Dr. No…! Or Dr. Knows!

Whenever there is a discussion taking place about medical field, most of the reactions are, “These guys always cheat!” It is like a popular phrase in not so rich a country like India, “All business people are profit mongering thieves!” This sentence is contradictory. Business is an activity of making one’s living or making money by producing or buying and selling products (goods and services). The definition clearly states that it is an activity for making money. It is also said that doing a job is noble thing to do but we forget that when we do a job, we do it for someone who is doing business!

This discussion came about during a chitchat at home where five of the family members were doctors. Subject for discussion was basically how much is the right fee for medical advice, surgery, tests etc. Tests performed are standard procedures where almost identical methods are used for evaluation. The only difference could be a little more automation and sophistication of equipment. So, fees here should be uniform. But ultimately charges are market driven. Consultation and surgery fees will differ as these are dependent on individual skills and expertise.

A doctor friend of mine bought a modern computerized x ray machine. I asked him why did he buy this expensive machine. His reply was very different and interesting. He is my age. He said, “Pramod what is your opinion about my buying this machine.” I said, “Fantastic! Now you will be able to judge patient’s problems better!” His establishment is in the older part of our city where rates for services are generally inexpensive. He told me, “You are one of the very few who has appreciated my going with latest technology, most said what is use if you are not going charge fancy rates.” His further comment was most interesting. He said, “Pramod, consider this as my Mercedes! I would rather move around in a Wagon R as roads in this area are small and congested. I enjoy using this modern equipment, as it helps me improve my diagnosis.”

Among all the pathy’s, we have to accept a fact that only in Allopathy, a lot of research is taking place. All this research is sponsored by pharma companies, who else will do it? It is the business of pharma companies to find new drugs which help improve treatment and rate of cure. Fifty years back, when cancer was detected, death was imminent. There was no chance of cure. This was happening because the equipment of those days, knowledge of doctors, quality of drugs created a situation where it was always too late! But now all these things have improved so much that detection is early, equipment and drugs are better and so is knowledge of doctors. This has resulted in improving cure rate tremendously. When research is done a lot of money is invested. The companies try to get ROI as early as possible (it makes business sense) but when they get competition the prices of new drugs or equipment start tapering off fast. The pharma companies are not thieves; they are investing a lot of money for betterment of themselves and also of the mankind. It is duty of pharma companies to be profitable on behalf of the share holders as they are not a charity organization.

I am not saying that all the pharma companies are saints and there are bound to be black sheep. But this is true in all fields and in all pathy’s. It’s human nature to cheat but this % is generally similar everywhere. Also, like in every field there are checks and balances. There are organizations and associations which track malpractice. I will give you an example. Years back one of the giant pharma company’s sales guy met a doctor in Harvard Medical School. He suggested to the doctor, that if the doctor prescribed certain drugs to patients, they would pay US $ 5000/ month. The doctor promptly reported this offer to his management. There was a court case and the pharma company was fined US $ 940/ million! This still does not mean that such things are not happening but these are not as rampant as they are said to happen.

There is another theory. The threshold values of BP, Diabetes, Cholesterol are changed frequently to suit the pharma companies. This is done with the help of famous doctors. During last fifty years computerization has helped medical field as it has helped all other fields too! These threshold values are not absolute values. Medical fraternity decides this based on the study of large number of patients over a large period of time. Finally, they average it out. What computerization has done is that collecting data and processing it has become extremely accurate and fast. Previously it was taking maybe 30 to 40 years to analyze changes due to manual methods, now this is done every 10 to 15 years! Hence, we notice these changes introduced, as the changes are more frequent! Another reason for this is that in the modern world of internet, news and information spreads really fast!

The fees charged by doctors, medicines prescribed by them, methods followed by them are based on their knowledge and experience; obviously the fees are market driven too! We hear the stories about doctor A squeezes the patients but doctor B does not. The fees charged by these professionals are absolutely market driven. Do you know what fees are charged by Supreme court lawyers? Sometimes these are in lacs per day. I know of one patent attorney who charges about 20 k per hour! Heart Surgeons charge in lacs for bypass surgeries.

