White sugar is a slow poison: IMA

White sugar is a slow poison: IMA

Refined sugar has emerged to be the single most hazardous component of modern age diet.

New Delhi, October 24, 2017: Ancient Indian tradition has always regarded sugar and sweet consumption as intrinsic. Data from the India sugar trade industry (2013) show that India is the second largest (after Brazil) producer and largest consumer of sugar in the world.

Refined white sugar such as sucrose and high fructose corn syrup contain an excess amount of calories and zero essential nutrients. Consuming unto 10-20% more sugar than recommended amount can contribute to adverse health effects. It can have harmful effects on metabolism and contribute to a variety of lifestyle diseases.

Padma Shri Awardee Dr. K.K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that, “The major problem with sugar is that it contributes to acute inflammation of the walls of blood carrying arteries. The resultant insulin spike from excess sugar consumption starts to damage the fragile arterial walls. Not only this, the tendency of blood to form clots and plaques also increases proportionately with white sugar consumption. This altogether creates an inflammatory environment in the circulatory system which can cause heart disorders and stroke to precipitate. Sugar is also linked to neural damage, recent studies have linked high sugar consumption to pre-mature cognitive decline.”

Sugar also contributes to weight gain which when coupled with sustained high insulin levels, can lead to insulin resistance and diabetes—which further increases your risk of cardiovascular disease.

“Free sugar that is the sugar unbound to any fiber such as in fruits, can lead to global instabilities in the blood which over prolonged periods can lead to health problems. Refined white sugar is also damaging to the digestive system, particularly for those who have difficulty digesting carbohydrates. Moreover, white sugar also increases the effects of hormonal imbalance in women leading to androgynous manifestations like facial hair and in rare cases, ovarian dysfunction. It is better to opt for sources of natural sugar such as sugarcane, honey and jaggery. The sugar in these products is fiber bound and hence healthy.”, added Dr. Aggarwal.

Some tips to avoid excess refined sugar:

Stay clear of high fructose corn syrup. Watch out for this ingredient in labels.
Use natural sweeteners like sugarcane, honey or jaggery.
Eat several small meals a day, rather than three large meals. By eating little portions spread throughout the day, you’ll feel more satiated and be less inclined consume unhealthy sweets.
Limit alcohol intake.Alcohol contains a large store of hidden sugar.
Restrict bread and bread products as much as you can, especially those containing wheat. Wheat has a higher glycemic index than table sugar. Avoid white rice and white maida as well as much as you can.

Source:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277009/

Should doctors study art and literature?

Should doctors study art and literature?

Dr KK Aggarwal

Emotions make up an important core of the doctor-patient relationship. A patient who comes to the doctor is emotionally vulnerable. He/she is struggling with feelings of anger, sadness, despair, guilt, irritability, anxiety, fear, etc., which may at times manifest as negative behavior. Failure to recognize these emotions of the patients in the rush of the day and accordingly respond in an empathetic manner often result in disputes, which may even manifest as violence against doctors. 

Suppressing emotions or feelings can manifest as disease. The stress of holding in strong feelings can increase blood pressure and heart rate and increase muscle tension. On the other hand, disclosing or expressing deep emotions can boost immune function as well as mood and well–being.

As doctors we need to know and understand humanity. Art and literature are both expressions of emotions or feelings arising from human experiences. This way both help to understand the emotions of a person.

In this age of litigation, doctors are relying more and more on lab tests and imaging methods. By doing so, they may be losing out on one of the most important skills for a clinician i.e. observational skill. 

Simply knowing the facts is not enough to practice medicine today. Medicine is an art based on science. And it is an uncertain science at that. No two patients are alike. Also, diseases often do not present in a classical, text book manner. Doctors need to be alert to recognize all atypical signs and symptoms. Sir William Osler said, “Listen to your patient, he is telling you the diagnosis.” 

Doctors need to broaden their horizon and avoid limiting their thinking. Study of art is one way they can do this.

Studying art or exposure to art, both visual and literary, can help doctors improve their observational skills during “inspection – the first step in patient examination” by training their eye to notice details that they might have otherwise not noticed to become better diagnosticians. Art also enhance their critical thinking and helps doctors to better understand facial expressions of the patient leading to a positive doctor-patient interaction.

