Ignorance and Superior Ignorance

Every new discovery happens to be a humbling experience. Physiologists and anatomists have now discovered that 'mesentery' which connects the abdomen to intestines is integral and not a mishmash and therefore qualifies as a human organ. Gray's 'Anatomy', the Bible for anatomists, has thus been revised to note there are 79 organs in the human body.

Some critics speculate that doctors, particularly gastroenterologists, have so far been treating digestive disorders without having a comprehensive knowledge of the organs and processes involved. (This is not to suggest that other doctors are doing a better job.) It is hoped that with a better appreciation of mesentery, we are in for better diagnosis and treatment.

As our knowledge widens, appreciation of our ignorance deepens. The laity is aware of its ignorance. The professionals are deluded by their superior ignorance and hence are  unable to comprehend their own unawareness.

Furore over NDM-1, the new superbug

The Lancet report on what is now referred to as "NewDelhi metallo-beta-lactamase 1 (NDM-1)" certainly deserves our serious attention. The report has been prepared by 31 researchers of whom 12 are Indians. The rest are based in the UK and Pakistan. Of these 31 authors, only two have acknowledged possible conflict of interest. Karthikeyan K.Kumarasamy MPhil had received a travel grant from Wyeth, one of the sponsors of this study. David M.Livermore PhD had received conference support from numerous pharma companies and also holds shares in Astra Zeneca, Merck, Pfizer and GSK. All other authors have declared absence of conflict of interest.

Naming a bug after the possible place of its origin is not uncommon. Verona Integron encoded metallo-beta-lactamase 1 (VIM-1) was first reported in Verona, Italy in the year 1997. In the same year another bug called the Sao Paulo metallo-beta-lactamase 1 (SPM-1) was first isolated in the eponymous Brazilian city. However, it is uncommon and rather strange that an alarm is sought to be created about visiting India for surgical treatment.

Lancet's assertion that "Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by NDM-1 are potentially a major global health problem" is certainly over the top. Carbapenem is the latest heavy-duty antibiotic but not the ultimate antibiotic. Superbugs are the mother of new antibiotics.

Lancet's argument that "Given the historical links between India and the UK, that the UK is the first western country to register the widespread presence of NDM-1 positive bacteria is unsurprising" is a little unscientific. Lancet's conclusion ("The potential {sic} for wider international spread of producers and for NDM-1 encoding plasmids to become endemic worldwide, are {sic} clear and frightening") is perhaps paranoia-genic in its impact and possibly suspect in its grammar.

The report draws inspiration from an an earlier editorial by Abdul Ghafur which highlighted the  widespread non-prescription use of antibiotics in India. It is no consolation to realise that prescription abuse of antibiotics is more widespread and not less dangerous in India.

Fatal insensitivity

The Haiti earthquake has devastated the country beyond recognition. The American government acted with a remarkable sensitivity and rushed succour to thousands of the dispossessed. Hundreds of critically wounded Haitians were airlifted to hospitals in Florida and other neighbouring states for emergency treatment. Unfortunately that has now come to an abrupt end. Florida's governor has pleaded inability to take in any more injured unless the Federal government bears the cost of treatment. This tiff between the state and the federal government is bound to cause a bad name to the U S despite their earlier aid. Maybe philanthropists like the Gates Foundation can step in. In the meanwhile, time is fast running out for the critically injured and fractured.

Dr.Y.S.Rajasekhara Reddy

Dr.Y.S.Rajasekhara Reddy , Chief Minister of Andhra Pradesh who was killed in a helicopter crash on 2nd Sept. was of course a politician. His government was notoriously corrupt. However, certain facts about him stand out.

1) He had his schooling in the Besant Theosophical High School run by Kalakshetra Foundation. This should have had atleast some impact on his value system.

2) He was a broadminded Christian equally at home in Bethlehem and Tirumala, as noted by The Hindu.

3) He was a medical doctor and he always empathised with the poor.

We have lost an assertive and confident politician.

Folic Acid

The Economist dated 29th August reports that the recommended daily dose of 0.4 mg of folic acid is converted into folate in most people. The conversion to folate takes place in the liver. The liver has only a limited capacity to make this conversion. Unmetabolised folic acid is found in human blood and urine. Intake of folic acid of more than 1 mg a day increases the body's exposure to circulating unmetabolised folic acid. High doses of folic acid are suspected to exacerbate certain cancers.
In India the most recommended folic acid drug is FOLVITE . This tablet contains 5 mg folic acid ! The ministry of health should study the possible harmful effects of such abnormally high dosage of essential chemicals.

Combating flu

Flu is a seasonal ritual. It gets christened differently each time. Thus we have bird flu, swine flu, Spanish flu etc. Diseases cannot be eradicated totally. However, impact of the disease can be managed both at societal level and individual level.

China says that though many have contracted swine flu, there was no death due to swine flu there. Is it possible? Given the state of authoritarianism, anything is possible in China. They doctor statistics as much as they doctor people. At the same time it is possible that China did indeed handle the swine flu threat exceptionally well.

What is happening in India is a matter of deep concern. People's hygiene levels and doctors' diagnostic capacity are crucial determinants of impact of flu. Sadly it is not uncommon to witness patients coughing on one another's face in a nursing home in the presence of medical professionals who blissfully turn a blind eye and a deaf ear to what is happening.

Personal hygiene with a concrete set of dos and don'ts should be taught at primary school levels. It is a mockery of our educational system if we need the outbreak of a pandemic in order to teach people how to cough and where to spit. Government should carry out educative campaigns wherever people gather to enable them to imbibe good hygiene.

Many doctors seem to have lost basic diagnostic skills. Instances are aplenty of prescription of antibiotics for viral cold and fever and of irrelevant antibiotics for bacterial infections. Diagnosis is poor and prescription is poorer. I wonder who can solve this problem.