Now a new trend has started in medical field about which we all need to be careful. Dental technicians now start their own clinics and charge 1/5 th of the fees charged by the dentists. Many of their patients end up, going to real dentist after wasting money and sometimes with incorrect treatment.  Dieticians suggest diets to people sometimes without knowing medical history of patients. When I said this during a discussion, one of my friends was angry. He said, “Doctors have no clue about diets!” I asked him, “What clue do dieticians have about medical side of the person?” There are certain orthopedic technicians who start their own practice. Physiotherapists have started their own practice. One person has ten bed facility to give traction. I know of someone who has taken 40 plus traction sessions of one hour each, from this person, without medical advice. Traction is suggested by Orthopedic Surgeons based on certain criteria. Many patients take treatment from Physiotherapists without even taking advice from Orthopedic Surgeons. Patients go by treatments suggested by non doctors!

I am not saying that everything is hunky dory in the medical field. Major errors do happen even in case of celebrities. Hema Malini’s mother was operated upon right leg while she had problem on her left leg. That too in a hospital in New York. Mistakes and goof ups are part and parcel of this field. If you want to know first-hand, how things do go wrong, read a book by Dr. Atul Gavande, “Checklist Manifesto”! Atul is well-known Indian born surgeon who lives in America. Dentists have told me patients come to them after being treated by other doctors where they have undergone root canal treatment. On re checking they have found that the cheats had never performed root canal!

I will round up with a very interesting story told to me by my Daughter Dr. Priya. She is a pediatric dentist. An eight-month old baby was brought to her. The parents said that the baby had a gold tooth, yes Gold Tooth! 3 to 4 other dentists had already seen the baby and had declared that this gold tooth must be removed and can be done only under general anesthesia.  Parents naturally did not want treatment under anesthesia. Priya checked the baby and used a small tool to check the “gold tooth”. She just gave a small jerk and out came the gold tooth! Well it was an ear piece which the baby’s mother had lost, stuck in the baby’s mouth. Time taken ten seconds, anesthesia not needed, fees 0.00 rupees!

Friends, select your doctor in such a way that you get a great treatment if needed. And Yes! Don’t be scared, there are goof ups as in any field but % of cheats is also similar to any other field!

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Moving Ranges Of Diabetes!

“Now the US doctors admit that HbA1C value in between 7 to 8 is normal, this mean that if the sugar level is 250 then it is normal. If mean of PP and Fasting is 250 then you are no more diabetic.”

This is a news item which has taken many by surprise. Whenever such news items are published there is a hue and cry that Pharma Companies are joining hands with Doctors, to fleece the general population. This was a reaction sometime back when it was declared by researchers blood pressure values are 120/80 are sacrosanct. Anything above 80 as well as 120 is to be treated as a person with elevated Blood Pressure.

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.Wrylt0xuK3A

There was a lot of noise, a lot of articles and a lot of resistance to these findings. How are these findings to be treated? How do scientists reach these conclusions? These findings are based on study of very large number of patients with different backgrounds, ethnicity, income levels, age, gender and so on. Similar methods have been followed over the years. The research also studies the effects of such values on the populace in general. In pre-computer days collecting and compiling such data was a nightmare because all this was done manually. After data collection there was statistical analysis, graphs and charts. This really took a long time. Hence changing patterns of such values were difficult to find and declare; probably time it took to find the changes, one more change may have already happened. But with advent of computerization and special software, all such important analysis can be done really fast and trend of what is happening in real life can be seen much earlier than manual methods. So, we might see such changes declared regularly.

As these limits of the Upper and Lower BP are shrunk, people want to blame it on business side of medical and pharmaceutical industry. Some say, it is done so that more people will need more medicines. Doctors are just awaiting the opportunity. But I have a different say in this. In every field in the world, there are unscrupulous people but to say that everybody in the system is unscrupulous, will be incorrect. Doctors will not just prescribe a drug, just because it is available. The R&D fraternity is doing their analysis based on data collected from thousands of patients. If that data indicates reducing the range for high BP tag, so be it! This is based on analysis, found in real patients in real life. Hence the medical associations have declared new set of values.

