. Some cancers like lung, colon, ovary, pancreas, stomach and endometrium have greater risk of DVT because of increased viscoity of blood. Few treatments can increase rik of DVT, example tamoxifen.

DVT can present insidiously. At times one can have redness, pain when the veins in the thigh are involved. If pulmonary embolism ha happened there can be dry cough, breathlessness.

Any perosn with cancer needs to be aware of DVT and should ask his treating Oncologist about the same and be on vigil.
Primary and seconadry prophylaxis have their own challenges. One needs to tell the treating phyician about all the medications one is taking as drug interactions are very common.

Take home message is:

1. Be on vigil
2. Drug interactions are common, so ask your doctor about the same when you are taking multiple medications.
3. Be active, exercise helps blood circulation and also in many other ways.
4. Be hydrated always.
5. Take extra precautions on long haul flights.

Be aware and ask right questions!

References:

1. http://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/cancer-and-the-risk-of-blood-clots

2. http://annonc.oxfordjournals.org/content/16/5/696.long

3. http://www.telegraph.co.uk/health/healthnews/9357487/Blood-clot-patients-to-receive-routine-cancer-checks.html

4. http://www.cancer.gov/ncicancerbulletin/062910/page5

5. http://www.webmd.com/cancer/features/exercise-for-cancer-patients

Monday, March 11, 2013

Global Burden Of Disease

We all strive and seek pleasure. This pursuit is through family, love, work, passion. We trade our time and pay a price for whatever success we aim and achieve. Most of the time, the price paid is in terms of health. Mental and physical health is always at risk and if not paid attention to lapses into ill health with severe damage and cost for self and others.
Most components of health are in our influence and we by right living can stay healthy. But there are certain elements which are beyond our control and they can overwhelm us. Lead poisoning is one such thing, mental and physical health deterioration by involving in the care of loved ones (especially spouses who take care of elderly patients with Alzheimers or Pakinsons disease).

While the world is making progress, we are moving from dangers of communicable disease to non-communicable disease.

Quoting from a recent publication:

1. Mental and behavioral disorders, such as depression, anxiety, and drug use, are the primary drivers of disability worldwide and caused over 40 million years of disability in 20- to 29-year-olds.

2. DALYs (Disability Adjusted Life Years)  from high blood pressure increased by nearly 30% between 1990 and 2010. High blood pressure is a major risk factor for cardiovascular and circulatory diseases.

3. Unlike other risk factors that primarily cause DALYs from communicable diseases, progress in reducing premature death and disability from iron deficiency was much lower, declining by just 7% between 1990 and 2010. Slow progress in reducing iron deficiency helps explain why iron-deficiency anemia ranks as the third leading cause of disability globally.

To stay healthy requires awareness and adequate actions to be taken.

The most disheartening thing is the number of premature deaths because of road traffic accidents, as illustrated in the graph below.



Thanks to Institute of Health Metrics and Evaluation.
Other publications related to this are in Lancet December 2012.

Hopefully will write more about this in future posts with insight into what actions can be taken to become more healthy!

Tuesday, March 05, 2013

Toyota Shoulder!! Tennis Shoulder

We all have heard of teniss elbow, tennis knee, tennis toe, now there is a condition called as tennis shoulder! It can also be called as Toyota Shoulder! All acceleration and no brakes!

Shoulder pains can be severe and debilitating. They can affect the young and the old. Ageing seems to make orthoarthritis of shoulder joint a very dsiabling and painful condition.
Tennis players, swimmers are more prone to this but that does not mean that an average person not playing any sport will not suffer from it.

Prevention is better than cure!

Strengthening shoulder joint is essential. Improving its stability by exercising all the muscles supporting shoulder is critical.

References:

1.http://well.blogs.nytimes.com/2010/09/08/phys-ed-how-to-fix-a-bad-tennis-shoulder/
2. http://www.physioroom.com/experts/asktheexperts/answers/qa_mb_20050225.php
3. http://www.muscleandstrength.com/articles/top-5-exercises-increasing-shoulder-mass.html

Thursday, February 28, 2013

Surgery For Diabetes

Diabetes a metabolic disorder which afflicts millions and takes a heavy toll is a controllable chronic disease maintained with help of medications. In past decade lot of research has been done to evaluate the role of surgery in diabetes. Yes, bariatric surgery or gastric bypass surgery helps diabetics and can potentially turn out to be more effective then medications in some subset of patients.

"Gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes. "

http://vitals.nbcnews.com/_news/2013/02/26/17104943-amazing-results-for-diabetes-patients-after-weight-loss-surgery?lite

http://care.diabetesjournals.org/content/early/2013/02/14/dc12-1596.abstract?sid=79afa429-64fe-480c-a1b2-b29ec7f58797

Godspeed!





Friday, February 22, 2013

Poor Quality Drugs!!

Lancet has published today an editorial highlighting the risk and cost of poor quality drugs.
Few numbers;
1. 120 people died and hundreds more suffered adverse reactions after taking a contaminated heart medicine in Pakistan.
2. Contaminated injectible steroid in US has caused outbreak of fungal meningitis resulting in 704 people getting sick and 46 killed.
3. The contamination of heparin by Chinese counterfeiters in 2007 and 2008, killed 149 patients in the USA.
4. In 2009, the European Union seized 34 million fake tablets in just 2 months, including antibiotics, cancer treatments, and sildenafil citrate (Viagra).
The numbers are much higher but we are not made aware of them because of various reasons.
There is a need for more research and robust data gathering to estimate the burden of poor quality drugs. This has been hampered on many accounts.
In fact Royal Pharmaceutical Society's 1989 statement reads like this, "no great  publicity (about fake drugs) should be sought because it could damage public confidence in medicines" (Cockburn et al : 2005; SCRIP, 1989).
With innovative technologies (like RFID), advanced data assimilators and analytics (Watson), advanced pharmacovigilance, collective involvement, responsibility, and responses of all interested parties: health professionals, drug regulatory authorities, judicial entities, and drug companies at both national and international levels.-Can and will make a difference.

References:
1.Strenghtening Global Action Against Poor Quality Drugs
2. Countering the Problem of Falsified and Substandard Drugs
3. Counterfeit drugs: a growing global threat

Saturday, February 09, 2013

Diabetes and Cancer


Chronic diseases are the scourge of the new age. All over the world people living with diabetes are expected to increase, especially in India.
Epidemiological studies indicate an increased risk of cancer for diabetic people. There is increased risk of hepatocellular cancer, pancreatic cancer, breast cancer, endometrial cancer, colorectal cancer, stomach cancer and bladder cancer. Prostate is the odd guy out as the risk for it is decreased if you have diabetes (possibly because of low testosterone levels).
The causal relationship between diabetes and cancer is not well established. There may be confounding bias, observational bias as the evidence is epidemiological. There are few biological hypothesis. Hyperinsulinemia drives growth and diabetics have hyperinsulinemia. Also cancer cells express IGF-1 (Insulin like growth factor receptors) receptors. Inflammation is more common in diabetics and chronic inflammation is a risk for cancer.
Summary and Actions To Be Taken:

1. Epidemiological evidence is there to say that diabetics are at increased risk for cancer.

2. Causal relationship and biological mechanism still needs further elucidation.

3. Diabetes and cancer share several risk factors, like obesity and physical inactivity. An effort to prevent and control diabetes will have a positive effect on cancer incidence. One need not have to wait for conclusive evidence to implement healthy habits and preventive measures.

4. Researchers and clinicians need to be more aware and collect prospective data. Also design studies to benefit patients.

5. The cancer risk conferred by diabetes may be moderate but considering that 366 million people have diabetes worldwide and it is expected to reach 552 million by 2030 calls for awareness and action.

Reference: Diabetes mellitus and cancer risk: Review of the epidemiological evidence

Saturday, January 19, 2013

Spending, Countries, Habitat and Health

Without health it is difficult to have fun, pleasure, wealth, freedom and drive for reason and responsibility. At times in pursuit of above mentioned things we lose our focus on health and lose health! This is true at individual and country level.