Bill Kirkup, a public health physician wrote in 2003 in the BMJ, “We have lost something of the art of medicine in a headlong rush to embrace the science” (BMJ. 2003 Aug 16; 327(7411): 401).

Developing visual skills in art observation can help doctors, including medical students, to pick up more subtle clues to diagnosis and sharpen their diagnostic acumen and also communicate more effectively with their patients.

Disclaimer: The views expressed in this write up are entirely my own.

No need to be alarmed by the new VDPV strain

No need to be alarmed by the new VDPV strain

• India has been polio-free since the last 5 years
• Adequate preventive measures and good nutrition can help manage the condition

New Delhi, 23 October 2017: As per recent studies, 14 sewage samples collected from various parts of India, including Hyderabad, between January 2015 and May 2016, have tested positive for vaccine-derived polio virus (VDPV). According to experts, the current immunization programme in India involving the use of Oral Polio vaccine (OPV) can become a risk factor for spread of the disease. However, India was declared polio-free in the year 2014, which was a major public health milestone for the country.

Polio (also called poliomyelitis) is a highly contagious disease. It is caused by a virus that attacks the nervous system. Children below 5 years are more likely to contract the virus than any other group. Even without symptoms, people infected with poliovirus can spread the virus and cause infection in others.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “There is no reason to panic as no wild polio virus has been detected. India is still polio-free for the last 5 years. This detected strain is a Vaccine-derived (VDPV) Polio Virus (VDPV) and not a wild Polio Virus stain. VDPV strain of P2 has been seen in the past also in sewage water, as P2 oral vaccine was given to children till recently. The current VDPV strain has been noticed in sewage water and not in a child. The risk of VDPV transmission to children is negligible. As per the current polio policy since 25 April 2016, tOPV (trivalent vaccine) has been withdrawn from the market and has been switched to bOPV (bivalent vaccine). India was declared t OPV free on 9th May. tOPV contains 3 types of polio serotypes: type 1, type 2 and type 3. The bivalent vaccine does not contain the type 2 virus.”

About 1% of polio cases can develop into paralytic polio. Some symptoms include loss of reflexes, severe spasms and muscle pain, loose and floppy limbs, sudden paralysis, and temporary or permanent deformed limbs, especially the hips, ankles, and feet.

Adding further, Dr Aggarwal, said, “There are two vaccines available to fight polio: inactivated poliovirus (IPV) and oral polio vaccine (OPV). IPV entails a series of injections that start 2 months after birth and continue until the child is 4 to 6 years old. OPV is created from a weakened form of poliovirus; this version is the vaccine of choice in many countries because it is low cost, easy to administer, and gives an excellent level of immunity.”

On World Polio Day, there is a need to create awareness on the fact that although improved public sanitation and careful personal hygiene can help reduce the spread of polio, the most effective way to prevent the disease is with polio vaccine. Also, there is no cure for polio as such and the focus is on increasing comfort, speeding recovery, and preventing complications.

Some supportive treatments include
• Bed rest
• Pain relievers
• Portable ventilators to assist breathing
• Moderate exercise (physical therapy) to prevent deformity and loss of muscle function
• A nutritious diet including fruits and vegetables.

WMA policy statement on participation of doctors in executions should be implemented

WMA policy statement on participation of doctors in executions should be implemented

Dr KK Aggarwal

Should doctors participate in state executions or capital punishments? This is a very controversial issue in medical ethics.

Doctors are required to monitor vital signs during the process of execution (hanging in case of India) and look for signs of life and then pronounce death. This is against medical ethics.

Opposing the participation of doctors, the World Medical Association (WMA) came out with a “Resolution on physician participation in capital punishment” in 1981 and amended in 2008. The resolution states as follows

“RESOLVED, that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.

The World Medical Association

REQUESTS firmly its constituent members to advise all physicians that any participation in capital punishment as stated above is unethical.