In case of diabetes, apparently the new research has established that HbA1C value of an individual can be between 7.5 and 8 instead of previously declared values of 6 to 6.5! Now people will not make noise or shout why this has been changed. With this change in values, the number of people requiring diabetic medicines will be drastically reduced and hence there is NO nexus between pharma companies and doctors! If people have to challenge any findings, then they should do so in either case. This is good because this challenge and questioning will enhance the quality of research further.

There is another case of cholesterol value. Till recently it was said that to be in danger zone, the cholesterol value was to be above 200! But new research says that cholesterol is no more a bad boy, so Statin sell will go down; research says simply don’t bother about cholesterol. This is the greatest benefit of computers in medical field; the research, data collection and analysis are done very fast, thereby doctors will know quickly about the moving targets of the so-called danger zone. No noise was made in this case too!

On the subject of research, I am always surprised that people are not comfortable about analysis and values, treatment and their side effects when Allopathy treatment is discussed. But in other pathy’s, I have not heard of any research carried out over a period of long time. Still nobody raises any voice, nor does anyone challenge the treatment. Nobody discusses anything about no research being carried out. Why this apathy against challenging other pathys? Why not raise any doubts? Allopathy uses most modern techniques of research, they spend huge amounts of funds on research. But we raise voice! For other pathy’s, we accept them as they are and many a time sing paeans of the glory of those pathy’s. Though we know that there is hardly any research done, if at all!

What should we call this reaction from humans? Is it hypocrisy? Is it abnormal thinking? Is it a typical behaviour like a mother who ignores many faults in her favourite child?  I feel that this not a rational behaviour but it can be treated like going to a psychiatrist. They find solace in other pathy’s when Allopathy does not work. There are bound to be many cases where Allopathy may not work at all! But in some of these cases, other pathy’s may work! For example for Jaundice there is no drug in Allopathy but an Ayurvedic drug Liv 52 works. We should choose the pathy, that really cures and not go by here say!

I will sign off with a story of a highly educated professional, working at director level in industry, for many years. His wife is not keeping well for sometime. She just manages her own personal day  to day chores. They have a big staff at home round the clock as our friend is required to travel a lot. Every 5/6 months the lady is taken for he “cleansing” treatment, whatever it means, of alternate medicine for a week. She rejuvenates and is back, needing support round the clock from the day she is back! What that treatment does only our friend knows, he claims she is good now; honestly, friends and family don’t see any change

So don’t be blinded by any pathy but at least believe in Allopathy which does lot of research and helps the humanity to improve our general health. The results are well known in the last 50 to 70 years! Doubting Thomases don’t value add!

Mirror, Mirror on the wall!

Mirror!

There is a common saying that “Beauty is in the eye of the beholder,” which means beauty doesn’t exist on its own but is created by observers. This famous quote can help you remember that a beholder is someone who sees or otherwise experiences things, becoming aware of them.

Even at my age, if someone says “Pramod, you don’t look your age and  look smart”, I feel nice from within! It is a natural human tendency and expectation to be a looker. Of course, everyone’s definition of looking good is different and humans try their best to achieve it by means like make up, exercise and some try to follow crash diets. Some of the common factors of defining beauty are height (more the better), Colour (fairer the better), Long Hair (not so sure these days what is better!), white teeth and so on. But most important aspect that I observe these days, has become a person’s weight in proportion with the height. Too fat a person or too thin a person is looked down! This is the point that came to my mind today, when I read a news item in today’s newspaper.