Which country has the best health care system?
Does spending more on healthcare ensure better health?
What is the optimum funding for healthcare?
How health is a linear and non-linear function?

The above questions require research and data collection and analysis. And it will always be a work in progress. Three articles published in Lancet throw some light and make us ponder on health.

Wealth But Not Health In USA The article speaks about the now well known fact that US spends more on health care per person than other G7 countries.
Americans especially American women are having declining health for 30 years.  Americans fare badly not only at life span but also at infant mortality, low birth weight, injuries and homicides, teenage pregnancies and sexually transmitted infections, drug-related deaths!, obesity, diabetes and heart disease, chronic lung disease, HIV/AIDS prevalence.  The data if segregated according to region and economic level will be more revealing about the disparity in health condition.
I suspect there is a great inequality in health care access and outcome within US. This despite the fact that US spends 18% of its GDP on health. The leading European countries range between 9.5 to 12 %. And they have better metrics to show. One thing which i dare to conclude without digging into the data  is that probably the level of inequality is less as of today. It will be interesting to note the metrics 5 and 10 years from now as austerity measures get implemented.

Cuba spends on healthcare and has results to show for it also.

What are the lessons for other countries? What model should one follow? How should the government intervene or give incentives for better health. This especially true for young nations like India and China which will have its major population moving above 50 years in coming decade or two.

The Lancet article mentions the following remedies for US.

"Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame. Lack of insurance, or inadequate insurance, restricts access to health care for many Americans. But the system is not the only problem. Unhealthy behaviours abound in the USA, particularly overeating, drug abuse, and other risk-taking activities such as not wearing motorcycle helmets, drinking and driving, and using firearms. Social and economic conditions in the USA contribute to high incomes for some, but to high poverty and income inequality for others, and to low standards of education. Welfare safety nets are not as robust as they are in other countries. Moreover, cities in the USA are often built around car use, which discourages physical activity and contributes to obesity."

Also it seeks implementation of National Prevention Strategy.

The report mentions the following things:


The Strategy’s seven Priorities are designed to improve health and 
wellness for the entire U.S. population, including those groups 
disproportionately affected by disease and injury. 
• Tobacco Free Living
• Preventing Drug Abuse and Excessive Alcohol Use 
• Healthy Eating
• Active Living
• Injury and Violence Free Living
• Reproductive and Sexual Health
• Mental and Emotional Well-Being


My opinion:

1. Behaviors are difficult to change. People who fight fires are normally the heroes and not the one's who prevent fires! We need to glorify fire prev-enters.
2. Corporate's, government, schools, colleges should stress on healthy living. Incentives and recognition should be given to healthy people. Ideal Blood pressure individuals in different age groups, Best Glycemic control in a particular quarter, Best Aerobic capacity person, etc etc.
3. Role of viruses in causing infections, chronic diseases and cancers should be highlighted. Vaccinations should be explained.

We need not have to wait to implement these strategies in Emerging Countries. Every nation stands to benefit by rewarding healthy living.

Other articles to read:
1. Guardian
2. UC Atlas
3. PBS Newshour-How US Compares

A slightly different view!

So what are you going to do to stay healthy?

Monday, January 07, 2013

Smoking!

We all know that smoking is injurious to health. But we find it difficult to quantify it. Also the observational bias impairs our ability to assess the damage caused by smoking. People who are dead because of smoking are never gonna come and tell us they dies of smoking. Also we do not see them at work place or parties. The people young and old whom we are are the one who smoke and are still attending parties or working!! This erroneously tricks us into a false sense of security. Our brain comes to conclusion that smoking may not be that harmful or that it selectively harms and I am not one of them.
Science/research can help/aid us to see things clearly.
Smoking affects both men and women. The data for females has matured late. A paper published in lancet documents the ill effects well. Without going into the statistics or much into the data, let me give only the conclusion here..

Among UK women, two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking; smokers lose at least 10 years of lifespan. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater. Stopping before age 40 years (and preferably well before age 40 years) avoids more than 90% of the excess mortality caused by continuing smoking; stopping before age 30 years avoids more than 97% of it.

Wish everyone healthy living!