URGES its constituent members to lobby actively national governments and legislators against any participation of physicians in capital punishment”

In its general assembly in 2012, the WMA again passed a resolution reaffirming its prohibition of physician participation in capital punishment.

“There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine—first, do no harm.

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

Therefore, be it RESOLVED that:

· Physicians will not facilitate the importation or prescription of drugs for execution.

· The WMA reaffirms: “that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions”, and

· The WMA reaffirms: that physicians “will maintain the utmost respect for human life and will not use [my] medical knowledge to violate human rights and civil liberties, even under threat.”

The WMA Declaration of Geneva or the “Modern Hippocratic Oath”, first adopted in 1948 was recently amended in October 2017 at the annual general assembly in Chicago, USA. The revised version also states: “As a member of the medical profession:

· The health and well-being of my patient will be my first consideration;

· I will maintain the utmost respect for human life

· I will not use my medical knowledge to violate human rights and civil liberties, even under threat”

This final version of the Declaration of Geneva has been accepted by all member national medical associations including the Indian Medical Association (IMA).

No doctor should be present during the process of execution. This is violation of medical ethics and is a professional misconduct.

The World Medical Association today has a membership of 112 national medical associations. IMA is a founder member of this world body. This makes India a signatory to all policies and resolutions adopted by the WMA. Hence, the WMA Resolution on Physician Participation in Capital Punishment should also be implemented in our country.

Disclaimer: The views expressed in this write up are entirely my own.

Prolonged neck and back pain should not be ignored

Prolonged neck and back pain should not be ignored

Incorrect posture and sedentary lifestyle are two major causes of back problems today

New Delhi, 22 October 2017: Recent research indicates that about 20% of youngsters today suffer from some form of back and spine problems, with a majority of such people falling the age group of 16 to 34 years. The prevalence of these disorders has been found to be more pronounced in the cities of New Delhi, Mumbai, Bengaluru, and Pune. The IMA indicates that it is not prudent to ignore back and neck problems. With timely treatment, the pain can be resolved by understanding the root cause of the problem.

Stress and lack of exercise are factors that can make the spine vulnerable to injury. This is exacerbated by driving on poor and potholed roads in cities. The spine is most important for accomplishing simple, daily activities such as sitting, standing, bending, and lying down. It is therefore, important to protect it and keep it healthy.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Spine is one of the most marvelous parts of the human anatomy. A string of 33 bony blocks are held together by ligaments and tendons and supported by large muscles. The spine protects our spinal cord and the nerve roots to safely relay messages to and from the brain to various parts of the body. The spine is so designed that it helps in flexibility, strength, and mobility; and helps a person with his/her daily life. Two most important reasons for spine problems are prolonged working hours and lack of exercise. The roads in the cities are also not too kind to this part of the body, with constant jerks from potholes affecting the spine in a major way. It is imperative to keep the spine healthy as it is the backbone of a healthy body.”

Some symptoms of back and spine problems include weight loss, elevated body temperature (fever), inflammation (swelling) on the back, pain down the legs and below the knees, urinary incontinence, difficulty in urinating, fecal incontinence,and numbness around the genitals.

Adding further, Dr Aggarwal, said, “Keeping the right amount of curvature in the back takes pressure off the nerves and will reduce back pain. If you experience fatigue or pain when you wake up in the morning or after you’ve been sitting at your desk for a couple of hours, it may be an indication that your posture is not right.”

The following tips can help in preventing back and spine problems.

Get moving Physical activity helps in keeping the joints fluid. A person who is not physically active is more susceptible to back problems.
Eat healthy If you maintain good eating habits, you not only will maintain a healthy weight, but you also will not put unnecessary stress on your body.
Sleep sideways The best position for sleeping is on your side. If you are sleeping on your stomach, put a pillow under your lower abdomen to help take stress off your back.
Correct your posture and avoid stress The importance of good posture cannot be overlooked in preventing back problems. Additionally, stress can you to tense your muscles, and constant tension of this kind can cause back pain. Thus, it is important to find ways to reduce stress.