A 33 year old woman, got herself treated for obesity. She was treated by a doctor in an institute. During this period, she was regularly given enema, which she was told to continue even after going back  home. The process was called naturopathy! She was on a diet of jaggery and lime water for two months! During this period, she was also given a potion and her last 35 days were only water! End result, now she cannot walk, talk or even sit properly. The naturopathy doctor when asked, said that the patients who don’t follow treatment properly at home, can have issues and brain damage is possible! No lime water, water or secret potion containers mentioned these side effects about brain damage! The woman is now afflicted with brain damage. Irreversible? Only time can tell.

Is each person’s body same? Is each persons metabolism rate same? Are their values like blood-sugar, hemoglobin, BP same? Are their weights same? Then how the same treatment can be given to different people. When someone questioned if the potion was poisonous, the doctor said potion consists of lemon grass and water. So, what was so secretive about the potion? Why was the family not told about the contents of the potion?  She was already being given lime water, lemon grass tea could have been given separately. But one can charge any price when you call it a secret potion. Are people so desperate, that they do not understand that surviving on lime water and such things for two months is almost impossible. Is becoming a person with normal weight that important? If your weight is causing serious health issues, then it is essential to control it drastically, under “proper” medical guidance. Unknown remedies should be not be attempted.

These days, I see a trend where there are diet experts by dozens, guiding people to become slim, trim and beautiful. But are they real experts, some are great at marketing, and most of them are not doctors. Do they really understand the meaning of the treatment they are suggesting? I know about a person who was ill with kidney related issues. He was told that he should weigh certain food items he was expected to take every day, to maintain the salt levels. He initially did not understand the meaning of this. He deviated slightly but the deviation resulted in body water being retained and in seven days his weight grew by a kilo each day. He then went to the hospital where the doctors explained to him the issue. They corrected things and sent him home. He over corrected what he was doing. End result was he started losing weight by a kg a day! He again went to the hospital and doctors again, corrected things. They explained to him the importance of salt levels which needed exact weighing of certain food intake. Finally, he managed to eat and drink exactly as suggested by the doctors. He overcame his health issue, finally. Ok, this is an extreme case but this is just to show you what can go wrong when you do not follow instructions given by experts; as against this we follow instructions of non experts, to the last T, many times.

There is another theory circulating. To have glowing skin, and in general to have smart skin, and to remain healthy one must drink at least three liters (or some such figure) of water, every day. This theory is told by some people very emphatically. It again boils down to the same thing. Our body is designed to handle body requirements correctly. In summer, we drink more water and in winter less. Due to certain body conditions, we feel thirstier, even in winter e.g. diabetes. So where did the figure of 3 liter come from? How can it be same for everybody? A friend of mine who has recently gone through a heart event, has been told by the doctor to ensure that he does not drink more than one liter of water every day. Should everyone go by 3-liter theory?

To remain healthy there are methods that need to be followed; these are complimentary procedures to looking beautiful, looking smart, good and healthy. But being good and healthy in mind and as a person is equally important if not more! A person who is always smiling looks most appealing! For a lady with a beautiful smile, she need not bother to wear her jewelry, her smile is her best ornament! A little plump woman with a beautiful small is lovely! A person’s good deeds and mind  are that persons best friends along with that persons healthy body.

So whatever physical methods one follows, should be under medical advice. If not, the results sometimes can be devastating as in case of the lady mentioned above. Doing exercise and following healthy life style is no doubt very important. But sometimes, people overdo it, do it incorrectly, do it very rigidly. Life is beautiful, don’t get stressed out in pursuit of becoming beautiful. Because crash diet courses are done for ¾ months. Once they are over, many people binge on food and come back to their normal self, physically! And the vicious circle continues.

So, don’t worry too much! People are going to judge you by your overall demeanor and not if you are fat or thin! So be a good person and feel happy about it. There is no crash course for being a happy person! So, there is no reversal of how you are!

Friends, now you decide which category you are in, the saying at the beginning or the saying below!

Mirror2

Ye Zindagi ke Mele!

This is an opening line of a song, from the movie Mela (1948). Mela means a Fair!