Fungal infections rebound with reckless use of topical steroid creams

Fungal infections rebound with reckless use of topical steroid creams

• People trust quacks and end up buying the medication they prescribe
• Over-the-counter sale of such medicines exacerbates the situation
New Delhi, 21 October 2017: As per the most recent data available, India consumes about Rs1,400 crore worth of topical steroid creams. This is a segment with an annual growth of 16%. This figure, however, excludes the over-the-counter sales.[1] Sale of topical steroids accounts for 82% topical dermatology market. What is alarming is that the top-selling combinations in these topical creams do not have any scientific rationale or logic behind them.

Even the strongest antifungal creams are unable to treat many fungal infections today. This is majorly due to topical steroid creams, which have turned these infections resilient. Topical steroid creams sell fast and are available anywhere over-the-counter. However, whether they are effective or not is still a question that remains unanswered.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Many fungal infections today tend to relapse as soon as the drug dosage is over. Resistance is a microbiological term based on lab data. However, these fungal infections are recalcitrant and are relapsing. Many topical creams are prescribed by quacks and other so-called medical practitioners. People trust them and buy these in order to get rid of the infections quickly. One major reason for this is also perhaps the fact that Indians are not very kind to those with any skin problems. Such use of creams without knowing their side effects can lead to a weakened immune response bringing back the infection when the dosage finishes. Fungal infections are also more pronounced today as many people prefer wearing tight -fitting clothes.”

Long-term use topical steroids can cause side effects, the most common being skin atrophy. This can become worse due to factors such as higher potency steroids, occlusion, thinner skin, and older patient age.

Adding further, Dr Aggarwal, said, “The fact that such drugs can be prescribed by anyone brings us to a serious issue facing the medical profession today – that of quackery. Unqualified people are masquerading as doctors. In the absence of doctors, people have no choice but to visit such quacks for treatment. The need of the hour is to create awareness among the masses about such people and the fact that one should not take medication unless prescribed by a registered medical practitioner. A stringent anti-quackery law also needs to be put in place.”

Here are some tips to prevent fungal infections.
• Wear cotton underwear Fungi thrive in a damp environment. Cotton clothes absorb moisture and perspiration better.
• Maintain good personal hygiene This one is a no-brainer. Whether it is your skin or the genital area, make sure you maintain hygiene and keep these areas clean.
• Avoid tight-fitting clothes Tight-fitting clothes do not allow the skin to breathe and should be avoided.
• Avoid too many perfumed products These can ay affect the delicate balance of yeast and bacteria and cause infections.
• Destress Research indicates that skin infections can flare up in stress. This is because stress lowers the body’s immune system.
• Take natural yogurt with live cultures Antibiotics destroy good bacteria in the body. Make sure you replenish the good bacteria by taking natural yogurt which contains friendly bacteria.

Justice delayed is justice done

Justice delayed is justice done

Dr KK Aggarwal

We are all familiar with saying “Justice delayed is justice denied”. But this by no means is a rule.

Most recently, the parents of the murdered 14-year-old Aarushi Talwar, both dentists, were acquitted of the murder of their daughter after 4 years of imprisonment since 2008 by the Allahabad High Court.

Earlier, Dera Chief Ram Rahim was convicted after 15 long years and sentenced to 20 years imprisonment.

Wrong has been done in both circumstances. While, the parents of Aarushi Talwar suffered imprisonment despite being innocent, in the other case, the Dera Chief was free for last so many years and enjoyed a free life in spite of doing wrong and probably kept on doing wrong.

The irony of the situation is that had these been cases of medical negligence, there would have been a public outrage against the doctor concerned. He/she might well have been arrested without the allegations being substantiated.

Both the above stories with two extreme judgements, became national headlines, exemplify justice delayed but justice done.

This then further raises a question, can the judges be made answerable? One who judged the parents of Aarushi guilty and other, who allowed the Dera chief to lead a free life.

If not, then why action against doctors?

In medical negligence cases, the benefit of doubt should always be given to the doctor unless mens rea can be established or the principle of res ipsa loquitur ‘things speak for themselves’ can be applied.

Justice should be imparted without any delay. It is wrong to delay justice.

Disclaimer: The views expressed in this write up are entirely my own