The meaning of the first couple of lines of the song is “This life is a Fair and there will be Fairs galore going on all the time! These Fairs will continue, alas, I will not be there!” The word “Fair” is the metaphor for “Life”!

This song represents the realities of life because life goes on and on! Our life is just a drop of water in the flowing river. At the end of our life, the water drop merges into river water and ends up as water. You folks must be wondering from my “All is Well” blog which I published yesterday, how come I have gone into reverse gear! I am not talking of sadness but realities of life. This is about one of most positive experience in my life!

This thought came in my mind when I attended a function for a book release. The book was written by my friend Vishwas’s wife Vineeta. The name of the book is “Grieving to Healing”. Vishwas died suddenly this year in January, and here is Vineeta publishing a book of poems she wrote while grieving. The courage shown by her is unbelievable and I am sure this book will guide many who have lost their spouses!

What is life? What would happen to this world if you and me never existed? What would this world be without a Gandhi or a Nehru? Where would this world be if there had been no Einstein or Picasso? World would have been the same if there had been no Lata Mangeshkar and Mohmad Rafi or a Tendulkar. Contribution of these eminent personalities is enormous. But had they not been born; our world would have been almost the same at it is today! Our individual contributions have no relevance, considering the life span of the earth. All of us are born and are assigned finite number of breathes. The beauty is we do not know that number. This lack of knowledge is what drives the world. Before the human being reaches the golden period of his life, after 60, fallibility as a concept is alien. In the golden period the thoughts come in mind about end of journey. If the end comes as a natural progression, after old age and illness, brief or long, humans accept the death philosophically. But when this happens suddenly, as if skidding on a speed breaker, the grieving is profound.

The book release, especially the thought behind it, is one of the important paths that Vineeta has shown us to move forward in life. People handle grief differently. Humans tend to think that sudden death occurs in someone else’s life and not their own life. Death of a spouse can happen in any home, like Cancer, Heart Attack, Fatal Accident also can happen to anybody. So why not plan for such possibility, the way people plan careers, and finances in life. Mind you, this is not going to be a golden wand solution, but planning will help one to handle the grief a little better.

What other ways come to mind? Create a small group of friends, who meet regularly. Do your exercise regularly and shun fast food!  But while doing this, be honest to yourself. A neighbour who died recently had a very different story. His son lives abroad and had come on a holiday. The neighbour had told his son that his BP/sugar values were regularly checked. His dad was going to Gym daily and met his friends post gym. As he died suddenly, the son kept on wondering why the death was sudden. He found, that testing was done regularly but values were wide outside the safe range. He did his Gym routine in a very relaxed manner, without sweating. He and his friends met after Gym for smoking and eating fast food. This was exactly opposite of what he should have been doing.

Trying to cultivate hobbies is a very important way of keeping yourself busy and interested in life. Planning, means one should start trying hobbies as early as possible and not after the event has occurred. Friends, history has shown that women handle the death of spouse much better than men. This could be because, day to day chores in the house like cooking, cleaning and tracking of groceries are ongoing and keeps women busy. Men also should try their hands at cooking and other daily chores; try helping your wife in the kitchen! Don’t start with something very fancy but start with something which you normally eat. Both men and women should start some activity which ensures that there is something to look forward to the next day or week. Do not plan your things around your children and their families. Sometimes we tend to forget that they have also grown and have their own life, worries and anxieties. Support them, help them. Be their lighthouse but don’t make them your lighthouse!  And do not expect the children to look after you! Anxieties increase when expectations are not met.  

If you are a people’s person, life can be much easier. After the death of your spouse, your most reliable partner is gone. Being people’s person will help you handle this change in a better way. Don’t go into shell. Start going to market for your daily chores. Initially you may find it tough. But over a period, things ease out. Start going on holidays, to movies. Do things that you normally do.

Friends, passing of a spouse is the thing that will hit you the hardest. It is the most difficult event to handle. But it is doable. Try to start doing things, that your spouse would have expected you to do! As the saying goes, your spouse will be  watching you from up there, till you take that final journey to rejoin!